• 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