practice partner
( iii) the rent is normal for the area in which the premises are located, and
( iv) the amount of the rent is not related to the referral of patients to the landlord;
As the regulation makes clear, if a physician elects to rent premises from a pharmacy, she / he must pay market rate that is normal for that area, and the rent cannot be related to referral of patients to the pharmacy. Patients must be able to freely choose the pharmacy at which they wish to have their prescriptions filled. Physicians should not coerce or unduly influence patients into using a specific pharmacy. As with any business contract or venture, the College strongly advises members to seek out an independent legal opinion to ensure that their proposal conforms to all relevant regulations and policies. If you have questions about this or any other practice related issue, please contact the Physician Advisory Service at 1-800-268-7096 extension 606. MD
Family Histories
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other during this tough time. This patient’ s own well-being was being compromised.“ Family comes into play. It can’ t be excluded,” says Dr. Ash. As the journal Family Practice Management once stated:“ Maneuvering among phantom family members in the room is an intricate dance. The first step is to become aware of their unseen presence.” When doctors confront family dynamics related to a patient’ s health, that presence isn’ t always unseen. For example, there are frequent opportunities in medicine to directly interact with family members – when they come to appointments together with your patient, or when they appear in hospital rooms. That can be positive. Families can ask questions and share information. They can be advocates and convey their wishes. They provide emotional and practical support. All of that can be important in ensuring the best health care and decisions. Yet when all these views emerge, the doctor’ s ultimate responsibility remains to his or her patient. In talking to family members, doctors might perceive abnormal or negative family dynamics( another reason to ensure private time with the patient) or simply conflicting beliefs. End-of-life periods are a prime example, where family values can be expressed in different ways. Like in switching from treatment to palliative care. Or in cases where family members ask the doctor to tell or don’ t tell the patient about the severity of the condition.“ That can be a very challenging situation for physicians,” says Dr. Brown.“ Often it’ s a matter of understanding the family’ s values and expectations, and trying to see the impact it has on the patient. Within that, you try to find common ground.” In this dynamic, however, one person matters most.“ I don’ t talk about person-centred care or family-centred care,” says Dr. Brown.“ My preference is to talk about patient-centred care, recognizing that the family is part of that care on some level. The patient comes first – that’ s the priority.” MD
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Dialogue Issue 4, 2016