‘If you report me to the MOT, I will report you to the CPSO’

I usually don’t try to win an argument—especially with patients—but I try to present my point of view. This philosophy has helped me tremendously in my career and life however sometimes I encounter a situation that I cannot retreat from—I have to inform the other party about my plan. I personally, like most doctors, don’t like to report patients to the Ministry of Transportation (MOT) over fitness to drive concerns or to the Children’s Aid Society without informing the patient or the parent. Read: Quiz: Test your knowledge on seniors' fitness to drive Mr. F is 66 years old and called to make an appointment about a lack of ability to concentrate and focus. He has been under my care for eight years and I have dealt with his narcissistic nature firmly but gently in the past few years. After a thorough history, I felt that what he had might be more than just a lack of attention or concentration ability so after an explanation I did the cognitive screening MoCA test. He didn’t score well in the test, which raised the suspicion of possible cognitive impairment. I advised him that I was concerned about the result, explained to him what it meant to score low in the test and outlined the next steps. I also advised him that doctors have a legal obligation to protect patients and the public so with such a MoCA result, we usually notify the MOT. Mr. F reacted angrily and said he didn't accept the result—he said he is under tremendous stress at work and that was the reason his performance on the test wasn’t good. I understood his anger and advised him that I would give him a note for two weeks off work, send him for a blood test and then we would meet again to repeat the test. He said he appreciated my offer. Mr. F didn’t show up for his appointment just over two weeks later and didn’t do the blood test. Another appointment was given to Mr. F but he also didn’t show up. I waited for him for more than three months but he didn’t call to reschedule his appointment. I honestly wasn’t sure what to do.... If this gentleman had a deadly motor vehicle accident, would I be liable? Should I just wait until he shows up? Or continue to ask him to come? Should I report him to the MOT based on the previous single questionable MoCA test which was done under the stressful situations the patient stated that he was going through? I asked a few colleagues but none had the answer. I tried to search for the answer on the internet but I found none. I contacted the CMPA. The doctor who I talked to stated that she didn’t really know the answer and that she needed some time to ask some colleagues in the CMPA. She came back with no conclusive answer—which I understood, as the situation is cloudy. I started to feel anxious about the whole situation. I didn’t want to report him to the MOT based on only one test—but what if he had a deadly accident? I asked the staff to call him and to tell him that: “Dr. Jassam is still concerned about your lack of attention and concentration and would like to see you to repeat the test as he didn’t like the first one.” Mr. F lost his temper over the phone and furiously started threatening the staff and myself and stated that he would call his lawyer and the CPSO as we were threatening him. He called the next day to inform the staff that he is checking the CPSO website to start the process of filing a complaint against me—which is a typical reaction for people with narcissist traits. After three days I called him and explained to him that we are not really threatening him but I have a legal obligation to protect him and the street. He continued to threaten me over the phone and stated that if I report him to MOT now or in the future he will report me to CPSO. I advised him that he is entitled to report me if he wants to but this will not stop me from doing the right thing. The conversation ended in an amicable way. The problem is I still don’t have an answer to my first question: After an abnormal MoCA test and the patient doesn’t follow up for further assessment and if they were then involved in a car accident and someone was killed, would I be liable because I didn’t inform the MOT in the first place based on one simple MoCA? Does anyone know the answer or have you encountered such a scenario? Dr. Jabir Jassam is a family physician in Ottawa.

‘If you report me to the MOT, I will report you to the CPSO’

Register for free access or login.

Related Topics