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What about death?
I understand that the policy may be a guideline. However, I believe that the CPSO should specify in their policy what to do in different styles of practice, ie, solo practice, group practice, academic practice, etc etc…
The reality is that if one is in a group practice, the other colleagues may take some of the “retiring” MD on.
Also, there are situations where an MD in a solo practice finds it hard to provide a replacement MD for a variety of reasons and through no fault of her/his own. These situations have to be taken into account. Unfortunately, OHIP or other employers, do not provide funds to look after these eventualities in MDs lives. Should the CPSO consider these facts in the content of the policy? It is very easy to establish policies that punish the MDs but do not have or offer any support in cases that may be related to unforeseen circumstances for an MD. We are human beings as well as being MDs….
It would be useful for the policy to provide more guidance about the nature of duty of ongoing care as part of a group of physicians, wherein the patient has been assessed and treated by more than one member of the group, selected perhaps by feasibility or convenience, wherein the departing physician is one member of the group. In other words, if the group continues to provide care, it is not clear what is the obligation of the departing physician in terms of notification.
As well, the obligations of the departing physician in regard to notes related to visits at hospital clinics should be made explicit. If there is no change in the hospital overall, and if access to the notes is not impacted by the physician departure, it would seem that no action is warranted in terms of preparing the records for practice closure. The same may hold for other medical organizations.
In general, the proposed policy is useful.
It would be great to know at least a year before if possible or more. It would also be great if the doctor who is leaving could introduce patients to someone who might take over or provide a list of doctors accepting new patients. This is much more serious than switching hair dressers.
As Managing Director of a medical records storage company, we have to deal with a lot of the gray areas that are not specifically addressed by the provincial Colleges of Physicians or the CMPA. One of the big ones is in the case of an EMR and a retiring doctor within a group (ie. a FHO) where the records are technically accessible by all of the members. If another doctor in the group is able to assume a small percentage of the patients from the closing practice:
- Is the assuming doctor (within that FHO)permitted to start working with that patient’s chart in the absence of an Authorization for Release of Information signed by the patient?
- Is the exiting doctor required to take an extract of all his/her patient charts from the EMR for retention?
- If a new doctor comes in to assume all the outgoing doctor’s patients (who wish to transfer to him/her), does the outgoing doctor still have to take an extract of all patient charts for retention or is it enough to have an agreement that he/she can have access to those EMR charts as needed for future medico-legal purposes, etc.?
- If there is a group of doctors that equally share ownership of a walk-in clinic where they each see any of the patients that walk in, who takes responsibility for, and what must be done with respect to retention of the charts if the clinic closes and the group disbands?
There needs to be some clarity about the recommendations for destroying charts – CPSO says this is acceptable after 2 years if patients are properly notified and if the md is fully retiring.
Questions include –
what if the md is not fully retiring but is leaving his/her full practice to do some occasional work as a locum or walk-in? – would the 2 year interval still apply?;
What if the charts are properly transferred to a responsible md, who then leaves practice within a short time interval, and perhaps does not look after the charts properly- who then is responsible for the charts/files?
why the discrepancy between CPSO and CMPA which usually suggests the longer 10 year interval for medico-legal reasons (and longer for children, possible reaching 28 years…..which is unreasonable time committment for a retiring md at the age of 65 or more. Even the CPSO adds a caveat that charts should be kept for 15 years for medicolegal reasons and the Limitations act.
All very confusing.