Alberta Doctors' Digest January/February 2017

Alberta Doctors'

DIGEST January-February 2017 | Volume 42 | Number 1

Priming our brains for 2017 I think I remember

Alberta Medical Association Board of Directors 2016-17

It’s a new year

We can all sharpen our focus

Cheese and crackers; sunshine and water; physicians and schools

AMA Youth Run Club: School health advocacy talks

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CONTENTS DEPARTMENTS

Patients First® is a registered trademark of the Alberta Medical Association.

Alberta Doctors’ Digest is published six times annually by the Alberta Medical Association for its members.

Editor: Dennis W. Jirsch, MD, PhD

4 From the Editor 10 Health Law Update 14 Insurance Insights 16 Dr. Gadget

Co-Editor: Alexander H.G. Paterson, MB ChB, MD, FRCP, FACP Editor-in-Chief: Marvin Polis President: Padraic E. Carr, BMedSc, MD, FRCPC, DABPN

PFSP Perspectives Residents' Page In a Different Vein Classified Advertisements

FEATURES

4 Priming our brains for 2017

President-Elect: Neil D.J. Cooper, MD, FRCPC, Dip. Sport Med.

Immediate Past President: Carl W. Nohr, MDCM, PhD, FRCSC, FACS

Alberta Medical Association 12230 106 Ave NW Edmonton AB T5N 3Z1 T 780.482.2626 TF 1.800.272.9680 F 780.482.5445 amamail@albertadoctors.org www.albertadoctors.org

21 24 26 30

I think I remember

7 It’s a new year. We can all sharpen our focus.

A message from our Editor-in-Chief

8 Alberta Medical Association Board of Directors 2016-17

13 AMA seeks 2017 nominations for our highest awards 18 Cheese and crackers; sunshine and water; physicians and schools

AMA Youth Run Club: School health advocacy talks

March-April issue deadline: February 10

The opinions expressed in Alberta Doctors’ Digest are those of the authors and do not necessarily reflect the opinions or positions of the Alberta Medical Association or its Board of Directors. The association reserves the right to edit all letters to the editor.

The Alberta Medical Association assumes no responsibility or liability for damages arising from any error or omission or from the use of any information or advice contained in Alberta Doctors’ Digest. Advertisements included in Alberta Doctors’ Digest are not necessarily endorsed by the Alberta Medical Association. © 2017 by the Alberta Medical Association Design by Backstreet Communications

AMA MISSION STATEMENT The AMA stands as an advocate for its physician members, providing leadership and support for their role in the provision of quality health care.

To request article references, contact:

daphne.andrychuk@albertadoctors.org

COVER PHOTO:

Dr. Dennis W. Jirsch, Editor, Alberta Doctors' Digest JANUARY – FEBRUARY 2017

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4

COVER FEATURE/FROM THE EDITOR

Priming our brains for 2017 Dennis W. Jirsch, MD, PhD | EDITOR

I think I remember When I was younger, I could remember anything, whether it had happened or not; but my faculties are decaying now, and soon I shall be so I cannot remember any but the things that never happened.

- Mark Twain (Autobiography)

T

oo often, I find myself in the basement of my house, looking for something I had in mind a moment ago. But I’ve forgotten what I’m looking for. It’s gone. One solution involves climbing the stairs again, returning to where I started and perhaps I’ll remember. This has been going on forever, I admit. I’m forgetful and make sure I have extras ¬ hats, gloves, car keys ¬ to handle my lapses and help me through the day.

It’s mere absent-mindedness, I tell myself, but my story has become less convincing. Too many colleagues and kith and kin, aging alongside me, have disappeared into clouded, anxious fuzziness. Truth is, I am worried. And so are my demographic cohorts: Alzheimer’s and other dementias have become grim prospects. In medical school, seemingly epochs ago, Alzheimer’s was an uncommon diagnosis; nowadays losing one’s marbles can seem almost inevitable.

Too many colleagues and kith and

kin, aging alongside me, have disappeared into clouded, anxious fuzziness. Truth is, I am worried. And so are my demographic cohorts.

The tragedy of losing personal memories has happened at the same time that technology has externalized our recall with all the electronic gadgets at our disposal.

AMA - ALBERTA DOCTORS’ DIGEST

It has perhaps encouraged students, trying to get at the marrow of things, to complain, “We don’t really have to know all this. Do we?”

I don’t know what to say to them, thinking that we still have to know something. Defining exactly what can be sourced and what must be known may be one of the most vexing issues in education today.

Years ago emphasis was more on rote learning, but even then some tricks could assist. Preparing for dreaded oral exams, I practiced classifying everything: eggs (small, medium, large), watches (battery driven, automatic, requiring winding, cheap versus expensive) and so on.

This was all preparation so that if one were asked, say, the complications of appendicitis, one might recall that these could be discussed as early, middle, late; or local versus regional; or even surgery-related or anesthesiarelated. A ready template on which to hang things could help show examiners a reasonable acquaintance with most subjects.

Looking farther back in history, memorization was crucial.

Recall the early days of books, when they were bulky, expensive things, written in run-together scriptio continua, lacking punctuation, paragraph indents and indices.

A robust tradition of oral recitation was one way to “own” the work. We doubtlessly read more widely now, with web resources available, but we read more superficially, as we hop from screen to screen.

Years ago, in The Mind of a Mnemonist,1 I read an account of a memory that was seemingly limitless. Soviet psychologist A.N. Luria, PhD, studied subject “S” for over 30 years and found his subject could memorize complex mathematical formulas, gibberish, huge matrices and even poems in foreign languages. Once memorized, S could regurgitate facts years later and he even had problems forgetting. Luria noted that S was not unusually intelligent but, attempting to explain his ability, was a synesthete, meaning that words and numbers readily evoked images, sounds, tastes and sensations.

More recently, I read Joshua Foer’s book, Moonwalking with Einstein: The Art and Science of Remembering Everything.2 It’s an engaging text that reminds us that on average we >

> all spend an extra 40 days each year catching up because we can’t remember. (Although just how that number was arrived at is not elucidated.) Foer became interested, and then enthused, with memory contests. He went on to study various mnemonic aids, and, denying any special abilities, went on to become a memory champion himself.

Did I say there were aids involved? Perhaps it’s best to call them tools. The oldest tool has been called the “memory palace” or “the method of loci.” It is attributed to the poet Simonides, who, standing in the rubble of a demolished temple in Thessaly, was able to recall the names of the persons involved from their locations prior to the destruction. Cicero expanded on the method of loci in his De Oratore. A subject recounts the layout of a building or a town with discrete loci or places, and moving mentally through these, commits an image to each site. Retrieval of associated memories occurs on mentally moving past or through the loci again.

Another tool is referred to as the “major system.” It is a device that helps with numbers. Each numeral from 0 to 9 is associated with one or more consonants. For example, 0 is s or z, 1 is t or d, 2 is n, 3 is hard k and so on). Vowels are undesignated so the number 302 becomes c, s, n and adding arbitrary vowels, could be remembered as cousin.

In medical school, seemingly

epochs ago, Alzheimer’s was an uncommon diagnosis; nowadays losing one’s marbles can seem almost inevitable.

Many other, often hybrid, mnemonic devices can be used to convert bland consonants or numbers into images and have made fortunes for champion mnemonists. Early memory pioneer Tony Buzan, for example, has become famous (and rich) for well-marketed books and courses aimed at improving memory.

Let’s not underestimate the size of this accomplishment.3,4,5 How many random numbers can you recall? How many binary (0, 1) digits? How many decks of playing cards (shuffled, of course), can you recall? Here’s the field you’re playing in: • Akira Haraguchi has recounted pi to 111,700 digits.

• Johannes Mallow memorized 4,356 binary digits in half an hour.

• Medical student Alex Mullen was able to memorize a shuffled deck of cards in 19.41 seconds.

Most tasks in the World Memory Championships involve recall of written and spoken numbers, binary digits or shuffled decks of cards. One of the jobs, however, involves remembering poetry. Many find this toughest since this has to be remembered perfectly, including punctuation and abstract text can be uniquely difficult to compress into images.

How many random numbers can

you recall? How many binary (0, 1) digits?

How many decks of playing cards (shuffled, of course), can you recall?

As Joshua Foer did, I began my own memory practice using T.S. Eliot’s The Love Song of J. Alfred Prufrock: Let us go then, you and I/When the evening is spread out against the sky/Like a patient etherized upon a table/ Let us go, through certain half deserted streets/ the muttering retreats/Of restless nights in one night cheap hotels/ and sawdust restaurants with oyster shells …

The nouns (evening, patient, table, streets, nights, restaurants, oyster shells) are straightforward enough, but what about the idiosyncratic descriptions of the evening, the patient, the half deserted streets? Not so simple.

Though I am able now to use the memory palace to recall in order a dozen nouns or so, and though I can correctly regurgitate a 12 or 15-digit number, Eliot’s stuff was difficult, perhaps impossible, for me to turn into sustainable images (including punctuation) with any of my new but inchoate tools.

Back to brute strength again. How do you get to Carnegie Hall? Practice, practice, practice. Repetition, repetition, repetition. With that old slam-bam method, I’m able to memorize a line or two a day, but perfectly and I am now about 40 lines into the poem. It’s been tougher than I expected, but also more pleasurable, getting to own a line of Prufrock.

I now remember pi to 20 digits, know a quarter of Prufrock. That’s gotta be called success. In sum, I’m modestly satisfied knowing that my cranium still has room for new memories, though I’m not so sure that these aren’t crowding old ones out.

Trouble is, I still don’t know where my car keys are.

And by the way, have you seen my hat?

References available upon request.

JANUARY – FEBRUARY 2017

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AMA - ALBERTA DOCTORS’ DIGEST

FROM THE EDITOR-IN-CHIEF

7

It’s a new year

We can all sharpen our focus

W

hether we're taking up new resolutions or just toning up after holiday relaxation, there's no better way to start 2017 than by sharpening our minds. Alberta Doctors’ Digest editor Dr. Dennis W. Jirsch starts us on the right road by providing some thoughts about memory and shares his suggestions for improving memory focus and acuity.

Here at Alberta Doctors’ Digest we'll be sharpening our own focus in 2017.

We'll bring you more of our popular specialty-themed issues and explore significant in-depth topics for the profession. As always, we’ll bring you different perspectives and voices.

Also this year we'll be looking at ways to ensure that Alberta Doctors’ Digest is delivered in the way that suits members best. We've had significant interest in taking the publication to an electronic format so we will explore what that might look like and how we can and should evolve to continue to meet your needs.

We will be talking to you about any new ideas as we consider our options.

I look forward to the conversation. Your comments on Alberta Doctors’ Digest and letters to the editor are welcome anytime. You can reach us at amamail@albertadoctors.org All the best in 2017.

Marvin Polis Editor-in-Chief Alberta Doctors’ Digest

JANUARY – FEBRUARY 2017

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FEATURE Alberta Medical Association Board of Directors 2016-17

Seated, left to right: Dr. Kimberley Kelly; Dr. Carl Nohr, Immediate Past President; Dr. Padraic Carr, President; Dr. Neil Cooper, President-Elect; Dr. Kathryn Andrusky.

Standing, left to right: Finola Hackett, MSA observer; Dr. Shelley Duggan; Dr. Paul Parks; Dr. Derek Townsend; Dr. Michael Martyna, PARA observer; Michael Gormley, Executive Director; Dr. Lloyd Maybaum; Dr. Paul Boucher; Dr. James Pope; Dr. Christine Molnar; Dr. Robin Cox.

AMA - ALBERTA DOCTORS’ DIGEST

JANUARY – FEBRUARY 2017

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HEALTH LAW UPDATE

I get high with a little help from my … prime minister?

Jonathan P. Rossall, QC, LLM | PARTNER,

I

n the fall of 2014, Alberta Doctors’ Digest published a Health Law Update story entitled “I get high with a little help from my … doctor?” It focused on one of the hot topics for discussion at the Canadian Medical Association (CMA) Annual General Meeting in Ottawa that year: the prescription of medical marijuana by Canadian doctors.

The medical profession is taking

shots at the federal government’s expressed intention to legalize the possession and use of marijuana by 2019.

The discussion was a response to the federal government’s restructuring of Canada’s medical marijuana system in the early part of 2014, which essentially made the physician the gatekeeper for accessing medical marijuana. Patients needed to obtain a prescription from their physician which, in turn, would be submitted to one of an increasing number of federally licensed growers. This caused significant discomfort for many physicians who simply were not satisfied that the science supported the use of this drug. Fast forward to December 2016. Now the medical profession is taking shots at the federal government’s expressed intention to legalize the possession and use of marijuana by 2019.

AMA - ALBERTA DOCTORS’ DIGEST

MCLENNAN ROSS LLP

Canadian Medical Association marijuana survey results The new controversy stems from the release of a federal task force’s recommendations regarding legalization.

Prior to the release of the recommendations, the CMA had conducted an electronic poll of physicians regarding non-medical use of marijuana. The results were diverse, and they conflicted in part with the ultimate determinations of the task force, as in the following examples.

• Doctors thought it was a bad idea to have marijuana sold in pharmacies and they wanted the federal government to ensure the quantity of THC was labelled and even regulated.

• 65% of doctors disagreed with using mail service to distribute non-medical marijuana and 57% disagreed with using pharmacies for distribution. 56% thought existing non-health care structures like liquor stores should sell it and 47% thought legal storefronts (dispensaries) were suitable for the purpose.

• Doctors were equally split on whether people should be allowed to grow their own non-medical marijuana.

• 80% said people should only consume non-medical marijuana in their homes, 36% said it was ok in designated public places and 43% said people should be able to smoke it wherever tobacco is permitted.

• 45% of doctors said Canadians over the age of 21 should be able to buy legal marijuana and 35% said the age should be 18 or 19.

• 72% said government should regulate THC levels in non-medical marijuana. >

> Federal task force recommendations The recent federal task force recommendations include a proposal to allow those 18 years and over to access marijuana for non-medical reasons. Doctors are still split on the adequacy of this age threshold. Many argue against it because of evidence that cannabis use can cause changes to the brain which, according to researchers, continues to develop until roughly age 25.

The CMA (perhaps relying in part on the survey results) has in turn recommended a compromise limiting legal purchase to those 21 and older. Of course, the difficulty with setting the age limit higher is the risk that this will continue the existence of the illicit market, with no regulation on the sale of a poorly controlled product.

Physicians seem united in backing

the science that demonstrates the impact even small amounts of THC can have on reaction times and general driving ability.

A related issue of concern to physicians (and others) is potential impact of legalized use of marijuana on driving patterns and, particularly, the current inability of police forces across the country to adequately detect the presence of excessive levels of THC in a driver’s blood. Physicians seem united in backing the science that demonstrates the impact even small amounts of THC can have on reaction times and general driving ability.

11

There are potential health dangers

to marijuana use, so there does seem to be a consensus in the medical community on one thing: the need for a comprehensive and well thought-out public education program …

“I don’t think there’s any Canadian … who smokes cigarettes who thinks it’s good for them … We’ve not done nearly as good a job educating people, particularly young people, about some of the potential dangers of marijuana use.”

It will be interesting to watch how this all unfolds in 2017.

References available upon request.

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Here’s one interesting side note in the discussion. The current thinking of the Liberal government in terms of taxation is to pro-rate the amount of tax payable on purchased marijuana based on the potency of the drug – the more THC present in the product, the higher the tax payable.

There are potential health dangers to marijuana use, so there does seem to be a consensus in the medical community on one thing: the need for a comprehensive and well thought-out public education program aimed at new and existing users. Dr. Jeff Blackmer, CMA vice-president of medical professionalism, recently underlined this need:

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JANUARY – FEBRUARY 2017

AMA - ALBERTA DOCTORS’ DIGEST

FEATURE

13

AMA seeks 2017 nominations for our highest awards

T

he Alberta Medical Association (AMA) is calling for Achievement Award nominations for individuals who have contributed to the improvement of the quality of health care in Alberta.

The Medal for Distinguished Service is given to a physician(s) who has made an outstanding personal contribution to medicine and to the people of Alberta and in the process has contributed to the art and science of medicine while raising the standards of medical practice.

The Medal of Honor is awarded to a non-physician(s) who has raised the standards of health care and contributed to the advancement of medical research, medical education, health care organization, health education and/or health promotion to the public.

Nominations must be submitted by April 28. The awards will be presented at the AMA’s fall 2017 annual general meeting in Edmonton.

To request a nomination form for these awards, please contact Janice Meredith, Administrator, Public Affairs, AMA: janice.meredith@albertadoctors.org, 780.482.2626, ext. 3119, toll-free 1.800.272.9680, ext. 3119. Or visit the AMA website at www.albertadoctors.org.

In 2016, three physicians were recognized with Medals for Distinguished Service: • Dr. John M. Conly, Calgary • Dr. Christopher J. (Chip) Doig, Calgary • Dr. Charles H. Harley, Edmonton In 2016, two people were recognized with the Medal of Honor: • Dave Colburn, Edmonton • Jocelyn M. Lockyer, PhD, Edmonton To read more about the 2016 honorees, visit the AMA website at www.albertadoctors.org.

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JANUARY – FEBRUARY 2017

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INSURANCE INSIGHTS

AMA Term Life Insurance Even more competitive in 2017 J. Glenn McAthey, CFP, CLU, CHS | DIRECTOR,

Harmonized Life Insurance update

E

xactly five years ago we announced our collaboration with the Doctors of BC and the Saskatchewan Medical Association (SMA) for a harmonized group life insurance program for our respective members.

By joining forces we were able to reduce our rates for non-smokers an average of 19% and introduce other improvements, most notably the conversion option that allows the insured to exercise a conversion of coverage to an individual permanent insurance policy at any time up to age 70.

In addition to the lower rates, the non-profit nature of the plan allowed us to return excess premiums (gross premiums less claims and expenses) to members through our Alberta Medical Association (AMA) Premium Credit. Our credit in 2012 and 2013 was 15%.

It rose to 20% for each of 2014, 2015 and 2016. As of December 2016, we insure over 6,500 members and spouses with total in-force coverage of $3.9 billion!

We are pleased to advise that for 2017 we have been able to further reduce non-smoker rates for members in age-bands 40 to 60 by an additional 15% and continue with our 20% AMA Premium Credit.

We can definitely conclude that our collaboration with Doctors of BC and the SMA has benefitted our members, and we are confident that improvements will continue in the future.

Is it time to review your coverage?

If you haven’t considered our coverage recently, perhaps you will now. The first step is to review your

AMA - ALBERTA DOCTORS’ DIGEST

ADIUM INSURANCE SERVICES INC.

life insurance needs. You can do this by contacting one of our salaried insurance advisors: • Ms Kelly Guest (from Red Deer north) • Ms Mona Yam (Southern Alberta) They can complete a life insurance needs analysis for you that encompasses your immediate cash needs, such as funeral expenses and debt (mortgage, line of credit, etc.), educational funding for children and income needs for surviving dependents. You may also use our online calculator to calculate your own needs.

• Go to the AMA website (www.albertadoctors.org).

• Enter “Life insurance rate calculator” in the (top-right) search field.

• Click “Life Insurance needs analysis and premium calculator.”

Note that our rate calculator provides our standard non-smoker rates before any premium credit and that for those members enjoying very good health, we have even lower Preferred and Elite rates that you may be approved for during the underwriting process, provided you apply for at least $250,000 coverage.

Is your mortgage or line of credit life insured through your financial institution?

Anyone who has taken out a mortgage or a line of credit has been asked if they want to insure it. The purpose of this is to pay off the balance of the debt in the event of your death. What many people don’t realize is that they can insure their mortgage or line of credit through their own life insurance, which encompasses the retirement of debt plus your other needs, such as income requirements for dependents. The coverage is all in one place and you might get a much better rate with the AMA Term Life Insurance plan. Plus your coverage will not decrease as your pay down your debt. >

> How much does AMA Term Life Insurance cost?

Below are sample monthly non-smoker premiums for $100,000 standard rates. These may be extrapolated to up to $5 million.

Female Age

Published Rate

After 2017 AMA Premium Credit

25

$1.58

$1.26

35

$3.15

$2.52

45

$5.19

$4.15

55

$15.03

$12.02

Age

Published Rate

After 2017 AMA Premium Credit

25

$2.79

$2.23

35

$4.24

$3.39

45

$8.00

$6.40

55

$21.93

$17.54

Male

Evolving needs As you age, your need for term life insurance typically will decrease or disappear as a result of paying off debt, dependents becoming independent adults and the maturation of your financial plan. The need for permanent life insurance should be discussed either with an ADIUM advisor, who may refer you to MD Financial Management for further information, or with your MD Financial Management financial consultant.

Permanent insurance is just that; it stays in force your entire life and is purchased for permanent needs such as paying taxes that become payable at death or for tax-free accumulation of funds inside the policy.

Need confidential advice dealing with patient advocacy or intimidation in the workplace? Call the Zone Medical Staff Association (ZMSA) operated

Practitioner advocacy assistance Line (PaaL)

1.866.225.7112



The PAAL is a 24-hour confidential service you can call to share the issue and obtain advice from your ZMSA. All calls are answered by Confidence Line, an independent provider of confidential reporting lines.

The PAAL service has been transferred out of Alberta Health Services and is now operated at arm’s length by ZMSAs.

For more information visit albertadoctors.org/paal

Trying to make sense of your medical billing?

Frustrated with your current biller?

Northern Alberta (from Red Deer north) Ms Kelly Guest, EPC, CHS Insurance Advisor T 780.482.0306 kelly.guest@albertadoctors.org Southern Alberta Ms Mona Yam, CFP, CLU, CHS, BComm, BA Insurance Advisor T 403.205.2088 mona.yam@albertadoctors.org

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JANUARY – FEBRUARY 2017

15

16

DR. GADGET

Is there a good app for that?

Wesley D. Jackson, MD, CCFP, FCFP

T

he interest in mobile health has grown exponentially in recent years with an estimated 200,000 health and medical apps currently available. While fitness applications (apps) have consistently been the most popular choice, more and more consumers download and use the plethora of other health apps available on all platforms. Standards of quality in apps have been slow in development.

In the United States, the Food and Drug Administration currently applies the only regulatory standards for apps related to medical devices. At the time of writing, Canada has no such regulation. In 2015, however, the Canadian Medical Association (CMA), published “Guiding Principles for Physicians Recommending Mobile Health Applications to Patients.”1 The document outlines basic information for physicians about how to assess a mobile health application for recommendation to a patient in the management of that patient’s health, health care and health care information. The seven characteristics of an app suitable for recommendation highlighted in this document include: 1. Endorsement by a professional or recognized association, medical society or health care organization 2. Usability 3. Information reliability 4. Privacy and security 5. Freedom from conflict-of-interest 6. No contribution to fragmented health information 7. Demonstrated impact on patient health outcomes

AMA - ALBERTA DOCTORS’ DIGEST

On November 16, 2016, the American Medical Association released a physician adjudicated guide to health app recommendation2 that mirrors many of the CMA principles, with specific focus on integration of these tools into clinical workflows, patient-physician relationships and reimbursement models. Other major health care providers on both sides of the border are contributing to standards that will hopefully shape the future quality of health care apps available. However, the clinicians of today must make informed decisions based on their own experience and research prior to using or recommending apps to colleagues and patients.

Librarians have been using a tool named "The CRAP Test"3 (who ever said that librarians were boring?), developed by Molly Beestrum, when deciding if a website is a credible, valid source. The CRAP test examines four major areas of a website: • Currency (regularly updated) • Reliability (evidence based) • Authority (author credentials) • Purpose (pushing agenda or selling something) While I’m unaware of a similar test to review health apps, these principles still apply and can be useful in evaluating any app considered for recommendation or use.

I have recently become aware of a new Canadian website, launched in August 2016, dedicated to the assessment of patient-focused health apps. Practical Apps,4 a collaboration between Ontario Telemedicine Network and The Women’s College Hospital Institute for Health System Solutions and Virtual Care, was created to help physicians use mobile tools to help their patients. Practicing physicians have been recruited to focus on a specific medical concern >

> and evaluate several patient-related apps addressing that concern. The goal is to have a new medical problem addressed each month. These reviews are available at the time of writing of this article: • Migraines • Insomnia • Hypertension • Alcohol consumption • Smoking cessation iMedical Apps5 is an independent US-based online publication for medical professionals, patients and analysts interested in mobile medical technology and health care apps. Physician editors lead a team of physicians, allied health professionals, medical trainees, and mHealth analysts in providing reviews, research and commentary on mobile medical technology. The publication is heavily based on personal experiences

in the hospital and clinic setting and can be a great resource for analyzing a specific app or finding a new one.

Primary Care Resources,6 funded by the department of Distributed Learning and Rural Initiatives at the University of Calgary, is a cross-platform tool designed to allow rapid access to many local primary care resources, clinical pathways and point-of-care tools (apps) available to physicians with a goal to improve patient care and learner education. Both the website and the associated iOS app contain valuable information about several physician tested apps.

While most practicing physicians do not have the time or the inclination to search for new medical apps, hopefully these tools, and others to be developed, will help us provide the best possible mobile experience for a changing generation.

References available upon request.

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JANUARY – FEBRUARY 2017

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FEATURE Cheese and crackers; sunshine and water; physicians and schools AMA Youth Run Club: School health advocacy talks Vanda Killeen, BA, Dip Ad/PR | SENIOR

COMMUNICATIONS CONSULTANT, AMA PUBLIC AFFAIRS

S

ome things just go together naturally; they complement each other, are mutually beneficial and when together, result in positive outcomes.

While it takes a plate to bring together some nice cheese and crackers, and a great day by the lake to join sunshine with water, the Alberta Medical Association (AMA) Youth Run Club (YRC) is the platform for uniting physicians with students and teachers through the opportunities it creates for school health advocacy.

The AMA Youth Run Club stands to achieve its greatest potential when it becomes a true and consistent collaboration of the health care and education sectors.

Schools, with their student, teacher and parent populations, are a logical environment for physicians to practice health advocacy. Often serving as the hub of the community, schools provide an objective, neutral and non-threatening setting (versus the more formal, sometimes sterile medical office), where physicians can meet with these key members of their communities, to educate and advocate on behalf of good health practices.

A June 2014 Canadian Medical Protective Association (CMPA) article1 – The physician voice: When advocacy leads to change – noted the long history of advocacy in medicine. “Recognizing the credibility associated with the medical profession, physicians have traditionally been called upon to speak up on behalf of patients or others in need, and to influence policy or program changes.”

From Dr. Rudolf Virchow’s comment in the 19th century, when he noted that physicians were “natural attorneys of the poor” to the advocacy role that physicians play (or have the potential to) in their patients’ lives today – serving as a “trusted source for health care information and support” amidst an increasingly “complex and shifting health care system” – the CMPA article acknowledges that the need for physicians to lead with advocacy is as vital as ever. “While the definition of appropriate advocacy in health care is evolving, physicians can show leadership by remaining engaged and seeking to advance their viewpoints in a professional and appropriate manner.”

AMA - ALBERTA DOCTORS’ DIGEST

Dr. Padraic Carr hands out YRC sunglasses to students at Prince Charles School.

Getting to the root of the solution As AMA member physicians, medical students and residents who have volunteered as YRC CHAMPions can attest, involvement with the AMA Youth Run Club presents a rare opportunity to share messages of the lifelong value of physical and mental wellness with children, teachers and often family members, in a school setting.

“We know that healthy students are better learners,” says Dr. Kimberley Kelly, AMA Comprehensive School Health representative, mother to two school-age children and a firm believer in the benefits of the health care practitioner/teacher-and-school collaboration. >

>

“By getting involved in the AMA Youth Run Club, we’re participating in and supporting grassroots prevention, while sharing our knowledge and skills with our communities,” she continues. “Physician leadership, coupled with building community connections at a local level, can significantly improve the health of students, staff and families in our school communities. And in my experience, it’s extremely rewarding to have a positive impact on the long-term health outcomes of our students.”

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Although still new to his term as AMA President, Dr. Padraic E. Carr has already helped out with two YRC season launches (in Calgary and Edmonton) and is eagerly anticipating more opportunities for involvement.

He says, “There’s a real sense of comradery and the kids supporting each other, engaging energetically in physical activity, in the fresh air, and benefitting from the active involvement of their teachers and principals, and even family members.”

Dr. Carr also notes the more sobering reality that today’s technology-focused lifestyles create a real need for purposeful, organized, healthful living-based programs like the AMA Youth Run Club. This is revealed by both personal observation and statistics:2 • 89% of coaches reported engaging students who are not traditionally physically active.

• 73% of coaches reported the club leading to positive changes in student behavior.

Dr. Carl W. Nohr, AMA’s Immediate Past President, is also a strong supporter of the AMA YRC. He has similar feelings on the importance of physical activity among youth.

“The value of physical activity as part of a healthy lifestyle cannot be overemphasized. The generation of youth involved with the Youth Run Club will be our professionals, civic leaders and workers of the future.

To them, physical activity will be second nature,” says Dr. Nohr. “They will redesign our cities, shopping areas and workplaces around more active and healthy lifestyles. Providing these youth with positive experiences with physical activity, good nutrition and healthy living early in their lives is essential, and the AMA Youth Run Club is doing just that!”

Dr. Carr has some additional thoughts and a call to action for all of us: “It used to be that play and associated physical activity was just a natural, everyday occurrence for children.

But with so much technology in our lives today, that’s no longer the case. Yet we continue to learn more and

Dr. Kimberley Kelly runs with her son, Alex Scrimger.

more about the physical and mental benefits of activity and a healthy diet and lifestyle,” he says. “These are the messages of good health advocacy, through involvement with the Youth Run Club, that we can role model and share with students, teachers and parents. I heartily encourage my fellow AMA members to get involved with the AMA Youth Run Club.”

References available upon request.

JANUARY – FEBRUARY 2017

Makes me feel

(Comments from YRC members, Mee-Yah-Noh School, Edmonton)

… “healthier and happier.” (grade 4) … “more less stressed.” (grade 6) … “welcome and needed.” (grade 6)

Favorite thing

(Comments from YRC members, Mee-Yah-Noh School, Edmonton)

“I feel that running club is my family.” (grade 6) My favorite part of run club is “running with my friends.” (grade 6) My least favorite part is “that it’s only once a week.” (grade 6)

Running Shoes Optional It’s called the AMA Youth Run Club but did you know about the other ways to get involved with the AMA YRC? All that’s required is a commitment to advocating and educating on behalf of a healthy, active lifestyle.

ImPRovINg CommuNITY hEAlTh ThRough PhYSICIAN lEAdERShIP ANd AdvoCACY

YRC PARTNERS

Since it began four years ago (with 4,000 participants in 74 schools), the AMA Youth Run Club has provided physicians and medical students with the opportunity to not only join Alberta students and teachers in physical activity, but also – through school health advocacy talks – to speak with students about the lifelong value of good health.

With Youth Run Clubs in over 400 schools and a goal of 25,000 students in 2017, we need physician and medical student advocates now, more than ever.

To find out how you can get involved with the AMA Youth Run Club, visit albertadoctors.org/yrc or contact Vanda Killeen, AMA Public Affairs, at vanda.killeen@albertadoctors.org / 780.482.0675.

YRC SPoNSoRS

PFSP PERSPECTIVES

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Wellness for women physicians Amber G. Fripp, MD, FRCPC | GENERAL

D

r. Amber Fripp, a practicing general internal medicine specialist in Calgary, is an advocate of taking ownership of a healthy lifestyle. She has a passion for fitness and an interest in promoting health and wellness amongst her colleagues. She believes health and wellness is achievable in every stage of a medical career and that it builds a stronger foundation for a balanced life. In other words, “Do it for your patients. Do it for yourself.®” In October 2016, I took eight female medical students and senior residents to a STRONGCAMP® event, a weekend for women of all sizes, ages and fitness levels to come together to celebrate their strengths. Boot camp-style workouts and yoga were interspersed with motivational speeches and nutrition seminars. The event was packed full of soul-fuelling inspiration. At the event, we bonded as we challenged ourselves physically, mentally and emotionally. Together, we sweated, shared stories, laughed and even cried. The experience moved, inspired and changed us, and we did it together as women in medicine, as we learned about fitness, nutrition, health and life.

Wellness is a passion of mine, and it was wonderful to share that with a group of medical students and residents. I believe it gave us, as women, an opportunity to bond and share experiences and build a mentorship relationship that is lacking for women in medicine, especially in the fitness arena. Many of the male staff physicians play hockey or other sports with the medical students/residents, but this opportunity is largely missing for women. This was a unique experience to build relationships, share a love of sport and reach out to women in medicine to build those relationships that are so important as medical students navigate their education. I've already been contacted by several of the group about career planning and practicum exposure, and of course questions around fitness. It was such a success; I plan to organize this as a yearly event.

The most common question I get asked is, "How did you keep it up through training?” My answer is that fitness is a priority; exercise is a powerful stress relief for me.

INTERNAL MEDICINE SPECIALIST

It empowers me as a woman to be strong and healthy, and I believe I model that to my patients as well. Fitness means a lot of different things to different people, but I believe helping my patients, medical students and family achieve moments of health empowers them to take control of what they can. This sense of wellbeing brings so much more than a pill or simple prescription can achieve. I believe we can all benefit from fitness and as female physicians, it’s a wonderful arena to bond and de-stress.

Fitness is a priority; exercise is a

powerful stress relief for me. It empowers me as a woman to be strong and healthy, and I believe I model that to my patients as well.

And the medical students and residents? They loved it!

For some, it was getting back into things after an illness.

For others, it reinforced positive exercise behavior. For others it was empowering and confidence building. And yes, whatever your sport is, it’s possible to keep it up through your residency, career, motherhood and beyond.

I plan to be exercising when I'm 90. It may look different, but it will still be exercise.

Meeting the medical students/residents and hearing their stories was wonderful. I was so inspired by each of them. I think it’s important to support each other as women as we journey through medical education and beyond together. Engaging women in fitness early on encourages positive behavior that helps provide an outlet to deal with stress. I believe it leads to better relationships, better physicians and more well-rounded individuals. And it’s fun!

When we are healthy and inspired, we have an opportunity to share that with our colleagues, our patients and our families. If you may be interested in being part of the next experience, contact agfripp@ucalgary.ca > JANUARY – FEBRUARY 2017

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> On my bookshelf Here are a few resources on mentoring that might be useful: Mentoring in Medicine www.ncbi.nlm.nih.gov/pmc/articles/ PMC2821244/ Mindtools on Mentoring www.mindtools.com/pages/article/ newCDV_72.htm How Social Media is Changing Mentorship mashable.com/2013/07/14/socialmedia-mentorship/#6sIDdSxp9PqC 7 Key Qualities of an Effective Mentor www.inc.com/jayson-demers/7-keyqualities-of-an-effective-mentor.html Federation of Medical Women of Canada fmwc.ca Publications from the Institute of Lifestyle Medicine (a variety to choose from on fitness and nutrition) www.instituteoflifestylemedicine. org/publications/ Articles by Dr. Mamta Gautam (previous president of the Federation of Medical Women in Canada) www.drgautam.com/gautam/ papers.htm Dr. Gautam will also be delivering a keynote on behalf of PFSP at the upcoming 2017 Alberta Psychiatric Association conference.

PHYSICIAN(S) REQUIRED FT/PT Also locums required

STRONGCAMP® is a registered trademark of STRONG Fitness Magazine.

ALL-WELL PRIMARY CARE CENTRES MILLWOODS EDMONTON Phone: Clinic Manager (780) 953-6733

Dr. Paul Arnold (780) 970-2070

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JANUARY – FEBRUARY 2017

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RESIDENTS’ PAGE PARAdime: Resident physicians support some of Alberta’s most vulnerable through annual community campaign Adele Duimering, MD | PGY

3, RADIATION ONCOLOGY, UNIVERSITY OF ALBERTA

O

n a chilly February day last year, I had the opportunity to tour the Youth Empowerment and Support Services (YESS) in Edmonton. Since 1981, YESS has opened its doors to provide shelter, food and support to youth in need. My colleagues from the Professional Association of Resident Physicians of Alberta (PARA) and I had spent the past 10 weeks collecting donations for the shelter in our annual PARAdime campaign. We were pleased to contribute a van load of clothing, toiletries, school supplies and food items, generously donated by resident physicians and health care colleagues at hospitals around the city.

Once again, resident physicians are collecting PARAdime donations at 15 hospitals in six cities across the province.

In early February, resident physicians in each city will deliver these items to local community organizations: • YESS in Edmonton

prenatal appointments. A young intravenous drug abuser presents with infectious endocarditis, but he discharges himself prior to antibiotic completion to care for his dog.

Some of the common challenges in such patient encounters are low income, unemployment, disability, food or housing insecurity and lack of social supports.

From medical school, we’ve been trained to elicit a social history, which reveals the more obvious of these social determinants of health. The subtler – abuse, illiteracy, HIV – may easily remain in the shadows.

As physicians, many of us have never

had to worry about lacking access to basic necessities. It can be easy from this privileged perspective to forget that for those in poverty, taking a medication or making it to a doctor’s appointment can take a back seat to finding food to eat or a place to sleep.

• Calgary Drop-In and Rehabilitation Centre • Safe Harbour Society in Red Deer • HIV North in Grande Prairie • Wood’s Homes in Lethbridge • Salvation Army Family Support Services in Medicine Hat Now in its eighth year, the resident physician-driven PARAdime campaign endeavors to support some of Alberta’s most vulnerable individuals, while increasing awareness amongst health care workers of the challenges faced by some of their patients. Indeed, resident physicians encounter social barriers to health every day in practice. An elderly lady living independently fails to cope with self-care and neglects to take her medications. A self-employed gentleman from Grande Prairie hesitates to forfeit income to undergo prostate cancer treatment in Edmonton. A pregnant 17-year-old girl with no family support is inconsistent in attending AMA - ALBERTA DOCTORS’ DIGEST

Why is it important to address social barriers to health?

In short, it makes a difference. We know that preventative health care is at least as important as disease treatment, and even small contributions to improving wellness in vulnerable populations can ripple out to improve health equity – the ability of populations to achieve their full health potential without being disadvantaged by such things as age, race, gender, sexual orientation, social class or level of education.

When shelter, clothing and meals are provided to a young person who is living on the streets, he or she is afforded the support to return to school or seek out a job. From a societal standpoint, by helping vulnerable individuals bring greater stability and comfort into their lives, we are promoting healthy communities and by extension, we are relieving some pressure on our stressed health care system. >

> In overseeing one of the PARAdime hospital collection bins, one unexpected benefit I’ve experienced is how the campaign brings people together. Our wicker collection basket, decked out in red Christmas ribbon, is a focal point in our office area. It leads housekeepers, nurses, radiation therapists and even the occasional curious patient to stop by to inquire what we are up to. This has segued into some interesting discussions on patient needs and has organically enhanced workplace collaboration and collegiality. The items we’ve collected have been thoughtful and diverse – toiletries, new socks and underwear, winter clothing, candle and soap gift sets, among others. Even the more unique donations like Christmas decorations will surely bring cheer to a family in need.

To properly care for the whole person,

we as physicians must not only recognize, but seek to address these barriers so many face.

Touring the colorful sun-filled rooms of the YESS shelter, it is easy to picture how each item collected in the PARAdime campaign might assist a young person to succeed: an outfit for a job interview, a backpack to carry to work, notebooks for school, granola bars for packed lunches and so forth. In combination with YESS’s programs, with objectives ranging from helping young people to set and achieve goals, to building healthy coping skills, it is inspiring to see how these PARAdime

donations may directly benefit those in need in our community. In parallel, via the five other wonderful organizations PARA has partnered with across the province, PARAdime will continue to contribute in a small but meaningful way to the wellness of some of Alberta’s most vulnerable.

As physicians, many of us have never had to worry about lacking access to basic necessities. It can be easy from this privileged perspective to forget that for those in poverty, taking a medication or making it to a doctor’s appointment can take a back seat to finding food to eat or a place to sleep. To properly care for the whole person, we as physicians must not only recognize, but seek to address these barriers so many face.

At the core of our residency training are the CanMEDS competencies, which list “health advocate” as one of the basic abilities that physicians require to effectively meet the health care needs of the people they serve. As physicians we have the privilege of being entrusted with our patients’ struggles, so we are in a unique position to leverage this knowledge and our influence to advocate for these needs, and bring about positive change on an individual or population level.

I’d encourage all health care workers to strive to support their patients and communities, speak on behalf of those who cannot and call for change when required. Whether through the PARAdime campaign or by other means, advocacy should be seen as a physician’s duty.

For more information on or to contribute to this year’s PARAdime campaign, please visit www.para-ab.ca/ paradime-campaign.

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IN A DIFFERENT VEIN

Doctor in the house of cards Alexander H.G. Paterson, MB ChB, MD, FRCP, FACP | CO-EDITOR

W

ith all the nasty, weird events now occurring around the world, R.D. Laing, PhD, the Scottish psychiatrist, came to mind. He’s made an excellent living from a single philosophical conceit: those of us who consider ourselves sane are actually the crazies, and it is the psychotics who have adapted to a vicious, incomprehensible, bewildering world.

In this vein of thinking, on November 10 – the day after the US Presidential election – I drove to Edmonton, dined and stayed with old friends Joan and Dr. Bob Turner.

Joan is a cancer researcher and Bob is a hematologistoncologist – who (in a startling but refreshing career change) is now the Member of the Legislative Assembly (MLA) for the riding of Edmonton-Whitemud. We are old friends and that means we’re mature enough not to let small differences of political opinion mar discussions and mutual respect. However, Joan, a dual Canadian and American citizen, was suffering from a serious case of PTSD (Post-Trump Stress Disorder). I tried a course of brief solution-oriented psychotherapy (“It’s democracy with American characteristics, Joan.”) She did not respond, but knowing her pragmatic character, a recovery is likely.

Next morning, a bright sunny Edmonton morning, we drove to the Alberta Legislature (actually in casual talk you don’t say “Legislature” always “Leg” pronounced “Ledge”). The North Saskatchewan River was still ice-free. When I lived in Edmonton, there were always plates of ice floating down river by early November. Bob parked his car roadside (MLAs have a nice parking pass) and we entered via security to The Ledge. Bob went off to take his seat on the government side and I was whisked up to the fourth floor – the visitors’ gallery.

The gallery was empty, but I was watched suspiciously by security (an elderly retired policeman) and immediately gave him something to do. Stretching out on the front row balcony seat, I placed my notebook

AMA - ALBERTA DOCTORS’ DIGEST

on the bench in front and was told to remove it in case it fell off and hit a member of the opposition below, who happened to be my own MLA, Richard Gotfried, the member for Calgary-Fish Creek.

The ongoing debate was on Bill 28: Public Health Amendment Act, 2016 (the “vaccination bill”). Dr. Starke, a leadership candidate for the Progressive Conservatives and a practicing vet, had the floor: “We heard yesterday from the Honorable Member for Edmonton-Whitemud about the importance of vaccination. For those who are interested, the word 'vaccination' comes from the Latin 'vacca', meaning 'cow'. Initial vaccinations were done from cowpox pus.

As a veterinarian, I’m proud of that. It’s bizarre that you can place a child in school with no knowledge of vaccination records, yet if you board your dog in a kennel, you must show proof of vaccination. Madam Chair, once again I’d like to commend the Minister and the Member for Edmonton-Whitemud.”

The political future of the Alberta

NDP is insecure. The upsurge in support at the 2015 election was a protest vote after 44 years of one-party rule and the attitude and alleged entitlement of Premier Redford.

This was unusual: mutual admiration and a Latin lesson.

Was there a catch? How long could it last?

“Thank you, Madam Chair,” replied Bob. “It’s a pleasure to support this bill that has the backing of teachers, parents and all of us. It’s refreshing hearing discussion from all members of the Legislature. I only wish we could inoculate this spirit of collegiality into our other discussions such as on the carbon levy.” >

> Well, that was pushing it. There were snorts and gargled groans from underneath me. Still, it was chummy and professional, and Bill 28 was passed amiably. Smartly dressed young girls glided unobtrusively among benches and seats passing notes between members and fetching coffee for The Ledge’s toilers and, once, bringing what I thought was lipstick, but which turned out to be lip moisturizer, for the speaker.

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Not being so interested in Bill 29: Vital Statistics and Life Events Modernization Act, I went on the morning tour of The Ledge. It’s odd that when you live in a place, you rarely visit sites of interest. We lived in London for five years and never visited the Tower or Westminster, likewise for The Ledge or the Muttart Conservatory in Edmonton.

Our enthusiastic youthful tour guide, Sean, showed us an old beaten-up mace in a glass case:

Dr. Alexander H.G. Paterson does a "Ledge-selfie" with Dr. Bob Turner, MLA for the riding of Edmonton-Whitemud.

“This was the first mace used in The Ledge when it opened. There was no time to get a proper one.”

Afternoon question period beckoned and on arrival I was astonished to find the galleries packed – all, that is, except the Press Gallery which was empty. The press these days sit in comfortable offices receiving televised proceedings, thereby missing out on the nuances of things like backbench members studying their mobile phones during important debates. The press should forthwith lose the privilege of having a separate gallery.

I found a seat at the side and the introductions began: His Excellency, the Ambassador of Mexico, the Commanding Officer and the Adjutant of the Loyal Edmonton Regiment (Remembrance Day being the next day), three classes from schools around the province and multiple individual introductions (including my own).

It was kutcha*: jury-rigged from a toilet plunger and a pin cushion stuck on the end. It’s one of the things I admire about Canadians – not the phoney “eh’s” and the “we have Medicare” bullsh*t. We have the ability to make-do.

To rise to the occasion without a fuss. We respect people who work with their hands.

The paintings of former premiers on the 5th floor are a strange mix of adequate to tacky – none of the rich oils giving depth as in pre-20th century portraits.

Taxpayers should demand their money back from the painter who painted Ralph Klein’s portrait, which is like an over-exposed photograph; Stelmach’s looks as if he’s just returned from a Caribbean holiday. I liked the Red Queen’s portrait which (in proper court tradition) flatters the subject. My heart warmed to her clutching a tartan scarf as she gazed toward the would-be Sky Palace.

I was introduced, but then Bob added: “Sandy is job shadowing me today as an MLA and I’ve been vetting him for the Calgary-Fish Creek Alberta NDP nomination.

Dr. Paterson, please receive the traditional warm welcome of this Assembly.”

Bob (having dealt with the third reading of Bill 24: Forest and Prairie Protection Amendment Act, 2016) took me over to the federal building. More could be done with that building. The entrance hall was cluttered with old roller bags and suitcases hung on the walls from various parts of the world, no doubt cleverly symbolizing the diversity of the province. I looked for a suitcase I’d lost at the airport 20 years ago. I was disappointed.

Laughter – though not from my MLA, Richard Gotfried, sitting below. Premier Notley peered up and beamed her fetching smile.

We retired to the members’ cafeteria and ate a slice of first-class pizza sitting with Bob’s fellow MLAs. It was good to see the camaraderie among the cross-party lines.

I sensed that Bob Turner is a popular MLA, getting waves and a salute from everyone we passed.

Brian Jean asked. “Why is the Premier driving jobs from the province and slamming Albertans with a new tax they cannot afford?” >

Then during a series of opposition questions, she demonstrated how fast she is on her feet – parrying opposition jibes like an Olympic fencer. The carbon tax was the elephant in the chamber.

JANUARY – FEBRUARY 2017

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> Premier Notley, in hallowed political tradition, ignored the question.

“Our climate leadership plan was developed with the expectation that nobody else would have a carbon tax in place. What happens in the U.S. or does not happen in the U.S. has no relevance to what we’ve been planning – we modelled our plan with them not having a carbon tax.”

I believe a united Wildrose and PC party

would decimate the NDP given the current economy, despite many of the good bills the NDP have passed.

Pandemonium. Jeers, hoots and thumping of desks.

This last requires hours of practice, getting the right downward action of the arm on the wood to produce a resounding desk thump and is one of the main jobs of a backbencher. An experienced MLA develops a hypertrophied dermal layer from the elbow to the tips of the fingers.

The Speaker then (no doubt concerned about the kids in the chamber) played teacher: “Allow me to underline that the objective is to have an engaged debate. Let’s be conscious of not only the number of hecklings but, more importantly, the volume.”

Yes, it was democracy in action and enjoyable, if a bit of an act for the school kids in attendance, who were learning that The Ledge is better fun than school – you can have a real good barney.

I particularly enjoyed Premier Notley managing Wildrose leader Mr. Jean’s and PC interim leader Mr. McIver’s persistent questioning about NDP support for the Keystone XL pipeline. With Mr. Trump now USA’s President, the Keystone pipeline will obviously be approved, so why waste political capital doing any more lobbying there? Premier Notley has enough difficulties ahead with Mr. Selfie in Ottawa and Christy Clark next door.

But Mr. McIver kept plugging away. “If the U.S. President approves Keystone XL, will you and your government stand in the way?”

“The answer to that is: Of course not,” Premier Notley said. Then to Mr. McIver’s demand that she actually champion the Keystone XL pipeline, she berated the previous PC government for wasting time and money lobbying in the USA.

AMA - ALBERTA DOCTORS’ DIGEST

“Because it’s a pipeline over somebody else’s country.

When it comes to things we can do – deliver outcomes for our industry partners – we focus on places where we can have an impact. That’s exactly – exactly – what our government has been doing,” she said to a deafening thumping of NDP desks.

So we can look forward to some feisty sparring when Jason Kenney gets into The Ledge.

We had become aware in 2014 that political tides were shifting in the province. I smelled a change of weather when our colleague Dr. Bob Turner made a good showing in the 2014 by-election for EdmontonWhitemud, a cosily middle-class community and a natural nesting ground for conservative households, running for the NDP against Stephen Mandel, the recently appointed the-then recently minister of health.

Much of politics is local, so when a decision was taken by the previous government to locate the new Calgary Cancer Centre at the South Health Campus after years of planning a Foothills Medical Centre site, and when that decision was taken by a novice Edmonton based health minister, many of my colleagues felt enough was enough.

Despite the PC’s reasonably good fiscal management, it was time for a change. Wildrose beckoned. But Wildrose was suddenly in disarray with the prescient (but ill-judged in both time and process) movement of its MLAs to the PC party.

Then at the election, Bob took Edmonton-Whitemud handily as part of the NDP provincial sweep and a hematologist-oncologist was now in the governing party.

How would a rookie MP with a good deal of administrative health care experience fare with the rush of cock-a-hoop Eastern NDP-ers ready to advise and push around a largely inexperienced caucus?

When emptying our garbage in a townhouse complex in Nanaimo, I discussed the situation with Don Braid, a Calgary Herald columnist on vacation, and we agreed there was such limited experience in the NDP that Dr. Bob Turner was a likely candidate for a cabinet post.

But what with requirements for geographical and gender balance, this was not to be. Ms Hoffman has done an OK job (or has managed to avoid much bad press – quite an achievement in the health portfolio). And yet many of us feel Dr. Bob Turner is seriously underutilized by the NDP. A mix of youth and experience is critical in all organizations for a mature balance of decision making.

There has been talk about bringing in a patient portal which Bob has been interested in pushing forward (one of the more practical recommendations of the Naylor Committee – see Alberta Doctors’ Digest SeptemberOctober 2015). But not surprisingly as a backbench MLA, he’s had difficulties getting things moving. This is typical of Alberta Health Services (AHS), which is too bureaucratic to efficiently activate a demonstration project. It needs to be piloted by a nimbler organization – perhaps the cancer program or one of the regions. >

>

The political future of the Alberta NDP is insecure. The upsurge in support at the 2015 election was a protest vote after 44 years of one-party rule and the attitude and alleged entitlement of Premier Redford. I believe a united Wildrose and PC party would decimate the NDP given the current economy, despite many of the good bills the NDP have passed. What the NDP must do is break away from and differentiate themselves from the federal NDP and their coterie of Eastern loonies; bearded, comfortable career activists; and hangers-on with exotic agenda – prioritizing those agendas that the working man or woman has limited interest in, but will have no problem making the connection to a persisting economic recession when the opposition gleefully points it out, as they undoubtedly will.

Surely the Trump success and the Brexit vote are clear indicators that the NDP is in grave danger of losing the working man’s vote and that critical creature whom David Cameron (and Ralph Klein) venerated – “White Van Man”: the small business plumber, electrician, odd job man with his team of five or six employees, often relatives. While Premier Notley is smart, amiable and fast on her feet, doing a good job on all but the critical economic front, any plans for a 10 to 15-year tenure will not happen without a clear cutting of the umbilical cord from other Canadian New Democratic parties.

I put this position to Dr. Bob Turner. He smiled and declined comment. * kutcha – Hindi: something (e.g., a house) built from naturally occurring materials, makeshift.

What the NDP must do is break away

from and differentiate themselves from the federal NDP and their coterie of Eastern loonies; bearded, comfortable career activists; and hangers-on with exotic agenda.

The old cutting and dicing into far, moderate, centrist right and left wings based on the French tradition of the King’s Party and the Revolutionary Party is breaking down across the western world, maintained only by the Journalistic Schools of Limited Thinking. Most people care more about their jobs, families and health than arguments about the precise percentage contribution of man-made greenhouse gases to climate change. Many career climate activists are merely paid lobbyists for renewable energy companies, hiding behind a concern for climate issues. Didn’t you know that?

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PHYSICIAN WANTED CALGARY AB Part- and full-time physicians wanted for a new clinic where we are exploring the newest modalities of medicine and patientcentered care. Tier 1 mall location, large, modern clinic. Very attractive split, great billings, no overhead or management hassles.

Contact: careers@hmed.ca CALGARY AB Westbrook Medical Clinic in southwest Calgary is recruiting full-time family physicians and psychiatrists. For 30 years the Westbrook Medical Clinic, a primary care clinic, has been serving a diversified community of children, teenagers, adults and seniors. The clinic has four full-time physicians, one-full time psychiatrist, one part-time registered nurse, one part-time behavior therapist, four experienced medical office assistants and one full-time clinic manager.

The office uses electronic medical records but will accommodate physicians who are computer shy.

Calgary has an active social and cultural scene. Good housing and schools available.

Applicants must hold a licence to practice in Alberta.

Contact: Dr. Shashi Lota T 403.618.4776 shashi.lota@hotmail.com CALGARY AB An exciting opportunity is available for family physicians and specialists to join Revolution Medical Clinic. We are located in the bustling Signal Hill Shopping Centre. Come and join the most modern and innovative clinic in southern Alberta. We offer a very competitive fee split in exchange for a superior patient-focused approach.

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Part- or full-time, flexible hours to accommodate work/life balance, very competitive fee split. Possible partnership opportunity available to committed members of our team.

Contact: Dr. Riyaan Hassen C 403.688.7867 rhpc@shaw.ca CALGARY AB Pain specialist Dr. Neville Reddy is looking to recruit physicians (general practitioners and specialists) to join his team of dedicated health care professionals. Innovations Health Clinic has two locations (southeast and southwest), favorable 25% expenses offered.

Contact: Neville Reddy, MB ChB, FRCPC (Anesthesia) T 403.240.4259 C 403.689.4259 nreddy@innovationshealth.ca www.innovationshealth.ca CALGARY AND EDMONTON AB Retiring? Semi-retiring? Want someone to take over your panel?

Imagine Health Centres (IHC) is growing and welcomes semi-retired and/or retired physicians who want to ensure continuity of care for their patients.

Come work part- or full-time and allow us to introduce ourselves to your patients. Imagine Health Centres are multidisciplinary family medicine clinics with a focus on health prevention and wellness. IHC prides itself in providing the best support for family physicians and their families in and out of the clinic. Health benefit plans and full financial/tax/accounting advisory services are available to all IHC physicians.

Do you want your patients to be cared by a team that collaborates with other health care professionals for enhanced patient care? If so, contact us.

Contact: Dr. Jonathan Chan to submit your CV in confidence corporate@imaginehealthcentres.ca www.imaginehealthcentres.ca EDMONTON AB Oxford Medical Clinic is looking for a part- or full-time family physician/ general practitioner to join our team; very attractive deals and incentives.

Contact: T 780.475.1966 F 780.475.1997 oxford.clinic@yahoo.ca EDMONTON AB Two positions are immediately available at the West End Medical Clinic/M. Gaas Professional Corporation at unit M7, 9509 156 Street, Edmonton AB T5P 4J5. We are also looking for specialists, internist, pediatrician, gynecologist and orthopedic surgeon to join our busy clinic. Full-time family physician/ general practitioner positions are available. The physician who will join us at this busy clinic will provide family practice care to a large population of patients in the west end and provide care to patients of different age groups including pediatric, geriatric, antenatal and prenatal care.

Physician income will be based on fee-for-service payment and the overhead fees are negotiable. The physician must be licensed and eligible to apply for licensure with the College of Physicians & Surgeons of Alberta (CPSA); qualifications and experience must comply with the CPSA licensure requirements and guidelines. We offer flexible work schedules, so the physician can adopt his/her work schedule. We also will pay up to $5,000 to the physician for moving and relocation costs.

Contact: Dr. Gaas T 780.756.3300 C 780.893.5181 F 780.756.3301 westendmedicalclinic@gmail.com >

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EDMONTON AB To meet our growing needs, we have a practice opportunity for a pediatrician at the Parsons Medical Centre. The clinic is in south Edmonton and is a high patient volume clinic.

You can enjoy working in a modern environment with full electronic medical records, friendly reliable staff for billing, referrals, etc., as well as an onsite manager. Parsons serves a large community and wide spectrum age group (birth to geriatric). The Parsons Medical Centre has a pharmacy onsite, ECG machine and offers a large array of specialist services.

Parsons Medical is a member of the Edmonton Southside Primary Care Network which allows patients to have access to an on-site dietitian and mental health/psychiatry health services. Overhead is negotiable, flexible working hours and open seven days a week.

Contact: Harjit Toor T 587.754.5600 manager@parsonsmedicalcentre.ca

EDMONTON AB Windermere’s newest clinic is looking for physicians to start as soon as possible.

Imagine Health Centres (IHC) newest clinic, Currents of Windermere is a top-notch, high-profile retail development is within the proximity of Riverbend and McGrath.

A multidisciplinary family medicine clinic with a focus on health prevention and wellness, IHC prides itself in providing the best support for family physicians and their families in and out of the clinic. Health benefit plans and full financial/tax/accounting advisory services are available to all IHC physicians.

We are looking for part- and full-time family physicians. Imagine Health Centres has an excellent opportunity to take over existing patient panels at our Edmonton locations.

Do you want to be part of a team that collaborates with other health care professionals for enhanced patient care? Do you want to make a difference in your patients’ care and take a proactive instead of a reactive approach to health care?

Compensation is fee-for-service and inquiries are kept strictly confidential. Only qualified candidates will be contacted.

Contact: Dr. Jonathan Chan to submit your CV in confidence corporate@imaginehealthcentres.ca www.imaginehealthcentres.ca EDMONTON AND FORT MCMURRAY AB MD Group, Lessard Medical Clinic, West Oliver Medical Centre and Manning Clinic, each with 10 examination rooms, and Alafia Clinic, with four examination rooms, are looking for six full-time family physicians. A neurologist, psychiatrist, internist and pediatrician are required at all four clinics.

Two positions are available at the West Oliver Medical Centre in a great downtown area, 101-10538 124 Street and one position at the Lessard Medical Clinic in the west end, 6633 177 Street, Edmonton. Two positions at Manning Clinic in northwest Edmonton, 220 Manning Crossing and one position at Alafia Clinic, 613-8600 Franklin Avenue in Fort McMurray.

The physician must be licensed or eligible to apply for licensure with the College of Physicians & Surgeons of Alberta (CPSA). For the eligible physicians, their qualifications and experience must comply with the CPSA licensure requirements and guidelines.

The physician income will be based on fee-for-service with an average annual income of $300,000 to $450,000 with competitive overhead for long term commitments; 70/30% split. Essential medical support and specialists are employed within the company and are managed by an excellent team of professional physicians and supportive staff.

We use Healthquest electronic medical records (paper free) and we are a member of a primary care network (PCN).

Benefits and incentives of being part of our clinics include the convenience to work at any of our locations, partor full-time available, attached to a PCN, nurse for physician’s patients provide one-on-one, on-site diabetic management care and comprehensive medical follow-up visits. Therapists

at our clinics provide one-on-one consults. Seminars and dinner workshops credit go toward their licence. Flexible hours, vast patient circumference looking for family doctors, continuing care and learning opportunities for accredited doctors.

Full-time chronic disease management nurse to care for chronic disease patients at Lessard, billing support and attached pharmacy are available at the Lessard and West Oliver locations.

Work with a nice and dedicated staff, nurse available for doctor’s assistance and referrals. Also provide on-site dietician and mental health/ psychology services. Clinic hours are Monday to Friday 8:30 a.m. to 8:30 p.m., Saturday and Sunday 10:30 a.m. to 5 p.m.

Contact: Management Office T 780.757.7999 or T 780.756.3090 F 780.757.7991 mdgroupclinic@gmail.com lessardclinic@gmail.com GRANDE PRAIRIE AB IMJ Medical Clinic is looking for a full-time family physician to join an established physician group.

Requirements are current registration with the College of Physicians & Surgeons of Alberta, qualifications and experience CCFP or equivalent.

Compensation is fee-for-service with a 40/60 split with an estimated annual income of $200,000 to $300,000.

Contact: Stanley Muwonge muwonge@telus.net LANGFORD AND VICTORIA BC Physicians required for family practice and/or walk-in clinic work. Both the Wheelhouse Integrative Medical Clinic and the Eagle Creek Medical Clinic require physicians. Wheelhouse Medical Clinic is located at 2349 Millstream Road, Langford and Eagle Creek Medical Clinic is located at 120-27 Helmcken Road, across from Victoria General Hospital.

Both clinics provide comprehensive primary care, have experienced medical office assistants, well-equipped examination and treatment rooms, Osler electronic medical records and onsite billing clerk. >

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> The walk-in clinic is open 8 a.m. to 8 p.m. weekdays, 10 a.m. to 4 p.m.

Saturdays and 8 a.m. to 2 p.m. on Sundays. Hospital privileges are not required. We have regular shifts available at both clinics and space available for individuals interested in doing family practice medicine.

Contact: Dr. M. Putland fogducker1@mac.com or Jeanette McCart jmccart@shaw.ca to learn more about available opportunities in either of these well run clinics

PHYSICIAN AND/OR LOCUM WANTED CALGARY AB State-of-the-art brand-new clinic, Zamin Medical Centre has opportunities for locums and partor full-time physicians. If you are an experienced family physician or a new medical graduate, we can help you build your practice in a supportive team environment. Excellent location, flexible hours and free underground parking.

Contact: sjmzhome@gmail.com or fauziakareemi@gmail.com CALGARY, EDMONTON AND RED DEER AB Imagine Health Centres (IHC) is currently looking for family physicians and specialists to come and join our dynamic team in part-time, full-time and locum positions in Calgary, Edmonton and Red Deer. Physicians will enjoy extremely efficient workflows allowing for very attractive remuneration, no hospital on-call, paperless electronic medical records, friendly staff and industry-leading fee splits.

Imagine Health Centres are multidisciplinary health clinics with a focus on preventative health and wellness. Come and be part of our team which includes family physicians, physiotherapists, psychologists, nutritionists, pharmacists and more.

Imagine Health Centres prides itself in providing the very best support for family physicians and their families in and out of the clinic. Health benefit plans and full financial/tax/accounting

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advisory services are available to all IHC physicians. There is also an optional and limited time opportunity to participate in equity opportunities in IHC and related medical real estate.

Enjoy attractive compensation with our unique model while being able to maintain an excellent work-life balance.

We currently have three Edmonton clinics. The clinics are near South Common, west Edmonton and Currents of Windermere.

We currently have two clinics in Calgary. The clinics are located downtown and south Calgary. We also have compelling opportunities available in Red Deer. All inquiries will be kept strictly confidential.

Contact: Dr. Jonathan Chan to submit your CV in confidence corporate@imaginehealthcentres.ca www.imaginehealthcentres.ca EDMONTON AB To meet the growing needs, we have a practice opportunity for family physicians to start as a locum (with an option to join part- or full-time) at Parsons Medical Centre (PMC) and Millbourne Mall Medical Centre (MMMC). Both clinics are in south Edmonton. PMC and MMMC are high patient volume clinics with friendly reliable staff for billing, referrals, etc., as well as an on-site manager. Enjoy working in a modern environment with full electronic medical records. PMC and MMMC serve a large community and wide spectrum age group (birth to geriatric). Both clinics have on-site pharmacy, ECG machine, lung function testing and offer a large array of specialist services including: ENT, endocrinologist, general surgeon, internist, orthopedic surgeon, pediatrician and respirologist.

PMC and MMMC are members of the Edmonton Southside Primary Care Network which allows patients to have access to an on-site dietitian and mental health/psychology/ psychiatry health services. Overhead is negotiable, flexible working hours and both clinics are open seven days a week.

Contact: Harjit Toor T 587.754.5600 manager@parsonsmedicalcentre.ca

SHERWOOD PARK AB Dr. Patti Farrell & Associates is a new, busy, modern family practice clinic with electronic medical records. We require locum coverage periods throughout 2017. Fee split is negotiable. Current clinic hours Monday to Friday 8 a.m. to 4 p.m. are negotiable. Dr. Farrell is a lone practitioner (efficient clinic design built for two doctors) looking for a permanent clinic associate.

Contact: C 780.499.8388 terrypurich@me.com SHERWOOD PARK AB The Sherwood Park Primary Care Network is looking for several physicians to cover a variety of locum periods in a variety of Sherwood Park offices. Practice hours vary widely. Majority of practices run electronic medical records. Fee splits are negotiated with practice owners.

Some practices are looking for permanent associates.

Contact: Dave Ludwick T 780.410.8001 davel@sherwoodparkpcn.com SHERWOOD PARK AB Well-established busy clinic with five family physicians seeks a locum or associate part- or full-time to replace a departing physician who has relocated to another city. We are located in a professional building with lab and X-ray on site, primary care network nurse support and excellent office staff. Clinic has been using Med Access electronic medical records for 10 years.

Contact: Dr. Lorraine Hosford T 780.464.9661 moahosford@shawcable.com SHERWOOD PARK AB Nottingham Medical Clinic is looking for part-/full-time family physicians.

Locums welcome. Clinic has a modern appearance. Pharmacy and dietitian services in the clinic, on-site laboratory and diagnostic services are also available. We currently have five family physicians and are looking for at least another three. Appointmentbased practice, flexible schedule and clinic uses Med Access electronic medical records. Moving bonus, 70/30 split.

Contact: Dr. Steve Denson T 780.298.6109 sdenson@shaw.ca >

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SPACE AVAILABLE CALGARY AB Medical office space is now available in the multi-award winning Mark on 10th. This A-Class, mixed-use building is located in the heart of the beltline and offers stunning views of downtown. Competitive lease rates in a one-of-a-kind location make this an unparalleled opportunity.

Contact: Dan Harmsen, Partner, VP, Associate Broker Barclay Street Real Estate T 403.290.0178, ext. 165 dharmsen@barclaystreet.com CALGARY AND EDMONTON AB Medical offices available for lease in Calgary and Edmonton. We own full-service, professionally managed medical office buildings. Competitive lease rates, attractive building amenities and turn-key construction management available.

Contact: NorthWest Healthcare Properties Lindsay Hills Regional Leasing Manager T 403.282.9838, ext. 3301 lindsay.hills@nwhreit.com Michael Lobsinger Leasing Manager, Edmonton T 1.877.844.9760, ext. 3402 michael.lobsinger@nwhreit.com

COURSES CME CRUISES WITH SEA COURSES CRUISES • Accredited for family physicians and specialists • Unbiased and pharma-free • Canada’s first choice in CMEatSEA® since 1995 • Companion cruises FREE JAMAICA – FAMILY ALL-INCLUSIVE CME AWAY™ RESORT March 10-17 Focus: Dermatology and family medicine Air Canada Vacations: Grand Bahia Principe Jamaica EASTERN CARIBBEAN CME AWAY™ CRUISE March 12-19 Focus: Endocrinology, geriatrics and psychiatry Ship: Holland America: Ms Nieuw Amsterdam

BAHAMAS – ADULT ALL-INCLUSIVE CME AWAY™ RESORT March 26-April 2 Focus: Chronic pain and addiction Air Canada Vacations: Sandals Emerald Bay BERMUDA CME AWAY™ CRUISE April 30-May 7 Focus: Primary care and neurosurgery for the non-neurosurgeons Ship: Celebrity Summit SPAIN CME AWAY™ LAND TOUR May 12-22 Focus: Internal medicine and medical/legal updates Spanish land tour exploring Madrid, Vigo and Rioja WESTERN MEDITERRANEAN CME AWAY™ CRUISE May 29-June 9 Focus: Rheumatology and pediatrics Ship: Celebrity Reflection ICELAND CME AWAY™ LAND TOUR June 3-9 Focus: Optimizing patient care, chronic pain and urology Iceland land tour SCANDINAVIA AND RUSSIA CME AWAY™ CRUISE July 6-18 Focus: Emergency medicine and diabetes management Ship: Celebrity Silhouette WESTERN MEDITERRANEAN CME AWAY™ CRUISE July 22-August 3 Focus: Sexual health, men’s health Ship: Holland America Ms Westerdam WESTERN CARIBBEAN CME AWAY™ CRUISE August 13-20 Featuring: Kids summer camp at sea Ship: Celebrity Summit ALASKA CME AWAY™ CRUISE August 20-27 Focus: Infectious diseases and dermatology Ship: Celebrity Infinity RHINE AND DANUBE RIVER CME AWAY™ CRUISE September 1-16 Focus: Cardiology, sport medicine and dermatology Ship: Avalon Illuminations

CANADA AND NEW ENGLAND CME AWAY™ CRUISE September 14-21 Focus: Save the date – CME AWAY™ Cruise Ship: Royal Caribbean Anthem of the Seas JAPANESE EXPLORER CME AWAY™ CRUISE September 24-October 5 Focus: Cardiology, internal medicine and endocrinology Ship: Celebrity Millennium TUAMOTUS AND SOCIETY ISLANDS TAHITI CME AWAY™ CRUISE October 18-28 Focus: Cardiology and emergency medicine Ship: Paul Gauguin CHILE, PATAGONIA, CAPE HORN AND ARGENTINA CME AWAY™ CRUISE November 25-December 2 Focus: Neurology and infectious diseases Ship: Stella Australis SINGAPORE TO HONG KONG CME AWAY™ CRUISE December 5-17 Focus: Rheumatology and pain management Ship: Regent SS Voyager EASTERN CARIBBEAN CME AWAY™ CRUISE December 30-January 6, 2018 Focus: Male and female sexual health and endocrinology Ship: Royal Caribbean: Harmony of the Seas AUSTRALIA AND NEW ZEALAND CME AWAY™ CRUISE February 3-17, 2018 Focus: Family practice, endocrinology, internal medicine and psychiatry Ship: Celebrity Solstice AUSTRALIA GREAT BARRIER REEF CME AWAY™ CRUISE March 30-April 11, 2018 Focus: Cardiology, pediatrics, women’s health and cultural anthropology Ship: Celebrity Solstice >

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> BALI TO HONG KONG CME AWAY™ CRUISE March 24-April 8, 2018 Focus: Anesthesia and emergency medicine Ship: Regent Seven Seas Voyager MEKONG RIVER CME AWAY™ CRUISE October 16-31, 2018 Focus: Neurology and endocrinology Ship: AmaWaterways – AmaDara For current promotions and pricing, contact: Sea Courses Cruises TF 1.888.647.7327 cruises@seacourses.com www.seacourses.com

SERVICES ACCOUNTING AND CONSULTING SERVICES Independent consultant, specializing in accounting and tax preparation services, including payroll and source deductions, using own computer and software. Pick up and drop off for Edmonton and areas, mail or courier options available for rest of Alberta.

Contact: N. Ali Amiri, MBA Consultant Seek Value Inc. T 780.909.0900 aamiri.mba1999@ivey.ca aliamiri@telus.net

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ALGO+MED Algo+Med are a medical billing service submitting to both Alberta Health and Workers’ Compensation Board Alberta. We provide timely submissions, detailed reports and advanced analytics of billing data.

Our processes are secure, ensuring privacy and confidentiality of both physician and patient information. Our rates are competitive and new clients receive their first three months free.

Contact: T 1.866.218.8041 www.algo-med.com DOCUDAVIT SOLUTIONS Retiring, moving or closing your practice? Physician’s estate?

DOCUdavit Solutions provides free paper or electronic patient record storage with no hidden costs.

We also provide great rates for closing specialists.

DOCUdavit Solutions has achieved ISO 9001:2008 and ISO 27001:2013 certification validating our commitment to quality management, customer service and information security management.

Contact: Sid Soil DOCUdavit Solutions TF 1.888.781.9083, ext. 105 ssoil@docudavit.com

DISPLAY OR CLASSIFIED ADS TO PLACE OR RENEW, CONTACT:

Daphne C. Andrychuk Communications Assistant, Public Affairs Alberta Medical Association T 780.482.2626, ext. 3116 TF 1.800.272.9680, ext. 3116 F 780.482.5445 daphne.andrychuk@ albertadoctors.org

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Now open in Edmonton 3rd Floor - 9888 Jasper Avenue T 780.990.4442 F 780.990.4443 JANUARY – FEBRUARY 2017

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