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Number of articles: 355

Just culture of safety: How to report and participate in reviews of patient safety incidents
A just patient safety culture promises the provision of higher quality and safer care. Advice is provided to CMPA members on participation in reporting and reviews of adverse events and close calls in hospitals and institutions.
Responding to a billing audit: How good records can help
Adequate record keeping may help during a billing audit.
Did you know? Patients can restrict access to their health information
Physicians should try to accommodate patients’ requests to limit access to their personal health information.
Chronic care can be improved with skillful communication
CMPA cases involving chronic disease indicate that improving the communication skills of healthcare providers can potentially make the medical care safer for patients with chronic illness and may reduce medical-legal risks for healthcare professionals.
Healthcare directives: What you really need to know
Greater clarity in patient care can be achieved through healthcare directives, and when physicians understand their purpose and the rules governing them.
Safe care in obstetrics—Maternal postpartum care: When things don’t go as planned after delivery
Suggested approaches to help avoid difficulties in maternal postpartum care, based on expert opinions in a review of CMPA cases.
Is that eConsultation or eReferral service right for your medical practice?
eConsultation and eReferral services can offer exciting benefits, but to use them successfully physicians should know the areas of potential medical-legal risks so they can be avoided.
International medical graduates face daunting challenges; getting help is key to success
While the challenges facing IMGs can be formidable, resources are available to help.
The ransomware threat: Are you prepared?
Considerations to help prevent and mitigate the damage arising from ransomware attacks to computer systems.
Direct-to-consumer genetic test results: Be prepared
When asked by patients to interpret or take medical action on direct-to-consumer genetic test results, physicians’ best response is to practise sound medicine and follow the profession’s standards of care.
Disarming statements can lessen conflict in the healthcare workplace
Disruptive behaviour in the healthcare workplace can take a toll on co-workers and patients, but conflict may be reduced by using a disarming approach.
Medical assistance in dying and the law: One year later
Medical-legal issues and other concerns have surfaced after one year of federal MAID legislation having been enacted.
New to practice? Practical tips for physicians in the first 5 years
Physicians in their first 5 years of practice are often unfamiliar with the regulations and guidelines of their medical regulatory authority (College) and find themselves in medical-legal difficulties as a result.
Doing medical administrative work? Do you have liability protection?
Physicians who do administrative work require liability protection for the professional medical tasks they perform and also for the non-clinical administrative tasks they perform in support of an organization.
Shining a light on the medical-legal risks of laparoscopic surgery
Laparoscopic surgery requires advanced surgical technique, experience with specialized equipment, and dynamic and complex clinical decision-making.
When multiple defendants are involved in a legal action, things can get complicated
Typically, civil legal actions launched against physicians are initiated by a patient alleging negligence in care, but there are variations to this scenario that can result in more complex litigation involving multiple parties and claims.
Social networks in healthcare: Opportunities and challenges for a connected future
Online social networks in healthcare provide a means for worldwide collaboration among physicians, but participants should maintain the standards of professionalism expected of the profession.
Safe surgery: Closing the gap with the surgical safety checklist
The use of a surgical safety checklist should decrease the risk of adverse events and surgical complications by fostering a patient safety mindset and encouraging team communication.
Providing medical records to patients seeking alternative medicine
Physicians should speak with patients about their alternative medicine treatments and, as much as possible, provide guidance on potential negative interactions.
The office safety plan
Physicians can take these steps to maintain a safe office environment for their employees.
Smartphone recordings by patients: Be prepared, it’s happening
Physicians can take steps to mitigate the medical-legal risks of patients taking photos and making video and audio recordings during healthcare encounters.
Patient portals—A new communication tool for doctors and patients
Physicians wanting to communicate with their patients using patient portals should consider the steps they can take to mitigate risks and ensure that portals are used properly and successfully.
Organ and tissue donation: Who has the final say?
Physicians who are familiar with regulatory requirements governing organ and tissue donations can more effectively meet their obligations and mitigate the potential for complaints.
CMPA Member Advice: Nova Scotia, Privacy and Confidentiality Obligations
Nova Scotia’s Privacy Commissioner, Catherine Tully, has signalled that her office will increase scrutiny of physicians – specifically those in private practice – around issues of transmission of personal health information and notification of privacy breaches throughout 2017.
How to manage conflict and aggressive behaviour in medical practice
Physicians regularly encounter patients or family members who behave aggressively and make demands that may be unrealistic and potentially harmful. In their medical practice, physicians need strategies and tools to manage conflict and such challenging behaviours.
How to address vaccine hesitancy and refusal by patients or their legal guardians
An overview of obligations and issues for doctors when providing or discussing vaccinations with patients or legal guardians.
Family disputes and the physician: Staying focused on safe care
Physicians can take reasonable steps to maintain the best interests of the patient in the midst of family disputes concerning the care of children or of elder patients.
Shifting practice settings makes following up investigations and monitoring medication tougher: Strategies for managing risks
Experts in CMPA cases make suggestions on how physicians who work in shifting practice settings can manage risks when providing follow-up care and monitoring medication.
Elder abuse and neglect: Balancing intervention and patients’ right to confidentiality
The management of elder abuse cases is an increasingly important aspect of physicians’ practices, though determining the appropriateness of actions to address suspected abuse can be challenging.
Safe care in obstetrics: Keys to effective interprofessional care
The quality and safety of obstetrical care can be strengthened when all members of the collaborative care team are fully integrated in the functioning of the unit.
Smartphone, smarter physician: Safely recommending mobile health apps in your practice
How physicians can take steps to minimize medical-legal risk when using mobile health applications (mHealth) in their practice.
Residents and resiliency
Wellness strategies and resources for physician residents
Navigating the challenges of safe antibiotic prescribing
The CMPA’s review of medical-legal cases that involved issues with antibiotic prescribing provides insight into opportunities for improvement in the areas of patient assessments, communications, and patient monitoring and follow-up.
Collegiality promotes safe care
By practising in a collegial manner, physicians may enhance the health outcomes of their patients and themselves.
Safe care in obstetrics: Recognizing signs of potential trouble in labour and delivery
Situational awareness is an essential skill for all healthcare providers, particularly those working in high-risk, continuously evolving clinical environments such as labour and delivery.
Safe use of opioid analgesics in the hospital setting
The safe use of opioids in the hospital setting requires strategies to safeguard patients from harm and must involve all healthcare team members.
Emerging trends and medical-legal risks in medical tourism
A review of main issues and new trends in medical tourism and how physicians can minimize risks in treating patients who seek medical tourism in Canada and abroad.
CMPA Member Advice: Ontario, Patients First Act, 2016 (Bill 41)
Bill 41, Patients First Act, was recently passed by the Legislative Assembly of Ontario.
CMPA Member Advice: Ontario, Health Information Protection Act, 2016 (Bill 119)
Ontario members have contacted the Canadian Medical Protective Association (CMPA) with questions regarding Bill 119. A number of provisions in Bill 119 amending the Personal Health Information Protection Act (PHIPA) are now in force.
What the legislation on medical assistance in dying means for physicians in Canada
On June 17, 2016, amendments to the Criminal Code came into force rendering MAID legal everywhere in Canada provided certain conditions are met.
Conscientious objection to medical assistance in dying: Protecting Charter rights
The Supreme Court of Canada’s decision declaring the prohibition on physician-assisted dying unconstitutional concerns some CMPA members who object for moral or religious reasons to helping patients end their lives.
Providing quality end-of-life care
End-of-life treatment decisions can be difficult for both physicians and patients, but many issues can be avoided by following the key concepts outlined.
Coordinating critical care: Communication challenges for providers and patients
An examination of coordination of care in the ICU and the importance of good communication.
Safe care in obstetrics: Improving teamwork and communication in an emergency
The management of obstetrical emergencies relies on effective teamwork and communication between members of the care team.
Transparency of physician information: What members need to know
Medical regulatory authorities are making more information about physicians available to the public. This article provides an overview of this trend, and explains how the CMPA helps members.
"Dictated but not read": Unreviewed clinical record entries may pose risks
The practice of marking transcribed reports or entries “dictated but not read” gives rise to medical-legal risks and can create uncertainty for those relying on that information in providing patient care.
The newborn with jaundice: We can do better
A review of medical-legal cases involving severe hyperbilirubinemia in newborns highlights the need for better understanding of treatment and adherence to published guidelines.
Completing medical certificates of death: Who’s responsible?
A discussion of physicians’ obligations when certifying a patient’s death.
Is this patient capable of consenting?
A discussion of consent issues that may arise when caring for adults with diminished mental capacity (competency).
Understanding the role of coroners and medical examiners
Physicians should understand the role of coroners and medical examiners in Canada, and how and when to provide information to them.
Working with physician assistants: Collaborating while managing risks
Physicians can work collaboratively with physician assistants, but should be aware of the potential risks inherent in this working relationship and how these can be managed.
CMPA type of work code for physicians in administrative roles
Physicians may apply their knowledge and expertise in many professional settings.
Providing medical input in an administrative role
The Canadian Medical Protective Association (CMPA) provides medical-legal assistance to members, where eligible, for matters arising from their medical professional work or that call into question their medical professional expertise.
Improving patient handovers
Patient handovers can be a time of high risk. Patient safety experts recommend various strategies to improve the performance of this task.
The aging physician: Maintaining competence and practising safely
This article focuses on how physicians can continue to practise safely into older age and recommends tools to help them tailor their practice to their skills and circumstances.
Medical-legal implications when using restraints
Requirements for consent and other lessons learned related to the use of restraints on patients from a review of CMPA medical-legal cases.
Meeting expectations with reality: Handling consent for elective cosmetic procedures
A review of the most recent 5 years of CMPA medical-legal cases involving cosmetic procedures identified a number of consent deficiency issues.
Disclosing harm from a healthcare delivery event
Patients expect to be informed about harm they have experienced, whatever the reason for it, and this information needs to be delivered in a caring manner. Effective communication with patients and the healthcare team can improve patient outcomes and satisfaction. Conversely, failures in communication may lead to patient harm, misunderstandings, complaints, and lawsuits.
Using electronic communications, protecting privacy
Protecting the privacy of patient information when using digital communication channels, including email, portals, and social media platforms.
Invasive, non-surgical procedures: What are the risks?
Physicians in non-surgical disciplines who perform invasive procedures may be exposed to medical-legal risks, though these can be effectively mitigated.
ENT practice — Mitigating the risks of procedural complications
This article focuses on the main areas of medical-legal risk for otolaryngologists (ENT specialists) based on the CMPA’s case files and on safety measures that can be taken to mitigate those risks.
Conflict between physicians and what can be done about it
While workplace conflict is inevitable, there are steps physicians can take to de-escalate and resolve disputes before they impact patient care.
Meningitis — Understanding the vulnerabilities
Meningitis poses a significant risk of death and disability, especially in vulnerable populations. Prompt diagnosis and treatment is critical.
Fitness to drive: When do physicians have a duty to report?
An overview of medical-legal problems resulting from physicians' decisions on whether to report patients with medical conditions that may make it dangerous to drive, or from physicians' decisions on whether to support the reinstatement of a licence to drive.
Immigrant health issues: What physicians should know and do
Learn how Canadian physicians can meet the care challenges posed by immigrants with a number of specific approaches.
The challenges of relieving chronic pain with opioids
Common medico-legal issues for physicians related to the repeated prescription of opioids for patients with pain unrelated to cancer.
Videoconferencing consultation: When is it the right choice?
Videoconferencing is a valuable tool in healthcare today, though in-person patient consultations are still necessary in many circumstances. Using videoconferencing appropriately improves safety and reduces risk.
Windows 10 and privacy
The CMPA recommends that member physicians and others working in healthcare adjust the default privacy options of Microsoft 10 to obtain greater control over their personal and patient information and address potential privacy concerns.
Stroke: Can you recognize the signs?
A review of medico-legal cases related to stroke, outlining some of the challenges in diagnosis and providing suggestions from experts to improve care and reduce risk.
Lessons from hip and knee arthroplasty complications
Hip or knee arthroplasty can greatly improve quality of life, yet it may also have significant risks.
When common symptoms resemble rare and serious conditions
Missed or delayed diagnosis of a serious medical condition is often related to inadequate assessment and physical examination, cognitive biases, and deficiencies in the system of care.
Physician health: Putting yourself first
When caring for patients, physicians can neglect their own health and well-being. Doctors should improve their self-care for their own sake, and for the sake of their patients and the healthcare system.
Medical-legal handbook for physician leaders
This guide provides insights into key medical-legal concepts and principles, as well as good practices that may assist physician leaders in their work in healthcare organizations and with other doctors.
Managing access to electronic health records
A discussion of the principles of access, the challenges with access, and managing the risks.
Treating transgender individuals
Physicians who treat or who are asked to treat transgender individuals should be aware of the ethical and legal considerations in these circumstances to avoid allegations of discrimination.
Are there risks to acting as a good Samaritan?
Physicians providing emergency care as good Samaritans often have questions about their legal and ethical obligations and the liability protection available to them.
Ending the doctor-patient relationship
Considerations for ending the doctor-patient relationship.
Age of consent for sexual activity and duty to report
Changes to the Criminal Code have raised the age of consent for sexual activity. Physicians should be guided by legislation in each province and territory on their duty to report such activity to the appropriate authorities if there are reasonable grounds to believe the child is being abused.
Sepsis can be difficult to recognize, but early diagnosis and treatment is essential
Early recognition and treatment of sepsis are imperative to prevent patient harm and medico-legal difficulties for physicians.
Consider the unique aspects of caring for athletes
Providing medical care to athletes has unique aspects. Physicians doing this work should be aware of potential medico-legal risks and take steps to keep their patients and themselves safe.
Part-time practice, full-time safety: Reducing clinical workload while addressing risks
Physicians who reduce or limit their clinical workload to attend to other commitments, for example conducting research or transitioning into retirement, are still obligated to provide patients with continuity of care.
Preventing the misuse of opioids
Physicians can take steps to help prevent abuse of the opioids they prescribe, while improving safety for their patients and reducing their own medico-legal risk.
Discharging patients following day surgery
After day surgeries, consider if patients are ready for discharge, require accompaniment on leaving the facility, and have sufficient discharge and follow-up instructions.
Checklist: Disclosing harm from healthcare delivery
Disclosing harm from healthcare delivery: Open and honest communication with patients
This publication provides guidance and good practices about physician communications with patients concerning the disclosure of harm stemming from healthcare delivery, and aligns with the Canadian Patient Safety Institute’s (CPSI) Canadian Disclosure Guidelines (2011).
Using email communication with your patients: legal risks
Issues to consider when communicating with patients via email: confidentiality, timeliness, clarity and consent.
Change is good: Taking action on healthcare safety
Strategies for successfully implementing changes in medical practice aimed at improving the quality and safety of care.
The safety performer: Putting safe care at the forefront
Increasingly medical education is focusing on physician competencies that address safe patient care and that enable more accurate assessment of performance.
How “systems thinking” can lead to safe care
This article discusses the culture of safety and describes system-level strategies for safe care.
Identifying the risks in medical practice
Healthcare safety improvements are contingent on identifying and mitigating risks both at the system and individual levels, and physicians should be aware of such risks in their practice
Collaboration for the future of healthcare safety
Drawing on the expertise of numerous organizations and resources dedicated to improving healthcare safety, healthcare providers can make changes to care practices and reduce the potential of harming patients.
Caring for patients with chronic diseases
How to enhance safety and overall outcomes when treating patients with chronic diseases, while reducing the exposure to medico-legal risks.
When to disclose confidential information
Physicians owe patients a duty to keep their personal health information confidential, yet there are times when this conflicts with other statutory duties or with concerns for public safety.
Recognizing the risk of ureteric injury in abdominal surgery
An analysis of recent CMPA cases highlighting the medico-legal risks associated with surgical ureteric injury.
Supporting patient engagement: What it means for physicians
Physicians can take specific actions to support patients’ engagement in their healthcare.
After the diagnosis: How to communicate with terminally ill patients
Tips to assist physicians in communicating effectively with patients and their families when a patient’s prognosis is terminal.
How office staff can help reduce risk
Physicians’ office staff can contribute to safe care for patients and reduce medico-legal risk. This article reviews several issues identified in the CMPA medico-legal files and provides suggestions on reducing risk.
Pitfalls in assessing and treating children in hospitals
A review of hospital-based patient safety incidents and common reasons leading to them.
Telemedicine — Opportunities, challenges, and obligations
Physicians practising telemedicine across Canadian provincial or territorial boundaries should be familiar with the applicable licencing and regulatory requirements in their own jurisdiction and in their patients’ jurisdiction.
The Canadian medical liability system: What makes it work?
The Canadian medical liability system has evolved to meet the unique needs of Canadians, but there remains an opportunity to enhance its fairness and effectiveness.
Commercial interests and how physicians can avoid the pitfalls
Physicians can take steps to avoid conflicts of interest that can arise when dealing with commercial interests.
Sharing records, improving care, staying safe
Providing patients with online access to their electronic medical records may offer improvements in patient health. Physicians should keep in mind their obligations to protect patient information and document appropriately.
A is for alias—Getting the right care to the right patient
Misidentifying a patient is a risk and can result in harm.
Lowering patients’ risk of hospital-acquired infections
A review of medico-legal cases involving healthcare-associated infection, and risk reduction strategies to consider.
Diagnosing back pain: Keeping an open mind helps minimize risk
Diagnostic assessment issues related to back pain, based on the experience of CMPA members.
Reducing unplanned hospital readmissions
Adequate discharge strategies to help reduce the risk of unplanned hospital readmissions, unfavourable patient outcomes, and medico-legal problems for physicians.
Medico-legal aspects of providing mental healthcare to patients
Specific risk management strategies for physicians who are providing care to patients experiencing mental health issues.
Working the night shift and managing the risks
Strategies to help mitigate risks for physicians who work night shifts.
Emerging trends: Are you socially accountable?
The potential future impacts of social media usage on physicians’ practices.
When disclosure generates media interest
When patients suffer harm from healthcare delivery, physicians will want to disclose the incident to the patient, and if the media become interested, then prepare appropriately.
Physicians in the spotlight: Practical media advice
Advice for physicians facing journalists or negative news coverage.
Top 10 tips for using social media in professional practice
Tips to help physicians participate appropriately in using social media.
On message: The physician as spokesperson
Advice for physicians acting as media spokespersons
Social media: The opportunities, the realities
Physicians should be aware of the pros and cons of social media and the risks of participating.
When a patient seeks a second opinion
When a patient seeks a second opinion about a diagnosis or treatment plan, the other viewpoint will confirm, modify, or offer alternatives to the initial one, and ultimately the patient is free to decide.
Medico-legal risks with fetal heart monitoring
An examination of medico-legal risks with fetal heart monitoring in the antepartum and intrapartum periods.
Recognizing boundary issues
Case studies related to boundary crossings and violations.
Online physician reviews: What’s to be done?
Physicians can successfully manage online ratings using a reasonable and measured approach.
The right test at the right time: Striking the proper balance
Considerations when determining a patient’s need for a medical test or procedure.
Issues during surgery, labour and delivery: Managing the risks in anesthesiology
Highlights of medico-legal issues associated with anaesthesia and analgesia administered by anesthesiologists for surgery and during labour and delivery.
A step too far: Lessons from a recent consent case
A case study illustrating the legal concepts of informed consent and of battery (or “a violation of the integrity of the person” under Québec’s civil law).
10 ways physicians can prevent privacy breaches when using fax with other healthcare professionals
Physicians have an obligation to protect patient information and can take steps to help prevent privacy breaches associated with sending and receiving faxes.
Physicians and research: Understanding the legal, ethical, and professional obligations
Physicians participating in clinical research studies should be aware of their relevant legal, ethical, and professional obligations.
Hospital complaints: Understanding the process and reducing anxiety
Physicians named in a hospital complaint can feel reassured that due process exists and will be followed, and that the CMPA is available to help.
Poster: Electronic records, 10 tips to improve safety
This poster will serve to remind you and staff about good practices concerning electronic records, aimed at helping ensure the security and integrity of patient information, and improving the safety of care you provide.
Long-term care: Quality decisions
Physicians can help contribute to quality of care in long-term care facilities by being mindful of communication issues, coordination of care (including medication reconciliation and management), consent to treatment, advance directives, and regulatory requirements.
Examining risk in psychiatric practice
This article focuses on the main areas of medico-legal risk for psychiatrists.
10 tips for using electronic records
A review of problems, pitfalls, and emerging liability issues with the use of electronic patient records
A challenging diagnosis: Traumatic compartment syndrome
Measures for reducing medico-legal risk in the diagnosis of traumatic compartment syndromes of the lower limb, based on 5 years of CMPA members’ experience.
The physician voice: When advocacy leads to change
Physicians are advocates for their patients and for healthcare improvements, but this dimension of medical care can be challenging. This article explores what advocacy means and what approaches are most effective and appropriate.
Medical marijuana: Considerations for Canadian doctors
Polices introduced by the medical regulatory authorities (Colleges) reflect concerns expressed by some in the medical community about the use of marijuana for medical purposes and the challenging role given to physicians and other healthcare providers.
Consent: A guide for Canadian physicians
In the medical context and as the law on consent to medical treatment has evolved, it has become a basic accepted principle that "every human being of adult years and of sound mind has the right to determine what shall be done with his or her own body."
Can a child provide consent?
Effective communication and awareness of legal requirements are key to obtaining consent for treatment of children.
Helping patients make informed decisions
This article explores the role of physicians in promoting the exchange of information and active decision-making by patients. It also examines the relationship between decision-making and consent.
Know the rules, avoid the risks: Treating family and friends
The circumstances under which physicians can treat themselves, family and friends are limited.
Electronic records handbook
A practical resource for physicians, describing the implementation and use of electronic medical records (EMRs) and electronic health records (EHRs), including benefits, technological issues, and medico-legal risks.
When physicians feel bullied: Effective coping strategies
Physicians can take steps to address bullying and other abusive behaviours they may be subjected to by patients and their families, colleagues and other healthcare workers, and third parties.
“Can I take your vital signs?” Key learnings from 3 case studies
Appropriately obtaining, interpreting, documenting, reassessing, and acting on vital signs are important parts of medical care.
When medicine and culture intersect
This article discusses what physicians can do to deliver culturally competent and culturally safe medical care.
Managing the risks of labour induction
How to better manage the risk of patient harm, adverse birth outcome, and potential medico-legal problems associated with the administration of oxytocin during labour.
Update on law for withdrawing treatment
While a Supreme Court of Canada decision clarifies that in Ontario, physicians must obtain consent before life support can be withheld or withdrawn, the effect of the decision in other jurisdictions is uncertain.
Communicating with pharmacists: Optimizing drug therapy
By communicating effectively with pharmacists, physicians can improve patients’ drug therapy and provide safer care.
Physicians and nurse practitioners: Working collaboratively as independent health professionals
When working with nurse practitioners, physicians should understand the scope, responsibilities, and accountabilities of these independent healthcare providers, and should communicate clearly and in a timely manner.
What to do when patients do not follow the doctor’s advice: Dealing with non-adherence
What can be done to reduce the medico-legal risks for physicians when patients do not heed their advice.
Medication management, quality healthcare
Physicians play a key role in managing medication. Careful attention to risk management strategies will help physicians provide quality care for their patients.
Thinking ahead: The value of situational awareness
Timely diagnosis and treatment depends on obtaining sufficient clinical information, monitoring the situation, and thinking ahead.
Managing information to deliver safer care
Physicians need accurate and up-to-date information to provide effective and safe patient care, but information overload can create distraction rather than improve knowledge.
Supporting physicians as clinical supervisors
Physicians acting as clinical supervisors play a valuable role in the remediation of physician colleagues and, as members of the CMPA, are eligible for the Association’s assistance if medico-legal difficulties arise.
Prostate cancer medico-legal issues: Diagnosis, communication, and treatment
Physicians can take a number of actions to reduce the risks in diagnosing prostate cancer and following-up on test results.
Pinpointing medical-legal risk for radiologists
This article focuses on the main areas of medico-legal risk for radiologists, based on the most recent 5 years of CMPA members’ experience.
Privacy: What the future holds
Physicians must stay abreast of changes related to health information privacy, contribute to privacy advancements, and comply with existing and new rules and regulations.
Practical steps to support effective compliance
Administrative and management practices, data sharing agreements, confidentiality agreements, and privacy impact assessments can help physicians to achieve compliance with their privacy obligations.
Protecting patient health information in electronic records
Tips for using electronic records and other technologies.
Incorporation of a medical practice in Québec
Stop and think — Return visits offer another chance
Physicians should carefully reassess patients who return with symptoms that are not resolving as expected or are worsening.
Health literacy — An asset in safer care
Steps physicians can take to help patients with poor health literacy skills.
Genetic testing — New options, new obligations
The increased availability of genetic testing raises a number of medico-legal questions that physicians should consider.
Addressing physician disruptive behaviour in healthcare institutions
Highlights from CMPA discussion paper “The role of physician leaders in addressing physician disruptive behaviour in healthcare institutions.”
Common medico-legal questions asked by members
A sample of medico-legal questions posed by CMPA members to physician and legal experts at the Association's education programs.
Winding down your practice
Physicians can make their transition into retirement easier for all those affected, particularly patients, by making preparations well in advance and giving ample notice.
Dealing with conflict in the doctor-patient relationship
Advice and tips on managing conflict, based on CMPA's experience in medico-legal matters, the medical literature, and consultation with experts. Practice management considerations are also discussed.
Managing risks associated with nasogastric and feeding tube insertion
A review of CMPA medico-legal cases involving feeding tube placement identifies clinical situations of higher risk that can affect patients and physicians.
Appendicitis — Lessons learned
Appendicitis in many cases remains difficult to diagnose. A review of CMPA medico-legal cases identifies many of the challenges.
New approaches: Healthcare integration
This article explores the role of physicians in the organization of integrated health systems such as regional health boards, health authorities, and health networks.
The physician as teacher — What are the responsibilities?
Physicians supervising medical trainees must keep in mind their responsibilities to patients when delegating tasks to trainees.
A matter of records: Retention and transfer of clinical records
An overview of the principles of retention, sharing and transferring of medical records.
Apology legislation in Canada: What it means for physicians
Certain provinces have legislation to prevent apologies for adverse events from being used in court proceedings.
Coping with a College complaint: Suggestions for reducing anxiety
Dealing with the stress of a College complaint is easier when a physician understands the complaint process and receives support, advice, and coping strategies from the CMPA.
Encryption just makes sense
Privacy legislation, regulatory policies and professional obligation require that CMPA members take reasonable measures to protect the privacy of their patients' personal health information. With the advent of electronic records, members should be cognizant that encryption can help secure personal health information and may be required by law.
Rural practice — Strategies to reduce medico-legal risk
Physicians practising in rural and remote areas should be aware of the medico-legal risks in these circumstances.
Co-morbidities — Have you considered all health conditions?
An overview of the medico-legal risks of caring for patients with co-morbidities.
Medico-legal vulnerabilities in cervical cancer diagnosis
An analysis of issues relevant to the diagnosis of cervical cancer and based on the 10 most recent years of CMPA closed medico-legal cases.
Preparing for a medical emergency — Anticipating the unexpected in an office or clinic
Physicians should expect that at some time they will have to manage a medical emergency in their office or clinic. Planning, preparation, and practice are key steps in mounting an effective response for both patients, and physicians and their staff.
Administrative medicine
A physician consultant for a workers' compensation board interprets the medical information received from the physician of an injured bricklayer.
The most responsible physician: A key link in the coordination of care
Clarity about who is responsible for the care of a patient at any given time improves patient safety and reduces medico-legal risk.
Physician leadership in safer medical care
Physician leadership and participation are essential for successful quality improvement efforts in healthcare.
Overcoming bias in medical practice
Recognizing and eliminating biases and prejudice contributes to safer medical care.
International adoptions — Assisting parents and managing the risks
Assisting prospective parents seeking to adopt a child from abroad can pose challenges for physicians, particularly when they are asked to assess a child’s condition without a physical examination or to prescribe medication for a child with whom they do not have a doctor-patient relationship.
Diagnostic delays in pediatrics
An analysis of the CMPA’s pediatric medicolegal cases identified a number of common factors that resulted in poor clinical outcomes.
Consent and minor procedures — What physicians need to know
A physician must provide certain information to patients to obtain informed consent, even for simpler procedures and treatments.
Effectively managing hospital test results — Key to timely diagnosis and patient safety
Effective management of test results and diagnostic imaging reports in a hospital setting can improve patient safety and mitigate risks.
Managing the risks of hernia repair
A review of medico-legal problems associated with hernia repairs in the preoperative, intra-operative, and post-operative stages.
The voice of professionalism within the system of care
Physicians assume key responsibilities in healthcare including the provision of much needed medical care, research into new treatments, teaching the future generation of doctors, and managing healthcare facilities, centres, or clinics.
Releasing a patient’s personal health information: What are the obligations of the physician?
To respond appropriately to a request to release patient information, physicians must understand the legal rules surrounding the ownership and handling of the information.
Physician professionalism — Is it still relevant?
The practice of medicine is undergoing unprecedented change.
Medical professionalism — What the future holds
The CMPA believes that medical professionalism has never been more important, both for individual physicians and for the medical community as a whole.
A medico-legal perspective on physician health and wellness: Removing barriers to treatment of physician patients
In a profession where the culture has shifted significantly, one aspect of medical practice continues to endure: a physicians’ ability to put the health and needs of their patient first, often at the expense of their own personal health.
Respect and understanding — How professionalism affects teamwork
As healthcare delivery relies increasingly on integrated or collaborative care, a growing number of physicians are working in teams composed of physicians and other healthcare professionals.
The enduring value of trust — Professionalism with patients and families
Trust, loyalty, and honesty are the foundations of a good doctor-patient relationship and of professionalism in the practice of medicine.
Risk management in cataract surgery
Medico-legal issues for ophthalmologists related to the pre-operative, intra-operative, and post-operative periods of cataract surgery.
Risk management when using drugs or medical devices off-label
Strategies to reduce medico-legal risk when prescribing medications or using medical devices outside of their licensed indications.
Pitfalls in the diagnosis and management of skin cancer
A review of medico-legal cases concerning diagnosis and management of skin cancer.
The changing practice of medicine: Employment contracts and medical liability
Physicians considering various arrangements for practising medicine, other than the privileges-based model, need to consider any medico-legal implications.
The new realities of medical care
As the healthcare environment continues to change, physicians remain committed to quality patient care, while keeping in mind accompanying risk management considerations.
Medico-legal problems and their emotional impact
Becoming familiar with the processes for legal proceedings and College complaints and knowing where to get support can help put medical-legal difficulties into perspective and alleviate emotional stress for physicians.
The engaged and empowered patient
Engaged and empowered patients take an active role in managing their healthcare, and physicians must be aware of the medico-legal implications.
Perils in the prevention of venous thromboembolism
Risk management lessons from a review of medico-legal cases related to venous thromboembolism prophylaxis.
Know the issues and risks of bariatric surgery
A review of the medico-legal issues with bariatric surgery in the pre-operative, intra-operative, and post-operative periods
Understanding how Colleges handle complaints or allegations of professional misconduct
A complaint to a medical regulatory authority (College) initiates a process that warrants a physician's attention and timely response.
Trauma care in the emergency department - Effective communication and resources vital to quality patient care
Risk management suggestions related to verbal and written communication in the trauma setting and when resources are limited.
Technology unleashed - The evolution of online communication
Physicians should learn about the benefits and medico-legal risks of each new information technology platform before considering using these web-based tools
Practising in a community setting — A hub of patient care
Physicians should be aware of the medico-legal risks that are inherent in practising in a community care location.
Trauma care in the emergency department — Early diagnosis a key factor in improving patient outcomes
Risk management suggestions from an analysis of medico-legal cases related to the diagnosis of trauma patients.
The impact of medical tourism on Canadian physicians
Canadian physicians can take steps to ensure continuity of care for patients engaged in medical tourism, and avoid medico-legal risk.
Protecting children — Reporting child abuse
If physicians have reason to believe a child is in need of protection, they are responsible for informing the appropriate authority in a timely manner. Planning what to say to the family is important.
Alternative medicine — What are the medico-legal concerns?
Physicians should be prepared to respond to patient enquiries about complementary and alternative medicine and natural health products.
Working with medical equipment — Reducing the risks
A review of medico-legal problems related to malfunctions, improper use, and deficiencies in training and supervision when using medical or surgical equipment.
The aging patient — Responding to changing demographics
As the Canadian population ages, physicians may need to adjust their practices to better meet the needs and expectations of older adults and avoid potential medico-legal risks.
Managing the medico-legal risks of placing a central line
Litigation related to the placement of central lines is most often related to consent, delegation, standard of care, and documentation.
Infective endocarditis — Still a challenge
A review of a five-year period of medico-legal files related to infectious endocarditis.
When a patient asks for another physician on cultural or religious grounds
Physicians can find themselves in a difficult ethical and legal position when patients refuse to be treated.
Privacy and a wired world — Protecting patient health information
Privacy legislation and policies set the foundation for safeguards to maintain confidentiality of patient information.
Physician interactions with police
An overview of a physician's duty to maintain confidentiality and protect the privacy of patients' personal health information in instances of disclosure requests from third parties, including the police or other authorities.
Changing physician-hospital relationships: Managing the medico-legal implications of change
Changes in the relationship between physicians and hospitals may have medico-legal implications that could lead to difficulties for physicians, institutions, and patients. Recommendations to address these implications are identified.
Clinical practice guidelines: What is their role in legal proceedings?
In legal proceedings where courts are determining if the care provided met the standard of care, authoritative clinical practice guidelines may be considered as one piece of evidence.
They can't sue me outside Canada, or can they? Considerations when treating or prescribing to non-residents
When treating non-resident patients, Canadian physicians are advised to ensure they have adequate liability protection.
Independent medical evaluations: be prepared
There are a number of steps that can be taken to reduce the likelihood of patient dissatisfaction with Independent Medical Evaluation.
Consenting to research
Physicians undertaking clinical research are expected to obtain valid consent.
Effective multi-patient disclosure
A discussion on how members can help meet the clinical, emotional and informational needs of patients after large scale adverse events.
Limiting discussion to one medical issue per visit: Know the risks
Limiting patients to one issue per visit can lead to negative perceptions if not communicated with respect and diplomacy.
Improving communication between physicians
A discussion of how physicians can improve their inter-professional communication skills, leading to better care for patients and reduced medico-legal risks for physicians.
Risk management in elderly patients: Medication issues
A review of medico-legal problems related to prescribing and monitoring medications for older patients.
How effective management of test results improves patient safety
There is growing evidence that effectively managing the results of test and diagnostic imaging reports improves patient safety.
Clinical practice guidelines — Guidance or a standard of practice?
Most physicians agree that clinical practice guidelines (CPG) can improve the quality of clinical care. In a legal case, however, a court may place more weight on the standard of care of a "prudent colleague" than on a CPG.
Expectations for experts’ reports are changing
This article looks at the changes some provinces and territories have made or are considering making to the Rules of Procedure (also known as the Rules of Court or the "Rules") for expert witness reports in civil actions.
Could the patient be pregnant?
A review of medico-legal problems related to patients who are unknowingly pregnant and have been exposed to investigations and treatments recognized to possibly harm a fetus.
Using clinical photography and video for educational purposes
An exploration of privacy and consent issues when using clinical images or recordings of patients to teach medicine.
When diagnosing subarachnoid hemorrhage, consider the possibilities
An analysis of medico-legal cases indicates that there are several possible reasons for delays in the diagnosis of SAH. Delays in diagnosis may result in medico-legal risks.
Why good documentation matters
Poor charting may be perceived as reflecting less attention to detail and risks the conclusion the care provided was poor.
Strengthening inter-professional communication
A discussion of how physicians can improve their inter-professional communication skills, leading to better care for patients and reduced medico-legal risks for physicians.
Reporting patients with medical conditions affecting their fitness to drive
An overview of medico-legal problems resulting from physicians' decisions on whether or not to report patients with medical conditions that may make it dangerous to drive, or from physicians' decisions on whether or not to support the reinstatement of a licence to drive.
More telephone problems
A case illustrates why it is important to take a sufficient history during a telephone call.
Informal telephone advice
When providing advice informally to others or over the telephone, obtain sufficient information on which to base your professional opinion, as they may rely on the advice.
A good defence depends on good records
CMPA provides free telephone record pads for physicians to use when documenting telephone advice.
Delay in diagnosis of ACS
Acute chest pain is a common, chief complaint in both an emergency department and family practice environment. Careful evaluation of the history, physical examination and ECG may provide valuable clues. In some cases, observation and further testing may also be advisable.
"Doc, I can't wear a seatbelt!"
Responding to patient requests for exemptions to wearing a seatbelt while driving.
Physician-patient communication: Making it better
Physician-patient communication is a critical aspect of effective care that may be enhanced with these suggested approaches.
Reporting another physician
A review of the legal duties and ethical considerations for physicians to report their reasonable concerns about the professional competency, conduct or behaviour of another physician to health care institutions/hospitals, public health officials or regulatory authorities (Colleges).
Lung cancer – The challenge of a timely diagnosis
Suggestions to reduce risk and optimize the timely diagnosis of lung cancer.
Medico-legal risks in busy and overcrowded emergency departments
A review of some of the medico-legal risks related to the use of medical directives in emergency departments, and patients who LWBS by a physician or sign out AMA.
What to do when facing a College complaint
For many physicians, having a complaint lodged against them with a regulatory authority (College) is stressful. If a College asks for a response to the complaint, either in writing or verbally, CMPA members should seek advice from the Association.
Reimbursement of CMPA fees: A benefit to physicians and their patients
Just culture of safety: Why protecting quality improvement reviews is important for everyone
A just culture of patient safety promises better quality and safer care. This article explores protected quality improvement reviews and discusses the benefits of learning from adverse events to limit the likelihood of their reoccurrence.
Medico-legal problems related to cholecystectomy vascular/hemorrhagic complications
A review of complications and ways to mitigate risks related to cholecystectomies and other laparoscopic procedures.
How to reduce the risks of dental injury
Any medical procedure where instruments are inserted into the mouth may result in dental injury, despite appropriate care. This article provides advice about obtaining and documenting consent for such procedures, and what to do should a patient allege wrongful damage to the teeth.
The legal limits of sterilizing the mentally incapable
In the case of E. (Mrs.) vs. Eve (1986), the Supreme Court of Canada established limitations related to therapeutic sterilization of mentally incapable (incompetent) patients.
Medico-legal problems related to cholecystectomy: Intestinal complications
A review of medico-legal cases involving complications of cholecystectomy. This article focuses on intestinal complications.
The new reality: Expanding scopes of practice
Potential liability issues for physicians working with independent health care professionals, and steps to mitigate those risks.
Subpoenas — What are a physician's responsibilities?
A subpoena or summons to witness requires the person named to attend the court, tribunal, commission, inquiry, inquest or military board proceeding or hearing named in the subpoena.
Managing intoxicated patients in the emergency department
Intoxicated patients pose special risks in the emergency department because of their behaviour, and the difficulty of adequate assessment and treatment.
Medico-legal problems related to cholecystectomy: Biliary tract injuries
A review of medico-legal cases involving complications of cholecystectomy. This article focuses on biliary tract injuries.
The medical record: A legal document — Can it be corrected?
Physicians should exercise care in modifying or correcting medical records. Suggestions on when and how to go about this are provided.
Acting as an expert in medico-legal proceedings
Key issues for physicians to consider when deciding to provide medical expertise in medico-legal proceedings.
Breast cancer detection and diagnosis: Part 2 Improving breast cancer diagnosis and management
A review of closed medico-legal cases alleging delays in the diagnosis and management of breast cancer, focusing on patients presenting with clinical findings suggesting a possible lesion of the breast.
Learning from adverse events: Fostering a just culture of safety in Canadian hospitals and healthcare institutions
It is well recognized that health care providers continuously strive to ensure the best possible clinical outcomes for their patients. They do so cognizant that no one individual or system can ever fully eliminate the risk and occurrence of adverse events
Timely diagnosis of ectopic pregnancy a key factor in reducing risk
Delays in the diagnosis of ectopic pregnancies may lead to poor patient outcomes and medico-legal difficulties for physicians.
Anticoagulant, antiplatelet agent and thrombolytic therapy: Amedico-legal perspective
An overview of the medico-legal difficulties associated with the use of anticoagulant, antiplatelet and thrombolytic agents
Indemnification clauses — What you need to know before you sign that contract
Physicians should carefully consider the meaning and implications of indemnification clauses in contracts with employers, research organizations, governments, health care agencies and others.
Breast cancer detection and diagnosis: Part 1
Clear communication among patients, referring physicians, technicians and radiologists, as well as attention to details in follow-up, will permit optimal outcomes from screening programs for breast cancer.
Adverse events — Physician-prescribed opioids
A review of legal actions involving physicianprescribed opioids.
New vaccines — What are your obligations
Issues to consider when discussing vaccination with patients.
Coping with an adverse event, complaint or litigation
Every physician in Canada is likely to be affected by a medico-legal issue at some point over the course of his or her career.
Third parties in the operating room
Before permitting persons not a part of the surgical team to be present in the operating room, it is important to consider many issues, among them patient privacy and confidentiality, consent, and safety.
Hyponatremia in children
Hyponatremia may occur during rehydration or with maintenance fluids, and can have serious adverse effects, including neurologic impairment and death.
Aminoglycoside therapy: Balancing risk versus benefit
Aminoglycosides are effective antimicrobial drugs but can have serious adverse effects. Indications, alternatives, dose, duration and co-morbidities are some of the important considerations.
Legal liability of physician for medical certificates
Medical certificates may be relied on by an employer or its insurer when making a determination concerning a patient's benefits.
Well-limb compartment syndrome
Although most physicians are aware of the possibility of compartment syndrome following trauma to a limb, it may occur in other situations.
Follow up for "orphaned patients"
Physicians discharging patients in need of follow up care may have certain responsibilities.
Delegation and supervision of medical trainees
Risk management considerations for supervising physicians, and supervised residents and other trainees.
Timely responses to requests for reports
Responding to third party requests for a medical report on a patient.
Failure to make the diagnosis of colorectal cancer: A window of opportunity missed
This risk identification paper identifies six areas associated with potential delays in the diagnosis of colorectal cancer.
If a patient relies on your professional opinion, you may have a duty of care
Before giving advice on medical matters, even informally, physicians should be satisfied they have considered and documented the relevant information.
It's a small world after all! Foreign travel, exotic diseases and your practice
Physicians may find it prudent to seek assistance from credible sources when patients seek pre-travel advice about, or later present with symptoms after travel.
Put it in writing, with care
Documentation in clinical notes and in reports to third parties should be factual, objective, and appropriate to the purpose.
Treating non-residents of Canada
The following outlines the CMPA's principles of assistance for members who provide care to non-residents of Canada.
Physicians and the Firearms Act: a dilemma
Considerations in responding to patients' requests for support in acquiring firearms.
Preparing medico-legal reports: suggestions for physicians
Care should be taken when writing medico-legal reports, such as reports of treating physicians, independent medical examinations and expert opinions. Suggestions are made as to factors to consider when preparing such reports.
Physicians acting as guarantors—New Canadian passport requirements
Passport applications no longer need to be signed by specified professionals, and when signing certain personal information must be included.
Aminoglycosides — A fine balance
Appropriate use of aminoglycosides requires awareness of the potential side effects and their symptoms.
Assistance to clinics and facilities
Treating professional athletes
CMPA Assistance when treating professional athletes
Responding to prescription fraud
Considerations for managing suspected prescription or narcotic fraud, forgery or theft.
Aortic dissections: “Tearing” apart the data
The diagnosis of aortic dissection may be complicated by an atypical presentation, but careful documentation and appropriate reassessment can reduce the associated risks.
Reporting to quality improvement committees in hospitals
Quality improvement activities can be expected to improve patient care, but care should be taken to avoid undue medico-legal risk.
A case for keeping good notes
Poor charting may be perceived as reflecting less attention to detail and risks the conclusion the care provided was poor.
How to apologize when disclosing adverse events to patients
It is right to express sympathy after an adverse event, but an apology with acceptance of blame may be inappropriate.
Scrotal pain may point to testicular torsion
It is important to consider testicular torsion in young males presenting with abdominal or scrotal pain.
Disclosing adverse events to patients: strengthening the doctor-patient relationship
Timely, unrushed disclosure of adverse events to patients is an obligation that may strengthen the doctor-patient relationship.
Keep privacy in mind when disposing of test reports
It is important to properly dispose of test reports.
Responding to requests for children's medical records
The physician's role in providing a child's medical information to a parent.
Shared care: issues you should consider
In a shared care environment, consider liability issues, the scope of practice and qualifications of other team members, and the importance of good communication.
Office privacy compliance
Privacy legislation affects physician's collection, use and disclosure of personal information.
Anesthesia airway management
A study examining the medico-legal risks of airway management by anaethesiologists from 1993 — 2003.
Anatomy of a well-written note
Avoid medico-legal difficulties by writing factual and objective notes.
Safety and the practice of medicine
Steps to create a safe working environment.
Cautionary tales: telephone advice
Carefully document telephone advice even if a patient rejects it.
Medical records: Advice about maintaining their integrity and providing them to lawyers
CMPA answers your questions about documentation.
Effective testifying
Recommended ways to promote confidence and effectiveness when testifying in court.
When joking isn’t funny
Respect and observation of professional boundaries allows you to express concerns about patient care without fear of reprisal.
Steroid eye drops: Use caution in repeating prescriptions
Exercise caution in repeating prescriptions.
Avoid pitfalls when preparing medico-legal reports
Exercise caution in preparing medico-legal reports: consider the nature and extent of risks and whether those risks are probable or, if serious but remote, would be risks the patient would want to be informed about. Avoid potentially misleading statements.
Collaborative care and medication monitoring: Who's responsible?
Monitoring medications in shared care.
Considerations when leaving a medical practice
Notifying and transferring patients and medical records when making a practice transition.
Physicians and their patients' wills: issues to consider
Physicians may be asked to attest to the capacity of a patient if the patient's will is contested or at the time the will is being prepared.
Class actions: On the increase?
Class actions are becoming more common in Canada.
Clinic held liable for a sexual assault
Ontario court decides that a medical clinic is liable for sexual assault committed by a technologist, who was an employee of the medical clinic.
Ill-considered statements can be costly
Statements in medical records should be accurate, objective and factual.
Provincial counsel commentary: The Krever Inquiry
An inquiry into the Canadian blood system recommended improved documentation and informed consent, and decreased allogeneic blood use.
How do the Courts determine standard of care?
The CMPA will seek expert opinion regarding a physician's standard of care.
Reducing your risk when you're not available
Clear messages regarding physician availability help reduce medico-legal risk.
Natural justice - an obligation for "fair play"
When involved in administrative proceedings (e.g. College proceedings, hospital proceedings etc.), an individual is entitled to fairness. The principles of “natural justice” are explained, and a hospital proceeding is used as a case example.
Keeping a sharp eye on sharps
The proper disposal of materials such as sharps is important.
Public health emergencies and catastrophic events
Protection against medico-legal risk for physicians during emergencies that overload health resources.
Relying on hospital staff
Physicians can rely on hospital staff to carry out their own functions but are also expected to exercise appropriate caution.
Being on call when resources are limited
Physicians may be expected to provide appropriate advice to referring physicians even when their facility cannot accept the patient.
Spinal epidural abscess: a rare, insidious and potentially catastrophic infection
Although spinal epidural abscess is rare and difficult to diagnose, it can have serious consequences for patients. CMPA experience has been reviewed.
Mandatory reporting: what you need to know
Legislation requires physicians to report individuals in the transportation industry whose medical condition may constitute a threat to safety.
House calls: What the courts have said
House calls place the doctor in an unfamiliar situation where it may be more difficult to obtain a history or to perform a physical examination.
Gratuitous criticism or "If we had only seen you sooner"
A physician's remarks about prior care may lead to medico-legal difficulties for a previous care provider. It is important to base any comments on a thorough knowledge of the facts.
Protection of quality improvement information
The collection of physician personal health information and public safety
Partnerships with other physicians
Physician partnership may put members at significant risk regarding their personal assets when allegations extend beyond the bounds of medical negligence.
Providing care as a good Samaritan
Medical-legal issues to consider with clinical research contracts
Criminal and sexual impropriety matters
Health promotion
Prescribing to non-patients a risky activity
Some Canadian physicians are engaging in risky activity by signing or co-signing prescriptions for individuals with whom they have no prior recognized doctor-patient relationship.
CMPA assistance with general contracts
CMPA Assistance with contracts
Billing investigations
CMPA Assistance in Billing Investigations
Serving on committees and boards
Serving on Committees and Boards
Physician personal health information: Supporting public safety and individual privacy
This paper addresses the individual privacy and public safety issues concerning the collection, use and safeguarding of physicians' personal health information.
Reporting and responding to adverse events: A medical liability perspective
This paper addresses the medical liability issues associated with the reporting of and response to adverse events, and proposes measures to strengthen the existing system.
Physicians with blood borne viral infections: Understanding and managing the risks
A diagnosis of infection with a blood borne pathogen such as Hepatitis B (HBV), Hepatitis C (HCV) or human immunodeficiency virus (HIV) can be potentially devastating for any individual and the impact is likely to extend to family and friends. In the case of physicians infected with a blood borne virus, there may also be significant implications for their professional practice. Such difficult situations pose challenges for physicians, medical regulatory authorities (Colleges) and others responsible for ensuring the safety of the medical care.
Joint Statement on Liability Protection for Midwives and Physicians
New and evolving models for health-care delivery have increased the opportunity for physicians, midwives and other health-care providers to all be involved in the treatment of the same patient. This inevitably reinforces the need for health-care professionals to ensure they individually have adequate personal professional liability protection and that the other health-care professionals who are part of the health-care team are also adequately protected so that one is not held financially responsible for the acts or omissions of another. The Canadian Medical Protective Association (CMPA) and the Healthcare Insurance Reciprocal of Canada (HIROC) have developed this document to respond to questions from midwives and physicians who may treat the same patient during the course of pregnancy, birth and the post-partum period.
Mitigating risks when implementing electronic records
Electronic records are becoming integral to healthcare delivery in Canada. While electronic records hold great promise to improve the overall effectiveness of the healthcare system, they may also contribute to liability issues. Legislation and regulation have not, in all cases, kept pace with the technology and many privacy-related issues still need to be resolved.
Changing physician-hospital relationships
The Canadian healthcare system is undergoing significant change as it evolves to meet emerging patient and societal needs. At the same time as the Canadian population's healthcare requirements are increasing, resource levels may not be keeping pace with growth in demand. New technologies, higher expectations for healthcare outcomes, an appropriate desire for greater accountability, and focus on assessing and improving system performance all contribute to added complexity.
CMPA supports apology legislation
Most Canadian provinces and territories have now adopted apology legislation. One objective of this legislation is to reduce concerns with the legal implications of making an apology. Apology legislation typically provides that an apology does not constitute an admission of fault or liability, must not be taken into consideration in determining fault or liability, and is not admissible as evidence of fault or liability.
Practising telehealth
The following outlines the CMPA's principles of assistance for members whose practice includes telehealth. The CMPA considers "telehealth" to include any technology that enables the delivery of care at a distance.
Clinical research
CMPA Assistance with Clinical Research
Allegations of defamation
Defamation is the offence of bringing a person into undeserved disrepute by making false statements.
Providing care outside Canada
The CMPA is structured to assist members who encounter medico-legal difficulties arising in Canada out of their medical professional work done in Canada. In some circumstances, members may be eligible for assistance when working outside of Canada including: travelling with Canadian groups participating at international non-professional cultural events or amateur sporting events; Canadian Forces physicians posted overseas; members working for established charities or missionary organizations; and members providing medical care as part of certain teaching or research programs.
Collaborative care: A medical liability perspective
Clinical care is increasingly provided by collaborative teams with the promise of better outcomes for patients. This document identifies potential medico-legal risks in collaborative care and proposes solutions to lessen those risks for patients and providers.
Collaborative Care Summary
Health professionals have a long-standing history of working together to deliver quality, sustainable health care for Canadians and to ensure the optimal use of resources. However as the demand for health care increases, new models are being explored. Increasingly, care is being provided by collaborative teams employing the skills of the most appropriate health-care provider for the care required. This new model of health-care delivery has the potential to provide better outcomes for patients and to improve the efficiency of the system overall.
Governing Law and Jurisdiction Agreement
The CMPA and Healthcare Insurance Reciprocal of Canada (HIROC) have updated the two "Governing Law and Jurisdiction Agreement" forms, which are designed for the use of physicians in private practice and healthcare organizations.
Confidentiality/non-disclosure agreement
Confidentiality is an important component of privacy legislation and a cornerstone of a medical professional's fiduciary obligations.
Teaching, research, and learning outside Canada
The following outlines the CMPA's principles of assistance for members who are involved in teaching, research, and learning activities outside Canada that involve elements of clinical care.
Wait Times — a medical liability perspective
The state of the nation's health-care system is an issue of great importance to Canadians. While Canadians appear to be generally satisfied with the quality of care provided, they are increasingly expressing concerns about the timely access to care. Access to care has many facets but the most commonly heard concerns relate to the time that a patient is required to wait before receiving medically necessary treatment.
Medical-legal issues to consider with individual contracts
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Specimen and report mix-ups
Pathological examination of a surgical specimen is the mid-point of a complex process involving many people. Mix-ups can occur at any point in the process, with adverse effects for patient and difficulties for health-care personnel.
Estate planning — Prepare a will and make a plan
Certain practice management issues arise when a physician dies, and should be considered as part of estate planning.
Limited health-care resources: The difficult balancing act
The Courts expect physicians to provide appropriate care to patients, making use of available resources. Physicians can be discussing limitations with patients and may discuss concerns and options with other physicians and administrators.
Cauda equina syndrome: A case for timely recognition and treatment
Cauda equina syndrome is not common, but has the potential for serious and long-lasting disability. Knowing the symptoms and signs, examining the patient adequately, and obtaining timely and appropriate investigations and consultations may help to avoid the risk of disability.
Abdominal aortic aneurysm in the emergency department
The diagnosis of symptomatic abdominal aortic aneurysms is challenging. A review of medico-legal cases related to patients presenting with this diagnosis in emergency departments is presented, with risk management considerations.
Thoracic aortic dissection: Medico-legal difficulties
Failure to diagnose thoracic aortic dissection is not always due to negligence.
Wait-time benchmarks — Medico-legal considerations
Considerations for consultants and referring physicians with regard to wait times.

DISCLAIMER: The information contained in this learning material is for general educational purposes only and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. The use of CMPA learning resources is subject to the foregoing as well as the CMPA's Terms of Use.