MDs' postop directives a medicolegal land mine: CMPA

The Canadian Medical Protective Association (CMPA) is warning physicians to discuss every possible adverse event with patients when providing postoperative instructions. “The duty to inform and explain risks is as important after the intervention as before,” CMPA legal counsel Margaret Ross said during the CMPA annual meeting in Quebec City last month.

But Ross also acknowledged that this is becoming harder to do. Even though courts are telling physicians to discuss important postoperative or post-treatment conditions that may lead to adverse — if rare — outcomes, quicker discharge times often make it impossible to know which patients are receiving at least some postintervention care. Ross described the situation as a legal “land mine.”

She said physicians' best defence is to inform patients as clearly as possible of all potential complications and give them precise directions about what to do if these arise. “My problem is that this is really a systemic issue, but it is the physician who is taking all the liability,” responded Dr. Barb Kane, a Prince George, BC, psychiatrist. “I think we are expecting a lot of our patients [by asking them] to recognize their complications.”

The CMPA is also warning doctors that courts will not accept that physicians cannot meet the standard of care due to limited resources. In her report to members, Ross stated: “There is little doubt that very soon the courts will have to face squarely the [limited-resources] issue and decide whether there should be any change to the standard of care expected of physicians, depending on the environment in which they work. In the meantime, it does not appear that the courts are prepared to [accept] a lower standard of care based on cost considerations.”