RESUMEN
In 2004, the Canadian Cardiovascular Society formed an Access to Care Working Group with a mandate to use the best science and information available to establish reasonable triage categories and safe wait times for common cardiovascular services and procedures through a series of commentaries. The present commentary is the first in the series and lays out issues regarding timely access to care that are common to all cardiovascular services and procedures. The commentary briefly describes the 'right' to timely access, wait lists as a health care system management tool, and the role of the physician as patient advocate and gatekeeper. It also provides advice to funders, administrators and providers who must monitor and manage wait times to improve access to cardiovascular care in Canada and restore the confidence of Canadians in their publicly funded health care system.
Asunto(s)
Enfermedades Cardiovasculares/terapia , Accesibilidad a los Servicios de Salud , Programas Nacionales de Salud , Derechos del Paciente , Derivación y Consulta , Canadá , Control de Acceso , Asignación de Recursos para la Atención de Salud , Prioridades en Salud , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Humanos , Programas Nacionales de Salud/legislación & jurisprudencia , Programas Nacionales de Salud/organización & administración , Derechos del Paciente/legislación & jurisprudencia , Responsabilidad Social , Factores de Tiempo , Triaje , Cobertura Universal del Seguro de Salud , Listas de EsperaAsunto(s)
Conducción de Automóvil , Enfermedades Cardiovasculares/diagnóstico , Aptitud Física , Accidentes de Tránsito/prevención & control , Arritmias Cardíacas/diagnóstico , Canadá , Enfermedad Coronaria/diagnóstico , Evaluación de la Discapacidad , Femenino , Insuficiencia Cardíaca/diagnóstico , Trasplante de Corazón , Enfermedades de las Válvulas Cardíacas/diagnóstico , Humanos , Masculino , Formulación de Políticas , Medición de Riesgo , SeguridadRESUMEN
BACKGROUND: Physicians are facing ever-increasing legal obligations in all Canadian jurisdictions to report patients believed to be unfit to drive a motor vehicle or pilot an aircraft. In most Canadian jurisdictions these statutory obligations are mandatory; in others, they are discretionary. OBJECTIVES: To provide a legal perspective on a physician's duty to report in the various jurisdictions in Canada. METHODS: Reporting legislation and case law from each of the Canadian jurisdictions were compared with respect to reporting requirements, physician protection and the production of medical reports. Federal legislation was examined in respect of the duty to report pilots deemed unfit to fly. Lastly, provincial guidelines and medical standards were examined for their impact on standard of care issues. RESULTS: While the obligations vary slightly from one jurisdiction to another, the majority of Canadian jurisdictions provide for mandatory reporting. Additionally, courts have been willing to apply and give considerable weight to medical guidelines, such as those formulated by the Canadian Medical Association and other provincial medical bodies, to determine the scope of a physician's obligation to report. CONCLUSIONS: In all jurisdictions, a physician who fails to report in circumstances where the physician is of the opinion that a driver is unfit faces potential quasi-criminal liability, civil liability and/or College disciplinary proceedings. The current statutory provisions and professional guidelines leave little room for the exercise of discretion on the part of the physician.