The Ontario College of Physicians and Surgeons (CPSO) has rejected a complaint from a Northern Ontario woman after a doctor in Sault Ste. Marie refused to provide further treatment to the woman's son, because the woman had a history of being abusive to the doctor.
The issue was described in the most recent issue (Oct. 2023) of The Medical Post magazine, which raised the question of what a physician can do about a patient's family member that acts in an abusive manner toward health care professionals.
If bad behaviour comes from a patient, the doctor can sever the relationship with that patient.
But if bad behaviour comes from a patient's family, what is the appropriate course of action?
The Ontario Health Professions Appeal and Review Board has upheld a physician's right to say no to verbal abuse by family members, said a review hearing.
The case involved a hematologist in the Sault who was treating an adult cerebral palsy patient, who is quadriplegic, cognitively intact, non-verbal with a communication board, uses a wheelchair and requires a gastrostomy tube.
The man's mother was his advocate and caregiver.
During one process when the physician was working to get biopsy samples, the doctor was seeking confirmation on whether the patient had a rare disease. The mother was frustrated when delays occurred.
In a complaint lodged with the CPSO, the doctor was quoted saying the mother was "aggressive, argumentative, intimidating, bullying, angry, sarcastic and demeaning.”
The doctor also revealed that not all of the mother's comments were documented because after all, it was the patient's chart, and the doctor was unsure that information should be put on the patient's chart, the magazine reported.
The patient was eventually treated by a hematologist in Toronto, but wanted to transfer back to Sault Ste. Marie. The hematologist in the Sault declined to accept the patient, partially based on the mother's previous behaviour.
In documents provided to the hearing, the doctor said he found the interview with the mother to be challenging and said she had a list of complaints.
“I described my discomfort in being involved with the patient’s mother again. In the end I refused to participate in the patient’s care in light of the ongoing antagonistic behaviours of the patient’s mother. The patient’s mother reported that she was prepared to escalate matters further,” said the doctor’s notes.
The mother filed a complaint against the doctor with the CPSO.
According to transcripts from the hearing, the mother complained that the hematologist behaved in an unprofessional manner in terms of providing care for her son.
She said the doctor abruptly discharged the patient’s care back to his family physician without providing any information about the results or diagnosis.
She accused the doctor of being “rude and combative,” despite knowing that there were no other hematologists available in their city, and she said the doctor failed to make alternate arrangements for care or follow-up for the patient, which impacted his health.
The mother also denied being a difficult person and at one point said she was told by "another medical person" that the doctor was "definitely on the Autistic spectrum.”
The doctor in question denied the mother's accusations. The CPSO board found the doctor had acted correctly in terms of his medical work and that when the doctor learned that certain conditions existed that were outside the scope of his practice, he referred the patient back to his family physician with appropriate communication to the mother. He also denied that the patient was abruptly discharged.
The mother's complaint was rejected by CPSO.
The mother appealed that decision to the Health Professions Appeal and Review Board.
The board upheld the initial decision and said the doctor's decision was reasonable.
The board said physicians "have a right to be treated with respect and not subjected to verbal abuse," the magazine reported.
The committee also commented in the hearing transcript "that it is important to document all relevant encounters (especially when such encounters are difficult or challenging, including over the telephone) with patients and their family members, that these need not necessarily be shared with the referring physician, but can remain on the chart for documentation purposes, and to take no further action."
The board decision was submitted by Thomas Kelly, Vice-Chair, presiding; and board members Michelle Mann-Rempel and Carla Whillier.
Len Gillis covers the mining industry as well as health care stories for Sudbury.com.