Assessment and Monitoring of Medical Conditions

Approved: June 25, 2008
Revised: June, 2014

Physicians suffer from the same health problems as the general population, although incidence and prevalence may vary. The College of Physicians & Surgeons of Alberta (CPSA) is mandated to ensure that physicians are fit to practice and that they do not pose a risk to patients.It can be difficult to determine if a medical condition needs to be brought to the attention of the CPSA and whether the CPSA needs to act. Physicians are encouraged to have regular medical care and discuss the impact on their practice with their physician. They may also want to seek feedback from colleagues who observe them in the workplace. The CPSA wants to ensure public safety but will work with physicians to have them return to work, if at all possible, and act as an advocate in matters of disability insurance. Disability is defined as a decrease in or absence of the capacity of an individual to meet social, personal, or occupational demand. Disability is the gap between what the physician can do and what the physician needs or wants to do.

Standards of practice outline the duty to report your own medical condition, that of a colleague or that of a physician patient. The duty to report a physician patient arises only when the physician patient has not reported their health condition and there is a risk of serious harm to others.Not all medical conditions will negatively impact or could reasonably be seen to negatively impact practice. The interplay between the actual medical condition, the type of work that the physician engages in, and the work environment, all need to be carefully considered. For example: A surgeon with a tremor secondary to Parkinson’s Disease could have their practice negatively affected but a psychiatrist might not. All of these factors will be considered in the assessment of the impact of any medical condition on medical practice.

Documentation Or Declaration:

At the time of registration, and on a yearly basis, physicians must declare whether they have had an illness that could negatively impact or could reasonably be seen to negatively impact practice. This includes any physical, cognitive, psychiatric or emotional conditions.

Physicians may also come to the attention of the CPSA as a result of third party reports.

The CPSA must then decide what information needs to be gathered, what assurances are needed to determine fitness to practice, and what monitoring should take place.

Questions To Be Considered:

1. What might be the type of impairment due to illness?
   1. Judgment
   2. Memory
   3. Executive function
   4. Physical ability
2. What is the timeframe of the illness impairing fitness to practice?
   1. Deterioration quickly: Less than one year
   2. Gradual: Greater than one year
3. What is the practice situation of the physician?
   1. Formally reviewed or observed practice
   2. Informal review or observation
   3. Solo practice
4. Is the physician more procedurally or cognitively oriented?
5. What are the immediate consequences of error that having a disability would cause or contribute to?

Process:

1. Identification of physicians with medical conditions:
   1. Self report.
   2. Concerns expressed by colleagues, nurses, or other health professionals.
   3. Concerns expressed by family and friends.
   4. Complaints or concerns expressed by the physician’s patients.
   5. Police or other authorities.
2. Gathering information to assess fitness to practice for health reasons. Regardless of the way in which a physician is identified, the process to determine fitness to practice will be similar and include the following:
   1. Reports of treating physicians and the opinion of these physicians as to the fitness to practice.
   2. Reports from colleagues of work performance.
   3. Additional investigations or requirements.
   4. Information held by the medical regulatory authority.

If there is a serious concern about a physician’s fitness to practice, voluntarily withdraw from practice may be requested until all information is gathered. If there are serious concerns about patient safety, there are provisions in the HPA (Section 118) that would allow suspension pending assessment of capacity. The physician will be reminded to seek legal advice.

1. Additional information may be requested. The College will make every attempt to balance the privacy needs of the physician with the need to have enough information to assess risk to practice. This may include the following:
   1. Cognitive assessment and neuropsychological testing to determine ability to practice.
   2. Physical assessment tailored to the specific problem, as appropriate.
   3. Psychiatric assessment, as appropriate.
   4. Multidisciplinary assessment for complex cases.

Physicians must agree to allow the CPSA access to medical records which confirm their fitness to practice.

1. Potential outcomes will be documented and the physician will be informed of this decision:
   1. Unfit to practice with no chance of recovery.
   2. Unfit to practice at the time of assessment, but improvements likely.
   3. Fit to practice with practice limitations or restrictions.
   4. Fit to practice with no restrictions.
2. Monitoring: Many of the illnesses that can impair the ability to practice are chronic illnesses and change over time. Ongoing monitoring is required to ensure compliance to recommendations of treating physicians, to reassess for fitness to practice, and to ensure compliance with any practice restrictions or limitations. This can include the following:
   1. Reports from treating physicians.
   2. Reports from colleagues or designated practice monitor.
   3. Reassessment by a third party.
   4. Practice visits or audits to review their practice.
   5. Competency assessment.
   6. Monitoring of billing or medical records to determine compliance to practice restrictions.
   7. Full review and assessment of activities undertaken, with the possibility of revision of expectations and conditions.
3. Continuing Care Contracts: These contracts are entered into to ensure compliance to the requirements as a condition of continued practice and using an informal process rather than the complaints process to resolve issues related to health.

If, at any time, a physician would like to resolve any issues related to their health in a formal way, they have the option of using the complaints and discipline process. The physician can report the matter to the Complaints Director, who may choose to act upon the information as a complaint under section 56 of the HPA.