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Health Law Blog

Do No Harm. Nicely.

May 25, 2015

If I could give Dr. David Mumford just one piece of advice, I would remind him it’s not necessarily what you say but how you say it.

Dr. Mumford, a surgeon who practices at Trillium Health Centre, was the subject of a complaint before the Ontario College of Physicians and Surgeons. His patient, Margaret Lumchick, a polio survivor in her mid-70s, filed the complaint after, she asserts, Dr. Mumford failed to offer her surgery as an option for treating her 2-centimetre colorectal tumour. He was concerned that as an individual with post-polio syndrome, a condition that can include breathing problems, Lumchick might never get off a respirator. When Lumchick protested and requested pursuing surgery regardless of the doctor’s concerns, she says Dr. Mumford became very irritated and abruptly ended the discussion. He remembers the interchange differently and recalls that it went “very well”.

One can only speculate what actually took place in this “he said-she said” drama but what is clear is that a patient like Ms. Lumchick, who is confined to a wheelchair, can be left feeling bullied and discriminated against when physicians don’t carefully communicate with them in a considerate and compassionate manner.

Given that, “First, do no harm is a fundamental tenet in the practice of medicine, many would agree with Dr. Mumford’s course of action. Faced with a case featuring a patient who is at high risk for complications because of her particular disability, he was understandably cautious, something Ms. Limchick may have perceived as patronizing. However, rather than being guilty of bullying and discriminating against people with disabilities, it is more likely that Dr. Mumford is guilty of being a poor communicator. He could quite possibly have avoided the unfortunate situation and stain on his reputation altogether if he had done what the College subsequently suggested, namely fully discuss treatment options, listen to patient concerns and get additional expert advice (in other words, a second opinion) so a patient can make an informed decision.

This case is notable in that it might very well be a bellwether of changing attitudes surrounding the physician-patient relationship. Ms. Lumchick, whose story was featured in the Toronto Star, has since taken her case to the Health Professions Appeal and Review Board, is but one situation in which patients who are loudly demanding respect. A Peterborough hospital, for example, recently garnered unfavourable media attention when a female patient sent them a $122.50 bill for her time after she was made to wait 90 minutes for her appointment. And in the age of social media, negative reviews on websites like www.RateMds.com can harm a physician’s reputation faster than you can click “Post”.

Our physicians are always pressed for time. However, when it comes to patient communication, you either take the appropriate time and effort now to address individual needs and requirements or you will pay later and addressing College complaints is an extremely time-consuming process.

Testimonials

Several years ago I was fortunate enough to have been selected as a Tremayne-Lloyd Fellow here at Western Law. I used the funds to finish a book and to begin work on a new one. It dawned on me far too late that I had never thanked you for that splendid gift. The new book is to be published by Harvard Press in 2010. The TTL Fellowships provided ritual seed capital for this project, which required me to spend a good deal of time and money at The National Archive in Washington. Again, with many thanks.

R. W. Kostal Professor of Law and History

Tracey Tremayne-Lloyd Health Law