MCC VaultThese duties are set mostly by provincial and territorial law, so details differ. The principles below are what the exam tests. A legal duty to report overrides confidentiality and does not need the patient's consent, but tell the patient where it is safe to, share only what is needed, and document it.
Reportable diseases
- Each province lists its reportable diseases. Report to the local public health unit (the Medical Officer of Health).
- Immediately, by phone, on suspicion: measles, invasive meningococcal disease, botulism and diphtheria, among others. Do not wait for a lab result.
- Also reportable: tuberculosis; chlamydia, gonorrhea, syphilis and HIV; hepatitis A, B and C; pertussis; E. coli O157 and other food-borne illness; Lyme disease; rabies exposures; and outbreaks in institutions.
- Public health usually traces contacts. Close contacts of meningococcal disease get ciprofloxacin, rifampin or ceftriaxone; health workers need it only after unprotected contact with secretions, such as during intubation.
Children
- Every province and territory requires anyone, including physicians, to report a reasonable suspicion that a child is being abused or neglected, to child protection services.
- Proof is not needed. The duty is personal: you report yourself, even if a colleague has also reported. Physicians are protected when they report in good faith.
- The age covered differs: in Ontario the duty applies under 16 (16- and 17-year-olds may be reported); British Columbia covers children under 19.
- In most provinces, exposure to intimate partner violence is a form of maltreatment.
- Sexual activity outside the Criminal Code's age-of-consent rules (16, with close-in-age exceptions) is reportable as abuse.
Driving, flying and other safety duties
- Unfit to drive: reporting is mandatory in most provinces (for example Ontario and British Columbia) and discretionary in a few (such as Alberta and Quebec). Use the CMA Driver's Guide. Tell the patient not to drive and document it.
- Pilots and air traffic controllers: conditions that affect safety are reported to Transport Canada under the federal Aeronautics Act. Similar federal duties apply to railway workers.
- Gunshot wounds: reported to police in several provinces (for example Ontario).
Deaths
- Sudden, unexpected, violent or unnatural deaths, and deaths in custody, go to the coroner or medical examiner. Do not sign the death certificate or remove lines and tubes yourself in these cases.
- Medical examiners are used in Alberta, Manitoba, Nova Scotia and Newfoundland and Labrador; coroners elsewhere, such as Ontario, Quebec and British Columbia.
Work and care homes
- Work injuries and diseases: report to the provincial workers' compensation board (for example Ontario's Form 8 to the WSIB). Tell the employer the worker's functional abilities, not the diagnosis.
- Long-term care: harm or risk of harm to residents is reportable in some provinces, including Ontario.
Colleagues
- Sexual abuse of a patient by a regulated health professional must be reported to their college in Ontario and other provinces.
- An impaired colleague at work: remove them from patient care first, then involve the department and the physician health program, and report to the college where required.
When you may break confidentiality to protect someone
- Smith v. Jones (Supreme Court of Canada, 1999): a clear risk to an identifiable person or group, of serious bodily harm or death, that is imminent. Disclose only what is needed to prevent the harm, to the person at risk and/or the police.
- A court order or subpoena: disclose only what it covers.
Not a reason to disclose
- A relative's or employer's curiosity, or a "concerned" phone call.
- Your own worry without a clear, serious and imminent danger.
- Looking at the record of someone you are not caring for is a privacy breach.