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CMAJ - July 14, 1998JAMC - le 14 juillet

Physicians in difficulty

CMAJ 1998;159:14

© 1998 Janice Hamilton

Quebec's physicians and hospitals are being reminded that they must intervene if they consider a physician unable to practise competently because of a psychologic or physiologic problem. As well, the physician has not sought treatment voluntarily, limited his or her practice, or stopped working. The Quebec College of Physicians notes that, according to the code of ethics, the safety of the public takes precedence over other considerations in these situations.

In most cases, physicians who are unable to practise competently do stop working. In the few cases where they don't, the treating physician or colleagues must disclose the situation and authorities at the institution involved or the college must take action. College spokesperson Brigitte Junius emphasizes that this type of disclosure is not a breach of confidentiality, but ultimately helps the physician concerned and protects the public.

The awareness campaign follows a recent case in which a pathologist was suspended and later retired. He had been treated for brain cancer since 1994. A subsequent review of medical records showed that while he was still practising between 1994 and 1997 he misdiagnosed 38 cases; 4 patients suffered significantly as a result.

In such situations, the college has the legal power to order a medical examination. However, this is a drawn-out procedure, and the college wants the government to change the Professional Code of Quebec to allow for more rapid intervention in emergency situations and to allow it to either suspend a physician's licence immediately or limit his or her practice. It also plans to develop a procedure to provide long-term follow-up of physicians in difficulty.

The college acknowledged that it plays an important role in these situations when a doctor practises alone, in a private office or on an itinerant basis, and doesn't receive any regular supervision. It also has a key role in situations involving diagnostic specialists because the performance of these physicians affects many colleagues, and when a physician is known to have had problems related to mental illness or substance abuse.

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