Medico-legal risk: What rheumatologists need to know

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

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)

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:

• eLearning activity: Principles of medical record keeping
• “Documentation and record keeping”, CMPA Good 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:

• CMPA Workshop: Advanced diagnostic reasoning

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

CMPA Learning: Optimize your communication

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

• “Patient-centred communication”, CMPA Good practices
• “Clinical decision-making”, CMPA Good practices

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.

Questions?

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Notes

1. 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. 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. 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.