Proper follow-up with patients needed before doctors retire, Quebec coroner says

A Quebec coroner has raised concerns with the follow-up provided to patients with mental health issues following the tragic suicide of a father of two who lost his family doctor because he retired.

The man, who was in his 40s, lived in a small city in Quebec's Montérégie region and died by suicide in the summer of 2023.

According to a report by Coroner Josée Castonguay, the man had a history of mental health issues for several years and was prescribed an anti-depressant following a previous suicide attempt. He suffered from social phobia, which is described as "an intense fear of being exposed to the gaze and judgment of others, creating significant anxiety and suffering," in the report.

However, the man was not being treated by a psychologist or any mental health professional and was left with no medical follow-up "since he no longer had a family doctor, following his physician's retirement."

Le Soleil first reported on the coroner’s report last week.

Castonguay said this issue was brought up with the Collège des médecins (CMQ) to flag the importance of referring someone with mental health issues to a health professional or ensure a colleague follows up when a doctor retires.

The coroner recommended that the Collège des médecins "intensify its efforts to inform and raise awareness among its members to ensure that when a physician retires or changes practice location, he or she ensures timely follow-up by a colleague for patients with mental health problems."

According to statistics from the CMQ, an estimated 330 family doctors over the age of 50 changed their status to "inactive" or "retired" in 2023, with a peak of 413 one year earlier. The figures show that there appears to be an upward trend since 2014, but the college cautions that the numbers are just estimates as it is not informed of the reason for the doctor's change in status and some doctors can subsequently re-register their status to "active."

The college declined an interview request from CTV News but said in an email on Tuesday that it had recently issued a reminder to physicians regarding their "ethical obligations with respect to cessation of practice." The reminder targeted family physicians over 50 since they are mostly likely to retire.

A 13-page guide published in April 2024 recommends doctors assign a priority rating to patients based on their conditions when referring them to the Guichet d'accès à un médecin de famille (GAMF) prior to leaving their practice.

"The notice should allow patients to know what they need to do to: 1) get a new family doctor, 2) receive medical care and services after their relationship with their doctor has ended, and/or 3) obtain a copy of their medical records," the guide says.

According to the guide, the highest priority should be given to patients with "unstable health problems or under evaluation."

Patients being treated for or in remission from depression should be placed under the Priority C category, with follow-up within six months.

The guide also includes samples of templates that can be used to refer patients for follow-up care.

Here is a list of mental health resources in Quebec

If ever you need help, don't hesitate to reach out to:

Your family doctor (if you have one)
Call Info-Social 811 to get help or information regarding your mental health or the mental health of a family member or friend.

Call the 911 emergency service if you fear for your safety or the safety of a family member or friend or to obtain immediate assistance.

Call or text the 988 suicide crisis helpline when in crisis, or when they know someone is in a crisis, 24 hours a day and seven days a week, free of charge.

Find a crisis centre (in French only) near you to obtain free specialized crisis intervention services for you or a loved one.

If you need immediate assistance, call 911 or go to the nearest hospital.