Your father's 'little heart is sick enough': Doctor ordered inappropriate cardiac scan then disclosed medical condition to patient's daughter

A Québec doctor with a disciplinary history of ordering inappropriate tests and breaching patients’ privacy has been found guilty of similar offences and suspended for eight months. Dr. Pierre Couchesne, a Montreal-area family doctor and cosmetic surgeon, was also ordered to pay a $7,000 fine plus investigation and hearing costs in his latest disciplinary case, which was triggered by a complaint that in July 2017 he had ordered an unnecessary cardiac computed tomography scan for a male patient—then left a voice mail for the patient’s daughter that stated her father’s “little heart is sick enough as is.” Until she listened to that voice message, the patient’s daughter had been unaware her father had health problems, according to the case document issued by the disciplinary board of the Collège des médecins du Québec. The patient in question was, at the time, the potential buyer of an inn owned by Dr. Courchesne. During a phone call to negotiate the terms of the purchase, the patient—who was not under the care of Dr. Courchesne—mentioned that he was feeling unwell and was experiencing indigestion, dizziness and pain in his left arm. Read: 'It drives me nuts!' Women undertreated for aortic stenosis Dr. Courchesne ordered a cardiac computer tomography scan, to be done at the Institut de cardiologie de Montréal, and stamped the request as “urgent.” He told college investigators that he was convinced the patient did not present signs suggesting acute coronary syndrome but rather an atypical chest discomfort which could be of cardiac origin. Consequently he asked the patient to go to emergency if the symptoms were to recur. The college’s witness observed that Dr. Courchesne’s notes on the patient were brief and missed a number of important elements, including the duration of the symptoms, if the pain experienced by the patient occurred at rest or with exertion, and whether or not the patient has a medical history of coronary artery disease or any other medical condition for which he might be taking medication a regular basis. Dr. Courchesne admitted that he did not have any of this information. Given that the patient was not under the ongoing care of his practice, Dr. Courchesne should have been more rigorous in his clinical investigation, the college witness stated during the investigation. When an acute coronary event is clinically suspected, as was the case with this patient, the appropriate course of action is to recommend that the patient go quickly to a hospital emergency department to be evaluated, given a physical examination and first-line tests, including an ECT, and administered a dosage of cardiac enzymes, according to the college witness. Read: Updated guidelines ask clinicians to Choose Wisely when ordering MRI and CT scans The college witness also noted that Dr. Courchesne’s own expert witness said coronary angiography is done when electrocardiogram results are not interpretable. In this case, however, an ECG was never ordered. Dr. Courchesne himself acknowledged that coronary angiography is a second-line examination, according to the case document. The cardiac computed tomography he had ordered for this particular patient was, in fact, the first time he had ever prescribed such a test. In his defence against the charge that he had breached the patient’s privacy, Dr. Courchesne argued through his lawyer that the daughter must have already known her father had health problems since she was aware he had spoken to Dr. Courchesne about them. But the disciplinary board stated it could not subscribe to such a view. “There is no half-offence,” the board wrote in its decision. “By mentioning this information, the respondent opened a breach in the confidentiality of the state of health of (the patient). Any deviation from this principle cannot be tolerated or trivialized . . .. Physicians must act as guardians of their patients' privacy and of professional secrecy.” Read: Coronary angiography Dr. Courchesne has been suspended twice over the last two decades for similar offences. His most recent disciplinary sanction, in 2017, got him a four-month suspension for pushing a patient to get unnecessary blood work at a private lab owned by his spouse, and for letting his clinic nurse’s 11-year-old daughter observe his appointment with the patient. When the patient’s extended health insurance provider rejected the claim for the lab tests, Dr. Courchesne demanded that he pay the $2,800 bill out of pocket and left a phone message calling him a “jerk” and insulting his wife. Dr. Courchesne also amended the patient’s files to note that he had given him a genital examination on his last visit—an apparently fictitious entry that got him into bigger trouble given that the nurse’s daughter had been present during this appointment. In 2000, the college reminded Dr. Courchesne about the importance of protecting patients' privacy after he produced a list of patients during a civil trial. Sixteen years later he was suspended for two months after being found guilty of failing to maintain professional secrecy. Read: Quebec family doctor suspended over tests, conduct

Your father's 'little heart is sick enough': Doctor ordered inappropriate cardiac scan then disclosed medical condition to patient's daughter

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