Medico-legal risk: What rheumatologists need to know

Know your risk – data by clinical specialty

A physician assessing a patient’s arm issue

3 minutes

Published: February 2023

As of the end of 2021, 625 CMPA members were rheumatologists (Type of Work or TOW 63).

The graphs below are provided to help you understand your medico-legal risk, and they are accompanied by key learning resources that will help you mitigate that risk level.

What are the relative risks of a medico-legal case for rheumatologists?1

  •  Rheumatology, College(n=167)
  •  Rheumatology, Legal(n=35)
  • All CMPA, College(n=45,421)
  •   All CMPA, Legal(n=13,857)

From 2012-2021, rheumatologists had generally lower rates of College (medical regulatory authority) and legal matters compared to other CMPA members.

What are the most common patient complaints and peer expert2 criticisms? (n=97)

Issue %, Patient allegation %, Peer expert criticism
Deficient assessment 42 8
Unprofessional manner 30 4
Diagnostic error 26 11
Inadequate monitoring or follow-up 22 10
Inadequate consent process 19 9
Communication breakdown with patient 12 11
Inadequate documentation 10 21

This chart and the next chart focus specifically on 97 cases involving rheumatologists from that same 10-year period (2012-2021). These cases contained more detailed information than other cases, providing the opportunity for more in-depth safe medical care analysis.

Complaints are a reflection of the patient’s perception that a problem occurred during care. There may be more than one complaint per case. These complaints are not always supported by peer expert opinion. Peer experts may not be critical of the care provided, or may have criticisms that are not part of the patient allegation.

CMPA Learning: Improve your record keeping

Documentation is central to patient care and safety. Our resources can help you develop best practices:

CMPA Learning: Enhance safety of care

For physicians with an interest in improving medico-legal practices, CMPA offers accredited workshops on diagnostic reasoning, to help you address information gaps, raise situational awareness, and enhance safety of care:

What are the most frequent patient presenting conditions? (n=97)3

Arthropathies (e.g. rheumatoid arthritis, psoriatic arthritis) (41.2%), Soft tissue disorders (e.g. fibromyalgia, bursitis) (12.4%), Back disorders (e.g. ankylosing spondylitis, kyphosis) (8.2%), Systemic connective tissue disorders (e.g. lupus, systemic sclerosis) (8.2%)

  •   Arthropathies (e.g. rheumatoid arthritis, psoriatic arthritis) (41.2%)
  •   Soft tissue disorders (e.g. fibromyalgia, bursitis) (12.4%)
  •   Back disorders (e.g. ankylosing spondylitis, kyphosis) (8.2%)
  •   Systemic connective tissue disorders (e.g. lupus, systemic sclerosis) (8.2%)

CMPA Learning: Optimize your communication

Good communication establishes effective partnerships with patients. Our educational resources provide guidance on communicating effectively to optimize care.

Risk reduction reminders

The following risk management considerations have been identified for rheumatologists:

  • Obtain the patient's relevant medical history (including current medications and co-morbid conditions), review the medical record, and conduct an appropriate physical examination.
  • Ensure protocols are in place to enable the timely receipt, effective review, and appropriate management and follow-up of investigative tests.
  • Consider whether additional diagnostic tests or consultations are necessary to establish or confirm the diagnosis.
  • Record relevant information in patients’ medical record to reflect the medical history (including symptoms and co-morbidities), the findings of the physical examination, any differential diagnosis, the investigation and treatment plan, discharge instructions, and follow-up.
  • During the informed consent discussion, provide appropriate information on the material risks and benefits of the proposed treatment, reasonable alternative options, the expected outcomes, and how a patient’s pre-existing conditions could increase the risk of complications. The patient (or family or caregiver, if appropriate) should be given the opportunity to ask questions. The discussion should be adequately documented in the medical record.
  • Communicate respectfully, professionally, and empathetically with patients, and address potential language, cultural, or cognitive barriers to effective communication.


CMPA medico-legal cases represent a small proportion of patient safety incidents overall. Many factors influence a person’s decision to pursue a case or file a complaint, and these factors vary greatly by context. Thus, while medico-legal cases can be a rich source for important themes, they are not representative of patient safety incidents overall.


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  1. Physicians voluntarily report College matters to the CMPA. Therefore, these cases do not represent a complete picture of all such cases in Canada.
  2. Peer experts refer to physicians who interpret and provide their opinion on clinical, scientific, or technical issues surrounding the care provided. They are typically of similar training and experience as the physicians whose care they are reviewing. Peer experts may not be critical of the care provided, or may have criticisms that are not part of the patient allegation.
  3. Frequencies of the presenting conditions among medico-legal cases are likely representative of rheumatologists’ practice patterns and do not necessarily reflect high risk conditions.