Do physicians meet their professional medicolegal obligations? GLENN SAWYER, MD, LLB

Physicians who choose clinical practice as a career soon become aware of the many interfaces between law and medicine and the responsibilities emanating therefrom. Some of these responsibilities are clearly enunciated in statute or regulation. Some have their origin in the Common Law, while others have been developed by the profession and set down in a code of ethical behaviour. How may one determine how well the medical profession is meeting its responsibilities? Where are the norms to guide us in our assessment? Do we compare ourselves to other professions or to the general public, and if we do, how valid are the comparisons likely to be? Do we say that if one physician fails or if ten, a hundred or a thousand fail, the profession as a whole has failed to meet its responsibilities in an acceptable manner? Without norms to guide us we are left to make a very subjective judgement based on our analysis of the information available to us. In the absence of meaningful standards that would make it possible to answer the question definitively, a reasonable approach would be to examine trends in compliance over the past decade. With that in mind I obtained information from knowledgeable people relating to cases dealt with by discipline committees of licensing authorities, malpractice actions and the reporting of venereal disease cases, persons judged unfit to drive motor vehicles and battered children. A physician who applies to a provincial licensing authority for registration accepts a responsibility, recognized by law, to measure up to

the standards of competcnce and conduct established by that authority. Some indication of how well doctors have met these responsibilities may be gleaned by reviewing the number of doctors charged with professional misconduct by the discipline committees of the authorities. In British Columbia in 1968, the chances of a doctor's appearing before the discipline committee were one in 153, but by 1977 it was one in 849. Comparative figures for Manitoba were one in 608 and one in 280; in Ontario one in 1063 and one in 1140; in Quebec one in 488 and one in 835; while in Nova Scotia there were in either year no cases in which a formal charge was laid. These figures would indicate a trend toward better compliance with the standard set by the licensing authorities. However, several registrars made the point that the number of cases appearing before a discipline committee may not be an adequate measurement of whether doctors are meeting their professional medicolegal obligations. No doubt these comments arose because of the increasing number of complaints that require consideration by complaints or inquiry committees but do not result in referral to the discipline committee. In British Columbia for example, in 1968 there were 19 complaints and 19 cases heard by the discipline committee while in 1977 there were 68 complaints but only 6 cases dealt with by the discipline committee. A stitch in time by the complaints committee apparently saves nine lashes by the discipline committee. Encouraged by the trend toward compliance shown by cases heard by

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discipline committees, I turned to the experience of the Canadian Medical Protective Association during the past decade. Here I found a discouraging trend in examining both the number of writs issued and the number of cases either settled or in which an award was made by the courts. In 1967 there was one writ issued for every 285 members of the association. In 1970 the figure was one for every 275; in 1974 one for every 132; and in 1977 one for every 117. The issuance of a writ of course does not mean there was actual malpractice. This is evidenced by the fact that of the 918 actions concluded in the 10 years 1967-76, 536 were either dismissed or discontinued. Of the remaining 382 cases 321 were settled and in 61 there was judgement given for the plaintiff. Looking at the cases in which either a settlement was made or a judgement given we find that in 1967 these amounted to one for every 830 members; in 1970 one for every 813 members while in 1974 and 1976 it was one for every 434 members. Do these statistics indicate that doctors are becoming increasingly irresponsible in fulfilling their obligations? More likely it is a reflection of the fact that medical science has made it possible for more doctors to investigate and treat definitively more and more conditions, which naturally gives greater scope for dissatisfaction, leading to lawsuits. However as one reads the judgements, in many of the cases one realizes an additional factor has been an infatuation with the science of continued on page 658

OBLIGATIONS continued from page 642

Hygrotorw

antihypertensive - diuretic with over 15 years of clinical use.

Geigy Dorval, Quo. H9S iBi

Complete prescribing information available on request.

658 CMA JOURNAL/SEPTEMBER 23, 1978/VOL. 119

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medicine to the detriment of the art of medicine and communication. In some jurisdictions, legislation requires physicians to report to a designated agency cases such as venereal disease, persons judged unfit to drive a motor vehicle and abused or neglected children. The experience in Ontario is probably typical of how the profession is meeting these obligations. In 1968 of the 4430 cases of venereal disease reported in Ontario only 1401 were reported by physicians in private practice. In 1972 there were 14 290 cases reported, 6270 by physicians in private practice; in 1976 the figures were 18 855 and 10 469 respectively. In 1967 Ontario physicians reported 235 persons as being unfit to drive a motor vehicle. By 1972 the figure had risen to 538 and in 1977 to approximately 1150. Ontario physicians are also detecting and reporting more cases of child abuse or neglect. At the Hospital for Sick Children, Toronto, for example some 60 cases were detected and reported in 1972, 100 in 1973 and just over 200 in 1977. The improvement in reporting venereal disease, unfit drivers and abused or neglected children is heartening in the light of existing legislation, which does not stipulate a penalty for failure to report. This short review of statistical information, relating to only a few areas where the law has imposed responsibilities on practising physicians, does not answer the question definitively since we have no way of knowing how many instances of professional misconduct were not brought to the attention of the licensing authorities, how many incidents of professional negligence were either undetected or a decision made to take no action or how many cases of venereal disease, unfit drivers or abused children were unreported. We are left to make a very subjective judgement and mine is that physicians do meet their professional obligations in medicolegal matters. This judgement is no doubt influenced by years spent listening to the many and varied problems of practising physicians.E

Do physicians meet their professional medicolegal obligations?

Do physicians meet their professional medicolegal obligations? GLENN SAWYER, MD, LLB Physicians who choose clinical practice as a career soon become...
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