Help and advice

You are not alone. Most physicians face at least one College complaint during their career.

1. Assess the specifics of the complaint, and determine who complained about what.
    
2. Determine what the College is asking you to do and if you have been given specific deadlines to meet.
    
3. Review the patient’s medical record when the matter is about a clinical event. However, if the record belongs to a hospital or other institution (e.g. clinic owner), contact the CMPA before accessing it.
    
4. Never alter a patient's medical record after a complaint.
    
5. Read the CMPA’s article What to do if you’re notified of a College complaint.
    
6. Contact the CMPA and schedule time to speak to a physician advisor for advice and assistance on how to formulate an effective response.
   • Request medical-legal assistance (login required)
7. With the CMPA’s assistance, respond in writing to the College in a professional and respectful manner, and objectively address the issues. Be succinct and direct, avoiding inflammatory language or accusations.
   

• College complaints on the rise: Better communication can help
• Coping with a College complaint: Suggestions for reducing anxiety
• Understanding how Colleges handle complaints or allegations of professional misconduct
• The medical record: A legal document — Can it be corrected?

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Breathe. Most complaints can be resolved by engaging collaboratively with the hospital and health authority.

1. Determine the specifics of the complaint. Your hospital should formally notify you of the complaint, if you will be asked to participate in an upcoming meeting or review.
    
2. Never alter a patient's medical record after a complaint or legal action is initiated.
    
3. Consider delivering an apology which expresses your sympathy and regret for what has happened. Before you apologize and accept responsibility for a mistake, you may wish to contact the CMPA.
   • Request medical-legal assistance (login required)
4. If applicable, participate in the discussion with the patient (or family) to give the complainants a factual understanding of what happened, an apology when appropriate, and what improvements are being made at the hospital.
    
5. If the hospital conducts a quality improvement (QI) review, participate and share what you know about the facts of the case. Avoid blaming others.
    
6. If the hospital conducts an accountability review, you are generally obligated to take part in a review of your professional work when requested. You may wish to contact the CMPA to discuss your participation.

• Hospital complaints: Understanding the process and reducing anxiety
• The medical record: A legal document — Can it be

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1. Take clinical care of your patient and reassure the patient his or her needs are being met.
    
2. Communicate to restore trust. As soon as reasonable to do so, disclose the adverse event to the patient and family. Do not speculate as to what may or may not have happened or comment on the care provided by others. Focus on the known facts related to the event and the provision of further clinical care.
    
3. Provide emotional support to the patient and family. Express your sympathy and regret for what has happened. Continue to demonstrate compassion.
    
4. Document your care and subsequent discussions in the medical record. Do not add to or change existing entries after learning of an adverse outcome.
    
5. Report the event as required by your hospital, institution, and jurisdiction.
    
6. Only after an analysis of the event, convey newly uncovered facts to the patient and include what steps are being taken to prevent similar harm to others.
    
7. Prior to expressing an apology acknowledging responsibility, you may wish to contact the CMPA.
   • Request medical-legal assistance (login required)

• Checklist: Disclosing harm from healthcare delivery
• “Physician-patient: Disclosure of patient safety incidents”, CMPA Good practices
• Disclosing harm from healthcare delivery: Open and honest communication with patients
• Learning from adverse events: Fostering a just culture of safety in Canadian hospitals and healthcare institutions
• Medical-legal handbook for physicians in Canada [PDF]
• Will you be sorry for saying “I’m sorry”?

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1. A patient may verbally communicate the intention to initiate legal action as a result of being dissatisfied with the care you provided. Try to address the situation, when appropriate, by demonstrating compassion and respect to the patient and family, and by fully understanding the motivation for the verbal threat. Use your discretion to assess the validity of the threat.
    
2. The threat may also be communicated to you in writing, either through a formal letter from the patient or the patient's legal counsel. You should treat written correspondence of a threat seriously. Follow-up action is always required.
    
3. If the threat is in writing, contact the CMPA and schedule time to speak to a physician advisor for advice. If the threat is verbal and you feel it will result in action, contact the CMPA.
   • Request medical-legal assistance (login required)
4. Ensure the medical record is complete and up-to-date.
    
5. Never alter a patient's medical record after receiving a verbal threat or a written letter indicating that legal action may be launched.

• Medical-legal handbook for physicians in Canada [PDF]

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1. Gather a copy of the patient’s medical record when the matter is about a clinical event. However, if the record belongs to a hospital or other institution (e.g. clinic owner), contact the CMPA before accessing it.
    
2. Never alter a patient's medical record after a legal action is initiated.
    
3. Contact the CMPA using the link below to request medical-legal assistance. Fill in the online form with details of your request and attach any documents you’ve received (such as you Statement of Claim). A physician advisor will respond as soon as possible and arrange for legal counsel to assist you.
   • Request medical-legal assistance (login required)
4. Work with your CMPA-assigned legal counsel to prepare a statement of defence, which will need to be submitted to the court within a specified period.
    
5. Seek support to cope with the stress of a legal action.
   

• Medical-legal handbook for physicians in Canada [PDF]
• When multiple defendants are involved in a legal action, things can get complicated
• Using clinical practice guidelines wisely

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1. Do not disclose patient information without the patient's express consent, unless required by law. (See the point below for information on when you are required by law to disclose.)
    
2. Consider whether you are permitted or obligated to disclose patient information without the patient's express consent (e.g. you received a court order, or search warrant).
    
3. If appropriate to disclose, release only the requested information. Consult with the CMPA or your legal counsel before releasing original copies of the medical record or other documents. Do not give away the original copies without contacting the CMPA first.
   • Request medical-legal assistance (login required)

• Physician interactions with police
• Responding to requests for children's medical records
• The medical record: A legal document — Can it be corrected?
• Medico-legal handbook for physicians in Canada [PDF]

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1. Read the article Treating non-residents of Canada to help determine whether the CMPA would assist you in the event of medico-legal difficulties.
    
2. If it is an urgent clinical matter, provide appropriate care.
    
3. If you undertake to provide care for a non-resident, make reasonable efforts for the patient to sign a Governing Law and Jurisdiction Agreement before providing treatment.

• Treating non-residents of Canada
• Governing Law and Jurisdiction Agreement
• Governing Law and Jurisdiction Agreement (for physicians in private practice) [PDF]
• Governing Law and Jurisdiction Agreement (for healthcare organizations) [PDF]
• Treatment in Canada of U.S. and other foreign residents (Consent: A guide for Canadian physicians)
• Medical-legal handbook for physicians in Canada [PDF]

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1. Review our technical help frequently asked questions (FAQs).
    
2. Call our automated telephone attendant at 1-800-267-6522 and follow the prompts.
    
3. Speak with a Member Representative at 1-800-267-6522, Monday to Friday between 8:30 a.m. and 4:30 p.m. ET.

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The CMPA developed the Member Support Program to further enhance its assistance to members, including those who have a pattern of recurring or increasing frequency of medico-legal events. By providing personalized support and educational advice, the program helps CMPA members to identify and address factors that may be contributing to their medico-legal risk. By so doing, the program helps members to practise safely and in a manner that contributes to their professional integrity and satisfaction, and to their well-being.

• Member Support Program

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