Originally published June 20, 2015 - Updated October 18, 2018
EXAM STUDY TIP
If you have a patient in an exam scenario who presents a risk to themselves others, in addition to the usual medical management and consideration of involuntary admission, be sure to consider mandatory reporting. As you'll learn in The Review Course, Management = More than Medication. Don't forget to include important non-medication management such as advising the patient if they are or are not allowed to drive.
With this in mind, think about how you might manage a patient who is:
An air traffic controller who reports diabetes with hypoglycemia unawarenes
A patient with postoperative pain who is using opioids to control their symptoms
A child in whom you suspect parental abuse
A ship captain who presents with his first seizure
A victim of a gunshot wound
A patient with diarrhea who works in a kitchen
(See answers below)
When preparing for the family medicine exam, you need to know reporting requirements (see Dementia & Loss of Consciousness, and Seizures, to name a few). We'll cover these and all of the exam prep content in The Review Course.
PEARLS FOR PRACTICE
If you work in many different provinces & territories like I do, you'll find that reporting requirements vary by region. Some useful resources to help you sort through these:
The CMA Driver's Guide (CMA website login required) - Page 13 shows you if you need to report, if you're protected, and the legal ramifications of reporting. It's also sorted by individual province or territory since requirements vary across the country (Thanks Dr. Boudreau from Hay River, NWT for pointing this one out!)
The CMPA has an article on reporting fitness to drive as well as an entire section in their Good Practices Guide on mandatory reporting
The CPSO has a regularly-updated policy on Mandatory and Permissive Reporting which is specific to Ontario for provincial reporting, but also includes the federal requirements.
Transport Canada has a helpful list of When to report pilots, sorted by medical condition including Vision, ENT, Cardiovascular etc.
Following an actual patient incident we recently contacted Transport Canada to find out minimum reporting requirements. According to Dr. Jay Danforth, one of their medical officers:
Notify in writing (fax preferred) - fax numbers of civil avation medical branch offices is available here
Include:
Patient's name
Pilot's licence # if known
Brief narrative of medical circumstances
Diagnosis (if known, otherwise working diagnosis)
Your name
Your contact info
Name of the facility (clinic, hospital, etc.)
Presenting complaint (e.g. MVA, certification under the mental health act, etc.)
The legal requirements are further detailed in Section 6.5 of the Aeronautics Act.
Mandatory reporting along with our PQRST management mnemonic will be covered in The Review Course - be sure to sign up to be notified when registration begins! Notify me when registration begins >>>
Answers:
Flight crew: Federal Aeronautics act - any flight crew member or air traffic controller who has a medical or optometric condition that can constitute a hazard to aviation safety should be reported. See the helpful Aviation Letter from Transport Canada on this topic
Opioids: CMA Driver's Guide - advise not to drive their response to the medication is known, or they are no longer impaired by the medication
Abuse: All provinces have legislation that requires reporting about child abuse. See the CMPA article on this topic for more information.
Train crew: Federal Railway Safety Act - physicians must notify the railway company's chief medical officer if they believe a patient has a condition likely to pose a threat to railway safety. A similar regulation exists for maritimers in the Federal Maritime Safety Act.
Gunshot reporting: Varies by province, usually requires reporting; consult provincial legislation and the CMPA article on this topic for information.
Infectious Diseases: In an exam scenario you will want to specify that you'll report a possibility of infectious disease to the local public health authorities. You could make a difference and prevent an outbreak of Hep A!
The information above is subject to change and is intended to help you prepare for your exam, and not as actual legal advice. For any specific situation be sure to call the CMPA or consult the legislation for advice.
Originally posted May 11, 2015. Updated Jun 20, 2015.
Photo: Ihm Min-hyauk