Worrying shortcomings: doctors dangerous for their patients

Worrying lapses: doctors are dangerous to their patients

UPGRADE DAY

Prescriptions of powerful drugs without follow-up, incorrect diagnoses, non-screening for cancer: dozens of worrying problems are raised each year by inspectors who scrutinize the practice of Quebec doctors.  

In several cases, the breaches put patients at risk, indicate the reports of the professional inspections of the College of Physicians of Quebec (CMQ) of 2021, obtained by Le Journal by the Law of access to information (see below). 

For example, a doctor used a product not recognized by Health Canada, depressed people n have not been assessed for their suicidal risk, and patients with chronic illnesses have not received the necessary follow-up. 

Many shortcomings in the use of antibiotics and the evaluation of geriatric issues have also been raised. 

Patients at risk 

As provided by law for all professional orders in Quebec, the CMQ must carry out inspections each year (hospitals, control questionnaires, individual visits ). 

“We are firmly convinced that there is no doctor in Quebec who gets up in the morning saying: 'I'm going to harm my patients,'” says Dr. Anas Nseir, director of professional inspection at the CMQ. 

“We absolutely want to protect the patient, but give the doctor the chance to improve,” he says. 

To be more effective, the inspection department uses a statistical targeting technique that selects physicians most at risk, out of the 22,566 physicians in the province. Thus, approximately 200 professionals are inspected each year.

“Instead of going fishing in the ocean, where we risk finding few doctors who need our help […] and perhaps letting dangerous doctors practice, we prefer to develop programs, validate with statisticians, and go see those doctors who are more at risk, underlines Dr. Nseir. And I'm proud to say that we have a very good success rate. »

For example, doctors over 70 are nine times more likely to have gaps in their practice, according to CMQ analyses. The other professionals most targeted are those who have been referred by the Syndic of the Order, and those who have been the subject of a report. 

Abuse of telemedicine< /strong>

It should be noted that doctors have been abusing telemedicine since the pandemic (sometimes more than 80% of consultations). 

“We are still seeing it, deplores the Dr. Nseir. Today, there are no more severe health restrictions. There is no reason for a doctor not to see his patients. »

As a general rule, the doctors inspected are notified, have completed a 40-page questionnaire, and know why they are being met. So they can prepare. However, surprise visits are also possible. 

“But these are special cases where it is believed that there is almost immediate danger for the patient,” notes Dr. Nseir.    

An intimidating and stressful inspection 

Although doctors are stressed and sometimes even refractory when they undergo an inspection visit, the exercise is carried out with an educational perspective, assures the College of Physicians of Quebec.

“It's something very intimidating for doctors, it's not a walk in the park when you receive a letter from the College, “says Dr. Sylvain Dion, vice-president of the Federation of General Practitioners of Quebec (FMOQ).

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Teaching approach

“We can't say that it's fun for a professional to be inspected, whether it's a doctor, a lawyer or an accountant, concedes Dr. Anas Nseir, director of professional inspections at the Collège des Médecins du Québec (CMQ ). Deep down, people don't like it. “

In the context, the College says it has a constructive approach, with the aim of helping the professional to improve when necessary.

“From the start, we explain to them that we come to look at with them as a peer”, he assures.

Moreover, the FMOQ says it has noted a beneficial change in tone in inspections over the past four years, which is now much less “traumatic”.

“A few years ago, it was very inquisitorial. We asked for a more humane process with these doctors. There was a crash. The visits are more constructive,” appreciates Dr. Dion.

Currently, a quarter of physicians in Quebec are over 60 years old. Thus, the targeting of older physicians for inspections must be carried out diligently, believes the FMOQ.

“Fragile balance”

“It can be a delicate balance when you put a lot of pressure on doctors. […] Sometimes, that could encourage some to withdraw. “

Furthermore, he assures us that the FMOQ agrees with the idea of ​​professional inspection.

“It is a profession where it is important to give quality and safe services,” says Dr. Dion.

The Federation of Medical Specialists of Quebec refused the request for an interview with Journal.

About 200 doctors are individually inspected each year by the College of Physicians of Quebec, to ensure that their practice complies with the rules of the art. However, all kinds of shortcomings are noted in inspection reports, obtained by The Journal. For reasons of confidentiality, no information does reveal the identity of the doctors. Here are excerpts. 

GAPS IN CARE 

  • Absence of screening for major geriatric syndromes in the population at risk
  • Absence of gynecological examination when indicated (ovarian torsion, bleeding)
  • Examination of the abdomen is often absent, even if the patient consults for abdominal pain
  • Incomplete examination in case of breast mass
  • Rare physical examination
  • Unsystematic monitoring of chronic diseases (asthma, type 2 diabetes, blood pressure control)
  • Patients with complications from glaucoma were not referred to specialists
  • Prevention issues
  • Cancer screening is not done rigorously
  • A note mentions that a 5 year old seems to understand words. “At that age, this uncertainty should have triggered more evaluation.”
  • Incomplete ADHD Assessment and Management

IMPROPERLY STORED MEDICATIONS 

  • Medications stored in a bar-type refrigerator without temperature control 
  • Drugs and medical equipment found in the doctor's office are expired: silver nitrate, urinalysis strip, etc.&nbsp ;

PROBLEMS WITH ORDERS 

  • Use of injectable products not recognized by Health Canada, or prohibited by the World Anti-Doping Agency
  • Medical cannabis prescription without follow-up
  • Renewal of drugs for 24 months without having assessed the patient's condition to know if the medication is still required
  • Use of platelet-rich plasma for unrecognized indications such as erectile dysfunction
  • Benzodiazepines: very frequent use, little or no withdrawal and cessation trials. Little review of their use and the clinical condition of the patient.
  • “Off-standard” testosterone prescriptions and for unrecognized indications such as pain
  • Naloxone use not indicated at end of life
  • In long-term opioid cases, “lack of assessment of risk factors for advice, overdose » 

MENTAL HEALTH 

  • No search for dangerousness in the event of paranoid ideation, suicidal verbalization or dark thoughts
  • The assessment of mental health problems such as anxiety disorders is superficial. There is usually no mental examination, except for suicidal ideation
  • Although the doctor usually links the patient's ailments to psychological problems, he does not there is usually no collaboration with a psychiatrist or psychologist in the records.

MISUSED TELEMEDICINE 

  • Diagnosis of acute otitis media without physical examination (telephone consultation)
  • Not verbal or written consent of the patient to a teleconsultation
  • More than 80% of a doctor's clinical interventions are carried out by telemedicine (chronic diseases without physical examination for sometimes more than 2 years, elderly patients, acute problems requiring physical examination)

BREACH OF CONFIDENTIALITY  

  • The doctor says he gets information about a patient by seeing his friend who is also his patient. He records the result of a patient's friend's test in the patient's file in order to compare them 
  • The technology used by a doctor does not respect the standards of confidentiality (use of personal email, photos of patients on the personal computer)
  • Photos of naked or identifiable minor patients are sent without informed parental consent.
  • Email to wrong recipient

OTHERS 

  • Frequent use of medical consultation as an opportunity to provide an aesthetic service not covered by the public system
  • Erroneous belief of the doctor in connection with nutrition: in order to justify the non-use of nutritionists, the doctor speaks of an old study which would have shown that the addition of fiber in bread was nothing other than the addition of sawdust of wood
  • Many doctors had a hard to decode, even indecipherable handwriting

WHO DOES THE INSPECTIONS?&nbsp ;

  • Nine full-time medical inspectors
  •  They must have at least 10 years of practice (often more than 15 years)
  • They come from different medical specialties
  • Each inspection lasts 1-2 days 

TARGETING INSPECTED DOCTORS 

  • Referred by the trustee 41%
  • Doctors over 70 24%
  • Reports 21%
  •  Doctors over 60 5%
  • Other 9% 
  • < /ul>

    Conclusion of inspections 

    • Adequate practice 53%
    • Internship or compulsory tutoring 29%
    • Limited practice or voluntary retirement 12%
    • Challenge 6% 

    < p style="text-align:right;">Source: CMQ

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