Caring for Legacy Patients

Professional Standards and Guidelines Regarding Caring for Legacy Patients

Preamble

In this document, legacy patients are defined as those whose care is taken over by a physician after treatment was initiated by another provider.

The purpose of this document is to guide physicians on the challenges of caring for legacy patients. Physicians must both manage the expectations of legacy patients and independently assess the risk and benefit of their existing treatment plan. These challenges are particularly difficult when involving medication regimes that do not conform to current best practice standards or guidelines.

Professional Standards

Physicians must:

1. not refuse to accept patients to their care because of the medical condition of the patient or their treatment plan; and
2. assess the legacy patient and provide patient-centered care, tailored to the specific circumstances and needs of the patient.

Guidelines

Good care should always consider the individual needs and circumstances of the patient. To provide safe and respectful care to legacy patients in particular, physicians should:

1. consider patient autonomy in shared decision making around treatment expectations. The College encourages the use of agreed upon treatment plans that are documented in the patient record;
2. regularly review medication regimes and discuss the risks and benefits of medications with legacy patients;
3. where appropriate, engage the patient in a discussion about tapering of medications to promote a shared decision-making approach;
4. where appropriate, implement a tapering program that is individualized to patient need and circumstances; and
5. recognize that tapering is not always possible or appropriate. Vulnerable patients should not be destabilized by the imposition of tapering. There will be circumstances where patients cannot tolerate the effects of tapering or refuse to engage in tapering.

Recommended Reading

College of Physicians and Surgeons of Nova Scotia: 

• Initiation of Opioid Therapy for Acute Pain 
• Professional Standard and Guidelines on Accepting New Patients

AMA Journal of Ethics:  

• Reider, TN – Is Non-consensual Tapering of High Dose Opioid Therapy Justifiable? August 2020  

Centre for Effective Practice in Ontario: 

• Managing Benzodiazepine Use in Older Adults 

The 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain   

Choosing Wisely Canada 

Legacy Drug Prescribing Patterns in Primary Care – Mangin, D et al. – The Annals of Family Medicine Vol 16 No 6 Nov 2018