Alberta Doctors' Digest July/August 2016 by Alberta Medical Association

Alberta Doctors'

DIGEST July-August 2016 | Volume 41 | Number 4

Special lssue: Support is growing for an Indigenous health revolution Voices for Indigenous Peoples

“If we are friends together, then we will be able to solve things between us together”

Canadian Medical Association responds to a need for action on Indigenous health A new resourse for providers

Virtual Hospice has launched lndigenous Voices: Stories of Serious lllness and Grief

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CONTENTS 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 Co-Editor: Alexander H.G. Paterson, MB ChB, MD, FRCP, FACP Editor-in-Chief: Marvin Polis President: Carl W. Nohr, MDCM, PhD, FRCSC, FACS President-Elect: Padraic E. Carr, BMedSc, MD, FRCPC, DABPN Immediate Past President: Richard G.R. Johnston, MD, MBA, FRCPC 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 September-October issue deadline: August 15

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.

DEPARTMENTS 6 From the Editor 8 Letters 22 Dr. Gadget 28 PFSP Perspectives

30 Health Law Update 35 In a Different Vein 38 Classified Advertisements

FEATURES 10 Support is growing for an Indigenous health revolution 1 1 A new resource for providers

Virtual Hospice has launched lndigenous Voices: Stories of Serious lllness and Grief

12 Canadian Medical Association responds to a need for action on Indigenous health 14 Voices for Indigenous Peoples

“If we are friends together, then we will be able to solve things between us together.”

20 Why bother with history of medicine? 24 Emerging Leaders in Health Promotion Grant program – project profiles 32 Preaching to the converted in Cochrane

Youth Run Club – Spring 2016 launch

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. © 2016 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. Alika Lafontaine says a movement is growing toward an lndigenous health revolution and Canadian physicians must play a central role. JULY – AUGUST 2016

A SPECIAL ISSUE

Indigenous health Marvin Polis | EDITOR-IN-CHIEF

he Truth and Reconciliation Commission hearing and report have opened the eyes of Canadians to the devastating effects of what has been termed "cultural genocide" on Canada's Indigenous Peoples. Awareness is leading to open conversation and a groundswell of support.

As our guest columnist Dr. Alika Lafontaine writes: "The health disparities of Canada’s Indigenous Peoples continue to widen despite various attempts by the health system to effectively intervene. For more than two decades, we have asked the question: “Why are Canada's Indigenous Peoples so sick?” Perhaps the more pressing question is: “Why are Canadians so healthy?”" The medical profession has long observed the inequities in care provided in Indigenous communities and the rest of the country. However, there has been little ability to effect change. This special issue of Alberta Doctors' Digest is devoted to considering the plight of Indigenous Peoples and looking forward to new solutions and an unprecedented level of cooperation and collaboration by and among the necessary parties to begin to make a difference. I hope you find this issue informative and thought-provoking.

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JULY – AUGUST 2016

FROM THE EDITOR

The end of doom Dennis W. Jirsch, MD, PhD | EDITOR

find that news regarding the health of our planet is mostly bad, with new perils in abundance while the old ones soldier on. I think we’re looking for hope – faint or otherwise. Journalist Ronald Bailey has impressed me with news that softens some of the bleak forecasts of coming environmental misery. In his new book, The End of Doom: Environmental Renewal in the 21st Century, Bailey argues that, given time and human ingenuity, the major environmental circumstances that threaten us will become more tractable.1 First, there is the matter of our soaring world population. We’ve been worrying about this since the 18th century with the writings of economist Reverend Thomas Robert Malthus. There is a fundamental mismatch, Malthus contended, in the tendency of our population numbers to grow exponentially (1, 2, 4, 8 and so on), at the same time that our ability to produce food grows but arithmetically (1, 2, 3, 4 and so on). Malthus foresaw a world in which population numbers would soon outstrip food supply. His forecasted global famine never happened but others have taken up the argument. The most prominent of the new-Malthusians have been Stanford biologist Paul Ehrlich and his wife Anne, who continue to predict looming global famine in which millions, if not billions, could perish. If the global starvations forecast by Malthus, Ehrlich and others haven’t happened, it has been because of the so-called “green revolution.” Dramatic increases in agricultural productivity began in the 1960s due to new and more productive seeds as well as vastly better fertilizers. The first commercially successful biotech crops were planted in the US in 1996 and included corn, potato and cotton varieties that were pest-resistant, as well as herbicide-resistant soybeans. The change has been remarkable and by one estimate as much as 80% of all prepared foods we’re fond of picking up at our local mart have biotech origins. World food production has more than tripled over the last 50 years. Though crops have become more bountiful, technological change has not happened quietly and there have been AMA - ALBERTA DOCTORS’ DIGEST

many claims that genetically engineered crops are dangerous. These are generally arbitrary, emotional responses that are at times outlandish. Author Bailey claims one of these as his favorite, citing a certain Irina Ermakova who found that ingestion of biotech soybeans turned mouse testicles blue! The truth, Bailey asserts, is much more straightforward: “No one has ever gotten so much as a cough, sneeze, sniffle or stomach ache from eating foods made with ingredients from modern biotech crops. Every independent scientific body that has ever evaluated the safety of biotech crops has found them to be safe for humans to eat.” If food production is less of a predicament than we anticipated, there’s more good news. Our total numbers are growing, but more slowly than we expected. Birthrates remain high in the poorest parts of the world, but as educational and economic opportunities – particularly for women – increase, and as average life expectancy crosses the threshold of age 60, fertility rates are expected to fall. Indeed much of the so-called civilized world is reproducing at replacement levels, or less. Most experts concur that world population will peak between 8 and 10 billion souls sometime during the second half of this century and will start to fall thereafter. The End of Doom goes on to address our collective angst that our detergents, plastics, pesticides and so on, are possible carcinogens and our suspicion that our risks of cancer are increasing. This may be reasonable enough given the work more than half a century ago that showed tobacco and asbestos to be unequivocally carcinogenic, plus the ensuing work of pioneering environmentalists such as Rachel Carson concerning the effects of DDT (an insecticide) on wildlife. Has the cancer epidemic forecast by environmentalists arrived? The answer would seem to be “no,” as experts suggest that pollution and chemicals in the environment account for no more than 3% of all cancers. As US figures attest, the overall incidence of cancer has been falling, about 0.6% per year since 1994. Cancer is most commonly age-related, and an apparent increase in cases is attributable to the facts that there are more people in the world and they are living longer. >

> Bailey considers our recent preoccupation with climate change. Though there remain the usual factions – the believers and the deniers – one set of these, the deniers, is getting smaller all the time. Atmospheric CO2, methane and nitrous oxide have risen to levels unprecedented in the last 800,000 years. As Bailey, himself a recent convert, says, “All data sets agree that the last 10 years or so have been the warmest on record and the vast majority of climate researchers agree that manmade warming is now under way.” Despite this concurrence of opinion and recognizing a long-term trend for global average temperatures to rise 0.12˚C per decade, global average temperatures have not increased in the past 16-18 years and have remained essentially flat. This phenomenon has been explained on the basis of natural weather fluctuation, while others suggest extra heat may be hiding in the oceans.

… given time and human ingenuity,

the major environmental circumstances that threaten us will become more tractable.

2100 if no policies were adopted to mitigate or adapt to climate change. Under these circumstances Bailey expects that the global economy would have reasonably grown eight-fold (from $67 trillion to $577 trillion in constant 2005 dollars by 2100). Accompanying this growth, average global temperatures could jump perhaps 2.5˚C and would be associated with economic losses in the range of 1.5-5% per capita. The losses accorded climate change, given this not unreasonable set of events, would be major and disruptive to be sure, but would not mean economic Armageddon. Bottom line, perhaps: pain, loss, hardship, difficulty, but considered globally, stuff we can probably handle. On the other hand, who hasn’t seen predictions that didn’t pan out, or turned out worse than expected? In any event, there is still plenty to worry about, and Bailey cites Yale economist William Nordhaus: “Biotechnology, strangelets, runaway computer systems, nuclear proliferation, rogue weeds and bugs, nanotechnology, emerging tropical diseases, alien invaders, asteroids, enslavement by advanced robots and so on.” We can all likely add more. But maybe, just maybe, our planet and most of its people will get through this ... Let’s hope. Reference available upon request.

This possibly anomalous situation can’t be considered as reason for inactivity. There are many computer models used to forecast climate change, and many are in limited agreement regarding what happens next. Many activists consider our situation a true emergency and would have us choose between economic growth and averting the possibility of disruptive climate change. Recall Al Gore’s call “to commit to producing 100% of our electricity from renewable energy and truly clean carbon-free sources within 10 years.” But it’s not doable, given the state of the world, and we continue to bumble along talking about economic underpinnings, technological capture of solar, wind and wave power, and carbon taxes. What then are we facing? I’m not one to usually take comfort in economic projections. But Bailey does. Consider the economic costs of extreme weather. Average temperatures over land have increased by about 0.7˚C since the 1950s and extreme weather has become commonplace. Researchers have studied worldwide economic losses due to weather extremes, thinking they would rise substantially, but this hasn’t been the case. Bailey concludes that climate change is not likely to be a big contributor to losses stemming from weather disasters in the next few decades and that, in dealing with our warming planet, boosting the wealth of the poor through economic growth may be the best protection against meteorological disasters. Bailey goes on to more directly consider the economics of climate change and considers various scenarios. The Intergovernmental Panel on Climate Change (IPCC) provides one such scenario, describing the world in

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JULY – AUGUST 2016

LETTERS

read the May-June 2016 edition of Alberta Doctors’ Digest on a rainy afternoon and found our editor’s concluding remarks in the article “Mortal rigors” very interesting. After asking the question, “Who indeed owns my life?” there is no response but an assumption that the answer is obvious. But the following sentences are interesting: “When there is no respite from grim circumstances, I expect some physicians will take part assisting patients toward a better end. It is an enormous responsibility.” As a palliative care physician, I want to thank you for sharing

s a recently-retired IMG who qualified in 1971 and has held leadership positions in medicine in three countries, I feel obliged to comment on Dr. Emery’s cover feature article in the March-April 2016 issue of Alberta Doctors’ Digest. To start with: I see the role of the physician as a person who needs to strive to relieve the real, psychological or imagined sickness (dis-ease) in his/her patient. Making a correct diagnosis is a means to this end. It is not the end. In the (bad) old days before multimedia, patients left the office mostly contented with a doctor’s diagnosis and advice. Unfortunately, those days have gone. Advice from friends and family, anywhere in the world, is as close as the phone. Doctors Google and Wikipedia are a tap away. Special exams like blood work and imaging are available and gratis. Worst of all, the pressure of the waiting room is a massive constraint to good doctor-patient relations.

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that our therapeutic presence and our work in alleviating suffering is “a better end” than continuing on treating disease as opposed to humans, and that this work “... is an enormous responsibility.” Your article assumes you are referring to those physicians who end lives but you could interpret your article as I stated above. You see, treating the human aspects and not the disease aspects of humanity is an alternative approach to medicine and it does lead to “dying well,” which could be stated as “a better end.” Has not the alleviation of suffering, instead of the termination of suffering or the ignoring of

suffering, been the traditional goal of medicine all along? If not, I must have missed something in my 40+ years of practice.

Now we come to low-back-pain. In the absence of “red flags,” we all know this will improve over time – especially with exercise and (where available) targeted physiotherapy. I say “we all” and I mean “except the patient.” His/her back is sore and having a bad effect on his/her life. That’s why the patient comes to the doctor in the first place. The patient finds it unacceptable to be told, even after a thorough examination, to wait it out. “Something” causing pain in my back won’t cut it. There must be a “treatable” cause.

an orthopedic specialist who will see a patient with low back pain without a lumbar series X-exam and, at least, a CT. I suspect this is the reason for the highly skewed pie chart on page 11. Patients are even sent back to the family practitioner with instructions to order this imaging. I have always wondered whether it wouldn’t be more appropriate for the specialist to order the imaging himself/herself. In this respect, I think Choosing Wisely Alberta could well suggest that ordering of imaging beyond the level of X-rays should be, where indicated, in the domain of the specialist.

That’s where the specialist consultation comes in. The six-month wait to see the specialist is generally good for the patient who knows that the pain will have improved by then. The patient will have the same thorough exam and be told by the “expert” that he/she needs to lose weight and exercise. Now, however, we come to the question of imaging: I do not know of

I, too, think of treating suffering as merciful – but it does not mean providing fixes and sending them off or ending it. It means walking along with our patients, side-by-side, and investing time with them. If we believe the literature, over 90% of patients who request death want these things – not the ending of life. Dr. David Falk Calgary AB

Finally, as was mentioned, the patient’s demands: Which of us will tell him/her “no” when, at the back of our mind, the thought arises that someday we would have to explain to an unsympathetic court why we denied access to the “readily available” resource. Dr. Selby Frank British Columbia, Alberta, Namibia, South Africa

JULY â&#x20AC;&#x201C; AUGUST 2016

COVER FEATURE

Support is growing for an Indigenous health revolution Alika Lafontaine, BSc, MD, FRCPC | REGION

8 REPRESENTATIVE FORUM DELEGATE, ALBERTA MEDICAL ASSOCIATION; PRESIDENT, INDIGENOUS PHYSICIANS ASSOCIATION OF CANADA

he health disparities of Canada’s Indigenous Peoples continue to widen despite various attempts by the health system to effectively intervene. For more than two decades we have asked the question, “Why are Canada's Indigenous Peoples so sick?” Perhaps the more pressing question is, “Why are Canadians so healthy?” The seven Truth and Reconciliation Commission’s (TRC’s) Calls to Action on Health clearly identify possible answers to these two questions and challenge physicians to rethink our role in Indigenous health. Last July, First Nation Chiefs across Canada – through the Assembly of First Nations – called on the Canadian Medical Association (CMA) to “… adopt and support Calls to Action #18 to #24…,” the TRC recommendations specific to health. Several Indigenous-specific resolutions were also passed at last year’s General Council.

A movement is growing towards

an Indigenous health revolution and Canadian physicians must play a central role.

What has happened since then? In November 2015, the CMA joined with 23 other national medical organizations to become a supporter of a national Indigenous Health Alliance. Led by Indigenous Peoples, this alliance has key partners including the Royal College of Physicians and Surgeons, Indigenous Physicians, HealthCareCAN, among others.

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Most importantly, Regional Chiefs from Saskatchewan, Manitoba and Ontario attended the debate to directly engage with health leaders. A movement is growing towards an Indigenous health revolution and Canadian physicians must play a central role. In June at the National Health Leadership Conference’s marquee event, the “Great Canadian Healthcare Debate,” I successfully argued on behalf of the alliance for implementation of the TRC Calls to Action on Health to become health leaders’ top priority for 2017 (with 73% support from participating organizations).

What can physicians do? First, we must recognize the opportunity. Over 150 First Nations have joined the movement to transform Indigenous health: 20% of all First Nations in Canada. Their communities – La Loche, Cross Lake and Attiwapiskat – suffer many of the worst health disparities of any Indigenous or non-Indigenous community in Canada. Nationally, the Assembly of First Nations supports the alliance through its executive. The number of Indigenous Nations joining this alliance will surely grow and there is early engagement of Alberta’s First Nations. Indigenous Peoples are organizing themselves and are ready to engage. Physicians will never again have the opportunity to impact Indigenous health as you will right now. Provincially and nationwide, political and public support is in our favor. We are living in an historical moment. Now is the time to act. Second, we must be honest and frank with ourselves about the concerns we have moving forward and the barriers we know exist. These include areas such as human resources, systemic policies that oppose patient-centered care, fear of unsuccessful results and difficulties engaging Indigenous Peoples in the past. On August 20, the CMA will hold a special session on Indigenous health – looking towards reconciliation in health and the seven TRC Calls to Action on Health. >

> We will discuss: • Re-profiling existing resources, with a focus on outcomes and measurements. • How to achieve successful results by adopting a clear and shared process. • Ways to engage with the intent to redefine the problems from multiple perspectives, identify multiple solutions and working with impacted groups to implement the solutions.

Physicians will never again

have the opportunity to impact Indigenous health as you will right now.

At time of writing, it is not known if live-streaming of the CMA special Indigenous health session in Vancouver will be available. I encourage you to participate that way if possible, or by following the reporting that comes from the event. As well, engage with the Alberta Medical Association in its ongoing Indigenous community engagement. Work with us to close the gap in Indigenous health disparities and be a part of an Indigenous health revolution.

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A new resource for providers: Virtual Hospice has launched Indigenous Voices: Stories of Serious Illness and Grief Canada's Indigenous Peoples are commonly underserved in the health care system and particularly in palliative care. The series, Indigenous Voices: Stories of Serious Illness and Grief, was developed to empower and support Indigenous Peoples and their families living with advanced illness, and to serve as a rich, educative tool for health professionals wishing to improve the delivery of culturally safe and inclusive care. In this video and print series, First Nations, Inuit and Métis from across Canada share stories about traditions, rituals and spirituality, experiences of care and after-death ceremonies and grieving. The video series consists of 170 short video clips organized by theme and highlights are captured in four longer videos: Ceremony, tradition and spirituality; Caring for the patient and family; Walking alongside for a good death; and Honoring our loss and grief (available on DVD and USB). A print series covers eight topics related to palliative and end-of-life care and grief, featuring powerful images by Indigenous artists. Indigenous Voices: Stories of Serious Illness and Grief was developed by Indigenous Peoples for Indigenous Peoples. The team (composed of researchers, clinicians, patients living with advanced illness and families) worked in collaboration with the Canadian Virtual Hospice and followed strict adherence to the principles of ownership, control, access and possession (OCAP). Funding for development of the series was provided by the Canadian Partnership Against Cancer. To view the Indigenous Voices series go to LivingMyCulture.ca

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anndawrant@shaw.ca JULY – AUGUST 2016

FEATURE

Canadian Medical Association responds to a need for action on Indigenous health R. Michael Giuffre, MD, MBA, FRCP, FRCPC, FACC, FAAC

ith Dr. Linda Slocombe, it is a great privilege to serve as Alberta Medical Association representatives on the Board of Directors of the Canadian Medical Association (CMA). That board addresses a wide variety of issues from across the country with deep implications for Canadians. Today, I believe there are few more critical opportunities to make positive change than with respect to the health, wellbeing and future of our Indigenous and Aboriginal Peoples. As others will also comment in this special issue of Alberta Doctors’ Digest, for far too long there has been an inequity between the care these Canadians receive vs. what non-Aboriginal citizens enjoy. As physicians, we have observed, we have tried to compensate, but we have had little ability to effect change. The time for living with the status quo is done. It is time for change now. The findings of the Truth and Reconciliation Commission have brought increased awareness to all of us regarding the crippling legacy of the residential school system on our First Nations People and the social determinants of health in their communities. Canadians are waking up and asking why we have been willing to accept that these neighbors and citizens are living in conditions so inferior to our own. Physicians in general can become more aware of the particular concerns of Indigenous patients and communities. That knowledge needs to be embedded in our training and our practice. Most importantly, we must gain the knowledge of what is needed from those who have experienced the inequity. We must speak with and be guided by Aboriginal physicians in every province, along with the chiefs of the treaty nations, elders, community leaders and members. Our plans for improving care need to be sound, not only from a clinical perspective, but also in terms of cultural safety. We cannot determine without discussing and we cannot apply one solution from the outside.

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For all these reasons, I am very pleased that the CMA will convene a special session to kick off the 2016 General Council in partnership with the Indigenous Physicians Association of Canada, the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada. The session is entitled “Indigenous Wellness and Canada’s Health Care System: The Physician’s Role.” The session outline appears below. I encourage you to watch for reporting on this event and related outcomes from the General Council itself.

The time for living with the status quo is done. It is time for change now.

Special Session Outline Indigenous Wellness and Canada’s Health Care System: The Physician’s Role The purpose of this session is to present the context of the development of the Truth and Reconciliation Commission’s Calls to Action, with a focus on the seven recommendations that address the health and health care of Indigenous Peoples. Attendees will hear presentations that include an update on First Nations health in British Columbia, an introduction to the collaborative practice of traditional Indigenous medicine and western medicine, and on how physicians can advance an Indigenous wellness agenda by advocating for reconciliation. These will be followed by table discussion on focused questions. This session is being organized in partnership between the Canadian Medical Association (CMA), the College of Family Physicians of Canada (CFPC), the Indigenous Physicians Association of Canada and the Royal College of Physicians and Surgeons of Canada. >

> After six years of discovery and deliberation, the Truth and Reconciliation Commission (TRC) released its final report in June 2015. The 94 Calls to Action include seven recommendations that are intended to close the gap between the health status of Indigenous and non-Indigenous Peoples. These recommendations cover a range of issues such as support for Indigenous healing centers and increasing the supply of Indigenous health professionals. They also call for recognition of the value of Indigenous healing practices by all relevant stakeholders and call upon medical and nursing schools to require all students to take a course in dealing with Aboriginal health issues and to provide skills-based training in intercultural competency and related issues such as anti-racism. In July 2015 the Assembly of First Nations adopted a resolution calling on the CMA to support the TRC health recommendations and CMA General Council 2015 adopted four resolutions supportive of collaborative activity to improve the health and health care of Indigenous Peoples. The CFPC, Royal College and CMA are exploring options to integrate cultural safety education in postgraduate medical education and continuing professional development.

Learning Objectives In this session participants will:

Agenda

13:00-1310

Welcome by Elder, Coast Salish First Nation

13:10-13:15

Welcome by Dr. Cindy Forbes, CMA President

13:15-13:45

The Truth and Reconciliation Commission: Setting the Context Senator Murray Sinclair, Chair, Truth and Reconciliation Commission

13:45-14:45

Panel Discussion

- “Nothing About Us Without Us” – an update on First Nations Health in BC, Dr. Evan Adams, First Nations Health Authority - Collaborative Practice of Traditional Indigenous Medicine and Western Medicine, Dr. Karen Hill, Indigenous Physicians Association of Canada - Moving an Indigenous Wellness Agenda Forward: Physicians as Advocates for Reconciliation, Dr. Alika Lafontaine, Royal College Indigenous Health Advisory Committee

• Identify how the Truth and Reconciliation Commission’s health recommendations fit in the broader context of reconciliation between Indigenous Peoples and Canada.

14:45-15:00

Break

15:00-15:30

Table discussion with guided questions

• Describe the magnitude of the health status and health care gap between Indigenous Peoples and those in the rest of Canada.

15:30-15:50

Concluding Q&A with panelists

15:50-16:00

Closing Prayer

• Realize that traditional medicine and knowledge are central to primary care in an Indigenous community.

When

• Explore how physicians can implement the Truth and Reconciliation Commission health recommendations in their practices. • Examine how medical associations can work together to advance the implementation of the Truth and Reconciliation Commission Calls to Action.

Saturday, August 20 1-4 p.m.

Where Coast Coal Harbour Hotel 1180 West Hastings Street Vancouver BC

Registration http://fluidsurveys.com/s/indigenous2016/langeng/

JULY – AUGUST 2016

FEATURE

Voices for Indigenous Peoples

“If we are friends together, then we will be able to solve things between us together.”

t the spring 2016 meeting of the Alberta Medical Association (AMA) Representative Forum (RF) in Edmonton, a session was held on health-related recommendations of the Truth and Reconciliation Commission. The RF was privileged to welcome two guests of national stature: Grand Chief Tony Alexis of the Treaty 6 First Nations and Justice (now Senator) Murray Sinclair, Chair of the Truth and Reconciliation Commission of Canada. The two speakers spoke to the RF and each, in their own way, issued a challenge to the profession. Their addresses have been transcribed for this article.

Today, I’m very honored to be here with my relatives, my guests, Justice Sinclair, Dr. Lafontaine, and my relative, Joe Joban. And as we are here, we are here in a way to provide some insight and an opportunity to allow questioning and to be open to ask the questions. You know, as physicians and as people who are committed to look after people and to help heal and bring people to health, we all have one thing in common and that is that we serve people. And that we do the best we can every day of our life so that we can enjoy life here on what we call Mother Earth. So there’s a lot of things that we can talk about.

[Indigenous Peoples] carry a trauma with them. And the trauma comes to you. So as you are looking after them and you’re finding strategies to take care of them, sometimes you’re not aware of what that trauma is.

Grand Chief Tony Alexis, Treaty 6 First Nations

Justice (now Senator) Murray Sinclair, Chair of the Truth and Reconciliation Commission of Canada

Transcript of Grand Chief Tony Alexis, Treaty 6 First Nations I want to bring greetings on behalf of the Confederacy of Treaty 6. If you don’t know who that is, the confederacy consists of 18 communities in central Alberta. Treaty 6 is a territory that goes right into Saskatchewan and a bit into Manitoba. So back in 1876, the Treaty 6 was signed in Fort Carlton, Fort Pitt, and a year later there were also adhesions to that treaty. Alexis, the community that I come from, adhered to a treaty just south of where we are standing/ sitting here right now in 1877. Next year will be our 140th anniversary but the Treaty 6 is 140 years today. And Canada next year is 150 years.

AMA - ALBERTA DOCTORS’ DIGEST

You know, the Truth and Reconciliation, there’s so much within that and when we think about what that means for us as Indigenous Peoples. What I’ve been doing in my travels is sharing what I’ve experienced and what I’ve witnessed in this Truth and Reconciliation. And I’ve seen stories all across the country. I’ve seen the presentations and I’ve heard stories in my own community with my own relatives. And the impact that it has provided on their life – it’s heartbreaking. When we think about it, those people and the generations afterwards, carry a trauma with them. And the trauma comes to you. So as you are looking after them and you’re finding strategies to take care of them, sometimes you’re not aware of what that trauma is. So, I’m going to share as a Chief. I want to share a vision with you. Something that we can work towards. Something that we can think about in 150 years – what is that day going to look like? We have Justice Sinclair who >

> is here who can provide more depth on the Truth and Reconciliation Commission and the calls to action. What I’d like to do is offer a different perspective in what we are here to do and the reason I came here and I will share it with you in a confession – is that when I was asked to come and speak here, I know I was asked to come and speak on the Truth and Reconciliation Committee and the calls to action and I have ideas of what should be done there. But there’s been a lot of work that’s been put into it. And so what I thought I can do today is to help influence our minds together. You know, there’s an Elder in my community who says you have to behave and conduct yourself in this community like you’re raised by one mother. And so Elder Nancy Potts, who has passed on now, she said that to people in my nation. I ask you to stand with me like we’re raised by one mother. And I ask you to stand with me and look 150 years into the future and to think of what that day might look like. But before we go there, let’s step back. Our people in Treaty 6 signed treaties with the Crown 140 years ago. At that time, I wonder if the Chief who was signing the treaty thought that, in his community, they would be dealing with addictions. I wonder if the Chief thought at that time that our languages would start to deplete. I wonder if the Chief and the people of that time thought that we’d be committing suicide in massive numbers. I wonder if they thought that our education level would be low. We would send 30 kids to kindergarten and of the 30 kids, 12 of them would graduate high school. Of the 12, four would to go into post-secondary. I wonder if they thought that. I believe not. I believe they thought that this was going to be a partnership with two nations. And that we would thrive and work together. From that existence, we know what has happened. We know we went through a different clash of cultures and the residential schools and what happened there. And another one called the Sixties Scoop where children are being taken from their community and just delivered anywhere in the world to be raised by someone else. The biggest impact of all of that today is the disconnection apparent in children. But in my community – and I can only speak for my community – there are some parents who are abandoning their children. And that’s not right. The government is not doing it, but there is trauma in the community and somehow they’re doing that. So my message is to work in my community and to try to inspire what this vision is going to look like in 150 years. I’m trying to portray that. And so, I think – what are we going to do? The provincial government has talked about nation-tonation and as a Grand Chief, I get the opportunity to sit with the Premier and the Ministers and to communicate dialogue with them, and in that dialogue we’re talking government-to-government and most of you may not know what that means. We don’t know what that means. And then the federal government: we’ve been with the Prime Minister a couple of times in this past week and a half, and that discussion is government-to-government.

And so when we think about that, no one really recognizes what that means. But for everyone sitting in this room, what does that have to do with you? That’s my intent here: to come and ask for your support. I’m here to seek your support to help us, as Indigenous Peoples, have the opportunity to sit at the table when strategies are being constructed across the country. Whether it’s medical, health, education, if it’s children’s services, whatever that might be, what happens is the government sits there – provincial, federal – and they sit around and in that discussion they talk about how they’re going to provide services for the residents of the land – the people of the land. A sliver of that people of the land are the Indigenous Peoples and the Indigenous Peoples are put into the same category as everyone else. But in your experience, do you find that they’re not the same? Most times we find that it’s not the same. I was interviewed by people in Health Canada: “Chief, we wanted to speak to you about health services in your community.” And I said, “Great, are you speaking to me as a Canadian resident or as a First Nations Chief?” The answer was, “As a Canadian resident.” I said, “OK the interview is done,” and she said, “Why?” “Because the stats have been done already in the country. The strategies have already been implemented in this country. You already have a playbook in front of you of how you’re going to conduct services and provide programs in the country – you don’t need to visit with me.” She said, “Well, I want to know about the First Nations.” “That’s my question: Was I a First Nations Chief or a Canadian citizen, the resident of the land?” And then again, she said, “the resident.” “Then there’s no more reason to talk.” It was when she finally accepted that I was a First Nation Person, that we can talk. Now I can share what I think is happening in my community. The services are minimal, there’s prejudice, there’s racism, there’s all of these things we can add to this pot, but where I wanted to go in that discussion was not at that level, was not at the area you work with, the patients that come to you. We need to turn around and go higher up. We need to talk to the government, for the government to recognize that as Indigenous Peoples, through everything that we have come through, for even all the court cases that we have won in Supreme Court, to identify us as an individual group of people, a demographic in this country, and recognize that we are different. We have Indian reserve lands, we have jurisdiction federal, here as I stand here in the City of Edmonton on the Province of Alberta on the country of Canada, I’m here as a First Nation Chief >

JULY – AUGUST 2016

> and what does that mean to everybody here, as a treaty Chief, what does that mean to everybody? The truth of it is, you don’t really need to know what that means right now. If you’re providing services to help me heal, or to my people, why do you need to know if I’m a treaty Chief or not? We just know that I’m genetically human and that I need some help. You should be prepared like that, but the government is not preparing you in that way. They give you a playbook and they tell you this is how we want you to provide services. Then the Indigenous Peoples are coming through and saying we have rights, the medicine chest clause, we have treaty rights, we have this and that, all of this, and you’re not hearing it because it’s not being forwarded to you. But really did you have to know all of that? You just have to find a way to fulfill your role as a physician to provide service to a human being – quality service. For all your effort and energy, you’ll be paid for that. And so that’s the economic side of it and the human side of it. The disconnect is at the government.

I ask you to stand with me like

we’re raised by one mother. And I ask you to stand with me and look 150 years into the future and to think of what that day might look like.

So I want to thank the AMA very much for this opportunity to be here to speak and I want to welcome all of you to the Treaty 6 territory. God bless you. Thank you very much.

Comments by Justice (now Senator) Murray Sinclair, Chair, Truth and Reconciliation Commission of Canada I have the distinct pleasure to have responded to your invitation to be here with you and I want to thank you for the invitation. I want to acknowledge that we are on Treaty 6 territory and thank the Chief for that welcome and for his remarks. I want to, as well, ask you to engage in another exercise but I’m not going to throw anything up on the screen to try to fool you. But I want you to take off your medical hats for a moment and I just want you to think as human beings, as Canadians, about what I’m going to talk to you about now because it is in that capacity that I really responded to your invitation. Though I know there are issues relating to health that we have addressed in our report, and that health is a predominant aspect of your life, and that health is a predominant issue in our future as a country, particularly for Indigenous Peoples, and that you have a prominent role to play in that – it is really our human-to-human discussion that we need to have at this point. I want to engage with you – because reconciliation is a very simple concept. We complicate it by doing so much analysis and word smithing about what reconciliation means, but reconciliation is really built on a very simple concept and that is: “I want to be your friend.” “I want you to be my friend.”

The Health Accord is going to be renewed here over the next few months. There’s going to be conversation with the federal government and the provincial government, but in that conversation, there’s no First Nation or Indigenous voice in that for this sliver of demographic of people to represent them properly, so that you’re not confused when they come to you ill or injured. We need the government to say first: Indigenous Peoples need have a voice so we are not disconnected, so we are not hurting them or being accused of hurting them on purpose. At the high level, that work has to be done. And that’s what I came here to share and to ask for your support in. We are working with the provincial government right now. We are lobbying the federal government today to have a voice at that table so that when we’re talking Health Accord and there’s a new program that’s going to be coming out across the land, that’s not confusing to you, that doesn’t mislead you. I’m here to ask for that help. Then, 150 years from now my people will be more like Dr. Lafontaine and your colleagues. We will be healthy, not in that poverty state. We will maintain the beautiful language and songs that we have, this traditional headdress and that we will walk in a way that helps and supports one another. And if that happens in 150 years, that’d be like a prayer answered.

AMA - ALBERTA DOCTORS’ DIGEST

“If we are friends together, then we will be able to solve things between us together.” We have to solve things between us, which is why I want you to take off your medical hats for a moment and just listen to what it is that I have to tell you. Next year, in 2017, Canada will celebrate the 150th anniversary of confederation. This country has existed for 149 years and it will celebrate its 150th year of existence next year. That pales in comparison to how long Indigenous Peoples have been here, but that’s not the point. The point is this: for 125 of those 150 years that Canada existed, the governments of this country and the society around which those governments were formed, deliberately embarked upon a process to culturally eliminate Indigenous Peoples. They deliberately embarked upon a process to wipe out Indigenous language, Indigenous culture and Indigenous identity because they set out on the task to try to ensure that Indigenous Peoples were assimilated totally into Canadian society so that, as Duncan Campbell Scott, the Deputy Minister of Indian Affairs in 1925, very clearly said: “We will no longer have an Indian problem in the future.” They saw Indian People, First Nations People, and all Aboriginal People, Métis and Inuit as well, as a problem that needed to be overcome. >

> And what was the problem? Well, the problem couldn’t have been simply that we spoke our own language, that we had our own identity, that we were a different colored skin. That was certainly a problem for those who believed in the purity of the white race. Sir John A. Macdonald believed in the Aryan philosophies that were predominant in the 19th century. He was an Aryan believer and there were others like that, but that wasn’t a dominant feature of Canadian society. That’s not what they were setting out to do. What they were setting out to do was to eliminate Indigenous presence and ownership of the territory. It was in order to eliminate Indigenous interests in the land that Canadian government wanted to eliminate Indigenous identity. It was in order to facilitate the takeover of Indian territory, of Indian lands, First Nation lands, of the Métis interests in lands that were guaranteed by the Manitoba Act of 1870.

I want you to take off your medical

hats for a moment and I just want you to think as human beings, as Canadians …

So the purpose of everything the government did when it came to Indigenous Peoples was to eliminate their identity, their culture, their uniqueness – because it was that identity, that culture and that uniqueness which allowed them or encouraged them to maintain a connection to their territories. And it was that connection to territory that the government very badly wanted to get rid of so that they could expand the nation of Canada into the west without any resistance.

according to the United Nations Convention on Genocide passed in 1949, because there is a very clear provision within it which talks about the deliberate creation of circumstances that will prevent people from being able to exist, from being able to maintain their sense of identity, as acts of genocide. One of the provisions of the Convention on Genocide which they practiced very significantly, both in the United States as well as in Canada, was to forcibly remove Indian children from their families and place them with people of another culture for the purpose of indoctrinating them into that new culture and eliminating their contact with their own culture. That’s in section 2E of the Convention on Genocide and that, if it were done today, would result in criminal prosecution in the world courts. But Canada was party to that. Canada deliberately set out to do that. And those who ran the schools that were created as the means by which they could achieve that by removing those children and placing them in those schools knew that was the intention behind the existence of the schools. The Catholic church ran most of the schools in western Canada and in conversations I’ve had with Catholic leaders since I became the Chair of the Truth and Reconciliation Commission, I said it has been my observation and the observation of many others that when you look around the world of where the Catholic church has gone, you see today that from Africa there are many Catholic leaders who are of African descent who participate in executive decision making at the church level. Cardinals come from Africa. Cardinals come from South America.

Everything the government did from 1871 onward was in order to overcome that resistance and when you look at some of the current historical research that has looked at back to that era, including the Truth and Reconciliation Commission report, you can see very clear evidence of that.

Yet there are no cardinals of Indigenous ancestry from North America. Why is that? In fact, there are no Indigenous archbishops from the Catholic church in North America. There was one once in New Mexico. He was of Spanish ancestry as well, but he was murdered for abusing Indigenous children. Only one Indigenous archbishop of the Catholic church has ever existed in North America and it’s because the Catholic church’s behavior in North America was different. It was because it participated in this policy of deliberately undermining the self-identity of Indigenous Peoples in North America – the existence, the separateness of Indigenous Peoples.

James Dashick from the University of Regina has written a wonderful book called Clearing the Plains in which Sir John A. Macdonald authorized the deliberate starvation of Indigenous Peoples who refused to move onto Indian reserves, give up their lands, sign treaties, because they were standing in the way of western expansion. The Government of Canada and the United States collaborated. Documents exist to prove this. They collaborated on a policy of wiping out the herds of buffalo on the plains so that Indian People would lose their source of food, lose their source of being able to self-sustain.

And what impact did that have? Well, we saw a lot of it coming out through the testimony that came to us at the Truth and Reconciliation Commission, but statistics I think are interesting to look at. In the early 1980s the first of several thousand survivors of residential schools went to court claiming that they had been abused. Many people who went to the schools had been abused, physically and sexually, virtually from the beginning of the schools. And those claims were never accepted by society, by people within the church, by even their own families who couldn’t believe that this is something that would happen.

And what does all of that really mean though? It means that they set out on a policy of destruction of culture, of people, of identity. That qualifies as an act of genocide,

And those claims were pushed down, were ignored, were put away. To the point that, in fact, people came to believe that if they did complain about what somebody >

JULY – AUGUST 2016

> from the church had done to them, that they would go to hell, that they would live a life constantly in pain and sorrow. And many parents of Indigenous children who had themselves gone to residential schools would tell their children, don’t say that about the priest, or you’ll live in purgatory or you’ll live in hell. So they denied the validity of their own children’s stories, though they themselves may have been abused by people in the schools. Physical and sexual abuse was rampant according to the documents that we looked at virtually from the time the schools were created, because physical and sexual abuse were rampant in the schools in the United States that had been created beforehand. Carlisle residential school had been created, for example, in Pennsylvania in the 1860s and all of that was forced into Canada when those abusers were caught and apprehended. The church’s practice was to move the abuser to another location and eventually they moved into Canada, into Alaska, into the Northwest Territories, and then eventually over into Ireland and then now into South America where just the other month, the Pope of the Catholic church acknowledged the abuses that had gone on in those countries and South America. But the onus wasn’t just all on the Catholic church. The abusers went to school no matter who was running them. Abusers worked for the Anglican church, for the Presbyterian church, for the United church and the abuse was not just sexual in nature – it was physical. A lot of people were physically damaged by what went on in the school. Those lawsuits led eventually to a settlement agreement being signed by the Government of Canada after the Supreme Court of Canada said that if an abuser abused a child in the school, then the government was liable. So the government signed a settlement agreement in 2005 allowing more survivors to come forward. And by the time the settlement agreement was ratified in 2007, 80,000 people had stepped forward to identify as those people who had been placed in those schools that were set out in the agreement. And of those 80,000 people, 37,000 of them – almost one-half – claimed to have been physically or sexually abused while in the schools to the point that it would sustain a claim for physical damage. Those claims were heard by adjudicators, most of them have been sustained to this point in time. But keep in mind that of those who were abused in the schools, came out of the schools in a damaged state, went back to their homes, tried to raise families, and in some cases, became abusive to their own children or to other children in the community, or to other people in the community. That has led to great damage within much of what has been going on in Indigenous communities for a long time. But the important thing is that now this has become recognized and that recognition has led to a movement, a strong movement, towards healing. And that question of healing within Indigenous communities and by survivors of themselves and for themselves, often embraces

AMA - ALBERTA DOCTORS’ DIGEST

western methods of healing as you have been trained in. But it also engages elders, traditional healers, traditional belief systems, some of which are not quite understood fully, but are seen as part of the process of recovery of identity that those who have been in the schools, and their families, want to engage in. They want to know who they are. And they want to become what they should have become, but for the schools.

Reconciliation is about the relationship … It’s about friendship. I want to be your friend. And I want you to be mine. And if we are friends, then we can solve these things together.

The last residential school closed in 1996. Hard to believe that occurred and was occurring still not only in your lifetime, but while you were going to schools just down the road. But keep in mind that within the schools, the children were not only being mistreated, they were being told that they were savages, that they were heathens, that they were inferior and they were lucky that the Europeans came here and saved them from extinction. That was a commonly held belief in Canadian society that Indian People would have extinguished, would have passed away, would have died out but for the arrival of European societies. But never mind the fact they’d been here for 20, 30, 50 thousand, 100 thousand years, depending on which archeologist you believe, but the evidence was they’d been here for thousands of years, without European influence. Yet here they were, being told “you would have died out but for us.” But that message not only was conveyed in the residential schools, it was conveyed in the public schools as well. That message of Indigenous inferiority was a very strong message in the public school system and I know because that’s where I went to school and that’s where you went to school. And if you think about it, if you think about how you were educated in the public schools that you went to in this country, you have to admit that the public schools didn’t teach you very much about Indigenous Peoples. They never talked about the Indigenous neighbors who lived beside you, the tribes you grew up along with. They didn’t talk about Indigenous rights, they didn’t talk about Indigenous exploration, other than those who may have assisted European explorers, other than those unique circumstances that may have arisen from time to time, such as the War of 1812 and Tecumseh’s participation in that. But they certainly did talk about the savagery of the Indians, they did talk about the heathenism, the paganism. They talked about Indigenous Peoples in general terms to deny their very existence and validity as human beings. >

> Those of us, as Indigenous Peoples who went to public schools, were educated in an environment that caused us to feel shame. And that was bad enough. What was even worse though was that those of you who were not Indigenous being educated in that environment were educated to believe in the myth of European superiority. You were taught to believe that Europeans who came here were superior people, were intellectually, culturally and in every other way superior to the Indigenous Peoples of this place because those people had laws who came here. They had culture. They had knowledge. They had awareness of the environment, the world. And Indigenous Peoples – you weren’t told about any of that – even though we did too. We had laws. We had knowledge. We had culture. We had awareness. We had teachings about the universe. But none of that was conveyed to any of those in the public schools. So unconsciously, you have been taught to believe in the myth of European superiority and the myth of Indigenous inferiority. And that has caused a great rift in your friendship or lack of friendship with Indigenous Peoples. And so you have some healing to do, too. Reconciliation is not an Indigenous problem. Reconciliation is a problem for all of us and we need to come to terms about where we are at on that path of reconciliation because reconciliation is about the relationship, remember? It’s about friendship. I want to be your friend. And I want you to be mine. And if we are friends, then we can solve these things together. But if we are not friends, there is no hope for us to solve these things. There really isn’t. It will always be a situation of we are demanding of you and you are reluctantly giving to us. And that’s not going to work very long. It hasn’t worked to this point in time. But if you agree, that this is an issue for both of us to solve together, then it’s a different problem and a different approach. The impact of residential schools is felt most deeply by children. It was children who were taken away to the

schools and they have lived into their adulthood and onto their deathbeds with the impact of the schools. One of the significant impacts, of course, was in the area of health. If you read our report, the health section is 190 pages. So we tell you all the statistics that you need to know. If you want to understand why we issued the calls to action that we did, it’s all set out in that material. And it will help you understand why those of you who are in positions of leadership now in society and the medical community is one of the great institutions of leadership in this society, you change the way health is delivered and can do that. You may not think it, but people listen to you. And you can have an impact, you can help to make things happen. So I ask you to read the report. I ask you to understand those calls to action and I ask you to take action to make them happen. Everybody asks after they’ve heard the presentations we’ve done or they’ve seen the videos that we’ve produced, "what is it that I can do?" And it’s very clear for you what you can do. You have resolutions that are going to be presented to you that call for certain steps to be taken by the medical community and I encourage you to look seriously at that and to do those things that you’re called upon to support, because the health of Indigenous Peoples will not improve unless you are willing to step forward and share in that responsibility. The health of our children is not going to improve unless all of society recognizes its responsibilities to those children. It’s the children who are going to give us the answer, because they intuitively know that something is wrong here and what it is. And they intuitively know that they are the ones who are going to fix it. Senator Sinclair concluded his address by playing a video in which children reflected on reconciliation, why it is needed and how we can move forward. For resources and further information, visit the Truth and Reconciliation Commission of Canada at www.trc.ca.

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FEATURE

Why bother with history of medicine? Dawna M. Gilchrist, MD, FRCPC, FCCMG, DHMSA | PROFESSOR

EMERITA, UNIVERSITY OF ALBERTA;

MEMBER OF THE BOARD, ALBERTA MEDICAL FOUNDATION

e call it the University Hospital and we probably always will. After all, it is a hospital, it is at the University of Alberta (U of A) and it has been called University Hospital since 1922. However, even when the room numbers end in WMC, many do not realize that WMC stands for Walter C. Mackenzie Health Sciences Centre – the official name of the “University Hospital” since 1979. There are many things named after individuals in the medical world – hospitals, institutions, societies, lectures, awards, even instruments. (I remember being totally confounded as a medical student by a surgeon calling for a Kocher. I subsequently, definitively identified myself as a prospect for a non-surgical specialty by asking for “tweezers,” i.e., forceps.)

The bigger topics

of why medicine has evolved as it has, and how this has affected the way we practice today, must be explored by formal historians with careful research and analysis.

Yet, do we remember who these people were and why we felt it appropriate to name things after them?

AMA - ALBERTA DOCTORS’ DIGEST

Let’s talk about Dr. Walter C. Mackenzie. Born in Nova Scotia, trained at Dalhousie and the Mayo Clinic, then tempered as a Royal Navy surgeon during WWII, Dr. Mackenzie became professor and chair of the Department of Surgery at the University Hospital in 1950. He subsequently was dean of the U of A medical school from 1959-74. Amongst many positions, Dr. Mackenzie served as president of the Royal College of Physicians and Surgeons of Canada and president of the American College of Physicians. In addition to multiple other accolades, he was awarded the Order of Canada in 1971 and became a laureate of the Canadian Medical Hall of Fame in 2014. Every day, hundreds of individuals pass his bust in the east foyer of “University Hospital.” A few will remember the man; many will not connect the name on the bust to the facility. The Alberta Medical Foundation (AMF) is the history of medicine arm of the Alberta Medical Association (AMA). Established by a bequest from Dr. Margaret Hutton in 1983, the AMF strives to promote and support educational and research activities in history of medicine in Alberta. As a member of the AMA, you can choose to support these activities by donating through a line item on your yearly membership renewal. On the national front, several groups support history of medicine. The Canadian Society for the History of Medicine encourages membership from both physicians and PhDs

with interest in history of medicine, culminating in a meeting held in different cities across the country annually. The Canadian Medical Hall of Fame chooses six laureates yearly from submissions from individuals, medical schools and other medical and non-medical institutions and also hosts an annual event.

As medical practitioners, both

singly and in our groups, we can certainly do more to ensure that those who are making their history today are nominated for honors so that their names, too, can be remembered in the future.

Most medical schools have some history of medicine group or program. Some even have funded faculty positions for history of medicine. In this latter respect, Associated Medical Services Inc. (AMS), also known as the Hannah Foundation, has been particularly helpful in funding several Hannah Chairs in History of Medicine in Ontario medical schools. AMS also funds history of medicine research, meetings (including travel for students) and educational programs across Canada. >

> Recently, Dr. Richard Fedorak, dean of the Faculty of Medicine and Dentistry at the U of A, found funds for an upcoming summer research project into documenting the background of 106 named awards given yearly to medical students. Eventually, each award-winning student will receive some information on the individual in whose name the award is given. Multiple physician groups such as the AMA, the Royal College of Physicians and Surgeons, the College of Family Physicians of Canada, the Canadian Medical Association, and numerous medical societies and specialty groups, support many named awards as a way of honoring both the past (the individual for whom the award is named) and the present (the individual who wins the award).

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As medical practitioners, both singly and in our groups, we can certainly do more to ensure that those who are making their history today are nominated for honors so that their names, too, can be remembered in the future. We can all think of individuals within our own areas of expertise that could potentially qualify for one of these many prestigious awards. And, perhaps, more awards can be named for those who are currently contributing in ways that should be honored and remembered by future generations of practitioners.

practicing medicine to remember those who have gone before. In closing, I do not wish to suggest that history of medicine is only a long list of names, dates and happenings. The bigger topics of why medicine has evolved as it has, and how this has affected the way we practice today, must be explored by formal historians with careful research and analysis. However, if we do not start with remembering the basics of who, when and what, can we ever attempt to appreciate our profession in its entirety?

It is important to realize that time passes, memories fade, colleagues retire and, eventually, die. It remains incumbent upon those currently

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DR. GADGET

Do I need a medical calculator? Wesley D. Jackson, MD, CCFP, FCFP

edical information is increasing at an exponential rate and, as physicians, we face the challenge of using up-to-date, evidence-based medicine (EBM) to provide the best possible assessment and treatment of those who come to us for help. Just as mathematicians, physicists and other scientists require calculators to help solve complex problems in their field, every medical provider should have access to a good, evidence-based and current medical calculator. Medical calculators aid in diagnosis, treatment, education, monitoring, and prognosis/risk of many conditions. They can be, when understood and used properly, incredibly useful in our decision making process. Selecting a high-quality medical calculator is much like finding a high-quality medical website: one must examine the provider, the funding, the quality of the information and any privacy concerns. App usability, cost and aesthetics are also important. Over the years, I have used several medical calculators, some of which are included in resources such as UpToDate and Dynamed. Unfortunately, the calculators included in these resources are not as comprehensive and are somewhat “hidden” in the app, requiring more time to use. I would like, therefore, to focus on three stand-alone, general medical calculators: MDCalc, Calculate and MedCalX. All of these calculators are independently funded, provided by practicing physicians and have similar, reasonable privacy policies. The MDCalc website (http://www.mdcalc.com), founded over 10 years ago and supported by a large team of practicing physicians from multiple specialties, receives over 850,000 hits per month based on a reputation of an emphasis on clinical decision rules based on evidence more than simply calculating a score. Almost all of the 170 clinical decision tools included on this website are associated with not only references to the source, but also: pearls/pitfalls, points to keep in mind, use cases and why use it. This allows for thoughtful and practical use of the tool.

AMA - ALBERTA DOCTORS’ DIGEST

Recently, an iOS app has been released bringing all of these features to your mobile device. This newly available app, while not optimized for the iPad, has a simple, intuitive interface allowing for rapid access to multiple tools and specific advice by an expert in the field. The app is free at the time of writing, with a note on the website stating: “Keep the MDCalc iOS App free! Get it now!” Calculate by QxMD (https://qxmd.com/calculate/) is also available as a website and provides both an iOS and Android app. It is also supported by a diverse team of practicing physicians and supplies more than 300 evidence-based medical clinical decision support tools encompassing all specialties. Like MDCalc, it provides links to the source and other helpful resources, but does not include the supplementary material noted above. The interface is optimized for the device and is more refined than that of MDCalc. This app is also free of charge. MedCalX (http://medcalx.ch/), a medical calculator for iOS, has been available for that mobile platform for many years. The app interface is well done and optimized for both the iPhone and iPad. It is supported by two physicians, offers over 100 support tools for free, with another 200+ available through an in-app purchase of $6.99. Like the other apps mentioned here, it is updated regularly. There is no web-based interface. In my opinion, MDCalc is slightly preferred over Calculate because of the increased amount of EBM content and the practical tips offered with most clinical tools. Both apps have availability through a web browser and my mobile device, satisfying my digital omnivore (more than one device) needs. Although MedCalX has been my go-to for years, and despite the larger number of clinical tools available, the lack of a web interface and the limited EBM content leave it lacking, at least in my opinion, when compared to its competitors. While the above apps provide access to multiple clinical tools, the Absolute CVD Risk/Benefit Calculator (http://chd.bestsciencemedicine.com/ calc2.html) developed by James McCormack and Pascal Pfiffner at the University of British Columbia >

> is a clinical decision support tool that I use almost daily to educate my patients and consider treatment for elevated cholesterol. Using the Framingham, QRISK2-2014 or ACC/AHA ASCVD risk calculators, this app provides an easily understandable graphic interface as well as evidence-based interventions and their effect on risk. While the app is primarily a web page, creating a home screen icon on a mobile device effectively simulates an app that can be used while offline. This calculator may do only one trick, but it does so extremely well.

Selecting a high-quality medical

calculator is much like finding a high-quality medical website: one must examine the provider, the funding, the quality of the information and any privacy concerns.

Whether you need to interpret a lab value (e.g., Ca correction for albumin), monitor patient progress (e.g., PHQ9), calculate risk (e.g., CHA2DS2-VASc), consider investigation (e.g., Canadian CT Head Rule) or simply respond to aggressive questioning from a keen student or preceptor, the choice of a good medical calculator is both personal and necessary.

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JULY – AUGUST 2016

FEATURE

Emerging Leaders in Health Promotion Grant program – project profiles Vanda Killeen, BA, Dip Ad/PR | SENIOR

COMMUNICATIONS CONSULTANT, AMA PUBLIC AFFAIRS

Bystander cardiopulmonary resuscitation (CPR) is the tool that too-few people carry in their skill toolbox. This knowledge and awareness gap has been well-documented by the Canadian Heart and Stroke Foundation and the American Heart Association, both of which have published position statements addressing the need to increase the rate of bystander CPR through increased CPR awareness and education in the community.

(L to R): Dr. William Stokes, Dr. Michael Bosch and project lead Dr. May Choi warm up the Mini Anne® Plus CPR Manikins at the 3rd Annual Corporate Soccer Tournament.

ABOUT Emerging Leaders in Health Promotion Grant program

n its fifth year, the Emerging Leaders in Health Promotion (ELiHP) Grant program provides funding to help medical students and resident physicians conceive and implement health promotion projects in support of the development of their CanMEDS/FM core competencies, particularly health advocacy. Jointly sponsored by the Alberta Medical Association (AMA) Health Issues Council and the Canadian Medical Association, ELiHP projects facilitate the growth of leadership and advocacy skills in a mentored environment, while enhancing the wellbeing of the general Alberta population through education, advocacy or community service.

Teaching CPR at community sports events There are lots of things that are good to know how to do. Like how to change a tire, how to (properly) wash the laundry, how to make a cake from scratch, or the big one … how to potentially save a life.

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With her Emerging Leaders in Health Promotion project – Teaching CPR at Community Sports Events – ELiHP grant recipient and University of Calgary (U of C) internal medicine resident physician, Dr. May Choi, set out to educate the public on how to respond in the event of a sudden cardiac arrest (SCA), including how to properly perform CPR and how to use an automated external defibrillator (AED).

Bystander cardiopulmonary resuscitation (CPR) is the tool that too-few people carry in their skill toolbox.

As the ELiHP Grant program supports Alberta medical students or resident physicians in the development and guidance of a health promotion project that advocates for the health of populations, Dr. Choi’s project struck at the heart (no pun intended) of a significantly underserved health promotion issue. “The results of our pre- and post-teaching session surveys showed that the most common reasons for not doing CPR were insufficient training (16/69, 23.2%) and forgetting the steps (16/69, 23.2%),” says Dr. Choi. While Dr. Choi and her project team of four fellow residents, Drs. Michael Bosch, Erin Miller, Rachel Lim and William Stokes, and her brother, John Choi (a Bachelor of >

> Health Sciences student), originally intended to focus on educating the community on how to perform CPR, a high level of public interest in how to apply the AED also led to Dr. Choi’s teaching team instructing participants on how to use the AED. The team consisted of 10 medical residents and one medical student.

Over the course of two community sport events – the Kimmett Cup Tournament (pond hockey) and the 3rd Annual Corporate Soccer Tournament (Calgary Street Soccer) – 150 people participated in the hands-on, live demonstration CPR/AED teaching sessions. “We thought it was important to reach out to athletes, their families, friends and coaches in their environment,” Dr. Choi explains. “We were thinking specifically of athletes who might be at risk of SCAs due to conditions like hypertrophic cardiomyopathy,” she adds. “By educating the public through well-attended community sport events, our goal is to increase the use of CPR in the community; to help save lives on and off the arena, rink or field.” The differences in knowledge levels before and after the teaching sessions spoke volumes and attested to the team’s success in raising awareness and knowledge of CPR/AED. Compared to pre-session, post-session results indicated that more participants were comfortable with CPR (48% vs. 78%, p <0.001) and AED use (41% vs. 63%, p <0.001), and were able to correctly identify how to perform CPR (75% vs. 96%, p=0.001).

Stepping outside the hospital/clinic box “As medical residents and students, we become familiar with advocating for our patients in the hospital or clinic setting,” says Dr. Choi. “We do this almost on a daily basis, working closely with individual patients and families to provide them with health services or resources in a timely manner. It’s also important to remember to practice our advocacy skills at the community or population level.” The ELiHP grant project afforded Dr. Choi and her project team the opportunity to expand their advocacy horizons. “It gave us a chance to develop our role as advocates on a larger scale,” she comments, and with plans underway to continue offering the teaching sessions at local community events, there will be no shortage of community health advocacy opportunities for Dr. Choi and her team.

No advocacy without relationships As Dr. Choi and her project team learned, advocating for the health of populations often involves, and evolves from, relationships with other health care professionals and community agencies. “We were grateful for the guidance and support of the Canadian Heart and Stroke Foundation and for helping us understand and work to address this health promotion need,” says Dr. Choi.

Internal medicine residents and members of the CPR at Community Sports Events ELiHP project team (L to R): Dr. May Choi, John Choi, Dr. Erin Miller, Dr. Andrea Fung (foreground) and Dr. Michael Bosch.

Another project-based relationship Dr. Choi is grateful for is that of her project mentor, Dr. Jeffrey Schaefer, a general internist and the former program director of the internal medicine program at the U of C. “Dr. Schaefer provided us with invaluable support and feedback through the whole project, but particularly during the planning phase,” says Dr. Choi. Known for his “great rapport with the residents,” Dr. Schaefer took time out of his busy schedule to bring his family to visit the Teaching CPR at Community Sports Events booth at the Kimmett Cup Tournament in Cochrane. Perhaps the most important relationship, and the one at the heart of this ELiHP project, was that of Dr. Choi and her father, who sadly died from an SCA. “Through sharing my personal experience of recently losing a parent to SCA and learning that there is a great need to increase bystander CPR/AED in the community, I engaged my colleagues and health/community organizations to turn my vision into action.” >

JULY – AUGUST 2016

Nehiyaw Kakeskewina Learning Society). The strong relationships that Dr. Baydala has fostered during more than 10 years of involvement with the Maskwacis community, developing culturally appropriate health promotion and education programs, also helped greatly in the project team’s implementation of Photovoice.

(L to R): Melissa Tremblay, Dr. Lola Baydala, Grand Chief Tony Alexis, Chief Ermineskin, Elaine Chiu and Natasha Rabbit

The Photovoice project met the requirements of the ELiHP in several ways. With its focus on promoting the community’s strengths and resilience through the creative expressions of its youth, as well as the subsequent public exhibits of the photos, Photovoice met the ELiHP requirement to “enhance the wellbeing of Albertans through education, advocacy or community service.” Additionally, Photovoice satisfied the ELiHP requirement that “the health promotion issue be underserved in some way” by focusing on a Cree First Nation community.

> The Strengths of our Community: A Photovoice

Project by Youth in Maskwacis, Alberta Shot from the ground, snug against the birch tree trunk, straight up into the sunshine warming the tree’s vivid orange, red and yellow foliage, the photo by Maria Buffalo is appropriately captioned: “This picture is about looking up … hope.” With her Emerging Leaders in Health Promotion (ELiHP) project – The Strengths of Our Community: A Photovoice Project by Youth in Maskwacis, Alberta – Elaine Chiu, Candidate Class of 2017, University of Alberta (U of A), leveraged a kernel of an idea hatched over a Saturday afternoon coffee. The inspiration happened with her project mentor, Dr. Lola Baydala, Associate Professor, pediatrician and long-time health advocate for the Maskwacis community. They conceived a creative opportunity for the youth of Maskwacis to express themselves through photos and accompanying words. “This project wouldn’t have happened without a lot of hard work from the youth in the Maskwacis community,” Elaine explains. “Their passion, combined with the support of community elders and their guidance of the youth as they got together to discuss the community’s strengths and culture, is at the heart of Photovoice.” With additional grant funds from the Alberta Centre for Child, Family and Community Research, Photovoice was expanded to include 11 participants, from the initial four. The 15-to-19-year-old participants were provided with digital cameras and training sessions with professional Indigenous photographers. Key members of the project implementation team included Dr. Baydala’s research team – Melissa Tremblay (PhD student, program evaluator/coordinator) and Arlene Loney (Research Administrative Assistant) – as well as Natasha Rabbit (Executive Director of the

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Photovoice resonated with the

Maskwacis community, as it captured their commitment to celebrating their culture, their elders and their youth, through creative photography and storytelling.

The past troubles of this community – known as Hobbema prior to its name change back to its original name of Maskwacis (meaning “Bear Hills” and pronounced mask-wa-chees) on January 1, 2014 – are similar to those encountered by other Indigenous communities, including struggles linked with social determinants of health. With the return to the Cree First Nation community’s founding name of Maskwacis, Chief Marvin Yellowbird expressed the community’s deep desire for change, when he said, “… it was very important for us to celebrate the name change in honor of our ancestors, in honor of our elders and in honor of our youth.” Photovoice resonated with the Maskwacis community, as it captured their commitment to celebrating their culture, their elders and their youth, through creative photography and storytelling. From October 2015 to January 2016, the Photovoice exhibit was featured at a number of venues in the Wetaskiwin and Edmonton area, including the Wetaskiwin Hospital, the Ermineskin Elders Centre, the U of A’s Faculty of Extension and the U of A Hospital After-Hours Gallery. Within the community, several of the Photovoice photos and stories will be exhibited permanently at the Maskwacis Health Centre. >

> As the following comments from a survey developed and distributed by Dr. Baydala’s research team at the photo exhibits indicate, Photovoice is achieving success with its goal to provide Maskwacis youth with a sense of empowerment, as their illustrations of the Maskwacis community and culture fly in the face of many common misconceptions:

“Hobbema/Maskwacis has a stigma surrounding it. The photos showed a beautiful community full of life, love and beauty, smashing those stigmas.” “I firmly believe there is an incredible voice and potential in the Maskwacis children and youth and I’m excited to watch and support their empowerment.” “I knew the community was resilient and beautiful, but these photos confirm and remind me of that.” Elaine concludes: “For me and the rest of the project team, this project was a unique opportunity to develop an appreciation of how social determinants affect health. As a future physician, I have a responsibility to utilize the skills and knowledge I’ve gained from this project to educate and inform my fellow colleagues on the importance of culturally appropriate medicine.”

Photovoice provided a creative opportunity for the youth of Maskwacis to express themselves through photos and accompanying words.

MUSCULOSKELETAL RADIOLOGIST CALGARY, ALBERTA, CANADA Are you a subspecialist fellowship trained Musculoskeletal Radiologist who is committed to excellence in patient care, dedicated to practicing evidence-based medicine, and passionate about providing education to future care givers? A career with EFW Radiology may be for you. EFW Radiology, a physician-owned and operated partnership in Calgary, Alberta, Canada is currently seeking a fulltime Musculoskeletal Radiologist to join our team. In this role you will join seven other sub-specialist Musculoskeletal Radiologists performing the full range of MSK imaging and interventional procedures as well as providing general radiology services and participating in our body on-call rotation. The ideal candidate will be highly skilled and have a keen interest in performing MSK and spine procedures. At EFW we pride ourselves on providing compassionate care, working to earn the trust of referring clinicians and patients, and offering meaningful career opportunities. As an EFW Physician you will receive competitive remuneration and flexible vacation with a mix of hospital and clinic work. This position is a partnership track role offering long term job security potential to the right candidate. Eligible candidates must be a Certified Fellow of the Royal College of Physicians and Surgeons of Canada and fellowship trained as a Musculoskeletal Radiologist. Candidates must be eligible for registration with the College of Physicians and Surgeons of Alberta, and legally entitled to work in Canada. EFW Radiology is a subspecialty partnership providing clinical service and teaching for the University of Calgary at Foothills Medical Centre and South Health Campus sites, as well as owning and operating several private imaging clinics within Calgary. We have been proudly serving Calgary and Southern Alberta for more than 40 years, and enjoy a high quality of life in this cosmopolitan thriving city with year-round recreation opportunities including nearby Banff National Park and the majestic Rocky Mountains. Interested in joining our team? Please submit a letter of intent and curriculum vitae to: Helen Lemieux Director of Human Resources Email: physicianrecruitment@efwrad.com

JULY – AUGUST 2016

PFSP PERSPECTIVES

Out of the shadows:

Shining light on physician suicide Sara Taylor, MD, CCFP | ASSESSMENT

PHYSICIAN, PFSP

“The life so short, the craft so long to learn.” – Hippocrates

anadian Indigenous communities are in the midst of a public health crisis related to suicides. Some of the newspaper headlines include: “First Nations’ suicide crisis focus of talks with Trudeau; PM to meet with chief in bid to solve mental-health woes at embattled Ontario reserve” (Toronto Star); “The Canadian First Nation suicide epidemic has been generations in the making” (The Guardian); “Five more suicide attempts made in Attawapiskat” (The Globe and Mail). Widespread attention has grown around the number of suicides involving Indigenous Peoples, with focus on certain reserves and, alarmingly, on the pediatric population. This awareness has prompted a call to action. Parallel to this awareness is a more hidden epidemic within the medical community that has also seen newspaper headlines, including André Picard’s November 2015 article in The Globe and Mail, “Suicide should not be an occupational hazard for doctors”.1 Although conversations around physician suicide are happening, the true gravity of the situation is difficult to appreciate with the secrecy and shame that often goes along with suicide.2

Why is suicide more common among physicians than the general population? The statistics around physician suicide are undeniable. Each year in the United States, 300-400 physicians commit suicide. The rate in male and female physicians is 40% and 130% higher than in men and women in general, respectively.2 In an interview with CTV’s Canada AM, Dr. Derek Puddester, Associate Medical Director of the Ontario Medical Association’s Physician Health Program, said: “The concerns here mirror those in the United States. We’ve known for a number of decades that physicians have a higher risk of attempted and completed suicide.” One would wonder if it is the proverbial chicken or the egg. According to Picard: “The very qualities that make someone a good doctor – empathy, caring, perfectionism – make them vulnerable to burnout, depression and

AMA - ALBERTA DOCTORS’ DIGEST

As with most things in both medicine and in life, awareness is the key in order to identify ways to help our colleagues before suicide happens.

suicide.”1 In fact, a study found that when students started medical school, they actually had lower rates of burnout and depression and a higher perceived quality of life compared to their counterparts.3 Higher levels of burnout are independently associated with suicidal ideation which is concerning given that more than half of physicians are experiencing professional burnout.5 Some of the other reasons cited4 for an increased rate of suicide in physicians include: • Not recognizing mental illness in themselves, self-treating a mental illness, or not seeking help because of the stigma surrounding mental illness. • Fear that disclosing suicidal ideation (and the underlying cause) or a mental illness may result in professional consequences such as losing their medical license. • Increased professional expectations from student to resident to practicing physician. • Higher rate of completed suicide versus attempted suicide due to knowing lethal methods (not due to an increased rate of depression). • Untreated comorbidity factors such as depression and substance misuse.6 >

> • Impaired judgment from an underlying medical disorder such as substance misuse or depression.7 • Physicians often use denial as an ineffective coping means and are not good at tending to their own wellness needs.8

What are some of the warnings signs of possible suicide of a trainee or physician? Many of these signs are applicable to the general population. However, certain personality traits such as perfectionism and workaholism are more common among physicians, which makes physicians at a higher risk when things go wrong. Intervention and support become crucial when any of the following signs appear: • Escalating substance misuse • College complaint, medical license suspension • Separation/divorce or dissolution of an important relationship • Death of a loved one • Serious financial troubles • Recent relatable suicide • Withdrawing socially/obvious change in behavior (could present as contentment/euphoria) • Apparent despair and hopelessness

What can be done to help physicians who might consider suicide? As with most things in both medicine and in life, awareness is the key in order to identify ways to help our colleagues before suicide happens. At the physician trainee level:

• Informal physician groups such as book clubs or journal clubs, which provide a supportive environment to promote expression of emotions. • Reflection exercises such as narrative/creative writing and journal writing. • Build physician resilience through various elements such as balancing work and family life, prioritization, organization, maintaining perspective and setting boundaries.

To anyone who has been personally touched by physician suicide Unfortunately, I am sure most of us know of a colleague, either directly or indirectly, who has ended his or her own life. During my 16 years as a practicing physician, I know of a handful of physicians who have committed suicide, but I am guessing there are more that I am unaware of. If you have been more personally impacted by suicide, you may experience feelings such as blame, shame and anger. Reaching out to health care professionals, your physician health program, colleagues, family and friends can make all the difference to your own emotional health. Shining light on physician suicide and having an open conversation about it can save the life of someone you know or even yourself. We are physicians, but first and foremost we are imperfect humans. As Brené Brown says, “Imperfections are not inadequacies; they are reminders that we’re all in this together.”

Resources • Physician and Family Support Program of the Alberta Medical Association – confidential support line 1.877.767.4637

• Ongoing discussions related to self-care and personal wellness through courses, academic half days, retreats and conferences.7

• American Foundation for Suicide Prevention – Physician and Medical Student Depression and Suicide Prevention DVDs

• Access to supportive resources through medical schools and provincial health programs.

• The American Balint Society

At the practicing physician level:

• Centre for Addiction and Mental Health

• Ongoing dialogue in the form of presentations to and publications for physicians to decrease the stigma of mental illness and stress-related conditions.

References available upon request.

• The Canadian Association for Suicide Prevention

• Formal physician groups such as Balint groups which consist of between six and 10 physician members with one or two trained leaders. These groups focus on doctor-patient relationships with peers, improve empathy and improve resilience (both personal and professional). In a commentary by Dr. Michael Roberts that appeared in the Canadian Family Physician, he states, “The goal is to improve physicians’ abilities to actively process and deliver relationship-centered care through a deeper understanding of how they are touched by the emotional content of caring for certain patients.”

JULY – AUGUST 2016

HEALTH LAW UPDATE

Health Information Act could use a few more teeth Jonathan P. Rossall, QC, LLM | PARTNER,

recent investigation report issued by the Office of the Information and Privacy Commissioner (OIPC) underlines the relative paucity of remedies available to the OIPC on the conclusion of an investigation pursued following a self-reported incident. As most readers will know, the OIPC is the body charged with oversight over the Health Information Act (HIA), including investigations of breaches, reviewing requests for release of health information, and conducting inquiries into various matters outlined in that legislation.

While the commissioner has certain

powers available during the course of an inquiry or investigation … there appears to be no jurisdiction under the Health Information Act to compel performance of an act by a third party or to penalize wrongdoers.

In the subject Report,1 Dr. A had practiced in a primary care clinic in a smaller Alberta center for a number of years. In the course of his practice, he utilized the services of a specific electronic medical record (EMR) vendor, with whom he entered into an Information Manager Agreement as provided for in the HIA. Dr. A discontinued his practice in the clinic and moved to a different location. However, he continued to maintain his records through the EMR vendor, in recognition of his continuing duty to his patients to retrieve and provide copies of medical records when requested. When he made his first requests for access to

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MCLENNAN ROSS LLP

his records, though, it was determined that the EMR vendor had mistakenly destroyed some 2,000 patient records, assuming the physician had permanently departed the jurisdiction. Dr. A reported the loss to the OIPC as required under the Act, and in due course, the OIPC appointed an investigation of the circumstances surrounding the loss of the records. For reasons not completely clear, the investigation took three years to complete. In the meantime, Dr. A was without access to any of the former patients’ records and, accordingly, was unable to respond to requests for patient information. At the conclusion of the investigation, the OIPC investigator determined that the information manager had destroyed the records without authority and was, indeed, in breach of its contractual obligations under its Information Manager Agreement with Dr. A. The Investigation Report made no comment on Dr. A’s obligations to his patients, but the findings were clear that his conduct was not the cause of the loss. The OIPC investigator also determined that, since the loss, the EMR vendor had taken steps to ensure that the mistake would not be repeated in the future and therefore made no other directions or findings with regards to the vendor’s actions. In the result, Dr. A was left with no records for the 2,000 or so patients he formerly dealt with, and no means of recreating or somehow re-generating the records. The stinginess of the OIPC findings is reflective of the lack of teeth in the HIA. While the commissioner has certain powers available during the course of an inquiry or investigation, such as the right to compel witnesses to cooperate, or to demand access to information (with a fine being an option for lack of compliance), there appears to be no jurisdiction under the HIA to compel performance of an act by a third party or to penalize wrongdoers. There is no ability to award damages or rectification of a wrong by a non-custodian. The physician who is the victim of an improper act (as was the case here) is essentially left to his/her own devices to remedy the wrong, which essentially means an expensive and time-consuming legal action. >

> It’s true that the HIA focuses its attention primarily on custodians of health information, and that the bulk of the regulatory power lies in that direction. However, given that the Act does provide guidelines and requirements governing the relationship between custodians and those who manage health information on behalf of those custodians, it would be helpful if the Act provided a means for redress when those information managers drop the ball. The Act itself requires a periodic review and refresh and one is currently scheduled. Hopefully the OIPC or those charged with the custody and control of health information will ensure that this issue is addressed.

Reference available upon request.

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JULY – AUGUST 2016

FEATURE

Preaching to the converted in Cochrane Youth Run Club – Spring 2016 launch Vanda Killeen, BA, Dip Ad/PR | SENIOR

COMMUNICATIONS CONSULTANT, AMA PUBLIC AFFAIRS

With a solid history of organized school runs and activities, including a regular early morning, freshoff-the-bus run, the December Run to the North Pole, the March Mission to Mars and the May Marathon for Martin Parnell – the newest AMA Youth Run Club Ambassador – physical activity is ingrained in the culture at Elizabeth Barrett School, making it a natural fit with the YRC. Once a week, during lunch hour, three teachers – Heather Nusl, grade four; Tasha Royer, grade two; and Paul Christophe-Schafer, grade four French Immersion – lead the 30 grades one-to-four members of the YRC in a weekly YRC run. (L to R): Martin Parnell, Dr. Neil Cooper (AMA), Susan Parker (Elizabeth Barrett School), Hayley Degaust (EAS), Brian Torrance (EAS)

ith more than 600 kids running around the field outside Elizabeth Barrett School, along with several teachers and some parents, there was energy to spare in the air at the spring 2016 launch of the Alberta Medical Association (AMA) Youth Run Club (YRC), April 29, in Cochrane, Alberta. The YRC launch was an all-inclusive affair, as the school’s entire 600-strong English and French Immersion (kindergarten to grade four) student population and many staff joined AMA board member, pediatrician and recent YRC Champion, Dr. Neil D.J. Cooper; AMA and Ever Active Schools staff; and local Marathon Man, Martin Parnell, in a fresh, early morning run through the crisp, spring mountain air. While this is the first year for the YRC at Elizabeth Barrett School, the philosophy of an active student and staff population is not a new thing. It’s clear that school principal Susan Parker is a passionate and dedicated proponent of physical activity. “I feel this has become such a health issue for a whole generation, we owe it to each one of them to let them explore their own potential and be proud of who they are, as active, lifelong learners,” she says.

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“By integrating physical activity and learning for all students, they’re empowered to recognize when they need to take a physical break,” comments Susan. “Having mentors through our work with the AMA YRC, such as Martin Parnell, has motivated and encouraged our school community to become more active participants in taking responsibility for their own health,” she concludes.

Meet YRC Ambassador Martin Parnell A Cochrane resident, new AMA YRC Ambassador Martin Parnell often comes out to Elizabeth Barrett School and runs with the kids – and it was Martin who introduced the idea of the YRC to Susan. Having met Dr. Carl W. Nohr, AMA President, at the Shaping the Future Conference in Kananaskis last January and having learned then of the AMA YRC, Martin thought it sounded like a great fit for Elizabeth Barrett School. “Physical activity is vital for the physical and mental health of all children,” he explains. “The AMA Youth Run Club provides the opportunity for schools to engage youth in a collaborative and fun environment.” Children and running are of equal importance in Martin’s life and he uses one to help the other. “In 2010 I ran 250 marathons and, of those, 60 were at schools. I was fundraising for the humanitarian organization Right To Play and on the morning of a school marathon I would start running around the soccer field,” >

> Martin says. “Throughout the day children would join me and their love of running and movement shone through. Some schools had running clubs, some didn’t.”

Martin’s involvement with the students at Elizabeth Barrett goes back two years and, for the past two winters, the school’s students and many staff have run in Martin’s annual December 31 marathon run/walk in Cochrane. Boasting (yet not boasting) a massively impressive and inspirational marathon/running/fundraising career (in and around his other career as a semi-retired engineer), Martin thrives on being able to connect kids with running and physical activity and the value and importance of caring for yourself. It must have been destiny that brought Dr. Nohr and his passion for the YRC together with Martin and his passion for all-thingskids-and-running. “I’m very excited to be an ambassador for the AMA Youth Run Club,” says Martin. “And I encourage all schools in Alberta to get involved. The support of this initiative by the doctors of Alberta is critical. Fitness is the best medicine and it’s a habit that needs to be started early.” (Read more about the AMA YRC’s newest ambassador at www.albertadoctors.org.)

Dr. Neil Cooper and Martin Parnell run with the pack

The (good) contagion of the YRC: 383 schools and 22,000 active kids Having attended the event in Cochrane, Dr. Cooper can attest to the contagious energy and inspiration of the YRC. “I’m not a big runner, but I’ve wanted to get involved with the YRC for some time and the experience at the spring launch at Elizabeth Barrett School was so much fun that I’m really looking forward to doing more things with the YRC.” If the YRC continues on its tremendous growth path of late, there will be opportunities aplenty for Dr. Cooper (and many others!) to get involved with the YRC. In our climate, it’s understandable that the level of school and student involvement in the YRC peaks in May and June, as schools rush to organize runs, races and events to wrap up the school year on a good, fit note. So it’s also understandable how the YRC statistics for the number of involved schools and students peaks at the same time. But the statistics this June have, by any standards, far exceeded expectations! From its beginnings three short years ago, with about 74 schools and 4,000 kids, this spring there are YRCs in 383 schools across the province, with close to 22,000 kids participating.

Back again in the fall! As the school year gets back into running gear in September, the AMA YRC follows suit, with its regular fall launch in early October.

Hayley Degaust high-fives kids as they complete the run

If you’re interested in joining the YRC as a physician or medical student/resident champion, please contact Vanda Killeen, AMA Public Affairs, at vanda.killeen@albertadoctors.org. Together with Hayley Degaust, Ever Active Schools Provincial Project Coordinator, we’ll work to connect you with a YRC school, or guide the start-up of a YRC.

JULY – AUGUST 2016

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)

THE AMA YOUTH RUN CLUB is a place for students to be physically active, have fun and learn about good nutrition and other healthy lifestyle habits. The YRC closed out its 2016 spring/summer season with a record-breaking 383 schools and close to 22,000 kids, handily surpassing the goal of 350 schools. This growing program needs support and as a Youth Run Club Champion, it’s a great opportunity to make a connection with your community. www.albertadoctors.org/youth-run-club ConTaCT Vanda Killeen, aMa Public affairs 780.482.0675 vanda.killeen@albertadoctors.org YRC PARTNERS

AMA - ALBERTA DOCTORS’ DIGEST

YRC SPONSORS

IN A DIFFERENT VEIN

Calling a spade a spatulous device Alexander H.G. Paterson, MB ChB, MD, FRCP, FACP | CO-EDITOR

“Pizza Day” will now be known as “ItalianAmerican Sauced Bread Day.” - Principal Seymour Skinner, The Simpsons.

he principle of freedom of speech is under threat in many parts of the world, not so much in the west … yet. But with increased migration and mixing of cultures and the rise of autocracy, particularly in the East and Middle East, there is a need for “all our sons” (sorry, “all of us”) to stand on guard to protect this foundation of democracy. I have three points: first, one must protect the right to poke fun at, ridicule and criticize those in power; second, no one enjoys being criticized or ridiculed, but we must be able to discuss sensitive issues in a civil fashion; and third, the phenomenon of liberal intolerance and precious political correctness is threatening our ability to speak plainly on uncomfortable topics that should be openly debated.

This tradition [of freedom of speech]

has become a fundamental principle, and it sanctions poking fun, ridiculing or criticizing those in powerful positions, especially if they are conceited, arrogant, ignorant or incompetent – a not uncommon occurrence in politics.

Many of you are aware of the harsh treatment of journalists and political commentators in Turkey by the would-be Grand Caliph, President Recep Tayyip Erdogan, and his demand that Jan Bohmermann, a German comedian (they don’t have a surfeit of comedians in Germany) should be prosecuted and sent to jail for a rather racy poem insulting to the G. Caliph.

Most would have shrugged their shoulders – that is, until Chancellor of Germany Angela Merkel ordered Bohmermann’s prosecution, now ongoing. The lawyer representing the Caliph in Germany says: “The goal is to stop a wave of insults against the Turkish president triggered by the poem.” This has led right-thinking people in the free world to rise up in indignation at the Turkish president who not only prevents ridicule and criticism of himself and his policies in his own country, he now demands that other sovereign nations in the West toe his line. This anger has been amplified by the German Chancellor’s cringing response to this inflated autocrat. However, The Spectator, a conservative British political magazine (the longest regularly published English language magazine – longer even than Alberta Doctors’ Digest) went one better than mere anger and set up the “President Erdogan Insulting Poetry Competition” – unfortunately now closed to entries. After thousands of entries and a nail-biting judging process, a winner has been announced. It is Boris Johnson, ex-mayor of London, and prominent leader of the Brexit campaign, the campaign to take the UK out of the European Union. His entry, beautifully written in a dominant anapestic meter with the occasional trochee thrown in, has a spontaneous freedom of rhyme worthy of inclusion in “Poems for Pleasure,” which should be in Canadian schools’ English syllabus. Here it is: There was a young fella from Ankara, Who was a terrific wankerer, Till he sowed his wild oats, With the help of a goat, But he didn’t even stop to thankera. The result of this and thousands of other poetic gems has been that the Grand Caliph’s sensitivity to criticism has become subject to the world’s guffaws, although Ms Merkel’s bowing to his will has revealed a dismal display of submission in the face of overt bullying. The so-called “deal” of paying Turkey cash per head to temporarily take back the surge of refugees making the hazardous >

JULY – AUGUST 2016

> journey via Greece (which German Willkommenskultur encouraged them to make) is a quite separate issue and should not be linked to her shameful cringing to this pumped-up popinjay’s demands. There is a long, fine tradition of speech freedom in the West well before Henry VIII’s jester, Will Sommers, was forgiven for calling Anne Boleyn “a whore.” This tradition has become a fundamental principle, and it sanctions poking fun, ridiculing or criticizing those in powerful positions, especially if they are conceited, arrogant, ignorant or incompetent – a not uncommon occurrence in politics.

So no one likes to be insulted,

ridiculed or criticized but we do have to be able to calmly discuss emotional subjects, such as climate change, Naomi Klein, Middle-East migration, abortion, religion, Ezra Levant … and Donald Trump.

This bracing pleasure in the free world is not widely shared. Try an insulting poem in China, or North Korea. Make sure you have a flight booked and an exit visa. Unfortunately some of our politicians prefer to kowtow. Take Stephane Dion, for example (he of the “Canada is back” foreign policy of “responsible conviction” – a formula for avoiding a principled stance and going whichever way the wind blows) who in early June hosted the foreign minister of the People’s Republic of Tyranny, a Mr. Wang Yi. In an Ottawa press scrum, a reporter politely asked a question about Chinese territorial ambitions in the South China Sea. Mr. Yi angrily answered that her question was full of prejudice, arrogance and was “unacceptable.” Our man, instead of politely telling the puffed-up prickle that he was in Canada now and the question was entirely reasonable, kept embarrassingly quiet – perhaps in the interest of selling windmills to the People’s Republic. And the principle of free speech holds for the conceited, arrogant, ignorant or silly even when they are in a minority group such as the disabled, First Nations, Hispanics, Blacks or LGBTQ – where often the retort from a minority group is that they should be immune from criticism, claiming victimhood because of their minority status. This must be firmly, politely and carefully rejected, keeping in mind the fine line between sticking to the argument with reasonable comment and avoiding name-calling and bringing in peripheral issues. I remember as a boy going with my father who thought it was educational to watch and listen to the ineffective

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ranting (usually about Roman Catholics) at Speaker’s Corner on the Mound in Edinburgh. The effect of these McTrumps was to provoke laughter. But they got what it was off their chests – and that was the point. But few individuals, tribes, religions or in-groups tolerate fun poking or ridicule by outsiders. It’s one thing poking fun at oneself and quite another having an outsider doing it, as Muslims are all too aware of now. Newfoundlanders may be an exception (sometimes only because they don’t get the joke) though I doubt it. Newfies are shrewd operators who talk funny and Newfie jokes focus on an apparent simple-mindedness that I have never observed. You can say anything you want to a Newfie but bear in mind the old Newfie one-liner: “What’s black and blue and floating in the bay? A mainlander who told a Newfie joke.” Newfies get offended but they don’t act the victim. And generally they don’t assassinate the offender. This is due to a secure identity, which tolerates the ignorance and stupidity of other tribes, although you do risk a clip to the head. If I were to say something politically incorrect like, say, the recent Alberta Health Services (AHS) “mission statement” put together with starry-eyed niceness: “Healthy Albertans, healthy communities. Together.” is ludicrous, I’m being insulting and I cannot then expect a cushy AHS admin job. But if I say that it engaged highly paid executives for too long, that the slogan is superficial and almost meaningless – and is, on perusal, dismissive of the unhealthy, ill and sick who are excluded from the AHS’s mission – well, this might be construed as constructive criticism. It all depends on which words you use. The word “ludicrous” invites emotion and opposition. The more tempered critique invites a discussion of the value of “mission statements” and “visions” from people who should be thinking about concrete and difficult problems, such as drug and alcohol abuse and addiction, managing mental illness and providing more operating room access. However, I do not expect to be beaten up or assassinated for saying “ludicrous” – but in Turkey, I might be.

As Voltaire said, “Monsieur, I disapprove of what you say but I will defend to the death your right to say it.”

I cringe when a non-Scot tries to tell a Scot’s story complete with a fake accent. And it must be galling to hear an outsider tell a Jewish joke. The only way this can be digested is by joshing in kind, as when my radiologist friend, David, hails me with a fake Scot accent and I usually trump him with my best London Fagin accent. >

> So no one likes to be insulted, ridiculed or criticized but we do have to be able to calmly discuss emotional subjects, such as climate change, Naomi Klein, Middle-East migration, abortion, religion, Ezra Levant … and Donald Trump. The Trumpster, the Grand Narcissist, and his “Pocahontas” name-calling comes to mind. Elizabeth Warren, a journalist, claims she has Cherokee heritage – however, this has been difficult to prove and it turns out it is a putative 1/32 heritage, which is probably not far off most people’s Cherokee heritage. It seems she was using it for political sympathy or gain. In this example, many thought it in poor taste – a bad hair day – others thought it mischievous but amusing, poking fun at someone who clearly was not of major Native American lineage. The Donald has harnessed his right of freedom of speech and goaded his opponents into attempting to deny that right. Many believe that his success is due to an inability to trust anything a modern politician says when it’s always couched in cautious political correctness. You just don’t know what they really think, as they are influenced by media, polls and fear of saying the wrong thing for the media to pounce upon.

As long as someone does not directly

provoke physical violence, it’s important that they be heard, shouted at, given the Bronx cheer or whatever. Protecting students with “safe spaces” (free speech, free spaces) from unpleasant topics is the opposite of an education.

Hair Trump, a draft-dodging, New York real estate smart-ass boxwallah, revels in the politically incorrect like calling John McCain, who fought for his country and suffered years of imprisonment in a Vietcong prisoner of war camp, “a loser”: “He’s not a war hero. He’s a war hero because he was captured. I like people that weren’t captured.” But thuggish tactics by his opponents are having the opposite effect to that intended – they create sympathy and bolster his campaign. As Voltaire said, “Monsieur,

I disapprove of what you say but I will defend to the death your right to say it.” There is now in the West the curious phenomenon of a new oxymoron – “liberal intolerance” – politically correct liberals who have discovered that by actively beating up on anyone opening a discourse on a controversial subject, they can pour scorn on their opponent and end the debate by using glib labels – racist, sexist, anti-Semitist, imperialist, climate change denier, etc. Liberal intolerance occurs a lot in universities where administrators bow to student (and amazingly, faculty) demands that some speakers (e.g., Christine Lagarde, Aayan Hirsi Ali, Condoleezza Rice and Ann Coulter) be banned from being heard. And in the interest of an easy life, they give the loudest outraged voices what they want. As long as someone does not directly provoke physical violence, it’s important that they be heard, shouted at, given the Bronx cheer or whatever. Protecting students with “safe spaces” (free speech, free spaces) from unpleasant topics is the opposite of an education. Political correctness is usually timidity and about following the crowd – fear of disapproval, fear of being disliked or fear of getting into trouble. It is also passive aggressive, as in suppressing uncomfortable opinions. At its best, it’s being considerate and thoughtful; at its worst, it’s phoney and manipulative. So where is the line between merely making people uncomfortable and inciting a riot? Probably at a place where someone is talking or joking about you or your tribe that makes you feel uneasy – but not insulted – when there’s a ring of truth to what they’re saying. But sometimes you’ve got to just let go: “Curse the blasted, jelly-boned swines, the slimy, the belly-wriggling invertebrates, the miserable sodding rotters, the flaming sods, the sniveling, dribbling, dithering, palsied, pulse-less lot. They’ve got white of egg in their veins, and their spunk is so watery it’s a marvel they can breed.” – D.H. Laurence Arrest that man … Footnote: To my dismay, just as I had finished the above article, I saw I’d been scooped. The major article in The Economist of June 4-10 is titled “Free speech under attack.” To my relief, it deals mainly with US and British university intolerance. It’s worth reading.

JULY – AUGUST 2016

CLASSIFIED ADVERTISEMENTS

LOCUM WANTED CALGARY AB Heritage Family Medical Centre requires a maternity locum from September 1, 2016 to June 1, 2017. Hours are negotiable, generous split, very busy family practice in a well-equipped clinic with wonderful staff. The clinic is on the corner of Heritage Drive and Macleod Trail SE. We use TELUS Health Solutions (formerly Wolf Medical Systems) electronic medical records and a member of the Calgary West Central Primary Care Network. Contact: Marion Barrett, Clinic Manager T 403.240.1752 msmc@telusplanet.net

PHYSICIAN WANTED CALGARY AB Part-time medical ophthalmologist needed. Western Laser Eye Associates is looking for a part-time, permanent medical ophthalmologist with high ethical standards and attention to detail. Hours and days are flexible. Contact: michele@westernlasereye.com For more information or to forward your CV. 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 30% expenses offered. Contact: Neville Reddy, MB ChB, FRCPC (Anesthesia) T 403.240.4259 C 403.689.4259 nreddy@innovationshealth.ca innovationshealth.ca

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CARSTAIRS AB Family physicians are invited to join a newly managed rural practice in the growing town of Carstairs, just 20 minutes north of Airdrie. Emphasis is placed on evidenced-based care, electronic medical records efficiency, progressive scheduling with same day patient access, quality improvements and close integration with Highland Primary Care Network services. Potential for hospital duties including emergency room shifts and inpatient visits in nearby Didsbury. Carstairs is a community of over 5,000 people, great for families and easy access to Calgary. Contact: Michael T 403.681.0247 carstairsclinic@icloud.com 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 of their patients. Come work part-time, 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 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), their 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 EDMONTON AB Parsons Medical Centre (PMC) and Millbourne Mall Medical Centre (MMMC) want you. To meet the growing needs, we have a practice opportunity for family physicians at PMC and 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 allow 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 F 587.754.8822 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 opened in January in the Currents of Windermere. This 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 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 AB To meet the growing need, we have a practice opportunity for gynecologists to join the Parsons Medical Centre (PMC) and Millbourne Mall Medical Centre (MMMC). The PMC and MMMC are in south Edmonton and have high patient volume. You will enjoy working in a modern environment with complete electronic medical records, gynecology equipment, supplies and sterilizer. There are a minimum of two examination rooms per physician, dedicated work/private office for physicians. Friendly and reliable staff for billing, referrals, etc., and onsite manager. PMC and MMMC serve a large community and wide spectrum age group (birth to geriatrics).Both clinics have a pharmacy onsite, ECG machine and lung function testing. Overhead is negotiable, flexible working hours and both clinics are open seven-days-a-week. Terms of employment and wages; this position is permanent, part-time/ full-time fee-for-service with anticipated annual income of more than $300,000. Anticipated start date is as soon as possible. Contact: Harjit Toor Parsons Medical Centre 105-625 Parsons Rd Edmonton AB T6X 0N9 T 587.754.5600 manager@parsonsmedicalcentre.ca EDMONTON AND FORT MCMURRAY AB MD Group, Lessard Medical Clinic, West Oliver Medical Centre and Manning Clinic each have 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 member of a primary care network. Benefits and incentives of being part of our clinics include the convenience to work at any of our locations, part- or full-time available, attached to a primary care network, 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 >

JULY – AUGUST 2016

RED DEER AB To meet our growing needs, we have a practice opportunity for a family physician at Discovery Walk-In & Medical Clinic. Our clinic is located in the centre of Red Deer. Our clinic is both walk-in and booked appointments which creates high-patient volume. Enjoy working in a modern environment with full electronic medical records, which is supported by a local IT team. Remote log-in permits access from the comfort of your home. We serve a large community and wide-spectrum age group. We have an on-site pharmacy, part of the Red Deer Primary Care Network and specialist within our clinic. Overhead is negotiable. Our clinic is open 364-days-a-year, weekdays from 8 a.m. to 8 p.m., weekends and holidays 10 a.m. to 5 p.m. The clinic is professionally managed, thereby allowing physicians to devote their clinic hours to medicine. We look forward in hearing from you soon. Contact: Vanessa Dent Discovery Walk-In & Medical Clinic 130-3410 50 Ave Red Deer AB T4N 3Y4 T 403.342.9444 F 403.340.8847 vdent@discoverymedicalclinic.ca ST. ALBERT AB Horizon Health Medical Clinic is a family medicine and pediatric clinic in St. Albert. Our group of four dedicated physicians is looking to recruit up to two part- or full-time exceptional family physician associates looking to start or transfer their existing patient panel. Physicians looking to wind-down their practices are also welcome. The clinic is equipped with TELUS Wolf electronic medical records. We are affiliated with the St. Albert and Sturgeon Primary Care Network. The physician must be licensed or be eligible for licensure with the College of Physicians & Surgeons of Alberta. Contact: horizonhealthmedical@gmail.com

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SHERWOOD PARK AB Synergy Medical Clinic is seeking the services of a physician interested in accepting new patients. The successful candidate must commit to building a patient panel and providing on-going comprehensive care to his/ her cohort of patients. The clinic is located in Sherwood Park at the Synergy Wellness Centre and is part of the Sherwood Park-Strathcona County Primary Care Network. We offer physicians a collegial and collaborative environment where one can provide care to a wide range of patients. Physicians are supported by a tremendous team and the clinic uses Wolf electronic medical records for enhanced patient care. Physician compensation is based on fee-for-service payment. The interested physician must be licensed and eligible to apply for licensure with the College of Physicians & Surgeons of Alberta (CPSA), their qualifications and experience must comply with the CPSA licensure requirements and guidelines. Relocation reimbursement is available for interested out-of-province physicians. Contact: Mel Snihurowych Chief Administrative Officer T 780.400.3303 msnihurowych@ synergymedicalclinic.ca www.synergymedical.ca

PHYSICIAN AND/OR LOCUM WANTED 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 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 our brand-new clinic opened in January in the 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 Edmonton medical clinic in the west end is looking for part-time, full-time and locum physicians to join our team. Must be eligible to be licensed by the College of Physicians & Surgeons of Alberta. Well-equipped facility with trained staff and we use TELUS Med Access electronic medical records; paperless charts. Physician offices and plenty of examination rooms with competitive 75/25 fee split. We have day or evening shifts as desired. If you have any further questions or are interested in this opportunity, please contact us. Contact: T 587.987.8002 >

> EDMONTON AND LEDUC AB Care Plus Medical Clinics are seeking physicians who would like to grow, start or relocate their practice with us. We are an independent, locally owned primary care and multi-specialty group that brings together health care professionals who believe in quality of life, honesty, integrity and excellent patient care. Working at Care Plus Medical Clinics is making a difference. It’s providing the highest quality patient care by placing the needs of patients first. At Care Plus Medical Clinics, you'll discover a culture of teamwork, professionalism and mutual respect. Why choose us? We have years of experience in our current model and work hard to support you, your practice and your career goals. We eliminate the administrative burden to allow our physician associates to concentrate on delivering the best patient care possible. We offer a competitive split along with sign-on bonuses and an introductory rate dependent upon your signed contract. Annual earnings can be up to $ 400,000 plus, depending upon your full-time equivalency. One-to-one staff includes well-trained medical office assistants, clinic leads and efficient administrative personnel. We use Healthquest electronic medical records and are affiliated with the Edmonton Southside Primary Care Network staff including a healthy aging team, dietitian, high-risk foot protection clinic, certified respiratory educator/ therapist, breathing for healthpulmonary rehab and an exercise specialist. Our physicians will experience a lifestyle that has unsurpassed freedom and flexibility. Choose the type of practice that works best with their ideals, commitments and lifestyle whether it’s part-time, full-time, family practice or walk-in only practice. We have two locations with opportunities for locums, part-time and full-time associates in Edmonton’s and Leduc’s ever-growing communities full of vibrant, young families. Our clinics are in brand-new facilities and situated in safe, newer Edmonton communities. Clean and comfortable with up-to-date equipment so your patients will feel safe and secure.

Our Edmonton location is open sevendays-a-week and our Leduc location is expanding. Please contact me today to discuss this exciting opportunity and schedule a tour at one of our facilities. We offer a trial period of three months with no commitment from the physicians to see if our team setting works for you. Bring your stethoscope and we will do the rest. Contact: Dr. Amr Nasr, Medical Director Care Plus Medical Clinics careplusclinic@hotmail.com SHERWOOD PARK AB Dr. Patti Farrell & Associates is a new, busy, modern family practice clinic with electronic medical records and require locum coverage periods throughout 2016. Fee split is negotiable. Current clinic hours are 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

PRACTICE FOR SALE EDMONTON AB Medical clinic with minor surgery room for sale. This established medical clinic equipped with a surgical room for minor surgeries is a newly built facility that has been operational since 2012. The clinic is beautifully designed and thoughtfully set up with a spacious patient waiting and receptionadministrative area, one lunch room with half bath, five ample-sized and fully equipped patient rooms, one minor surgeries room, one doctor’s office, one sterilization/computer room and state-of-the-art medical and surgical equipment. The clinic is also equipped with a liquid nitrogen cryotherapy unit and an in-house instrument sterilization unit. The configuration of the patient rooms and of the overall clinic is very versatile and can be suited to various other types of medical practices. This

clinic can accommodate up to two physicians practising concurrently and can accommodate 100 to 120 patients a day. The practice is located in a prime central location in Edmonton with ease of access and ample free parking for patients and staff. The clinic has been used for a dermatology practice specializing in medical dermatology and a limited number of cosmetic procedures for wide range of patients and is complemented by a very experienced and loyal clinical team consisting of one nurse and one clinic manager, both of whom are ready to be transitioned to the next medical team. The clinic currently is operating at four days per week, boasts about 265 new patients and about 200 follow-up patients a month. This is a ready-tooperate, full turn-key clinic. Asking price is $395,000. All prospective buyers need to provide proof of qualification as a physician registered in Canada and sign a confidentiality agreement prior to accessing further information. Training and support is available. Seller financing is available. Contact: Simon Roa T 780.906.8933 simonroa360@hotmail.com http://canada.businessesforsale.com/ canadian/edmonton-medical-clinicwith-minor-surgeries-room-forsale.aspx

SPACE AVAILABLE 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 turnkey construction management available. Contact: NorthWest Healthcare Properties Lindsay Hills, Leasing Manager, Calgary T 403.282.9838, ext. 3301 lindsay.hills@nwhreit.com Shelly Fedorak, Leasing Manager, Edmonton T 780.293.9348 shelly.fedorak@nwhreit.com >

JULY – AUGUST 2016

EDMONTON AB Medical office space available in southeast Edmonton near the Whitemud. Share common space with another practitioner. Two treatment rooms available full time. Price varies on number of rooms needed. Contact: T 780.466.5221 EDMONTON AB Edmonton medical clinic in the west end is looking to rent out one or two examination rooms. Rent would include one physician desk, examination room(s), staff, waiting rooms and TELUS Med Access electronic medical records. We are open Monday to Saturday. If you have any further questions or are interested in this opportunity, please contact us. Contact: T 587.987.8002

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 JAPAN AND KOREA September 18-29 Focus: Endocrinology and dermatology Ship: Celebrity Millennium MEDITERRANEAN September 24-October 8 Focus: Cardiology, endocrinology, rehabilitation and psychology Ship: Celebrity Silhouette HAWAII October 15-22 Focus: Family medicine (university at sea) Ship: NCL Pride of America DUBAI AND UNITED ARAB EMIRATES October 24-November 3 Focus: Neurology and rehabilitation medicine. Plus visit to Dubai Healthcare City. Ship: Azamara Journey

AMA - ALBERTA DOCTORS’ DIGEST

TRANS-ATLANTIC BARCELONA TO BARBADOS November 5-21 Focus: Mental health in the workplace Ship: Silver Spirit BAHAMAS SANDALS RESORT November 6-13 Focus: Rheumatology, chronic pain and hot topics in medicine Resort: Emerald Bay, Exuma Island TAHITI AND MARQUESAS November 19-December 3 Focus: Endocrinology and dermatology Ship: Paul Gauguin SOUTHERN CARIBBEAN December 21-January 2, 2017 Focus: Dermatology, pediatrics and emergency medicine Ship: Celebrity Eclipse SOUTH AMERICA January 22-February 5, 2017 Focus: Psychiatry, endocrinology, rheumatology sport medicine and computers in medicine Ship: Celebrity Infinity AUSTRALIA AND NEW ZEALAND February 5-17, 2017 Focus: Psychiatry, dermatology and women’s health Ship: Celebrity Solstice BAHA AND SEA OF CORTEZ February 9-21, 2017 Focus: CME with BC Medical Journal Ship: Azamara Quest BALI TO SINGAPORE: MALAY ARCHIPELAGO February 23-March 7, 2017 Focus: Endocrinology, geriatrics and psychiatry Ship: Crystal Symphony EASTERN CARIBBEAN March 12-19, 2017 Focus: Gastroenterology update 2017 Ship: Holland America: New Amsterdam BERMUDA April 30-May 7, 2017 Focus: Primary care and neurosurgery for the non-neurosurgeons Ship: Celebrity Summit

SPAIN - CME LAND TOUR May 12-22, 2017 Focus: Internal medicine and medical/ legal updates Spanish land tour exploring Madrid, Vigo and Rioja ICELAND - CME LAND TOUR June 3-9, 2017 Focus: Optimizing patient care, chronic pain and urology Iceland land tour RHINE AND DANUBE RIVER September 1-16, 2017 Focus: Cardiology, sport medicine and dermatology Ship: Avalon Illuminations JAPANESE EXPLORER September 24-October 5, 2017 Focus: Cardiology, internal medicine and endocrinology Ship: Celebrity Millennium TUAMOTUS AND SOCIETY ISLANDS TAHITI October 18-28, 2017 Focus: Save the date – topic coming soon! Ship: Paul Gauguin PATAGONIA November 25-December 2, 2017 Focus: Adventures in medicine 2017 Ship: Stella Australis SINGAPORE TO HONG KONG December 5-17, 2017 Focus: Save the date - topics coming soon! Ship: Regent SS Voyager EASTERN CARIBBEAN December 30, 2017-January 6, 2018 Focus: Save the date - topics coming soon! Ship: Royal Caribbean: Harmony of the Seas For current promotions and pricing, contact: Sea Courses Cruises TF 1.888.647.7327 cruises@seacourses.com www.seacourses.com >

SERVICES

MISSION

ACCOUNTING AND CONSULTING SERVICES

MEDICAL AND HEALTH SERVICE TRIP TANZANIA AFRICA NOVEMBER 13-29

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 DOCUDAVIT MEDICAL SOLUTIONS Retiring, moving or closing your practice? Physician’s estate? DOCUdavit Medical 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

I am pleased to provide you with information about the Journeys of Inspiration Medical and Health Tour to Tanzania. This journey combines mission and memories into a 16-day experience of a lifetime. The sooner we make plans, the better we can enjoy the trip and avoid unnecessary delays. The first package contains all the needed information at this stage of planning. Items to be returned together include: Registration form; liability release form; health care professionals credentials form (to be completed by health care professionals only); copy of practice permit (to be completed by health care professionals only); copy of picture page of passport and non-refundable $200 deposit. If you wish to reserve a spot, enclose your non-refundable $200 deposit per person with the registration form. If you would like to see some photographs or have any questions, please do not hesitate to contact us. Also, please note that a portion of the trip is tax-deductible; if you decide to deviate from the group and extend your stay this portion is not eligible for a tax receipt.

To enter Tanzania, you will need your passport, which must be valid for at least six months from your date of entry. If not, you will need to renew it before you travel. Canadian passport renewals take a minimum of 10 days. Contact: Dr. Ray Comeau rayderyl@gmail.com for more information

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

JULY – AUGUST 2016

MD GIVES FINANCIAL ADVICE THAT EVOLVES WITH

MY LIFE. Dr. Edward Kucharski, Family Physician

Trust your MD As a CMA company, we understand physiciansâ&#x20AC;&#x2122; finances better than anyone. For personalized advice, call 1 800 267-4022 or visit md.cma.ca. MD Financial Management provides financial products and services, the MD Family of Funds and investment counselling services through the MD Group of Companies. For a detailed list of these companies, visit md.cma.ca.