Telemedicine: Have you chosen the right physician?

Since oversight and obligations related to the practice of medicine vary widely from one place to another, the following information will allow you to make an informed decision.

Jurisdiction

To be eligible to practice medicine with people located in Quebec, a physician must have a valid permit to practice medicine in Quebec and be registered as an active member with the Collège des médecins du Québec (CMQ). The CMQ is the professional order of physicians in Quebec.

However, if you make an appointment with a physician for a teleconsultation through a clinic located outside Quebec or a telemedicine company, they may not have the right to practice in Quebec. In this case, the physician is not required to meet the CMQ’s quality criteria. Consequently, if a problem occurs, the CMQ will not be able to intervene with the physician.

Usually, before your teleconsultation starts, the physician should tell you where (province, country) they are licensed to practice. Ask them for this information if they do not volunteer it. If you have to pay a fee for your teleconsultation, you should given this information before you pay.

Physician training

In Quebec, as elsewhere in Canada, physician training is provided by recognized programs. Upon completion of their studies, physicians are certified by the College of Family Physicians of Canada or the Royal College of Physicians and Surgeons of Canada.

For physicians who practice in Canada and who have been trained abroad, Canadian colleges of physicians verify the quality of their training before granting them a permit to practice.

Throughout their professional life, Canadian physicians - including those in Quebec - must complete continuing professional development activities to keep their knowledge up to date and ensure they practice in accordance with the highest standards.

It is impossible to determine the quality of the initial or continuing training of physicians who only have the right to practice outside Canada, since the quality of training can vary from place to place.

Quality of practice

Through its professional inspection programs, the CMQ monitors the quality of practice of physicians who are registered on the Roll of the Order. These programs do not apply to physicians who are registered with another order of physicians, either elsewhere in Canada or in another country.

Other Canadian provinces and territories also have monitoring programs of varying size. Outside Canada, the level of oversight of medical practice varies from country to country.

The CMQ oversees the practice of all physicians who provide consultations in Quebec, regardless of where they obtained their permit to practice or which order of physicians they are registered with.

Referral corridor

During a teleconsultation, it may turn out that your health problem requires a physical examination or an in‑person appointment. If so, a physician who has the right to practice in Quebec must be able to see you in person or refer you to a physician or a clinic with which they have established a referral corridor. They should be able to tell you quickly where to go for the appointment and when.

It is unacceptable for a physician to ask you to take steps to find another physician to have your examination, for example by asking you to go to a walk‑in clinic near you (whether or not through a registration service on a website). Nor is it appropriate for them to refer you to an emergency room if your condition does not warrant urgent care.

Physicians practicing outside Quebec are expected to respect these principles too, but this is not always the case.

Complaints process

If you are not satisfied with the services provided by a physician, here is what you can do.

• If the physician is registered with the CMQ: you can make a report to the Inquiries Division of the CMQ. The Inquiries Division will investigate in order to ensure that the physician has complied with their obligations, in particular with the Code of ethics of physicians of Quebec, the Medical Act, the Professional Code and their regulations.
• If the physician is registered with an order of physicians elsewhere in Canada: you can file a complaint with the medical regulatory authority in the province or territory where the physician is registered. Note that the laws are not the same as in Quebec, the process may take place in English and travel outside Quebec may be necessary.
• If the physician is registered with an order outside Canada: the complaints process varies widely. For more information, consult the medical regulatory authorities (the equivalent of the CMQ) in the state or country concerned.

Sometimes a patient who is not satisfied may decide to take action in the civil courts. Note that Quebec has different laws from the rest of Canada in this regard.

In Canada, all physicians must have professional liability insurance, but this is not necessarily the case in other countries. This insurance allows a physician who is found guilty by a court to pay compensation to the injured party.

Communication

During your consultation with the physician, it is important to understand what the physician is saying and vice versa. To practice in Quebec, a physician must have or acquire sufficient knowledge of the French language to meet the requirements of the Charter of the French Language. If the physician you choose to see does not have the right to practice in Quebec, they may not be able to communicate with you in French. It is advisable to check the languages spoken by the physician who will be doing the teleconsultation, especially before paying the fee.

Validity of prescriptions

Prescriptions for medications issued by Canadian physicians¹ are generally recognized by pharmacists in Quebec. If a prescriber outside Quebec suggests that your medications be sent directly to your home, be careful. Make sure that the prescription has been prepared by a pharmacist who is a member of a Canadian professional order. If in doubt, ask that the prescription be sent safely to your regular pharmacy to make sure you are getting the medication that was prescribed. This way, you will avoid ending up with pills that do not contain the medication or the dose prescribed.²

Prescriptions for laboratory tests or imaging tests (radiology, etc.) issued by a Canadian physician should be accepted by laboratories or imaging clinics in Quebec. Since these situations are still new, some centres may not be accustomed to dealing with prescriptions issued outside Quebec.

Note that it may be more difficult for a pharmacy or a test centre to contact a physician located outside Quebec in order to obtain, for example, clarifications about the prescription or to inform the physician of a result requiring urgent attention.

Prescriptions issued by physicians who are not registered with a Canadian order of physicians are not valid in Quebec.

Consultation request

During an appointment with a physician who does not have the right to practice in Quebec, they may ask you to consult a medical specialist. It will be difficult to obtain this type of consultation in Quebec’s public system. You will have to find a medical specialist in the private system and pay the additional cost. Please note that not all types of medical specialists are accessible in Quebec’s private system.

Access to the medical record

Regardless of where a physician practices, they can access your medical record if you sign a consent form to this effect. It can take a few weeks to obtain the record, which is not very convenient if you are consulting for a semi‑urgent problem.

Only physicians who have the right to practice in Quebec may consult your list of medications and your test results in the Québec Health Record (QHR).

In order to ensure the safety and confidentiality of your personal information, there are rules governing the use of electronic medical records in Quebec. Outside the province, the existence and application of these types of rules vary.

Payment

In Quebec, the fee for a consultation with a physician in the public system is covered by the Régie de l’assurance maladie du Québec. If you consult a physician in Quebec who works in the private system (e.g., private clinic, telemedicine company) or a physician outside Quebec, you must expect to pay the fee for the teleconsultation.

Since fees vary, it is preferable to find out what they are before your teleconsultation starts.

In the event of a dispute about the fee you have been charged, you can submit a request for a conciliation of accounts to the CMQ. However, you cannot request a conciliation of accounts if you have consulted a physician who does not have the right to practice in Quebec.

¹ Canadian physicians: physicians registered with a Canadian order of physicians, that is, the equivalent of the Collège des médecins du Québec in another province or territory.

² For more information, see Health Canada’s website.