Dialogue Volume 14 Issue 2 2018 - Page 48

PRACTICE PARTNER the patient remains informed about his or her care, and to address patient questions and concerns.” Dr. Cape did not meet these expectations and more specifically, did not meet her legal and professional obligations to obtain valid consent. The law and the CPSO’s Consent to Treat- ment policy states that in order for consent to be valid, it must “be obtained from the patient if they are capable with respect to the treat- ment or from the incapable patient’s substitute decision-maker; be related to the treatment; be informed; be given voluntarily; and not be obtained through misrepresentation or Patients may fraud.” In order for consent to be informed, the policy requires also be less physicians to engage in a dialogue likely to follow regarding the nature of the treat- treatment plans ment, its expected benefits, its that are developed material risks and material side effects, alternative courses of ac- without their tion and the likely consequences understanding of not having the treatment. It is unlikely that Dr. Cape obtained and trust valid consent to prescribe the second drug because it was not informed: there was no dialogue with Mr. Jones. In fact, when Mr. Jones asked questions about the second drug and dose, Dr. Cape did not answer them and put the onus on another health-care professional to do so. How might Dr. Cape’s interactions im- pact the quality of care? Given that Dr. Cape never addressed the concerns Mr. Jones raised regarding the ap- propriateness of the two different drugs she prescribed, Mr. Jones may remain concerned about the treatment. Mr. Jones may even feel as if he cannot trust Dr. Cape’s opinion, and feel unsure about whether he is proceeding with the correct treatment. If Dr. Cape treats patients in this manner, she runs the risk of harming the trust that is inherent to an effec- 48 DIALOGUE ISSUE 2, 2018 tive physician-patient relationship, which may lead to patients feeling less comfortable being forthright with her. This could impact Dr. Cape’s ability to assess and diagnose patients. Patients may also be less likely to follow treat- ment plans that are developed without their understanding and trust, which could impact the quality of care provided. How should Dr. Cape have responded to the questions and concerns raised? Even if Dr. Cape was running behind sched- ule, she would have served her patient far bet- ter if she took the time to address Mr. Jones’ questions and concerns with respect and compassion. Dr. Cape could have explained to Mr. Jones that spending an appropriate amount of time with patients who had par- ticularly complicated medical issues was the reason she was running behind schedule that day, and therefore he would also be afforded with as much time as necessary to ensure his questions and concerns were addressed. Dr. Cape could have also offered Mr. Jones a fol- low-up appointment to discuss any outstand- ing concerns or questions he may have. Dr. Cape should have been more aware of how her behaviour would come across to patients and avoided looking at her watch and sigh- ing. It is not unusual for physicians to run behind schedule, but if it is a common occur- rence and one that might be jeopardizing the quality of the physician-patient relationship or the care that is provided, Dr. Cape might want to consider changing the way appoint- ments are scheduled in her practice. The above is a case study from the online Medical Professionalism learning module. The CPSO has partnered with medical schools across Ontario to develop modules on key professionalism topics. For more information about the College’s Profes- sionalism and Practice Program please visit www.cpso.on.ca/professionalism. MD