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Home / Consequences of a Np Caring for Self or Family Memebers

Consequences of a Np Caring for Self or Family Memebers

Physician Treatment of Self, Family unit Members, or Others Close to Them

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Approved past Council: November 2001
Reviewed and Updated: November 2006, Feb 2016, June 2017; May 2018

Companion Resources: Advice to the Profession

Other References:

  • "Treating Those Closest to You,"Dialogue, Issue ane, 2016
  • Results from the well-nigh recent consultation

Policies of the College of Physicians and Surgeons of Ontario (the "College") prepare out expectations for the professional deport of physicians practising in Ontario. Together with the Do Guide and relevant legislation and example law, they will be used by the College and its Committees when because physician practice or conduct.

Within policies, the terms 'must' and 'brash' are used to articulate the College's expectations. When 'advised' is used, it indicates that physicians can use reasonable discretion when applying this expectation to practice.

Additional data, general advice, and/or all-time practices can exist found in companion resources, such every bit Advice to the Profession documents.

Definitions

Family member: An private with whom the md has a familial connection and with whom the doc has a personal or shut relationship, where the human relationship is of such a nature that it would reasonably touch on the md's professional person judgment. This includes, but is non express to: the physician's spouse or partner, parent, child, sibling, members of the physician's extended family unit, or those of the physician's spouse or partner (for instance: in-laws).

Others close to them: Any other individuals who have a personal or shut relationship with the physician, whether familial or non, where the relationship is of such a nature that it would reasonably affect the physician's professional judgment. This may include, but is not limited to, friends, colleagues, and staff.ane

Treatment: Annihilation that is done for a therapeutic, preventive, palliative, diagnostic, cosmetic or other wellness-related purpose. This includes: the performance of any controlled act;2 ordering and performing tests (including blood tests and diagnostic imaging); providing a form of treatment, plan of treatment, or community treatment program.3

Small-scale condition: A non-urgent, not-serious status that requires only short-term, episodic, routine care and is not likely to be an indication of, or atomic number 82 to, a more than serious condition, or a condition which requires ongoing clinical care or monitoring.4

Emergency: an "emergency" exists where an individual is plain experiencing severe suffering or is at chance of sustaining serious actual harm if medical intervention is not promptly provided.

Policy

  1. In order to come across their professional obligations to practise medicine safely and effectively, physicians must only provide treatment for themselves and family members in limited circumstances, every bit set out in this policy.

Providing Treatment

  1. Physicians must not provide treatment for themselves or family members except:
    1. For a pocket-sized status, or in emergency situations;
      and
    2. When another qualified health-care professional person is not readily available.
  2. Physicians must non provide recurring episodic treatment to themselves or family members for the aforementioned disease or status, or provide ongoing direction of a disease or status, even where the disease or condition is minor.
  3. Every bit the aforementioned risks of compromised objectivity and meeting the standard of care may arise when providing care to others close to them, physicians are brash to advisedly consider whether it would be appropriate to provide handling in these instances.
    1. Where the relationship would reasonably bear upon the doctor'due south professional sentence, physicians must not provide treatment to an private close to them, except in accord with the circumstance set out in provision 2 of this policy.
  4. When the nature of the relationship with family members or others close to them has changed, physicians must re-evaluate the nature of their relationship to determine whether they tin can notwithstanding be objective.
    1. If the physician's professional judgment has been reasonably affected past changes in the relationship, physicians must transfer care of the individual to some other qualified health-intendance professional as soon every bit is practical.

Telescopic of Treatment and Transfer of Intendance

  1. Physicians must always act within the limits of their cognition, skill and judgment.5
  2. Providing treatment in accordance with this policy is limited to addressing the immediate medical needs associated with treating a minor condition or emergency. Where boosted or ongoing care is necessary, physicians must transfer intendance of the individual to another qualified health-intendance professional every bit before long as is applied.

Expectations well-nigh Documenting Intendance and Maintaining Confidentiality

  1. Physicians must advise the individual receiving care to notify their main health-care professional of the handling that the physician has provided.
  2. Where the individual does non have a principal health-intendance professional, physicians are advised to explain to the private the importance of informing their side by side wellness-care professional, where practical, of the treatment received from the physician.
  3. Where information technology is impractical for the individual receiving treatment to inform their own primary health-care professional person of the treatment the private received (e.g., children), physicians are advised to inform the private's primary health-care professional person, with the individual's consent, of the handling they provided.
  4. Physicians must maintain the confidentiality of the personal health information of any individual they treat.half dozen

Spouses or Sexual/ Romantic Partners

  1. Physicians must be mindful that providing treatment to a spouse, partner, or anyone else with whom they are sexually or romantically involved may give ascent to a physician-patient relationship and that providing treatment that exceeds the circumstances set out in this policy may give ascension to a doctor-patient relationship7 such that the sexual corruption provisions8 of the Regulated Health Professions Act, 1991 would use.
  2. Physicians must non provide handling to a spouse, partner, or anyone else with whom they are sexually or romantically involved, beyond the circumstances of a pocket-sized condition or emergency, and where no other qualified health-care professional is readily available.

Prescribing or Administering Drugs

  1. If prescribing drugs is required as part of providing care in accord with this policy, physicians must comply with the College's Prescribing Drugs
  2. Physicians must non prescribe or administer the following for themselves, family members, or others close to them:
    1. narcoticsnine,ten,
    2. controlled drugs or substances11,12,
    3. monitored drugs13,
    4. cannabis for medical purposes14, or
    5. whatever drugs or substances that are addicting or habituating.
  3. Physicians must not prescribe or administer the drugs or substances set out in provisionxv fifty-fifty when another health-intendance professional is in accuse of managing the treatment of the disease or condition.

Endnotes

1. Physicians are brash to contact the College's Doctor Advisory Services or the Canadian Medical Protective Clan (CMPA) for further guidance equally to which individuals may exist included in this term.

2. Controlled acts for physicians, as set out in due south. 4 of the Medicine Human activity, South.O. 1991, c. 30.

3. The definition of "treatment" has been adjusted, and modified, from the definition of "treatment" as ready out in the Health Intendance Consent Act, 1996, S.O. 1996, c. 2, Schedule A, at Section 2(i); the exceptions to "handling" nether the Health Care Consent Act do not use to this policy.

4. For the purposes of this policy, "pocket-size condition" does non include providing ill notes or completing insurance claims for themselves, family members, or others shut to them.

5. Sections 2(i)(c), 2(v), O. Reg. 865/93 (Registration), enacted under the Medicine Act, 1991, S.O 1001., c.30.

6. Physicians must bide by their legal obligations nether the Ontario Personal Health Data Protection Deed, 2004, South.O. 2004, c. iii Sched. A (PHIPA), every bit well as the expectations set out in the College's Confidentiality of Personal Health Information policy.

7. Patient criteria, O. Reg. 260/eighteen, under subsection 1(6) of the Health Professions Procedural Code, Schedule 2 of the Regulated Health Professions Act, 1991, Southward.O. 1991, c.eighteen (hereinafter HPPC). For more information, encounter the College's Maintaining Boundaries and Preventing Sexual Abuse policy section "Determining Whether a Physician-Patient Human relationship Exists".

viii. Legislative provisions relating to sexual abuse are prepare out in Sections 1(3) to (half-dozen) and Sections 51(one) to (three) and (4.1) to (9) of the HPPC. This includes the amendments to the HPPC contained in Bill 87 (Protecting Patients Human activity, 2017) in force as of May 1, 2018. It does non include whatsoever other requirements that may exist adult in regulation. Physicians are advised that the passing of Neb 70, the Regulated Health Professions Amendment Act (Spousal Exception), 2013, has not changed the constabulary with respect to physicians, as the College has non opted to exempt physicians who treat their spouses from the sexual corruption provisions. For more than information, see the Higher'south Maintaining Boundaries and Preventing Sexual Abuse policy.

9. Narcotics are defined in south. 2 of the Narcotic Command Regulations, C.R.C. c. 1041, enacted under the Controlled Drugs and Substances Deed, S.C. 1996, c. xix (hereafter the CDSA)  CDSA: the term 'narcotics' includes opioids.

10. While these drugs or substances may exist a legitimate treatment, regulations under the CDSA prohibit physicians from prescribing or administering narcotics, or controlled drugs or substances for anyone other than a patient whom the doctor is treating in a professional capacity. There are no exceptions under the CDSA for prescribing or administering these drugs or substances to non-patients, even in emergencies. Come across s. 53(2) of the Narcotic Control Regulations C.R.C. c. 1041, and south. 58 of the Benzodiazepines and Other Targeted Substances Regulations, SOR/2000-217, nether the CDSA.

11. Controlled drugs and substances are defined in s. 2(1) of the CDSA and mean a drug or substance included in Schedule I, 2, III, Four or 5 of the Act.

12. Please see footnote 10.

13. The Ontario Ministry of Health and Long-Term Care (Ministry) monitors a number of prescription narcotics and other controlled substance medications as part of its Narcotics Strategy. A list of monitored drugs is bachelor on the Ministry building's website http://health.gov.on.ca/en/pro/programs/drugs/monitored_productlist.aspx. Come across likewise due south. 2 of the Narcotics Safety and Sensation Deed, 2010, Due south.O. 2010, c. 22 for a definition of 'monitored drug'.

14. See the Higher's Cannabis for Medical Purposes policy for more information.

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Source: https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Physician-Treatment-of-Self-Family-Members-or