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