That day, two children lost their father. The man in his forties, who lived in a small municipality in Montérégie, took his own life.
In her report dated November 18, coroner Josée Castonguay explains that the man had already been hospitalized “several years previously” following a suicide attempt. Suffering from “social phobia and depression”, he had received “psychiatry follow-up for several months”.
The father was not followed by a psychologist or another mental health professional. “No longer having a family doctor following the retirement of his doctor, he found himself without any medical follow-up,” explains the coroner.
In his report, Me Castonguay questions the follow-up to be offered to patients living with a mental health problem who lose their family doctor.
“There is reason to question the importance of directing a person suffering from mental health problems for several years to a professional or a help center or at least of ensuring, when a family doctor puts an end to when following up a patient with a mental health problem, have a colleague take care of him.”
— Extract from the report of coroner Josée Castonguay
Me Castonguay recommended that the College of Physicians of Quebec “intensify its information and awareness efforts among its members” so that patients with mental health problems obtain “timely follow-up” when their doctor takes their retirement or change of practice location.
An upward trend
Without having precise statistics on the number of family doctors who retire, the College provided data on the quantity of general practitioners over the age of 50 who change their status to become “inactive” or to “resign”. These data, although “approximate”, make it possible to detect an upward trend over the past ten years.
The College of Physicians recently issued a “reminder to doctors” about their ethical obligations when they stop practicing. A 13-page “support guide” was published in April to guide those who wish to retire or stop working for health reasons.
To help doctors prioritize which patients they should discontinue, the guide provides some examples.
Priority A (“without delay” care) should be granted to “patients with unstable health problems or those currently being evaluated”.
Cases of chronic psychiatric problems “such as schizophrenia, with onset of cognitive impairment” should be assigned a priority rating of B to obtain follow-up within one month.
Patients whose depression is “in treatment” or “in remission” should be considered priority C cases, which requires follow-up within six months.
The guide emphasizes that cases classified A or B “should not be transferred” to the access desk during a slowdown in practice.
Dr. Mauril Gaudreault, president of the College of Physicians of Quebec (COURTESY)
The president of the College of Physicians of Quebec, Mauril Gaudreault, specifies that “technically”, no article of the Code of Ethics prevents a doctor from “relieving part” of his patients. However, it is important that they respect “the articles related to care and follow-up”.
In a written statement sent to the Coops de l’information, Dr. Gaudreault adds that a slowdown in practice “is a difficult process” for doctors. Several also “regretfully” opted for a complete stop, due to not being able to transfer some of their patients to other doctors.
In the eyes of the president of the College, it is “obvious that the family doctor can no longer be the only entry point to the health network”. The College welcomes the fact that specialized nurse practitioners can now take care of patients registered at the family doctor access window.
Since the start of 2024, seven complaints have been received by the Office of the Syndic “in relation to doctors who are retiring and who do not respect their Code of ethics”. There are, however, very few cases where a doctor (or ex-doctor) has been found guilty of an offense under articles 35 or 36. According to the review carried out by the College, this has happened only twice since 1988 and none of these cases was related to retirement.
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