The medico-legal aspects of intraprofessional care

December 2013
The medico-legal aspects of intraprofessional care
Doug Bell, MD, FRCSC
Associate Executive Director,
Canadian Medical Protective Association
The team approach to patient care is growing as family physicians become increasingly skilled in
managing common skin conditions and may only need to refer more complex dermatology cases
to specialists. Given this situation, effective communication between specialists and family
physicians is essential to minimize risks to patient safety and medico-legal problems.
Communication basics and teamwork
Communication forms the basis of every relationship, and the CMPA’s case files demonstrate the
importance of effective communication between physicians, and between doctors and other
healthcare providers.
Poor communication between physicians can adversely affect patient care due to lack of
information sharing, unnecessary testing, delayed diagnoses, lack of ongoing patient monitoring,
adverse events, and disruptions in continuity of care. It can also result in frustrated physicians and
dissatisfied patients.
Meanwhile, good communication skills can help to minimize risks, establish common goals for
patient care, support teamwork, and build trust between physicians and with patients.
Communication among physicians should be open and comprehensive. Interactions should be
polite and respectful. Physicians require sufficient and timely information, as well as adequate
notification about changes in a patient’s condition. Active listening and clarifying understanding is
also important. Moreover, family physicians and dermatologists require a clear understanding of
each other’s roles and responsibilities for patient care and follow-up.
Sometimes, physicians may wish to clarify a patient’s care plan with another physician, and obtain
an understanding for the chosen treatment. Recognizing the heavy workload faced by all doctors,
reaching out and responding to colleagues in a timely manner are important contributors to
continuity of care and patient safety.
Effective referrals and consultation
Dermatologists regularly receive requests for consultations from family doctors. An effective
referral and consultation process can go a long way to facilitate the exchange of patient
information and the prompt follow-up of urgent cases.
Referring physicians should be aware of the core elements of a good referral, which include:
• pertinent patient details
• relevant clinical information about the medical problem for which the referral is made
• relevant investigations, treatments, and medications
• the clinical question to be answered
• a sense of how urgent the referral is
In return, consulting physicians should provide answers to the specific questions raised. A
management plan, including designation of the most responsible physician for follow-up
management of the patient, should also be provided. Colleges often recommend the use of
templates for referral letters and consultation reports to enhance communication.
It is important to remember physicians depend on each other, and collaboration is part of
delivering effective and safe care.
Documentation
The importance of comprehensive and timely documentation in the patient record cannot be
overstated. The medical record should provide sufficient information for other physicians and
healthcare providers involved in the patient’s care to understand the nature of the medical
problem, the care provided, and the ongoing management plan. Doctors should use only
accepted and standard abbreviations in the medical record. Documentation should be clear
and convey the degree of urgency of an order (e.g. biopsy of a suspicious skin lesion).
Dermatologists should also take care to review the documentation provided by other doctors,
nurses, and pharmacists.
Supporting family doctors
Dermatologists play an important role in supporting family doctors to learn more about skin
conditions and skin disease management. Specialists are encouraged to direct family
physicians to relevant articles, journals, conferences, and web-based materials. By working
together, dermatologists and family physicians can provide good patient care.
Don’t hesitate to contact the CMPA
Doctors with questions about intraprofessional care issues should not hesitate to contact the
Association’s medical officers for advice and guidance. The CMPA also has a number of online
resources on this topic including:
CMPA Good Practices Guide — “Communication” (http://www.cmpaacpm.ca/cmpapd04/docs/ela/goodpracticesguide/pages/communication/communication-e.html)
CMPA, “Improving communication between physicians,” June 2011 (http://www.cmpaacpm.ca/cmpapd04/docs/resource_files/perspective/2011/02/com_p1102_2-e.cfm)
Editorial Board /
Conseil de rédaction
National editor/
Rédacteur en chef
Regional editors /
Rédacteurs régionaux
Robert Jackson, MD
Ottawa, ON
Paul Kuzel, MD
Edmonton, AB
Charles W. Lynde, MD
Markham, ON
Benjamin Barankin, MD
Toronto, ON
Ian Landells, MD
St. John’s, NL
G. Daniel Schachter, MD
Toronto, MD
Executive director /
Directeure générale
Marc Bourcier, MD
Moncton, NB
Catherine McCuaig, MD
Montréal, QC
Victoria Taraska, MD
Winnipeg, MB
Chantal Courchesne
Ottawa, ON
Peter R. Hull, MD
Saskatoon, SK
Kathleen Moses, MD
Ottawa, ON
Catherine Zip, MD
Calgary, AB
Statements and opinions expressed in the CDA eBulletin
reflect the opinions of the authors and not necessarily the
CDA. The CDA does not assume responsibility or liability for
damages arising from errors or omissions or from the use of
information or advice contained in the CDA eBulletin articles
or letters.
The Canadian Dermatology Association eBulletin is issued monthly as a
forum for Association news, information of interest to members and for
members’ opinions. Please notify the Executive Director of any change
in address.
L’Association canadienne de dermatologie publie chaque mois le
bulletin électronique en tant que forum de nouvelles de l’Association,
d’informations qui pourraient intéresser nos membres, ainsi que pour
Les textes et les opinions publiés dans le bulletin
électronique de l’ACD reflètent les points de vue de leurs
auteurs et non pas nécessairement ceux de l’ACD. L’ACD ne
peut être tenue responsable des dommages qui pourraient
résulter d’erreurs ou d’omissions reliées à l’utilisation de
renseignements ou de conseils inclus dans les articles ou
lettres apparaissant dans le bulletin électronique.
recueillir leurs opinions. Prière d’aviser la directeure générale pour tout
changement d’adresse.
CHANTAL COURCHESNE
EXECUTIVE DIRECTOR / DIRECTEURE GÉNÉRALE
425-1385 rue, Bank Street, Ottawa, ON K1H 8N4
Tel: (613) 738-1748 / 1-800-267-3376 | Fax: (613) 738-4695
[email protected]