VOL 47: JULY • JUILLET 2001Canadian Family Physician • Le Médecin de famille canadien 1389
clinical challenge
défi clinique
Medicolegal File
Philip G. Winkelaar, CD, MD, CCFP
Dr Winkelaar, a Fellow of the College, is on staff at the Canadian Medical Protective Association in Ottawa, Ont.
Demands from a patient’s lawyer
QUESTION
My patient’s lawyer has sent a letter demanding that I order certain tests and send my patient to specific spe- cialists. Am I obliged to follow those directions?
ANSWER
A doctor’s obligation is to provide appropriate medical care to his or her patients. That includes obtaining a proper histor y, performing appropri- ate physical examinations, and ordering necessary laboratory and imaging investigations to arrive at a diagnosis. Consultation with appropriate specialists is also expected, when necessary. Doctors are also required to provide factual reports on patients they have attended, when requested to do so.
Consultations, investigations, and reports required by a third party, such as
a lawyer, are not paid for by most provincial health plans. Submitting a bill for medically unnecessary services might result in investigation of a doctor’s billing practices, a require- ment to repay fees inap- propriately billed, and perhaps even a charge of fraud. A doctor who orders
medically unnecessary tests could face these or other sanctions.
On the other hand, if a patient requests a particu- lar investigation on his or her own behalf or at the instigation of a lawyer, it behooves a physician to carefully consider whether the investigation might, in fact, be medically indicated. Refusal to carry out a medically indicated investigation, referral, or treat- ment could expose a doctor to civil action if damage resulted or to a complaint at a licensing body. In the face of such requests, therefore, physicians should carefully assess patients’ conditions and needs and document reasons for ordering or refusing to order requested investigations, treatments, or referrals.
While doctors are not expected to comply with patients’ demands for unnecessar y care or treat-
ment, it is appropriate to help patients obtain ben- efits to which they are entitled. If this requires investigations or consul- tations that are not medi- cally indicated, it would be quite reasonable to advise a lawyer that these are uninsured ser- vices and that payment will be required.
A
lthough laws governing medical practitioners are simi- lar across the country, they can vary greatly from one jurisdiction to another. Specific answers to questions cannot be given in a national publication. While the information in this article is true in general, it is intended to bring issues to your attention, not to give specific advice. You should consult a lawyer if you have specific concerns. Members of the Canadian Medical Protective Association can contact the Association at 1-800-267-6522.Readers may submit questions on medicolegal issues by fax to Dr Philip Winkelaar at (613) 725-1300. They will be considered for future Medicolegal Files.
