Cases and recommendations of the Inquiry Committee

A physician’s role in an association must be distinctly stated and not exaggerated

Physicians are sometimes perceived as desirable associates for many organizations as their professional expertise may lend an unparalleled brand of security and comfort. Referencing a physician’s association can elevate an organization’s credibility. While there may be some perceived benefit to the consumer, there is also a risk that the public may be misled by the manner in which a physician’s role is represented. If the public is attracted by the appearance of physician oversight where there is none, the public is not adequately protected.

The Inquiry Committee recently concluded an investigation with criticism of two general practitioners for allowing a private program for troubled teens to mischaracterize them as program leaders. The website for the organization had, at various times, identified one or both as “medical director” or “consulting physician.” The physicians readily acknowledged that their role was limited to intake medicals and mostly minor GP services on request. The committee determined that the program and the physicians ought to have recognized that the information on the website was misleading.  

The College cautions physicians that the scope of their roles must be distinctly stated and not exaggerated when involved with various treatment facilities or programs, including behavioural treatment centers for youth, homestay programs, group homes, sports camps, summer camps, esthetic or health spas, fitness programs, and sports and recreation organizations. Particularly to the extent that such groups or organizations are led or controlled by individuals who are not members of regulated professions, it may be inappropriate for registrants’ names to appear on promotional materials such as brochures and websites. Where a physician’s association is informal, infrequent or not within the physician’s control, the safest reference is an unnamed notation to the effect of “physician services available on request” in the organization’s promotional materials and website.

The types of associations described above potentially give rise to a second issue: stewardship of medical records, which was another aspect of the committee’s criticism of the physicians involved in this case. One of the physicians had an arrangement whereby the non-registrant organization electronically stored the physician’s records and had the capability to access and summarize the medical records which the physician created. The Inquiry Committee determined that record management issues needed to be rectified.

This case serves as a reminder to all physicians that they must ensure patient confidentiality is protected by retaining control over the maintenance, storage and use of the medical records they generate, in accordance with applicable College Bylaws, and professional standards and guidelines. 

Letters should be factual and not based on hearsay

The Inquiry Committee is frequently asked to investigate complaints which involve letters written by physicians in support of their patients. Such a letter should contain only factual information. When hearsay information is included, it must be clearly identified as such. Following are two recent examples from College complaints:

Example 1

A couple is engaged in a bitter divorce and custody dispute. The father complained to the College regarding the content of a letter written by Dr. X in support of his patient, the mother of the children. The physician’s letter stated, in part, “The father does not pay child support and has minimal involvement with the children.” The father stated this information was untrue, yet the physician presented it to the court as though it was factual. 

The College was critical of the physician in this instance. Such a letter should focus on the physician’s professional interactions with the mother and the children. If absolutely necessary, the physician could include the statement above by identifying the source of the information: “I am advised by my patient that the children’s father does not pay child support.”

Example 2

Another common scenario involves the provision of letters written in the context of a workplace dispute. Again, the physician must specify the information that is obtained from the patient, versus factual information, and versus the professional opinion of the physician. The following three statements are illustrative of this concept:

  • “The patient cannot work at a keyboard.”
  • “The patient advises that working at a keyboard causes hand discomfort.”
  • “In my medical opinion, the patient’s symptoms are such that time at a keyboard should be limited for a period of five days, at which time the patient will be reassessed.” 

The physician’s opinion regarding the workplace itself should be similarly cautious. Statements such as, “The patient has a hostile workplace,” should be compared with “The patient advises me that he considers his workplace to be hostile, resulting in significant symptoms.”

The general principles are set out in the College standard entitled Medical Certificates and Other Third Party Reports. The CMPA has a helpful article dealing with the issues directly entitled Put it in writing, with care.