Organization
[May 09, 2024 3:37 PM]
Ontario Medical Association (OMA)
 
Response in PDF format:
OMA Response_20240509.pdf
Member of the public
[May 06, 2024 2:58 PM]
Hello,

After reading the few comments, the advice document and the policy (2017) much has evolved including how people now communicate, fewer physicians including general practice family doctors, specialists among others, nursing shortages, pandemic lifestyle and medical care access.

Patients are likely grateful to some extent when they do have a family doctor and when they are referred to a specialist when indicated so might be less likely to disengage from the physician-patient relationship.

How to communicate under unexpected events.

The ideal would be a plan by the physician.

Office contact data for each patient should be current - include smart phone, text, address, e-mail address, family member or other person for contact in emergency, preferred pharmacy, update at each office contact.

A certain percentage of patients may become unreachable for reasons not foreseen.

An identified office practice employee with access when/if needed to the physician’s plan.

My experience is the ideal since in Guelph a large Family Health Team was organized in the early 2000’s.  This created evening and weekend walk-in, other benefits and communication.  My doctor is in a group setting with 4-5 colleagues, all are not accepting new patients so this setting would not result in my expecting to be assigned to another doctor.  His practice does have my e-mail and other contact information. 

Revision of this 2017 policy will be challenging in the presence of newer means of communication, more mobile population, shortage of family doctors, other factors.  I noted reference to registered mail.  I am not sure how much that is encouraged by the post office and registered mail destination addresses has restrictions as I understand
Physician (including retired)
[April 14, 2024 7:44 PM]
Note: Some content has been edited in accordance with our posting guidelines.
I don’t think physicians should have to put up with non sense.
I have the right to reject patient care…to abusive patients that make me an hour and half behind because they dont do the paperwork. Then turn around and make a College complaint because I was so slow when they are the author of their own misfortune. (Awaiting the family doctor faxed req)
I am the only doctor in The world that can do this injection and I refuse to do it.
[redacted].
The average patient waiting to see me has waited seven years and yes I have stopped six people in pain from committing suicide.
I don’t have the time for complainers who expect me to jump over hoops for them. That’s not how it works. 
[redacted].
Physician (including retired)
[April 14, 2024 12:44 AM]
Although I am a psychiatrist and my views might be from psychiatric perspective, I feel all patient physician relationships are two way street. Patient and physician both have to be comfortable with each other. If for whatever reason a therapeutic relationship is broken e.g. non-compliance, disagreement over treatment, no shows, disability entitlement, rude and demanding behavior towards physician and staff, etc then termination is a logical outcome.
Physician (including retired)
[April 12, 2024 5:19 PM]
I question if it would be necessary for the policy to address / clarify ending of patient relationships when a Physician Assistant is involved. Could there be issues when a patient wishes to end a (supervising) physician relationship, but demands to keep Physician Assistant care?
Physician (including retired)
[April 12, 2024 10:44 AM]
Note: Some content has been edited in accordance with our posting guidelines.
This policy might sound good for family physicians but not good at all for specialists. Increasingly we have abusive patients to the physicians doesn’t matter specialist or not. I have an abusive patient to my staff, delayed treatment of other patients waiting expecting long consultations not paid for at all by my specialty it goes to GP, Physiatrists etc but not to me.
[redacted]
The injections I do are all ALONE in Canada. Mayo Clinic Geneva Switzerland and Padua Italy are the ONLY other places.[redacted].I’m it for Canada and yes I am an expert. No medical school trains what I do maybe except Mayo.
[redacted] I don’t feel the need to give increasingly abusive patients my time of day.
I have patients that are downright suicidal with the pain. I have fixed several now all better. I don’t take unnecessary risks but only those that HAVE to be taken.[redacted]
[redacted].
[redacted]. Your guideline cannot force a physician to do that which he doesn’t want to start. [redacted]
[redacted].
I don’t know how you write that in a specialists guideline.
The policy is good for GP’s but doesn’t work when there’s only 4 places in the world.
This is the net result of physician abuse.
Physician (including retired)
[April 11, 2024 3:44 PM]
The term “ reasonable length of time” needs to be clearly defined or patients will decide to do nothing. In addition the “time” should be reasonable and not based on any waiting time that exists as a result of the failure of the MOH to provide adequate manpower .The MOH is is charge of health care delivery now and with that comes responsibility for the shortcomings.
Physician (including retired)
[April 11, 2024 3:15 PM]
It is cumbersome to have to send a letter by mail. It would be useful for the policy to comment on whether it is sufficient to communicate via email if patients have provided consent to communicate via email. The MD could ensure that the email is documented in the patient’s health record.
Physician (including retired)
[April 11, 2024 3:11 PM]
The policy does not define what constitutes a physician-patient relationship. For example, if a patient attends an initial consultation with a specialist and then does not attend a follow up appointment to further discuss the care plan/treatment options and there is no active treatment (ex meds, engaged in a treatment intervention) does that constitute an active relationship? The same question applies for a patient who has stopped attending appointment.
Physician (including retired)
[April 11, 2024 2:42 PM]
given the limitations on resources and that this varies geographically too a blank policy for all specialties isn’t realistic. often cpso policy are based on family practice scenarios without recognising the different roles within different specialties. as a psychiatrist in an outpatient setting trying serve a large underserved community 50% without primary care insisting that follow up be long term unless mutually discharged/has gp means many dont get seen at all. a better use of the resource would be to establish at out set that input may be short term/time limited even if no gp as do other specialists. this is why many psychiatrist only do consults to avoid indefinite follow up
Physician (including retired)
[March 31, 2024 8:01 PM]
The policy is less useful for a specialist settings. As a specialist in psychiatry, working in a community based hospital, I find this policy too demanding. First, it is challenging to identify which endings are “unexpected “. Then the policy seems to indicate we should send letters of inquiry, and more than that they must be sent by registered mail. This creates significant administrative burden. I suggest that there be greater clarity and allowance around ending the relationship for specialists where patients fall out of care. If a patient has not called to book an appointment with me for an X amount of time, It does not strike me as productive to send a letter of inquiry.
Physician (including retired)
[March 08, 2024 1:29 PM]
I am a specialist in solo practice providing psychotherapy, and nearing retirement. It remains rather unclear to me how best to prepare for unexpected closure of my practice if I were to die in the meantime, or become fully incapacitated and unable to discharge the duties of closing my practice.

The current policy states: "Physicians must take steps to proactively plan for unexpected practice closures due to death or illness so that their practice is managed appropriately and in compliance with this policy and physicians’ legal obligations. This could include, for example, identifying a designate to facilitate compliance with the policy in the event the physician is unable to do so." However, I do not know how this would work... I have no practice partners or administrative staff, and my estate executor would be a non-medical person. A possibly pertinent link in the 'Resources' section is broken and inaccessible. Further specific guidance and advice would be helpful, both for physicians in planning for this possibility, and for their executors / POAs. Presumably the latter could contact the College and CMPA for advice, arrange for records storage with a storage company etc., but they would also need to quickly access confidential information (patient contact info, schedule etc) in order to notify patients, as a start. A specific guide for executors of medical professionals' estates (particularly doctors still in practice at the time of death or incapacity) would be a very helpful resource, linked to this practice guideline.
Physician (including retired)
[March 06, 2024 4:59 PM]
There should be specific guidance for specialists ending the patient-physician relationship.
Physician (including retired)
[March 05, 2024 8:17 PM]
Dear CPSO,

First of all I would like to thank you for giving us the opportunity to speak out and share our point of view about this guideline.
As a Family physician we are facing with different scenarios each day. I feel that physician are obliged to serve patients who are frankly increasingly rude to us.
Specially after COVID pandemic and introducing virtual care.
As a doctor I see less respect and they are pushing us to serve them the way they want and follow all their expectations in one session when they come once per year. I think this guideline should be more flexible.
These days I see patients who are threatening doctors on websites and media’s and healthcare providers have to continue their care which does seem acceptable.
It is a breach of trust.
Physician (including retired)
[March 05, 2024 4:41 PM]
Can further clarification be provided for sub-footing 7. "Physicians must ensure that any decision to end the physician-patient relationship is compliant with relevant legislation. This legislation includes The Commitment to the Future of Medicare Act, 2004, which prohibits physicians from ending the physician-patient relationship because the patient chooses not to pay a block or annual fee" and if this conflicts with sub-footing 3. "When a patient has refused to pay an outstanding fee."?