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Continuing medical education
SAAQ – SAQ: The « A » that changes everything.
When a physician comes to the conclusion that one of his patients is incapable of driving a vehicle, article 603 of the Highway Safety Code can override the physician’s professional obligation to confidentiality. In fact, it allows him to send to the SAAQ the information relevant to the patient’s ability to drive. The Code provides legal protection for the physician against civil litigation, but this legal protection is applic able only for the report made to the SAAQ. All reports must be based on a rigorous and objective evaluation of the patient’s medical condition. The decision to suspend the driver’s license belongs to the SAAQ. Read more In French
An informed expert is worth double: the importance of choosing the right words.
In their daily practice, phys icians are called upon to complete medico-legal reports, in which they express an opinion. When placed in this context, they must act in accordance with the Code of ethics and be prudent and diligent. They should always adopt a neutral, objective and impartial tone and avoid irrelevant comments or criticism towards colleagues. Physicians should never change the opinion they have expressed in a form or a report just because a patient is unhappy or suffers a prejudice; there is no room for complacence. When asked by a patient to fill out a form, they dispose of a maximum of thirty days to do so. Because many different forms have to be filled out, it is important to differentiate a temporary assignment from an assessment of functional limitations, as the physician’s role will vary.
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Disclosure of medical information: out of the maze
There are many circumstances where third parties seek information on the health of your patients and the care you have provided. The disclosure of information in medical records is possible when the patient consents, preferably in writing. However, only information covered by this consent must be disclosed. The Collège des médecins, the coroner and the RAMQ revisory committee have the right to access medical records without the patient’s consent. Similarly, some organizations, such as CSST, have the right to request and receive a report from the physician without the patient consenting to the disclosure of confidential information. Police authorities are not entitled to the information contained in medical records without a warrant, court order or patient’s consent. The Collège des médecins has produced a useful guide with respect to disclosure of records (L’accès aux renseignements personnels contenus dans le dossier médical constitué par le médecin en cabinet, May 2007). When in doubt, the physician should seek expert advice before disclosing records, for instance by contacting the Canadian Medical Protective Association.
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Chronic hepatitis C: A curable disease
Chronic hepatitis C is defined by the persistance of RNA virus six months after the presumed acute infection date. Natural evolution of the illness varies from one individual to another: some will not need treatment while 20% of chronic carriers will develop cirrhosis. Therefore, it is important to make a complete assessment of the patient with chronic hepatitis C, including anamnesis, signs and symptoms, and level of hepatic fibrosis. The FibroScan, now available in Quebec, represents the biopsy alternative to quantify progress of hepatic fibrosis. These elements help determine treatment indications for cases with invalidating symptoms and/or fibrosis F2, and help detect countraindications such as psychiatric issues. Implications are not to be ignored since new treatments can cure up to 70% of patients! Read more in French
Managing difficult clinical situations… and knowing how to say “goodbye”!
When facing a difficult situation with a patient, the physician must maintain the best communication possible. He must also define his role and how the patient is expected to behave, and act upon his requests, providing that they are medically justified. A physician can put an end to the professional relationship with his patient if there is reasonable cause. However, he must give a notice sufficiently in advance so that the patient can find another physician. He must also document the various steps of the patient’s transfer. As long as the patient’s care has not been transferred to a colleague, the physician must provide the follow-up rendered necessary by the patient’s health condition, and emergency care.
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Communications with the syndic of the Collège des médecins: professionalism required
When a physician receives a request from the syndic of the Collège des médecins investigating a matter or a complaint regarding his professional conduct, he can be assisted by counsel. The physician has an obliga tion to assist the syndic in his inquiry, and provide a response to his requests as soon as possible. This response must be related to the facts in the patient’s medical record, and should not include any assumptions or opinions. It must also remain neutral and courteous. Failure to respond to the syndic or delay to do so may result in a complaint to the Disciplinary Council of the Collège des médecins. An inaccurate or inadequate response may also have a negative im pact on the physician’s practice because of the broad powers of intervention conferred to the syndic by the law. Therefore, any request made by the syndic of the Collège des médecins should be taken seriously.
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