For Physicians

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• Conditions of Re-Registration

  How do I renew my Alberta medical practice permit?

  Physicians must renew their registration by December 1 each year to avoid late payment penalties and possible suspension. The renewal process includes:

  • payment of annual fees,
  • possession of liability coverage/insurance, and
  • completion of the online annual renewal form.

• Consent Issues for Underage Patients

  Am I obligated to inform the parents/guardian of a young (underage) patient who has requested birth control or a controversial procedure such as breast implants?

  • You should determine if the patient is mature enough to understand the consequences of his/her decision. If you believe the patient is mature enough, you must provide him/her with the information they need to make an informed decision.
  • The decision to go ahead with the care plan and the decision to share this information with others rests with the patient.
  • For more information go to: CMA Code of Ethics - Section 25

• Physician/Patient Relations

  Can I refuse to treat/accept a patient?

  The Canadian Medical Association Code of Ethics (which the College endorses) states physicians cannot discriminate against patients on grounds such as age, gender, medical condition, national or ethnic origin, physical or mental disability.
  
  However, in some circumstances:

  • You may not feel qualified to handle the patient’s treatment.
  • The patient has missed several appointments.
  • The patient has signed a treatment contract and is not following your treatment plan.
  • The patient has been abusive or threatening to you and/or your staff.

  Note: A physician may not refuse to treat/accept a patient in an emergency situation if they have the skills required to do so.

  Also refer to the CPSA Standards of Practice: Physician/Patient Relationship.

  Can I accept gifts from my patients?

  Yes, if the gift is small, and of minimal monetary value.

  Notes:

  • Items of value or items of a very personal nature should not be accepted.
  • If you feel uncomfortable accepting a gift of any kind, you should decline the offer.

  For more information, go to:

  • The Messenger, February 2006:  Page 6
  • The Messenger, April 2006:  Page 11

  What do I need to consider when discharging a patient?

  You must give adequate notice (preferably in writing) to the patient, with specific reasons for terminating care. These reasons may include (but are not limited to):

  • future retirement or reduction in practice
  • concerns about staff and physician safety
  • abusive behaviour toward staff
  • non-compliance with doctor’s recommendations or refusal to accept advice. (Note: The CMA Code of Ethics, Section 24 states that a physician must “Respect the right of a competent patient to accept or reject any medical care recommended.”)

  You should also assist the patient by:

  • offering a list of physicians accepting patients or the name of a referral agency (such as the College)
  • providing them with details regarding the care you will provide (until a certain date) or arrangements made elsewhere, and where to access their medical records.

  For more information, refer to the CPSA Standards of Practice: Physician/Patient Relationship.

  What should I do if a patient becomes abusive or utters threats?

  • Document the details of the incident(s), including the names of any witnesses.
  • Contact the Canadian Medical Protective Association for advice at 1-800-267-6522.
  • If you believe the threat to yourself, family members and/or staff is serious,  report the matter to the police.

  If attempts to reach a resolution with the patient are unsuccessful, you are entitled to discharge the patient from your practice, provided you provide written notification stating the reasons for terminating care.

  Can I refer a patient to an unregulated professional (i.e. a massage therapist)?

  Yes, as long as you believe:

  • the treatment will benefit the patient
  • the treatment will not harm the patient
  • the provider is qualified to provide appropriate treatment

   

• Electrocardiogram

  Does approval to interpret ECGs include approval to interpret exercise ECGs (treadmill)?

  • No. Consistent with the recommendations of the American Heart Association, approval to interpret cardiac exercise stress tests requires a minimum of two weeks of full-time training with supervised assessment, attendance and interpretation of 100 or more studies, under one or more cardiologists.
  • If testing includes pharmacological stress testing, evidence of training and experience with these procedures is also required.

  More information on Cardiac Exercise Stress Testing

  Does approval to interpret ECGs include approval to interpret Holter monitors?

  College approval is not required to read and interpret the results of Holter monitors.

  Must all 12-lead ECGs be interpreted by a College-approved ECG interpreter?

  The College strongly recommends that all 12 lead ECGs are interpreted by a qualified physician who is either a cardiologist or College-approved ECG interpreter.

  Are electronic ECG interpretations acceptable? Could all ECGs be read electronically and the abnormal ones re-read by a qualified ECG interpreter?

  No. Computerized electrocardiography has not advanced to the point that it can replace an expert physician interpretation, even as a screening tool for excluding “normal” ECGs.

• Fees & Billing

  Where can I go for general information on fees and billing?

  • Alberta Health and Wellness Schedule of Medical Benefits
  • CPSA Standards of Practice: Charging for Uninsured Medical Services (p 36/65)
  • The Alberta Medical Association (AMA) Guidelines to Billing Uninsured Services
  • Canadian Medical Protective Association (CMPA)

  Can I charge a fee for completing forms, writing notes or making copies of medical records for patients?

  Yes. Patients can be billed directly for services not covered by Alberta Health Care. This includes writing sick notes, consulting by phone, copying patient records and filling out insurance or legal forms.

  Note: If a patient is older than 74.5 years, Alberta Health and Wellness will pay for their driver’s licence examination and completion of forms.

  Can I refuse to fill out certain forms for insurance or employment?

  No, but you can charge a fee (see above). See CPSA Standards of Practice: Charging for Uninsured Medical Services (p 36/65)

  Can I bill a patient for a missed appointment?

  Yes, if patients are informed of this policy when they book the appointment.

  Note: If a complaint is lodged by the patient, the physician must be able to justify the billing. Documentation of patient consent to the policy would be useful.

  Can I charge a patient directly if he/she does not have a valid Alberta Health Care number?

  Yes. This is considered an uninsured service, assuming it is an elective visit.

  How much can I charge for activities not covered by Alberta Health Care?

  • Please refer to the Alberta Medical Association’s (AMA) Guidelines to Billing Uninsured Services.
  • Contact the AMA Health Economics department:

              Alberta Medical Association (AMA) 
              Health Economics 
              Phone: 780-482-2626     Toll Free: 1-800-272-9680 
              Fax: 780-482-5445 
              Email: amamail@albertadoctors.org     
              Website: www.albertadoctors.org

              Mailing Adress:

              CMA Alberta House 
              12230 – 106 Avenue NW 
              Edmonton AB T5N 3Z1

  Can I refuse to work with a legal or insurance firm that has not paid me for previous work?

  Yes, if negotiations with the firm have not resulted in payment. You may also request pre-payment or a down-payment for new work being requested.

  Note: To ensure a paper trail, conduct all communications in writing.

   

• Keeping Patient Records & Medical Recordings

  How long must I keep patient records and medical recordings, including for deceased and minor individuals?

  • A minimum of 10 years, following the date of the patient's last visit.
  • For patients under 16 years, at least two years past the age of majority (18 years) or for 10 years, whichever is longer.

  For more information, see the CPSA Standards of Practice: Patient Records.

  How long must I keep X-ray films and reports?

  • Films must be kept for at least five years.
    • For patients under 16 years, films must be kept for at least two years past the age of majority (18 years) or for five years, whichever is longer.
  • Reports must be kept for at least 10 years.
  • Mammography films must be kept for a minimum of five years to a maximum of 10 years, when there are no intervening studies.

• Managing Your Practice

  If I am the only physician within a small region and already have a full practice, can I refuse to take on more patients?

  Yes. Physicians must be able to manage their patient population as well as ensure their own well-being. They are not expected to take on more patients than they believe they can safely manage.

  Note:  In an emergency situation, a physician is required to provide care to the best of his/her ability.

  For more information, go to CPSA Standards of Practice: Establishing the Physician/Patient Relationship.

  Is it appropriate for me to use an introductory appointment before accepting a patient into my practice?

  Yes, if done correctly. Meeting with patients before entering into a physician/patient relationship can be an opportunity to:

  • share information about the practice and to understand the individual’s medical history,
  • allow the individual to determine if this relationship will meet his/her expectations for managing future health needs, and 
  • allow both parties to decide if this relationship will be mutually beneficial.

  However, you may not use the appointment as a means of screening patients (i.e., choosing only healthy or less-complex patients).

  The CMA Code of Ethics states: "Physicians cannot discriminate against patients on such grounds as age, gender, marital status, medical condition, national or ethnic origin, physical or mental disability, political affiliation, race, religion, sexual orientation, or socioeconomic status.”

  For more information, go to: 

  • CPSA Standards of Practice: Establishing the Physician/Patient Relationship
  • The Messenger, May 2005: Page 6

     

  Can I limit my patients to one concern or complaint per visit?

  Yes, if doing so:

  • will ensure patients are seen in a timely fashion, and 
  • won’t jeopardize patient care.

  You may prioritize the concerns of patients with several complaints to address those that need immediate attention and suggest future appointments to address the others. Note: The patient must be advised that this is the recommended approach or plan.

  However, it should be noted that:

  • Patients are not always able to determine which symptoms or concerns reflect a significant problem.
  • Patients with an array of symptoms may not have their condition properly identified if they are limited to one concern per visit.

  For more information, go to The Messenger, May 2006: Page 4.

• Prescriptions/Pharmacy

  Are physicians allowed to write prescriptions for themselves or for family members?

  No, unless another physician is not readily available for emergency services. Note: You cannot bill for this service.

  For further information, go to CMA Code of Ethics: Section 20

  Can I phone in a prescription refill or do I need to see the patient first?

  Yes. For the majority of drugs, you may refill a prescription over the phone without seeing the patient in person. However, some drugs (e.g., Triplicate Prescription Program Medication List) cannot be refilled over the phone.

  If you do phone in a prescription:

  • You may need to follow-up with your patient to ensure the prescribed medication is working or to adjust the dosage.
  • You may want to check if the patient has had any significant changes to his/her health that might require a change to the prescription.

  Can I write a new prescription for a patient without seeing him/her?

  No. You must see the patient first before prescribing new medication. For more information, refer to the CPSA Standards of Practice: Telemedicine.

  Can a prescription have an electronic signature?

  All prescriptions, including computer-generated prescriptions, require the prescriber’s “hand” signature. Note: A computer-generated prescription with a scanned signature must be hand-initialed by the prescriber.

  Will the College provide a list of physicians who prescribe specific drugs such as methadone or narcotics?

  No.

  Can I prescribe medical marihuana to a patient?

  Yes, but this requires both you and the patient to submit the appropriate application forms to Health Canada. For more information, go to the Health Canada website or call toll free 1-866-337-7705.

  Notes:

  • The College recommends that physicians do not prescribe marihuana to patients due to the lack of scientific evidence regarding the risks and benefits of medical marihuana and the lack of clarity surrounding civil litigation risks.
  • If you decide to prescribe marihuana, you need to ensure your compliance with the complex regulations outlined by Health Canada.

  Will the College provide a list of physicians who prescribe medical marihuana?

  No.

  Can I own, or own interest in, a pharmacy?

  Yes. However, there must be no conflict of interest. This means patients cannot feel coerced to purchase from that pharmacy, including having to walk through the pharmacy to get to your medical office.

• Releasing Patient Records

  What should a physician consider?

  Medical records are not the property of the patient; they belong to the physician/physician's office where they are held. However, the patient is entitled to access and review the information in their record and to receive a copy on request, with some caveats:

  • You may charge the patient a fee for copying their record. However, if the patient is leaving your practice, you should tell them to check with their new physician first, to confirm they need a copy.
  • You are allowed to remove sensitive information before disclosure, if you feel it may cause harm to the patient or to others. Note: If challenged by the patient, you may be required to justify this decision to the Privacy Commissioner.
  • You may withhold reports from a third party (other physician, consultant, etc.)  if you believe the information would not have been supplied if the contributor knew it would not be kept confidential.
  • By law, you must retain a full copy of a patient’s records for at least 10 years after the date the patient was last seen. This is to help ensure patient safety and to protect you against any legal liability.

  Record of a Deceased Patient

  The Health Information Act states the medical record of a deceased individual can only be released (or disclosed) under the following circumstances:

  • To administer the individual’s estate.
  • To provide health services to a descendant, if the privacy of the deceased individual is sufficiently protected.
  • To investigate circumstances in the death, or recent health services, of the individual, if it does not contradict a request by the deceased individual.

  For more information:

  • Contact a College Information & Project Officer at 780-423-4764, toll free 1-800-561-3899 (Alberta residents only) or publicinquiries@cpsa.ab.ca
  • Alberta Health Information Act, Section 35d.1
  • Alberta Office of the Information and Privacy Commissioner