Negligence in Canadian Medical Law | MCCQE1 Prep

Introduction

Understanding medical negligence is crucial for Canadian physicians and MCCQE1 candidates. This comprehensive guide covers the key aspects of negligence in the context of Canadian healthcare, essential for MCCQE1 preparation and practice.

Elements of Negligence in Canadian Medical Law

To establish negligence in Canadian medical practice, four key elements must be proven:

Standard of Care in Canadian Healthcare

The standard of care in Canadian medical practice is a critical concept for MCCQE1 candidates to understand:

• It's defined as the level of care a reasonable and competent physician would provide in similar circumstances.
• The standard varies based on the physician's specialty, training, and the specific situation.
• It's not perfection, but rather what's reasonably expected given the circumstances.

Types of Negligence Relevant to MCCQE1

Understanding different types of negligence is crucial for MCCQE1 preparation:

1. Diagnosis Errors: Misdiagnosis, delayed diagnosis, or failure to diagnose
2. Treatment Errors: Improper treatment, medication errors, or surgical mistakes
3. Failure to Warn: Not adequately informing patients of risks (related to informed consent)
4. Abandonment: Terminating the physician-patient relationship improperly

Informed Consent in Canadian Medical Practice

Informed consent is a critical aspect of avoiding negligence claims:

Defenses Against Negligence Claims

Canadian physicians should be aware of potential defenses against negligence claims:

1. Contributory Negligence: Patient's actions contributed to the harm
2. Volenti Non Fit Injuria: Patient voluntarily assumed the risk
3. Statutory Immunity: Protection provided by specific laws

Canadian Guidelines on Negligence Prevention

The Canadian Medical Protective Association (CMPA) provides guidelines to help physicians reduce the risk of negligence claims:

1. Maintain clear and comprehensive medical records
2. Ensure proper communication with patients and other healthcare providers
3. Stay updated with current medical knowledge and practices
4. Recognize and work within the limits of your competence
5. Obtain informed consent for all procedures and treatments

Key Points to Remember for MCCQE1

• 🔑 Understand the four elements of negligence: duty, breach, causation, and damages
• 🔑 Know the standard of care concept in Canadian healthcare
• 🔑 Be familiar with different types of negligence, especially diagnosis and treatment errors
• 🔑 Understand the importance of informed consent in Canadian medical practice
• 🔑 Be aware of potential defenses against negligence claims
• 🔑 Know the CMPA guidelines for negligence prevention

Sample Question

Sample Question

A 55-year-old woman presents to her family physician with a 3-month history of a painless lump in her right breast. The physician performs a clinical breast examination but does not order any imaging studies. He reassures the patient that the lump is likely benign and advises her to return if it grows larger. Six months later, the patient is diagnosed with advanced breast cancer. Which one of the following elements of negligence is MOST clearly demonstrated in this scenario?

• A. Duty of care
• B. Causation
• C. Damages
• D. Breach of standard of care
• E. Contributory negligence

Explanation

The correct answer is:

• D. Breach of standard of care

This scenario demonstrates a clear breach of the standard of care expected from a family physician in Canada. The standard of care for a patient presenting with a breast lump typically includes:

1. A thorough clinical breast examination
2. Ordering appropriate imaging studies (mammogram and/or ultrasound)
3. Considering a biopsy if the lump is suspicious

By failing to order appropriate imaging studies and providing false reassurance without proper investigation, the physician's actions fell below the accepted standard of care for managing a patient with a breast lump.

While all elements of negligence may be present in this case, the question asks for the MOST clearly demonstrated element. The other options are less directly evident from the information provided:

• A. Duty of care: This is present but not the most prominent element in the scenario.
• B. Causation: While the delay in diagnosis likely contributed to the advanced stage of cancer, this is not explicitly stated and would require more information to establish.
• C. Damages: The patient's advanced cancer diagnosis implies damages, but this is not the most prominent element in the scenario.
• E. Contributory negligence: There is no information suggesting the patient contributed to the negligence.

This question highlights the importance of understanding the standard of care in Canadian medical practice and the potential consequences of failing to meet this standard, which is crucial knowledge for the MCCQE1 exam.

References

1. Canadian Medical Protective Association. (2021). Medico-legal handbook for physicians in Canada. https://www.cmpa-acpm.ca/en/advice-publications/handbooks/medico-legal-handbook-for-physicians-in-canada (opens in a new tab)

2. Picard, E. I., & Robertson, G. B. (2017). Legal Liability of Doctors and Hospitals in Canada (5th ed.). Toronto: Carswell.

3. Canadian Medical Association. (2018). CMA Code of Ethics and Professionalism. https://policybase.cma.ca/en/permalink/policy13937 (opens in a new tab)

4. College of Physicians and Surgeons of Ontario. (2021). Policy Statement #2-15: Consent to Treatment. https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Consent-to-Treatment (opens in a new tab)

5. Canadian Breast Cancer Foundation. (2022). Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. https://www.cbcf.org/healthcare-professionals/clinical-practice-guidelines/ (opens in a new tab)