Dialogue Volume 14 Issue 2 2018 - Page 37

• Patients are receiving appropriate care; • Dosages are being tapered, when clinically indicated to the patient’s circumstances. In some cases, physi- cians have changed their own prescribing practices in response to more recent evidence, or they are taper- ing dosage levels initiated by other physicians. Advice or Remedial Self-Study Where minor issues are identified, advice will be given to the physician to improve future practice or the physician may be required to participate in self- study with follow-up from the College to ensure the identified learning needs have been addressed. If an investigation results in no action, advice, or remedial self-study, these outcomes are not available on the public register. Mandated Remediation The College will take a remedial approach, whenever appropriate, to help physicians practise to current stan- dards. Our goal, where possible, is to support education and continued prescribing under supervision, where the physician’s capacity for remediation is apparent. The terms of a physician’s mandated remediation are set out in an “undertaking”, which is a binding and enforceable agreement between the College and the physician. In general, undertakings set out an obliga- tion or restriction that a physician is giving to the Col- lege (i.e., an agreement by the doctor to participate in remediation; practise under clinical supervision; ce ase to practise medicine; or abide by practice restrictions, such as no longer being permitted to prescribe narcot- ics and controlled drugs). Undertakings to Complete Individualized Education; Clinical Supervision; Reassessment The majority of physicians with identified learning needs have undertaken to participate in and suc- cessfully complete an individualized education plan developed by the CPSO to address the identified specific learning needs of each physician. The elements of professional education include completion of the University of Toronto Faculty of Medicine program in Safer Opioid Prescribing; and may include the univer- sity’s Medical Record-Keeping Course. Additionally, a review of a number of resources (e.g., CPSO Prescrib- ing Drugs policy; 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain, etc.) is generally under- taken. Physicians practise under the guidance of a clini- cal supervisor, over a graduated period of time, who oversees completion of the educational plan. The level of supervision is reduced to the next phase only when recommended by the clinical supervisor and approved by the College. After successful completion of the pe- riod of clinical supervision, each physician is reassessed to gauge improvement. In some cases, a physician may also receive a caution from the committee that over- sees investigations, regarding specific aspects of his or her practice, professionalism or conduct. Each physi- cian’s undertaking will be posted on his/her profile on the public register while the terms of the undertaking remain in effect. Undertakings Imposing Prescribing Restrictions In a small number of cases, physicians have under- taken to no longer prescribe narcotics and controlled drugs. In some cases, a physician may also receive a caution from the committee that oversees investiga- tions, regarding specific aspects of his or her practice, or professionalism or conduct. This information is on the public register. ➢Undertakings to No Longer Practise Medicine In a small number of cases, physicians have under- taken to no longer practise medicine in Ontario. This information is on the public register. Referrals to Discipline Where a physician has been referred to the Discipline Committee, the Notice of Hearing, which sets out the allegation(s), is on the public register. Any practice restrictions, if ordered pending the outcome of the hearing, are on the public register. MD ISSUE 2, 2018 DIALOGUE 37