Physicians used to be the only people prescribing drugs to patients. Those days are long gone.

Over the last four years or so, in almost every province, limited prescribing and renewal authorities have been granted to other health workers, including pharmacists, nurse practitioners and even naturopaths.

The latest province to follow the trend is Ontario. Despite the Ontario Medical Association’s objections, work is now underway to permit pharmacists to extend, adapt and adjust prescriptions. New draft regulations will govern prescribing by nurses and naturopaths as well. British Columbia, P.E.I. and New Brunswick already have similar legislation, while Alberta pharmacists can become certified to initiate certain prescriptions. Nearly every other province is working on some variation of these ideas.

The decision to extend prescribing authority to non-doctors is a logical response to the growing queues of orphan patients, and to doctors’ clamouring about suffocating workloads. But the trend towards expanding prescribing authority introduces new liability issues for physicians.

“They needn’t fear they will be held liable for the acts of other health professionals where they are working independently,” says Dr. John Gray, the Canadian Medical Protective Association’s executive director and CEO. “But with pharmacists or nurse practitioners, if a physician becomes aware of a drug ordered with the potential to harm a patient, we believe case law suggests a physician has a duty of care to the patient to alert the patient.”

So, in this case, ignorance is an excuse — but not if you haven’t made an effort to be informed. The CMPA, in a notice published in its CMPA Perspective magazine in December, advises that you establish clear lines of communications with your patients’ pharmacists or NPs if they are initiating or changing prescriptions. “This [effort] may include specifying that any communication in this regard be in writing and sent within a defined period of time,” the CMPA’s notice said. “It may also be prudent to clarify in advance the expectations regarding follow-up care and who will typically be responsible for conveying care and information to the patient.” And, just in case you don’t hear it often enough: document, document, document.

Liability exposure aside, Gardiner Roberts health law specialist Lonny Rosen says establishing communication with other prescribing health professionals is an important part of providing good care. “By overlooking this detail, physicians may be placing their patients at risk of harm, and may not be undertaking as thorough an assessment as is required.”

Asking prescribing non-doctors to inform you of your patients’ medication changes is simply a matter of adapting to the latest evolution of Canadian healthcare, says Dr. Gray. “We know pharmacists in hospitals are involved in collaborative care teams, and well accepted by MDs. But there are more safeguards in hospital care, so what we are saying is that the same kinds of safeguards in regards to communication should now be extended into care in the community as well.”