Dialogue Volume 14 Issue 2 2018 - Page 64

DISCIPLINE SUMMARIES and controlled substance prescribing, and do not meet the standard of care of the profession for a fam- ily physician as follows: • Dr. Fenton’s recorded histories are often non- existent and lack detail to understand the patient’s story. His documented physical examinations are either lacking entirely or insufficient for the com- plex chronic pain condition this patient reports. No investigations are done with respect to Patient A’s physical pain or anxiety conditions. Impressions and management plans are not outlined regularly. Not all prescriptions given are recorded in the EMR. Rationale for the prescription of medications (choice of drug, dose or quantity), including many controlled substances, is not found in the medi- cal record. CPP was not completed until after the patient was discharged from the practice; • Dr. Fenton’s prescribing of controlled substances including narcotics, benzodiazepines and stimulants is excessive and without documented justification; • Prescription information from the NMS database and Dr. Fenton’s chart calculate over 1000 mor- phine equivalents daily – well in excess of “watchful dose” limits. There is a lack of evidence of applica- tion of recognized controlled substance prescribing guidelines. There is no adequate discussion of side effects, risks and alternative analgesic options. There are no clear treatment goals documented. There is no documented indication for either stimulant or sedative medication, or discussion about the use [of ] both categories of medication being prescribed concurrently. There is no supporting documenta- tion of underlying diagnoses to support the use of these medications. There is no supporting evidence of favourable clinical outcomes as a result of these treatments. • Dr. Fenton appropriately advised Patient A that because of repeated breaches of their opiate treat- ment agreement, he would no longer continue to prescribe controlled substances for Patient A. This would be partially considered to be within the standard of care for termination of a physician- patient relationship as per College policy, however 64 DIALOGUE ISSUE 2, 2018 the policy also indicates a copy of this letter should be sent by registered mail to the patient and a copy be in the patient record. There is no documenta- tion in the chart or in the patient complaint that the patient received such a letter. In addition, in considering termination of the pa ѥеͥ)ɕѥ͡ѡɔ́٥ѡЁɅ)ȁ䁍ձхѥ́ݥѠȁѕɹє)ɽ٥ȁݕɔݡݽձͼݥѡѡ)хɐɔ䁵5ɔȴ)хѱ䰁ѡɔ́٥Ʌѕ́Ѽх)͕́ȁمɥ́ѥ́ȁͥ)͵ȁՅѥѥ́Ёѥݡݽձٔ)ѕѥ䁵ѥѕͽѡɥͬȁ٥)хՍ͕́ɍѥ͕́)ѥٕ̤ɥȁѼȁ͵ͅ)%Ё݅́չѡЁȸѽ́ѕЁ)ѼхѡхɐɅѥ)ɔɕѵЁAѥЁ͍́ɥٔ)Ց́ɔѼ܁ѡ é)ѡAͥAѥЁIѥ͡)AѥЁ)%)Յ԰ѡ ɕٕ)ɽAѥЁݡѥЁȸ)ѽéɽɽ᥵ѕ)ձչѥ9ٕ(иAѥЁ éѽ䁥Ց́ѕ)ͥɍѕɽѕ́ɽ))Q ЁѡЁȸѽéɔ)AѥЁЁЁѡхɐɔՑ)́ɕɐ́ɽ͕͔)Ё́ܵɵѕЁɕձ́)՝ѥ́ձх̸M䰁ѡ)ѕѡݥ+Qɔ́٥ѡЁѥ́ɔɕ͍ɥ)ЁЁɕɑݥѡѡ5Hɝ)́ѡЁѡɔ́٥ɽ͕͔)Ёݕѡɥ́)չ́Ѽ)5иQɔ́٥ѡЁɵѕЁɔ)ձ́՝ѥ́䁄ձхЀѡ)͔ѡHѽȤɔЁݕ+ȸѽéɕѵЁmAѥЁ etѕͥ)́Ёȁɽѡյхѥչѡ