Alberta Doctors' Digest May/June 2016 by Alberta Medical Association

Alberta Doctors'

DIGEST May-June 2016 | Volume 41 | Number 3

Are you conducting a risky business? The time has come for secure messaging

We said what?

2016 Tracker Survey assesses member opinions on the association and the system

Emerging Leaders in Health Promotion Grant program

Helping Edmonton seniors to become more health savvy

AMA Youth Run Club welcomes new sponsor

Alberta Blue Cross is getting the summer season off to a running start Patients FirstÂŽ

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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

4 From the Editor 6 Letters 12 Health Law Update 14 Mind Your Own Business 1 8 Insurance Insights

FEATURES

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 July-August issue deadline: June 13

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.

20 Dr. Gadget 27 PFSP Perspectives 30 Residents' Page 34 In a Different Vein 38 Classified Advertisements

8 Are you conducting a risky business?

The time has come for secure messaging

16 We said what?

2016 Tracker Survey assesses member opinions on the association and the system

22 Alberta Medical Students’ Conference and Retreat

Celebrating a dozen years of connecting and inspiring Alberta’s medical students

24 Emerging Leaders in Health Promotion Grant program

Helping Edmonton seniors to become more health savvy

32 AMA Youth Run Club welcomes new sponsor

Alberta Blue Cross is getting the summer season off to a running start

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. Scott F. Wilson says there's no doubt that as physicians, we need a secure platform to message each other. MAY – JUNE 2016

FROM THE EDITOR

Mortal rigors Dennis W. Jirsch, MD, PhD | EDITOR

have been mulling over physician-assisted death. It’s become a front burner topic across the country and the cause of considerable concern. I have not gotten far in my thinking, perhaps because there’s been a run on the more typical – i.e., unassisted – dying among my confreres, but it too has been instructive. A friend of mine from surgical residency decades ago recently fell ill. Ofei (pronounced O-fay’) was fine when I last saw him on a trip east. He was anticipating retirement from a busy surgical practice, had bought new golf clubs and was looking forward to traveling with wife Jill to new and exotic places. Ofei never got that far. He was felled, over a number of months, with an acute neurological illness that was progressive and unremitting and that, so far as I know, was never accurately labelled. There were night-time seizures, trouble walking that soon required a wheelchair, and perhaps most dismaying his sensorium was ever more clouded. Despite trips to a handful of neurological Meccas, useful diagnosis and treatment remained elusive. Jill called me when Ofei was admitted to hospital a final time. I promised I would visit and prepared for it, but I was too late and death supervened. I made it to the funeral though, and thought I saw a few familiar faces in the crowded church. A fine picture of Ofei in happier times had been reproduced on the program that guided the church service. The picture was a good one and my friend’s warm smile brought back memories. I missed him, felt mixed grief and regret, but was surprised by my own tears. Post-service there was a celebration at a nearby hall. We all ate little sandwiches, drank too much wine for an afternoon and were too loud greeting one another as we rejoined the living, recalling to one another memories of our fallen friend.

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Ofei had died in hospital but a short week earlier he’d felt game enough to come home for the weekend. He knew he was failing and that trucking all the paraphernalia required for overnight care would be arduous.

As Sue Rodriguez said, 20-odd

years ago, in her battle to end her own suffering from ALS: “If I cannot give consent to my own death, whose body is this? Who owns my life?”

What he wanted, more than anything, Jill told me was to watch his three grandchildren play round his bed before he had to return to the hospital. At this late juncture, talk of golf, travel or normal living had been abandoned and was irrelevant, but joy in family endured and was sufficient. I found it remarkable that, in the all-too-swift declension of our lives, we can be surprisingly adaptable to the crucible circumstances of our lives and can move on, beyond our former selves. Nevertheless, death never fails to surprise. It has been said that man is the only animal cognizant of its mortality. Paleontologists tell us that our species seems to have begun rituals associated with death 50 to 100,000 years ago. It wasn’t just us, however, for our Neanderthal cousins had funerary rituals as well, scattering flowers and other ornaments around their dead and placing them just so. Notwithstanding human rituals, there are tales of elephants brooding over the corpses of their kin, trying to lift them, and returning to death sites again and again. If this sounds like mourning, dolphins, chimpanzees, giraffes and western scrub jays have all been observed engaged in similar behavior. >

> Our individual experiences with death are unpredictable but the details in our memories are indelible. From my youth, I recall a grandmother who was moved to a “facility” when she became feeble, and I remember “myocarditis” scrawled across her death certificate, probably accepted shorthand for the more accurate age-related infirmity-leading-to-death. Later, but still before medical school, I worked in a mental hospital one summer as an orderly and was seconded to sick bay. Protocol required me to wash the newly dead – generally old, emaciated souls – and I remember how difficult shaving the dead can be, especially the troublesome hollows beneath each zygomatic arch. A wad of cotton batting stuffed up the rectum, a ligature tied round the penis, and a yellow ID tag around a big toe, and, sheet drawn, we were ready for the final gurney ride to the morgue.

In the peekaboo, now-you-see-it-

now-you-don’t relationship we have with our mortality, it is difficult to envisage a new role for physician’s that is anything but uncomfortable.

In medical school there was cadaveric dissection. Four of us – two to a side – spent hours looking for vessels, nerves and muscles, and we quickly became inured to the pervasive odor of formaldehyde that clung to our hands, books and even our sandwiches. We knew that our corpse had come to us by way of prison, but I don’t know how we knew this, nor can I remember wondering about the life or lack thereof of the poor fellow who’d fallen prey to our dissective inistrations. In later clinical years, death intruded more often, but still sporadically, as when patients succumbed to fulminant disease before transfer to palliative care or when trauma was too extensive and beyond repair. Death was commonly a night-time thing. In the harsh light of operating rooms filled with urgent calls for more blood, more plasma, our efforts were sometimes to no avail and left a sudden ringing stillness once all had stepped away from the carcass of one who had earlier carried the so-called elan vital.

Nevertheless, death and its concerns are for most of us, a sometime thing. If our evolution as Homo sapiens has depended in large part on the accident of our burgeoning frontal lobes, and appreciating cause and effect and their relationship to time, it has also given us the ability – and probably the need – to put death as a burden out of our lives. We think magically for the most part, as if through some fluke of fate or perhaps inordinate attention to the details of living, that we can be the first to escape this misery. We don’t know why, but agree with Woody Allen: “I’m not afraid to die. I just don’t want to be there when it happens.” We face death most often obliquely. It’s generally a taboo subject and we arm ourselves with euphemisms which attempt to ameliorate the sting of more candor. Others don’t die – they pass, or pass on and those affected are deceased, not dead. There is wry humor in some of the terms. We say that someone “kicked the bucket,” or “bought the farm,” without unpacking these grisly terms. On a subterranean level we acknowledge our impermanence and opt for youth as closer to birth than death. We’re successful, if only for a time, with distracting baubles and diversions that let us pretend a longer while that we are young and near immortal. “No worries,” as the saying goes. In the peekaboo, now-you-see-it-now-you-don’t relationship we have with our mortality, it is difficult to envisage a new role for physician’s that is anything but uncomfortable. Suffering can be countered with support and medicines, but most convincingly, with hope. Most times our agonies are brief and limited, and – as my friend Ofei demonstrated, wanting to see his grandchildren play on his final weekend – can be imbued with meaning. Most times, but not always. Our Supreme Court last year decided that patients have a right under particular circumstances to seek physicians’ help ending their lives. As Sue Rodriguez said, 20-odd years ago, in her battle to end her own suffering from ALS: “If I cannot give consent to my own death, whose body is this? Who owns my life?” Who indeed? 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. I think of it as merciful.

MAY – JUNE 2016

LETTERS

Open letter to the Chief Justice of Canada

Open letter to the Chief Justice of Canada on a motion "tabled indefinitely" at the 2016 Spring Representative Forum of the Alberta Medical Association. Submitted also to Alberta Doctors' Digest. Dear Chief Justice of Canada: I must draw your attention to a decision of the Representative Forum (RF), the governance body of the Alberta Medical Association (AMA) on March 12. (The AMA is the representative organization for the physicians of Alberta.)

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The motion read: THAT the AMA agrees with the principle of appropriate enforcement and adequate regulation to protect the “right to life” of those at risk from “involuntary euthanasia.” I stressed to the RF that involuntary euthanasia is not physician-assisted death and provided the definition as being “the killing of a patient without their knowledge or consent.” The motion was “tabled indefinitely…” It is a sad day for the people of Alberta when the representative body for physicians chooses not to carry a motion which would agree with having adequate regulation and enforcement to protect Canadian citizens from being killed without their knowledge or consent. Yours sincerely, Kevin M. Hay, MB, BCh, BAO, MRCPI, CCFP, FCFP Wainwright AB

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Mauro Castellanos, B. Comm t: (780) 707-4241

e: mauro@ualberta.net

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LETTERS

Accepting transgendered individuals I have been accepting transgendered (trans) individuals (gender dysphoria) in my practice since 1978. I have had a subspecialty clinic in this area since 1996 and have seen over 1,500 individuals with gender dysphoria. The World Professional Association for Transgender Health and the Diagnostic and Statistical Manual Five guidelines are followed. The majority of individuals seen are seeking hormones and eligibility for gender-affirming surgery, which is paid for by Alberta Health. As a result of my specialized practice, I have become aware of the many barriers that exist for this population in accessing health care. Some of these barriers include: • Difficulty for an individual who feels they may be transgendered to find a primary care physician to accept them and to make an appropriate referral. • Difficulty for a trans individual who has had gender-related surgery to find a primary care physician to see them for complications such as an infection or a specialist to see them for a later complication such as an urethral stricture. • Difficulty for a trans individual, whether pre- or post-surgery, to find a primary care physician to provide general health care, as well as care related to their gender surgery, such as vaginal infections, prostate exams or the supervising and prescribing of hormones long term.

• Difficulty with the negative and stigmatizing attitudes of some medical and other professional staff in emergency departments and medical units in hospitals. A recent estimate for the prevalence of transgenderism in the general population is around 1 in 500 and could even be 1 in 100. As societal acceptance increases, greater numbers of transgendered individuals are taking the risk of coming out of the “gender closet” and asking for assistance. As time passes, this has become a younger group with many being in their late teens or early 20s. Assessments on children as young as five are being requested by concerned parents. This means that more and more practitioners in the province will be dealing with this population in some way as time passes. The human rights of transgendered individuals are also being better defined. For example: • Bill 279 proposes to expand the definition of gender and gender expression in the Canadian Charter of Rights and Freedoms. Gender is already included, of course. • Bill 10 in Alberta was passed, which defines the rights of students in any school to start, with faculty or administrative support, a gay/straight alliance club for students who are transgendered. Further to this, in January the current minister of education gave a directive that all publicly funded schools in Alberta must have a comprehensive

policy regarding the rights of transgendered students and faculty, to be in place by the end of March 2016. • Bill 27 was recently passed in Alberta that expands the definition of gender and gender expression in the human rights legislation. • The Canadian Medical Protective Association has made very strong statements regarding non-discrimination toward transgendered individuals who are seeking health care. A statement has been made to the effect that any litigation that is the result of discrimination would not be defensible. The world is changing, as it always has. Our traditional binary approach to gender, acquired from European culture and religious influence, no longer holds true. Trans males and females (with shades in between) have always been part of any human group since recorded time, oppressed and suppressed for hundreds of years, and are now very visible. Medical practitioners, as always, need to acquire new information and re-evaluate existing attitudes. Thank you. Sincerely, Lorne B. Warneke, BSc, MD, FRCPC Clinical Professor of Psychiatry, University of Alberta Staff Psychiatrist, Grey Nuns Community Hospital Edmonton AB

MAY – JUNE 2016

COVER FEATURE

Are you conducting a risky business? Vanda Killeen, BA, Dip Ad/PR | SENIOR

COMMUNICATIONS CONSULTANT, AMA

The time has come for secure messaging

“S

aving lives or risky pics? ‘Revolution’ in MDs’ smartphone photos raises ethical concerns,” read the headline of an April National Post article. Followed by, “Would you want your most intimate photos saved alongside your doctor’s baby pics? Patients across Canada are increasingly asked for that consent.” Those are attention-grabbing headlines, particularly for physicians. E-communications have become ubiquitous in our busy lives and while you know that emailing, texting and faxing are not secure channels over which to exchange confidential information, you continue to use it, thinking (hoping) that you’ll never experience a security breach. Despite having set gold standards for yourself and your clinic staff, when undertaken in the context of a maxed-out-busy work environment, e-communications (such as texts and email exchanges) are fraught with the potential to be compromised.

They’re not secure; “… it’s that simple” “There’s no doubt that as physicians, we need a secure platform to message each other,” says Dr. Scott F. Wilson, member of the Alberta Medical Association (AMA) Secure Messaging Engagement Committee and President, Section of Neurology. “Security is a growing concern and the faxing, texting and emailing of information is not secure; it’s that simple.” Dr. Wilson’s interest in secure messaging began while he served on the Physician Office System Program Committee. “Our goal was to facilitate the ability to message across platforms through a health information exchange, and I thought it could enhance my job as a specialist, in communicating with family physicians, to provide better care for patients in Alberta,” Dr. Wilson continues. Fast-forward a decade and with Alberta’s physicians using electronic medical records (EMRs) more than any other province, the emphasis is now on facilitating health information exchanges among health care providers that are not only secure but, “enhance the entire workflow of a physician’s office, from the nurse or medical office assistant directly to the physician,” says Dr. Wilson.

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“AMA dr2dr Secure Messaging does that. This platform takes the movement of information to a whole new level with multiple enhancements. Patient demographic information can easily be included with a secure message and medical office staff can track the status of any secure message, whether it’s simple advice regarding patient management or a referral.” And those EMR systems? Well, AMA dr2dr can be integrated with any EMR system hosted by a vendor open to integration. Currently Healthquest is integrated and Telin users will be happy to know that Mediplan EMR is in the works.

Start now, by signing up for a pilot

or early access! The full-system launch takes place on July 4, after which there will be a three-month Free Trial Period (the subscription rate after the free trial will be $34.99 per month, covering a physician and all clinic staff reporting to the physician).

Stand-alone system with a fee code = good business decision “It can also be used as a stand-alone system for physicians who either don’t have an EMR or don’t have EMR-integration ability,” adds Dr. Wilson. “And with the new E-Consult fee code (03.01R; accompanied by the earlier fee code; 03.01O), the cost of the system can be completely offset, for both the family physician and the specialist,” continues Dr. Wilson. “From that perspective alone, it’s easy to see that adopting the AMA dr2dr secure messaging system is a good business decision.” >

> The capabilities of AMA dr2dr and its financial win-win aside, it’s the other features and benefits of secure messaging, and how they set the environment for providing his patients with coordinated, informed care, that stand out as the deal-closers for Dr. Wilson.

Improved coordination of care “When you look at the secure messaging system’s ability to accommodate the gathering and management of clinical advice, opinions and information; its flexibility and security with respect to attaching patient files; and its ability to serve as an efficient, reliable record of referral and other communications – all of which form the foundation of coordinated patient care – this is the system that can help physicians provide better care for our patients.” “I think there are some misconceptions about secure messaging,” Dr. Wilson notes. “Physicians may be thinking that they’re going to be saddled with one more thing to log into, and upload files and move patient data to." He goes on to stress that: "The quick-fix is to engage your office staff, as the reality is that the dr2dr system supports clinic staff, as well. In fact, they can do most of the initiating of a message for the physician, such as adding the attachments or a note. The physician can add any final comments and push ‘send.’ Finally, a copy of the conversation can be printed and added to the patient’s paper record. It’s as easy as that.”

With or without an EMR,

AMA dr2dr is your secure solution for sending and receiving messages, consult requests and referrals.

Foundations of change At the AMA Spring 2014 Representative Forum, with motion RF14S-22, the need for a secure electronic messaging system was recognized as a priority. Gaps in continuity of care, many of which were identified in the Health Quality Council of Alberta’s Continuity of Patient Care Study (December 19, 2013), were a contributing factor in the secure messaging motion, moved by Dr. Wilson. “We’ve long recognized the need for a secure messaging system that facilitates new modes of coordinated care,” he explains. “It’s also imperative that it complies with current privacy legislation and expectations for standards of care. For the past six months, the Secure Messaging Engagement Committee and the AMA have been working closely with Microquest to ensure that AMA dr2dr does that, and more.”

With its web-based, secure server, the AMA dr2dr system protects sensitive data or information that is sent beyond the corporate/clinic/device borders and complies with industry regulations and standards for the secure transmittal of confidential patient data, as stipulated by: the Health Information Act (HIA); the Freedom of Information and Protection of Privacy Act; the Personal Information Protection and Electronic Documents Act; the Personal Information Protection Act; the Office of the Information and Privacy Commissioner of Alberta; the College of Physicians & Surgeons of Alberta and Alberta Health.

Understanding secure messaging: Helping you care for your patients while respecting their privacy In the name of seeking advice, opinions and ideas from their peer physicians and other health care providers, many physicians are ramping up their use of personal mobile phones (cameras and texting) as well as new online mobile applications and tools, such as Instagram and Figure 1. While convenient and effective in their own right, security can be sacrificed in the name of expediency; at the sobering cost of the patient’s right to privacy. Misunderstandings of the security aspects (or lack thereof) of mobile technology are rampant, evidenced by a Calgary-based study (conducted by plastic surgeons in Alberta) recently published in the journal Plastic Surgery, in which 75% of the 147 surgeon respondents said “getting simple verbal consent for photos was good enough.” As Ingrid M. Ruys, privacy advisor to the AMA observes, “Verbal consent is not sufficient. Mobile applications, including photos, need to have patient consent, recommended to be obtained in writing when the patient first visits a physician or during an appointment. If a physician obtains verbal consent, it must be recorded with date, time and reason (e.g., emergent broken arm) in the patient file, and should the patient contest that, it’s open for challenge.” In other words, verbal consent doesn’t cut it, at all. Ms Ruys notes that obtaining verbal consent contravenes Section 23 of the HIA, which states that use of a “recording device or camera” must obtain written consent … “All forms that obtain patient information (of which pictures are deemed to be) require consent,” she continues. “Consent is obtained in writing, as outlined in all Privacy Impact Assessments.” “Protecting privacy and safeguarding clinical information are at the core of AMA dr2dr,” says Dr. Wilson. “It complies with all related industry regulations and standards; the log-in process requires two-factor authentication; all exchanges and attachments are centrally stored and contained within the dr2dr.ca website; in-transit data is 256-bit SSL-encrypted and at-rest data is also encrypted.” >

MAY – JUNE 2016

> Axe the Fax

All onboard!

“Plus,” he adds, “dr2dr is just easy to use. I recently had a family physician from southern Alberta message me regarding an MRI result in the context of headaches. I was quickly able to answer the question about the MRI findings and suggest a further care plan for the patient; all done in minutes, without going near the fax machine. Best of all, with dr2dr, the family physician could see instantly, after sending his message, that I had received it. No standing around the fax machine, wondering if the fax transmitted, to me, and did I receive it … there’s so much efficiency and clarity, with dr2dr.”

All good things do take some time (and patience). AMA dr2dr is no exception. Integrating the system into your practice, engaging your staff and trialling the system are investments in your business that will pay off tenfold.

The demise of the fax machine isn’t a matter of if but when, and it can’t happen soon enough for Dr. Wilson. “The potential of secure messaging to improve the workflow in our offices, in our practices, with the frustrations and inadequacies of faxing in the past … that’s my goal.”

The other essential ingredient to improving office workflow with secure messaging is for AMA dr2dr to become the primary means of e-communications between physicians, clinic staff and other health care professionals. “The more users that are on the system, the better,” Dr. Wilson emphasizes. “As the network grows, it will become exponentially more beneficial to all users.”

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Start now, by signing up for a pilot or early access! The full-system launch takes place on July 4, after which there will be a three-month Free Trial Period (the subscription rate after the free trial will be $34.99 per month, covering a physician and all clinic staff reporting to the physician).

Technical support With any new technology, technical support is paramount and the AMA and Microquest technical support teams are already hard-at-work, supporting the 12 system trials currently underway. They have a comprehensive knowledge of the EMR landscape in Alberta and can advise you about the best solutions for your office. With or without an EMR, AMA dr2dr is your secure solution for sending and receiving messages, consult requests and referrals.

Are you getting the message?

The SECURE message, that is. If you’re still texting, faxing and emailing confidential patient information to your health care colleagues, you’re clearly not getting the message. AMA dr2dr Secure Messaging uses a central-server, 256 bit SSL-encrypted mode of email communication to transmit and receive patient information. That’s bank-level, Fort Knox-type security. Streamline your commmunications and collaboration, facilitate efficient, productive referrals and reduce wait times for accessing specialists and arranging consultations. Using AMA dr2dr makes life easier for you, and your patients benefit from improved coordination of care.

Free trial period; limited time

Sign up now for an AMA dr2dr pilot or register for an early-access account. After the AMA dr2dr free trial period ends September 30, the subscription rate is $34.99/month (per physician and any/all reporting clinic staff). Recover your monthly subscription cost with the e-consult fee codes, for use by both requesting and receiving physicians. Talk about good business sense! Join AMA dr2dr: https://www.dr2dr.ca For more information: www.albertadoctors.org/dr2dr Email info@dr2dr.ca

MAY – JUNE 2016

HEALTH LAW UPDATE

Physician-assisted death: One more reflection Jonathan P. Rossall, QC, LLM | PARTNER,

y now it’s common knowledge that on January 15, 2016 the Supreme Court of Canada granted the Federal Government’s request for an extension of the suspension of its ruling in Carter vs. A.G. Canada. The extension was sought as a consequence of the delay in considering amendments to the Criminal Code caused by the intervening federal election. However, in granting the extension, the Supreme Court also allowed individuals in specified circumstances to seek exemptions from the extension and avail themselves of physician-assisted death (PAD) immediately. As of the date of the writing of this column, four such applications have been made before the Superior Courts in Canada in British Columbia,1 Alberta,2 Manitoba3 and Ontario.4 All four applications were granted, in part because none of them were opposed by either the provincial attorneys general or the family members named as respondents. The distinctions in how the various courts have dealt with the applications, and the varying evidentiary requirements in each court, underline the need for certainty and consistency across the country in the application of the policies and rules expressed in the Carter decision. However, there have been four consistent developments that will impact the future interpretation and application of the pending legislative changes. The first determination, which is common to all four decisions, is that in granting the exemptions, and therefore allowing the applicants to avail themselves of PAD, each one of the courts extended the protection from prosecution to those individual health care providers who were identified as assisting in the process, including pharmacists, nurses and other physicians. This is a very helpful finding, as following the issuance of the decision in January 2015, there was a great deal of discomfort and uncertainty surrounding the narrowness of the ruling, being restricted on its fact to physicians assisting in death. The findings of the four Superior Court justices reflect a very practical interpretation of just what “physician-assisted death” involves.

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MCLENNAN ROSS LLP

The second determination relates to requirements to notify the coroner’s office (or, in the case of Alberta, the Office of the Medical Examiner). All four jurisdictions have varying requirements to notify that office when a death has occurred for any reason other than disease, or under circumstances which require investigation. The concern expressed in three of the decisions was that it was overly intrusive or undignified to invoke the process of investigation which could, in some circumstances, involve an autopsy and significant delays in the release of the body, where clearly the death is not suspicious. The arguments that prevailed were that, essentially, the medication administered by the physician to bring death is a consequence of, and a treatment of, an underlying condition (which is the disease that caused the death). It should be noted that the direction that the coroner’s office not be notified was found in a court order, and was not touched on in the Carter decision. It is by no means certain that the provinces will address this issue in the context of existing coroners’ or medical examiners’ legislation.

By the time this column is

published, we should have some sense of what the federal and provincial governments have actually enacted to address the ruling in Carter vs. A.G. Canada.

The third determination was that in all cases, the courts acceded to the applicant’s request for anonymity, as well as the anonymity of those supporting the application through the swearing of affidavits and those agreeing to provide assistance.5 In doing so, the courts balanced the benefits of transparency and seeing “justice being done” with the privacy rights of the applicants. The final determination, which is somewhat troubling, is that in all four cases, the court seemed to at least take comfort, if not expressly accept as a condition, that the applicant’s medical condition was terminal. The requirement >

> from the Carter decision that the patient seeking PAD “… clearly consents to the termination of life, and has a grievous and irremediable medical condition (including illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition” does not include a requirement that the patient’s condition be terminal. This is in contrast to the legislation passed in the province of Quebec, which does include that factor as a pre-condition to granting PAD to a patient. This distinction was placed squarely in the spotlight in mid-April when a 61-year-old Sherbrooke, Quebec man who suffered from a non-terminal, yet grievous and irremediable medical condition ended his life legally after starving himself for 53 days and refusing water for eight days. He arrived at a point so close to death he satisfied his doctors that he'd met all the criteria under Quebec's assisted-dying law. Following on the heels of that, of course, was the introduction of Bill C-146 on April 14. This bill introduced, amongst other things, the notion of “grievous and irremediable medical condition” including the requirement that “… natural death has become reasonably foreseeable, taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time that they have remaining.”

In the meantime, the (provincial)

courts continue to deal with patients seeking physician-assisted death on a case-by-case basis, showing compassion and adopting a practical approach to the issues at hand.

Reliance on the fact that the medical condition is terminal clearly takes the interpretation of the Carter decision one step further than strictly necessary and may prove an impediment to those seeking PAD. It may also lead to a further charter challenge based on equality rights. By the time this column is published, we should have some sense of what the federal and provincial governments have actually enacted to address the ruling in Carter. In the meantime, the courts continue to deal with patients seeking PAD on a case-by-case basis, showing compassion and adopting a practical approach to the issues at hand. References available upon request.

MAY – JUNE 2016

MIND YOUR OWN BUSINESS

Results are in! 2015-16 provincial pay survey for clinic staff positions Practice Management Program Staff

he results are in from the 2015-16 provincial pay survey of medical clinic staff positions, initiated in partnership between the Alberta Medical Association (AMA) and the Alberta Association of Clinic Managers. The survey represents data from 91 clinics, a 107% increase (i.e., over double the responses) from the first survey completed in 2013-14, which had 44 participant clinics. Notably, the number of specialist participant clinics increased from one participant in 2013-14 to 18 participants in this year’s survey, as well as 10 clinic respondents with both specialists and general practitioners.

However, survey data is not the be-all and end-all. Instead, it is intended as a general market indication – a guideline. As with any survey, this data represents a sample of the entire population and caution should be exercised in data interpretation.

The survey report provides data segmented by clinic size, population size, geographic area (based on the five Alberta Health Services geographic zones) and practice type (general practitioner and specialty practice), relating to:

The following are highlights from the survey results:

• Pay rates and cash compensation for 13 common clinic positions – including bonuses and overtime. • Pay practices such as whether or not clinics have formal pay structures in place, how clinics decide on annual increases, projected increases for next fiscal year, and type and frequency of performance reviews. • Benefits and paid time off (including statutory holidays, vacation and sick days).

Why is this important? Many factors influence how your employees feel about their work and their workplace. Pay is one of them, and perception of pay fairness is just as important as the reality of it. A recent study found that 25% of employees say that fair pay is the single most important thing their organization can provide. Pay programs that are anchored to the market establish a certain amount of credibility right from the get-go.1 Market surveys, such as ours, can help you.

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Our Practice Management Program consultants are available to help to ensure your clinic’s pay program is on the right track and/or helping you build a plan from the ground up. We can also help you in interpreting the survey results and understanding what the data means for your clinic.

Some survey highlights

• Less than half of survey respondents have a formal wage structure (45%) with regular, across-the-board annual increases reported by 47%. • 73% of respondents indicated performing regular performance reviews, most of these (70%) on an annual basis. • The median cost-of-living increase for last fiscal year was 2% and is projected at 2% for the upcoming year. The median performance-based pay increase for last fiscal year was 3% and is projected at 3% for the upcoming year. • 65% of respondent clinics indicated providing some type of employer-sponsored benefits plan and/or a health spending account. The most commonly provided coverage was prescription drugs (57%), dental care (55%) and extended health care (52%). The median annual dollar value of the employer contribution to the benefits package (per employee) is $1,437. • Paid time off: - Beyond the statutory minimums of two and three weeks, respondents indicated providing additional vacation at four weeks (58%), five weeks (33%) and six weeks (14%), with qualifying years of service contained in the detailed analysis. >

- 42% of respondents provide the statutory minimum of nine annual holiday days, 15% provide 10 days, 31% provide 11 days and 11% provide 12 days. - Just 11 clinics (12%) indicated providing a specific allotment of time for education days (ranging from one to seven days, most of these at two to four days). - Just 10 clinics (11%) indicated providing a specific allotment of time for “flex” days (e.g., personal, bereavement), ranging from one to eight days, with several at five days. - The most common sick day allotment is five to six days per year – 50% of respondents earned days per month.

To find out more This is just a glance. Detailed survey results are available to survey participants while a high-level summary of

survey wage data is available to non-participants. For questions relating to the survey report and to access the data, please contact the AMA at 780.733.3632. One of our consultants will be happy to help you.

We need your support Please consider participating in our next survey (likely to start in fall 2017). In doing so, you can have access to the detailed analysis the next time around. The Practice Management Program is available to assist in a number of areas related to the effective management of your practice. For assistance, please contact Linda Ertman at linda.ertman@albertadoctors.org or 780.733.3632. Reference available upon request.

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MAY – JUNE 2016

FEATURE

We said what?

2016 Tracker Survey assesses member opinions on the association and the system

he first Alberta Medical Association (AMA) Tracker Survey of 2016 was conducted in February. In this issue of Alberta Doctors’ Digest, we are pleased to report the findings. Thanks to all members who participated. Watch for the next tracker in early June.

In terms of the AMA’s performance, 79.5% agreed that the association is an effective advocate for physician members by providing leadership and support for their role in the provision of quality health care.

By the numbers

In summarizing the results, our external polling firm provided the following commentary:

The survey was conducted with a random sample of 3,000 members, with a 15% response rate (450 physicians). The data is valid 19 times out of 20 with a margin of error of +/- 4.26%. Roughly equal proportions of family physicians and specialists responded: 48% family medicine (including specialist in family medicine), 51% specialist. Respondents were more likely to be male (58%) and urban (75%). The majority of respondents are in mid-career phases: 38% between 11 and 25 years in practice and 34% with 26 or more years in practice.

Notable results The strongest member approval ratings are with respect to communication and information from the AMA. When asked if they felt well informed about activities and news from the AMA, 80% agreed while only 54% agreed they felt informed about news and initiatives about the health care system at large. Members agree that they are able to effectively share their opinions with the AMA when issues or changes will impact them; 68% agreed. Only 7.2% disagreed with this statement; the remainder were neutral.

Our pollster’s interpretation

The levels of agreement suggest the AMA is continuing to effectively manage the issues and initiatives underway. The comments provided by members do suggest a level of caution and the need to continue to pay attention to how the communications, processes and issues are being viewed by members. In some areas, members report opposing views as to the speed of progress, level of consultation and the use of partnerships. • Some members expressed distrust in government and Alberta Health Services. • Some members expressed a disappointment with the focus of the AMA being perceived as exclusively on compensation. • Some members believe that the implementation of primary care networks is not living up to expectations.

Full results Here are the full results of the 18 benchmark questions.

Summary of findings – Benchmark questions Questions 1. The AMA is effectively supporting the Patients First® vision where physicians positively influence a health system built around patients and families. 2. The AMA is an effective advocate for physician members by providing leadership and support for their role in the provision of quality health care.

AMA - ALBERTA DOCTORS’ DIGEST

Disagree

Mean

Neutral

Category percentages 0

3.76

100

67.0% 0

4.00

Agree

79.5%

Disagree

3. Physicians are shifting their practices to support partnering with patients in the delivery of care. 4. The AMA is making progress in supporting fair allocation of compensation based on relative value. 5. The Physician Compensation Committee process for defining and administering physician compensation is fair. 6. In our system, incentives and financial/compensation supports for physicians are aligned with the system objectives of timely access for patients to quality care. 7. The AMA is effectively contributing to efforts to promote system-wide efficiencies and savings. 8. An integrated provincial electronic medical record (EMR) strategy that includes seeking value from existing infrastructure is essential for improvement of the health care system. 9. Patient-physician confidentiality and safeguarding of that private information remains a requirement for effective patient care. 10. Primary Care Network (PCN) evolution toward the medical homemodel will improve access, quality and continuity of care. 11. The AMA is creating and sustaining opportunities for physicians to play active leadership roles within their communities (e.g., leadership development, Many Handsâ&#x201E;˘, Youth Run Club, etc.). 12. The AMA is effectively building and managing the partnership with Alberta Health and Alberta Health Services.

14. I feel well informed about the news and initiatives within the Alberta health care system. 15. I am able to effectively share my opinion with the AMA when an issue or change will impact me.

Agree

3.57

3.32 20

3.37 20

3.12 20

3.44 20

4.14 20

4.56

3.62

3.58

100

51.7% 0

3.60

100

59.2% 20

3.94

100

80.2% 0

3.44

53.9% 0

3.76

100

67.7% 0

3.72

55.4% 0

Overall averages

100

95.5% 0

4.18

79.8% 0

18. I am satisfied with the benefits and services provided by the AMA, e.g., insurance, continuing medical education (CME), Physician and Family Support Program (PFSP), etc.

100

49.6% 0

3.58

100

41.1% 0

17. I feel the Representative Forum is able to understand and receive feedback from physicians to support their governance role.

100

47.3% 0

3.99

100

47.7% 0

16. Physicians are being supported by the AMA in maintaining their own health and that of their families.

54.9%

13. I feel well informed about the activities and news from the AMA.

Neutral

80.1% 0

53.8% 0

100

87.8% 0

64.0% MAY â&#x20AC;&#x201C; JUNE 2016

INSURANCE INSIGHTS

Final year medical students and residents June is the time to act J. Glenn McAthey, CFP, CLU, CHS | DIRECTOR,

hile most people are thinking about their upcoming summer vacations, final year medical students and residents are busy getting ready to either start their residency training or start medical practice – a very exciting time in their medical careers. Part of the hectic transition is making sure that adequate insurance protection is in place in the event of unforeseen accidents, illnesses or even death. Being able to secure insurance protection with the least hassle is paramount at such a busy time. The Alberta Medical Association’s (AMA’s) ADIUM Insurance Services has insurance arrangements in place to ensure the transition is as smooth as possible.

Medical students If you haven’t already, enrol in the AMA Student Starter Program up until June 30, without proof of good health. The AMA Student Starter Program for final year students consists of disability insurance in the amount of $4,000 per month, which will supplement the Professional Association of Resident Physicians of Alberta (PARA) Group Disability Insurance coverage for students commencing residency in Alberta. For students moving out-of-province, it provides a base of coverage that may be supplemented by any provincial plan you may be provided.

AMA - ALBERTA DOCTORS’ DIGEST

ADIUM INSURANCE SERVICES INC.

There is also $100,000 of life insurance, which would supplement any life insurance provided by the provincial plan. With the 80% AMA Premium Credit for medical students, a non-smoker under age 35 will pay less than $11 per month for both plans for the balance of 2016.

Medical residents Ministry-funded medical residents are automatically covered under the PARA Disability and Life Insurance plans for: • Disability Insurance – 75% of gross monthly salary • Life Insurance – $150,000 • Accidental Death & Dismemberment This coverage ceases on the final day of your contract when your residency program has been completed. For the majority of residents, this date is July 1. The PARA plans contain a conversion option to the AMA plans, without proof of good health. To ensure there is no gap in coverage, residents need to complete a very simple PARA conversion application and remit it to our office before the end of June. We also offer supplemental disability coverage for first-year-in-practice physicians through the Guaranteed Insurability Benefit rider that comes with the PARA conversion. This rider may continue to be used annually, up to age 55, to increase your coverage without proof of good health. Any supplemental AMA disability or life insurance residents carry will continue unchanged during the transition. >

150

> Medical residents receive a 50% AMA premium credit on the AMA Disability Insurance plan.

Act now

YEARS!

Once in practice, you will no longer receive non-medical insurance offers as robust as these. This means that your ability to acquire coverage will be based on your health status at the time you apply for coverage. Please lock in this coverage now, while you can.

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We’re proud to call thiscredit long-standing Canadian company • Non-profit group plans and AMA premium diagnostic sleep studies (portable and in(premium credits provided the past 12 years from a partner for over 20 years. house polysomnography) for the full spectrum premium refunds from Sun Life)*. Our clinics provide clinical assessment and of sleep disorders. Previous sleep medicine

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that understands thestudents unique insurance needs of physicians. • 80% AMA premium credit for medical with opportunity for both fee-for-service and on Life and Disability Insurance plans.

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• 50% AMA premium credit for medical residents on Disability Insurance plan (including out-of-province resident members). • Worldwide portability of Life and Disability Insurance coverage (subject to $50 per year non-resident membership fee for practising physicians).

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Congratulations Sun Life Financial! • Salaried insurance advisors provide objective advice to members. For further information on the insurance programs available to final year students and residents, please contact us at your convenience.

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MAY – JUNE 2016

DR. GADGET

Data rich or data poor? Wesley D. Jackson, MD, CCFP, FCFP

e live in a world where the average person has ready access to almost unlimited data from many sources. Over the last 15 years, I have noted that more and more of my patients have gone beyond their friends, neighbors, relatives and Oprah Winfrey, to unknown sources on the Internet in an attempt to understand their symptoms prior to their consultation. I am also learning that more than 10 years of postgraduate training and 30 years of experience as a physician do not necessarily trump the information my patients receive from other sources.

(Real-time data) will surely lead

to more precise diagnoses and treatments of disease, while, at the same time, having the potential of bringing our health care system to a grinding halt.

The emerging popularity of crowd sourcing, defined by Merriam-Webster as “the process of obtaining needed services, ideas or content by soliciting contributions from a large group of people, and especially from an online community ... ” is also present and gaining traction in the medical community, as evidenced by websites such as CrowdMed (https://www.crowdmed. com), providing yet another source of data. Genomics is now available and affordable to the masses through websites such as 23andMe (https://www.23andme. com/en-ca). Wearable technology is ubiquitous and is providing an increasingly complex and more accurate array of personal medical data. Apple recently introduced a new framework called CareKit (http://www.apple.com/ researchkit/?sr=hotnews.rss), which is intended to

AMA - ALBERTA DOCTORS’ DIGEST

help patients manage their own health care needs. It will operate in tandem with HealthKit, which was introduced about two years ago, and ResearchKit, introduced last year in an attempt to provide data-driven and evidence-based care to individuals. Apps using ResearchKit are already in the process of investigating Parkinson’s disease, autism, epilepsy, asthma, concussion, chronic obstructive pulmonary disease, diabetes, hepatitis C, melanoma, post-partum depression, sleep health and others. The mPower app, developed by the University of Rochester, has enrolled over 10,000 participants, 93% of which have never taken part in any kind of research before. It helps researchers better understand Parkinson’s disease by using the gyroscope and other iPhone features to measure dexterity, balance, gait and memory, allowing for better insight into the symptoms of this disorder. A CareKit app for Parkinson’s, based on the data derived from the ResearchKit, will include a detailed care card, with instructions for diet, movement, medication, physical therapy and other treatment categories. The apps will also provide insights into the patient condition, monitoring and progress. As data quantity continues to grow logarithmically and data quality continues to improve (albeit not as quickly), patients are faced with the formidable task of attempting to take a sip of water from a fire hose. As any former medical student knows, any risk, no matter how small, of a significant health issue means in patients’ minds a 100% chance of contracting the illness. Future physicians will be tasked to an even greater degree with reassuring, educating and guiding their patients safely through this deluge of data. Figure 1 illustrates the progress More patient of transforming raw data to centered useful, patient-centered information. The physician’s Wisdom role in the interpretation Knowledge and individualization of data is key in increasing Information the benefit to the patient. This role will Data Less patient centered need to expand considerably > Figure 1 Ben efit

> as patients become more informed and more knowledgeable about their own health. Tools to assist are already emerging. The Choosing Wisely campaign, launched in 2012 by the American Board of Internal Medicine in the United States of America, with a goal to reduce waste in the health care system and avoid risks associated with unnecessary treatment, has been adopted, adapted and promoted widely in Canada through a helpful website (http://www.choosingwiselycanada.org) and an app available for Android and Apple devices. Both resources provide up-to-date guidance on wise use of resources in the interpretation of data from “a team of leading Canadian physicians, in partnership with the Canadian Medical Association.” This team has also

provided many highly informative and well-written patient handouts available to web savvy patients and physicians, which I have found to be quite useful in explaining, for example, why we don’t need to check Vitamin D or PSA levels in low-risk individuals. These are exciting times! Real-time data from millions of individuals can now be collected and distributed to individuals and physicians at their request on their smartphones. This will surely lead to more precise diagnoses and treatments of disease, while, at the same time, having the potential of bringing our health care system to a grinding halt. As physicians, we cannot – and perhaps should not – stop the flood of health data, but it is our responsibility to welcome it and use it wisely.

MAY – JUNE 2016

FEATURE Alberta Medical Students’ Conference and Retreat Celebrating a dozen years of connecting and inspiring Alberta’s medical students

and massages; and practising clinical skills like inserting IV lines and suturing. All of these activities were held at the beautiful Banff Centre, with Alberta’s famous mountain scenery as a backdrop. The weekend also featured a number of speakers who shared their personal experiences and thoughtprovoking messages for those just beginning their journeys in medicine. Alberta Medical Association (AMA) President Dr. Carl W. Nohr participated throughout AMSCAR in many ways, from greeting students to joining them on an alpine jog. His keynote address to attendees called on them to reflect on the social contract between doctors and society, encompassing the true meaning of accountability and their responsibilities to patients as they embark on their careers.

Students took the opportunity to go skating in the beautiful outdoor setting around Banff during AMSCAR weekend. From left to right: Taylor Nelson, Catherine Kucey, Julie McSweeney, Monique Jarrett, Nathalie Kupfer, Amy Norquay, Katrusia Pohoreski, Christine Patterson, Sarah Henschke, all from the University of Alberta.

n the weekend of January 29-31, over 300 medical students from the University of Calgary and the University of Alberta came together in Banff for the 12th annual Alberta Medical Students’ Conference and Retreat (AMSCAR). Over the past dozen years, AMSCAR has grown into one of the standout annual events for Alberta medical students. The weekend retreat provides a wonderful opportunity for Alberta’s future physicians to connect with their colleagues, gain inspiration and knowledge in the medical profession, and participate in a variety of fun activities promoting health and wellness. Students were able to choose from a wide range of sessions: learn about nutrition, sexual health and financial wellness; exercising creativity in clay sculpting and charcoal drawing; working out with yoga, flow power

AMA - ALBERTA DOCTORS’ DIGEST

Over the past dozen years,

AMSCAR has grown into one of the standout annual events for Alberta medical students.

The Honorable Sarah Hoffman, Minister of Health, was also present, giving an address highlighting the current state of health care in the province and calling on students to work as allies with government in tackling Alberta’s most pressing health issues. As part of the AMSCAR banquet, the Rural Physician Action Plan 2015-16 Dr. John N. Hnatuik Rural Medical Student Bursary recipients were announced. In addition, the celebration featured speeches by Dr. J. Breanne Everett and Dr. Shawna Pandya, resident physicians already making their mark as leaders and innovators. >

> Dr. Everett is a plastic surgery resident, CEO and founder of Orpyx, a company which aims to prevent the foot complications of diabetes through wearable technology. She shared her experiences of training in medicine and the desire to make social change, while highlighting the importance of awareness and self-care to address the burnout faced by many trainees and physicians. Dr. Pandya is a resident in family medicine who has worked in aerospace medicine with NASA. She has a master’s degree from the International Space University in Strasbourg, France and founded CiviGuard, an emergency response software company. Dr. Pandya candidly shared her advice on things to consider when choosing a medical specialty, as well as tips for future doctors to reflect on in their practice.

Dr. Carl W. Nohr, AMA President and the Honorable Sarah Hoffman, Minister of Health, with members of the AMSCAR 2016 Committee. Back row, left to right: Dr. Nohr, Larissa Shapka, Colin Andrews. Front row, left to right: Drayton Trumble, Kaley Donaldson, Ms Hoffman, Sharon Feng, Barbara Pedryz, Emily Macphail, Calvin Tseng, Moses Fung.

Of course, AMSCAR also offered plenty of opportunities for students from both medical schools to relax together, from evening socials to free time exploring Banff and surrounding areas. Many students took the chance to go skating, skiing and visit the local hot springs. Thanks are due to the incredibly dedicated AMSCAR Committee who worked hard over the entire year to make this conference another resounding success. In addition, the support from our extremely generous sponsors, including the AMA, makes this event possible. Thanks to this support, AMSCAR 2016 united medical students in building a common sense of wellness and resiliency, empowering and inspiring them to work together in service of Alberta patients and communities.

University of Calgary student Bernard Ma practices starting an IV line on University of Alberta student Calvin Tseng.

University of Alberta students Kathleen Degner and Michelle Young during the clay sculpting session at AMSCAR 2016.

Swing a club in support of medical student bursaries! Register today for the 89th Annual North/South Doctors’ Golf Tournament Don’t miss out on the best doctors’ golf tournament of the year!

Monday, July 11 | 8 a.m. shotgun start | Red Deer Golf and Country Club Register online at http://bit.ly/89northsouthregister OR contact Jennifer McCombe at jennifer.mccombe@albertadoctors.org, telephone 780.732.3359 or toll-free 1.866.714.5724, ext. 5359. Your registration fee of $275 includes a buffet breakfast, a round of golf with a powered cart at the renowned Red Deer Golf and Country Club and a BBQ lunch. You’ll get free use of the driving range and practice facility, a fantastic souvenir and the opportunity to win great prizes! This stroke-play tournament, co-hosted by the Alberta Medical Association, the College of Physicians & Surgeons of Alberta and The Canadian Medical Foundation, raises funds for medical student bursaries and physician health programs. Support Alberta’s next generation of physicians by sponsoring the 89th Annual North/South Doctors’ Golf Tournament: http://bit.ly/sponsor89northsouth

MAY – JUNE 2016

FEATURE Emerging Leaders in Health Promotion Grant program Helping Edmonton seniors to become more health savvy

About Emerging Leaders in Health Promotion Grant program In 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 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 well-being of the general Alberta population through education, advocacy or community service.

Health Savvy Seniors

hile the Public Health Agency of Canada has identified seniors’ health as a health promotion priority, Dr. Aditi Amin, internal medicine resident at the University of Alberta (U of A), doesn’t need official recognition of this significantly underserved health care demographic to know the seriousness of the matter. She sees evidence of it every day in the course of her residency. “It’s so disheartening to see seniors admitted to hospital for preventable reasons, such as falls and a lack of understanding of their medical conditions, or how to properly take their medications,” Dr. Amin comments. “That’s what’s at the basis of my Emerging Leaders in Health Promotion Grant project: Health Savvy Seniors. We wanted to provide Edmonton seniors with the knowledge and resources to understand and manage the health issues they face, and by doing so, enable them to make healthy choices (ideally preventing disease and disease progression), and ultimately, to improve the quality of their lives.” Project lead Dr. Amin and her founding project team (Dr. Laura Burnes and a committee of six U of A medical students: Youness Elkhalidy, Sarah Hanafi , Charissa Ho, Michelle Huget, Jessica Li and Molly Neil) reached out to the division of geriatrics and Dr. Angela Juby for initial guidance. Subsequently, for groups of 10 to 20 seniors, the team conducted a series of five, interactive and educational activity-based sessions addressing hypertension, bone health/fall prevention and memory/aging.

AMA - ALBERTA DOCTORS’ DIGEST

From January to November 2015, Dr. Amin and her team presented their Health Savvy Seniors sessions at Strathcona Place Senior Centre, South East Edmonton Seniors Association and Garneau United Assisted Living Place. Dr. Amin and her fellow resident, Dr. Burnes, assisted the medical students with content development for the presentations, coached them on their presentation skills and helped prepare the students for potential questions from the session participants.

We wanted to provide Edmonton

seniors with the knowledge and resources to understand and manage the health issues they face, and by doing so, enable them to make healthy choices …

Not only did Dr. Amin find the experience of her ELiHP grant project and its effect on the session participants’ confidence and knowledge with respect to managing and understanding their own health to be positive, she also appreciated the opportunity the project afforded her to mentor medical students. “As someone with training in public health and a passion for health promotion and prevention, I found that my residency training was lacking in opportunities to practice >

these skills,” explains Dr. Amin. “Establishing Health Savvy Seniors has allowed me to continue to pursue my interest in health promotion, prevention and advocacy, and share this enthusiasm with a group of dedicated medical students.” Based on the positive results from the pre- and post-session surveys, Dr. Amin expanded her Health Savvy Seniors program into 2016, incorporating survey feedback into a broadening of the session subject matter to include mood and mental health, preventive health strategies and diabetes. The growth of the program necessitated adding another resident and more medical students to ensure the sustainability of the project.

Dr. Aditi Amin, internal medicine resident, University of Alberta; project lead for Health Savvy Seniors.

“We’re considering registering as a student club with the U of A,” says Dr. Amin. “This would enable us to qualify for student club funding through the U of A and may also permit us to pursue not-for-profit organization status.” “I hope that this program, and programs like it, will result in fewer seniors being admitted to hospital for preventable reasons,” she adds. “It’s been a great experience to work with Edmonton seniors to help them understand and feel like they are in control of their health.” CORRECTION: to Emerging Leaders in Health Promotion (ELiHP) Grant program project profile, March-April edition of Alberta Doctors’ Digest: Lungs are for Life Smoking Prevention Program and Workshop Kit. ELiHP project lead and medical student Alicja Krol-Kennedy’s name appeared incorrectly (appeared as Alicja Krol and should have been Alicja Krol-Kennedy). We sincerely apologize for this error.

You can read Dr. Amin’s Health Savvy Seniors blog at healthsavvyseniors.blogspot.ca

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MAY – JUNE 2016

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AMA - ALBERTA DOCTORS’ DIGEST

PFSP PERSPECTIVES

How is the nature of our care affected by the mode of communication we use? Vincent M. Hanlon, MD | ASSESSMENT

PHYSICIAN, PFSP

arlier this year, I presented a webinar on the disclosure of adverse events for the University of Calgary, Office of Continuing Medical Education and Professional Development. It was advertised as an interactive session with computer link-ups and an open phone line. I was a little surprised during the hour-long session that no one used the phone; all the participants chose to make comments and ask their questions by texting. I found it a little ironic that session moderator, Dr. David A. Topps, and I were the only ones who spoke aloud in a presentation about having challenging conversations with patients after something goes wrong. The form of an educational session should be determined to some extent by its content. In similar fashion, the subject at hand may influence the way we choose to connect or converse with patients about a new diagnosis, an adverse event or their end-of-life care. How is the nature of our care affected by the mode of communication we use?

Getting the diagnosis A friend and colleague told me recently he received a text from his family doctor confirming his suspected cancer diagnosis. My friend said he was OK receiving that news by text. It was immediate and direct. Given the uncertainties of trying to have a phone conversation on that Friday afternoon, he said he preferred a text to getting a voicemail request to phone his doctor about his results and perhaps playing a few rounds of suspenseful telephone tag. When, with the consent of my friend, I texted a specialist colleague inquiring about proposed treatment options for my friend, he declined to text back. When we eventually spoke, he told me he found texting a reply to that kind of question unsatisfactory. He preferred to have a conversation about such a complex topic.

Our recurring, moment-to-moment challenge is to reconcile communication format with the content of our message, the intended recipient and how well we know them, the time of day and the location of the two parties.

To talk or to text I imagine how differently my week of call for the Physician and Family Support Program help line (1.800.767.4637) would be if, instead of telephone conversations with 15 or 20 colleagues, I connected with callers by text or email. Based on my past experience, on-call and the variety of callers’ problems, I expect some individuals looking for assistance would be satisfied with a digital approach, while others would not.

Communications circa 2016 In 2016, we can communicate more or less effectively using diverse modes or media. Sinsky, et al., in a 2013 report on 23 high-functioning primary care practices, make the point that, “Face-to-face verbal communication is often more effective, efficient and enjoyable than circulating asynchronous electronic messaging.” Perhaps more effective but not always desired, as my examples above suggest. Our recurring, moment-to-moment challenge is to reconcile communication format with the content of our message, the intended recipient and how well we know them, the time of day and the location of the two parties. What is the difference between a conversation and connection? When does it matter? >

MAY – JUNE 2016

> Digital etiquette One truism about digital etiquette is that you shouldn’t break off a relationship by text or email. Another is that you can strengthen family relationships by gathering around a table to share a meal and conversation (without phones) at least once a day. If we believe that conversation has enduring benefits in our professional work, what are the best ways to acquire, maintain and improve our competence as both skilled conversationalists and effective communicators? Is there a minimum daily threshold of serious talk needed for someone to retain conversational competence – to be able to listen and speak effectively with another human being about illness or sudden death, end-of-life care, conflict with a colleague, a failing marriage, our insecurities as parents or our fear for the future of the planet? Framing conversation as a mindfulness practice, are we able to show up and pay attention to a colleague, patient or friend without losing the thread of conversation because our mind is restless or disinterested, or we succumb to one of the seductive and ubiquitous digital distractions? It is not always easy to remain open, curious, and attentive to the person in front of us.

Reclaiming conversation Sherry Turkle is the Abby Rockefeller Mauzé Professor of the Social Studies of Science and Technology at Massachusetts Institute of Technology. She has been doing research for more than a generation about our relationships with digital technology. Her most recent book is Reclaiming Conversation – the Power of Talk in a Digital Age. “My argument,” she says, “is not anti-technology. It’s pro-conversation … When we invest in conversation, we get a payoff in self-knowledge, empathy and the experience of community.”

The empathy gap Turkle describes “an empathy gap among young people who have grown up emotionally disconnected while constantly connected to phones, games and social media.” She has interviewed school children who text rather than talk to each other at school and on the playground. Referencing the work of psychologist Dr. Sara Konrath, Turkle is troubled by a 40% drop over the past 20 years in the markers for empathy among college students. The influence of digital culture on human empathy is not a phenomenon limited to kids with smartphones. Among physicians, a loss of empathy is one of the three warning signs of burnout, along with exhaustion and growing feelings of inefficacy at work. Reading Turkle makes me wonder to what extent our reliance on immersive digital technology will increasingly undermine our willingness and ability to engage empathically with the important people in our lives.

AMA - ALBERTA DOCTORS’ DIGEST

You can strengthen family relationships by gathering around a table to share a meal and conversation. A cup of coffee together can also do nicely!

Conversation is about fruitful questions and thoughtful replies; it’s also about spontaneity and vulnerability. In the feedback I receive on the education sessions I present, participants often comment on how much they enjoy and benefit from the opportunity within a session to speak and listen to their colleagues about the given physician health theme. Turkle describes endangered conversations these days as “the kind in which you listen intently to another person and expect that he or she is listening to you; where a discussion can go off on a tangent and circle back; where something unexpected can be discovered about a person or an idea.”

Increasing joy in medicine The next American Medical Association, British Medical Association, Canadian Medical Association International Conference on Physician Health takes place in Boston, September 18-20. The conference theme is “Increasing Joy in Medicine.” According to Sinsky et al., “Joy in practice implies a fundamental redesign of the medical encounter to restore the healing relationship of patients with their physicians.” Is it time to reclaim conversation as an essential aid to daily living? Let’s talk about it.

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RESIDENTS’ PAGE

Putting resident physician wellness first Resident Physician Wellness Week Adele Duimering, MD | PGY

ork. Eat. Sleep. Work. Study. Sleep. This routine can so easily become the cadence of residency life. Some days we take the easy route – Netflix over the gym, sleep over socializing. While it’s fine – and human – to do that from time-to-time, when the missed activities become too frequent, causing life and residency to be indistinguishable, that should be a warning sign. A warning sign that we are sacrificing our own well-being for the sake of our profession.

In the ambitious climate of medicine, it is easy to adopt the mindset that caring for patients must always supersede caring for ourselves.

Simple as it seems, it can take resident physicians months or years to come to this realization. In the ambitious climate of medicine, it is easy to adopt the mindset that caring for patients must always supersede caring for ourselves. Resident physicians don’t typically question exchanging lunch break for dictating discharge summaries or sacrificing dinner plans to do a late admission. Above all, we strive to not let our team and patients down – sometimes at the cost of letting down family, friends and ourselves.

AMA - ALBERTA DOCTORS’ DIGEST

2, RADIATION ONCOLOGY, UNIVERSITY OF ALBERTA

If not prioritized, wellness is the first thing to fall by the wayside during residency training. The people-pleasing, responsibility-upholding and self-doubting personality of typical residents, result in being oblivious to or in denial of burnout until it’s all but too late. Fortunately, we’re training in an age where it’s widely recognized that residency is stressful – and that burnout does occur – and there are safeholds put in place by the University of Alberta, University of Calgary and Professional Association of Resident Physicians of Alberta (PARA) to help resident physicians recognize burnout and prioritize well-being. The Alberta Medical Association’s Physician and Family Support Program (PFSP) is also available to offer assistance to medical students and residents. The PFSP’s toll-free line is 1.877.767.4637 and help is available 24-hours-a-day, seven-days-a-week, 365-days-a-year. PARA’s Community and Wellness Committee is a group of resident physicians from across the province that, as part of their mandate, organizes activities to promote resident well-being. From running and bowling to hockey games and dinner theatre, PARA sponsors social and recreational events throughout the year, supporting resident physicians in spending time outside of work with friends and family. In addition, one week each year – this year May 16-22 – was designated Resident Physician Wellness Week (RWW). RWW provided opportunities for resident physicians to partake in well-being activities and also served as a reminder to staff and resident physicians alike of the importance of finding the right balance between our personal and professional lives. Less explicitly, it broached the often swept-under-the-rug issues faced by resident physicians – stress, burnout, relationship strain, depression and anxiety, amongst others – helping resident physicians recognize that they are not alone in these experiences and that there is support available in addressing them. As such, RWW fulfilled both prophylactic and therapeutic roles. >

> This year RWW kicked off with healthy snacks provided for resident physicians in their hospital lounges. Subsequent days featured wellness prizes, disc golf, trampolining and family friendly recreation concluding with a Sunday afternoon at a board game café. The activities have been well-received in past years and are adapted each May based on feedback received.

Ann Dawrant RE/MAX Real Estate Centre 780-438-7000 - office 780-940-6485 - cell

Resident Physician Wellness Week

(RWW) provided opportunities for resident physicians to partake in well-being activities and also served as a reminder to staff and resident physicians alike of the importance of finding the right balance between our personal and professional lives.

In the world of medicine, medical school is analogous to childhood, filled with lessons and new experiences, which makes residency the teenage years, spent figuring out how to get by on our own. Like anything else in medicine, practicing in a way that minimizes stress and maximizes personal well-being is something that must be learned, and residency is a great time to lay the groundwork. By encouraging open discussion on resident physician stressors and burnout, and supporting resident physicians in overcoming these challenges, PARA and our universities are equipping us with the life skills we’ll need to succeed as healthy practicing physicians, so that we may do our best to see to our patients’ well-being, without compromising our own. For more information on Resident Physician Wellness Week, visit https://para-ab.ca/news-events/residentphysician-wellness-week/. The Professional Association of Resident Physicians of Alberta is the voice of the more than 1,600 resident physicians providing round-the-clock medical care to Albertans in acute care hospitals and outpatient facilities. PARA advocates excellence in education and patient care while striving to achieve optimal working conditions and personal well-being for all its members. For more information: www.para-ab.ca.

• Consistently in top 5% of Edmonton realtors • Prestigious RE/MAX Platinum Club

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

Practitioner advocacy assistance Line (PaaL)

1.866.225.7112



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

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

For more information visit albertadoctors.org/paal

MAY – JUNE 2016

FEATURE AMA Youth Run Club welcomes new sponsor Alberta Blue Cross is getting the summer season off to a running start

hanks to a generous donation from new, gold-level sponsor, Alberta Blue Cross, the Alberta Medical Association (AMA) Youth Run Club (YRC) is getting its 2016 summer season off to a running start! In early April, Alberta Blue Cross entered a three-year agreement to sponsor the YRC with a commitment of $25,000 per year, plus an additional $5,000 per year as an YRC school participation incentive. This comprises of five annual prize draws of $1,000 each, for winning schools to put toward the purchase of sports equipment or other physical activity-related infrastructure costs. “Alberta Blue Cross is thrilled to come on board to support the AMA Youth Run Club,” says Brian Geislinger, vice-president, Corporate Relations, Alberta Blue Cross. “We have a close working relationship with the AMA and Alberta physicians, and are excited to extend this relationship into working together on this excellent program.” Funding for this involvement is provided through the ABC Benefits Corporation Foundation, through which Alberta Blue Cross supports a wide range of wellness and active living initiatives across the province.

AMA - ALBERTA DOCTORS’ DIGEST

With its focus on encouraging and educating children and youth on the importance of regular physical activity, good nutrition and overall student well-being as the foundation of a lifetime of good physical and mental health, Geislinger says the Youth Run Club has a great alignment with Alberta Blue Cross’s wellness promotion activities.

Other YRC sponsors include MD Financial Management and Physiotherapy Alberta. Heading into its third year with the goal of developing clubs in 350 schools, the Youth Run Club relies on sponsorship funds to help grow the adoption and capacity of the Youth Run Club in urban and rural communities across the province.

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. From 300 schools in 2015 to this year’s goal of 350: YRC is reaching more and more schools and needs Champions, like you. Connect with a school community, as an AMA Youth Run Club Champion. www.albertadoctors.org/youth-run-club ContACt Vanda Killeen, AMA Public Affairs 780.482.0675 vanda.killeen@albertadoctors.org YRC PARTNERS

YRC SPONSORS

MAY – JUNE 2016

IN A DIFFERENT VEIN

Shimmying with sharks Alexander H.G. Paterson, MB ChB, MD, FRCP, FACP | CO-EDITOR

4 a.m. Rattle on the door. “Time for shark.” It’s Renelo, the Filipino dive master. I hadn’t slept well and was in a poor mood. Was this a good idea? I’ve done maybe 20 dives with the basic open water certification where the main objective, at least for the first few dives, is to keep alive. But I now enjoy moseying around the coral at 30 to 60 feet with an experienced diver nearby and have zero ambition to go with Sean Connery chasing frogmen (or turning to Claudine Auger after harpooning a SPECTRE agent on the beach: “I sh-ink he got the point”).

walk round it in three hours. You don’t have to dive and plenty of people just relax on the beach and swim, eat and drink. Our plan was to relax for a few days after a week teaching at Zamboanga City Medical Centre where the University of Calgary’s Global Health program has had a development project for 23 years.

Most of the time you live in a comfortable

kennel with a daily routine. Sometimes you have to push yourself to sniff a different lamp post in an unfamiliar part of town.

“No, you do fine. Last year I took old man on advanced. Filipino. 72 year old.”

Squeezing into a damp, sandy wet suit at 4:30 a.m. is not bracing. The primary regulator on my buoyancy control device (BCD) jacket leaked and compressed air hissed out. I’d seen yesterday that Ray had a streaming cold and hacking cough. But that was his problem. Now he generously stuck my regulator in his mouth, blew and sucked several times, handed it back and spat into the sand. Now it was likely my problem.

“Oh, well then…” I said too quickly … and was caught.

“Check alternate regulator, please.”

“Tomorrow we go shark dive Monod Shoal then four more dives, do exam and then you are advanced.”

The dive boat headed out toward the dawn, surf splashing over the bows, soaking those sitting in the front. The dark surrounding islands – Bilaran, Masate, Carnasa – rose from the Visayan Sea, just another day in millions for them.

“You do advanced diver course?” Renelo had said yesterday after we’d gone on a review dive (advisable if more than six months since your previous dive). “No. I’m getting on. Older than I look,” I said.

“Can’t I do the advanced and then we go shark dive?” “No. Trip to Monod Shoal tomorrow. By way, course is 15,000 pesos. Pay Rebecca. I wake you 4 a.m.” And he was gone. This seemed not one of my best decisions – but you only live twice, according to Ian Fleming. Most of the time you live in a comfortable kennel with a daily routine. Sometimes you have to push yourself to sniff a different lamp post in an unfamiliar part of town. The island of Malapascua, northeast from the northern tip of Cebu, Philippines, is a diver’s destination. You can

AMA - ALBERTA DOCTORS’ DIGEST

We were a cheerful group: two fit, young couples, Karina and Mani from Austria (divers on vacation), and Jenica and Travis Davenport from Los Angeles (exploring opening a clothing factory on Cebu). Then there was me, the old geezer, gloomily pondering what a heart attack 34 meters underwater might be like. Would that spoil it for the others? Should I have asked for oxygen-enriched “Nitrox?” Would one with chest pain ascend too rapidly and forget about the three-minute pause at 15 feet – adding nitrogen bubbles, a stroke and osteonecrosis to the problem? Do breakfast-hungry sharks pick up >

> wireless panic signals from a black beast blowing bubbles, flailing around and giving the distress signal (the index finger drawn across the throat)?

As we approached the dive site, Karina and Mani calmly walked to their tanks, checked their first and second stage air lines, regulators, the gauges on their BCDs, cleaned their masks, strapped on their waist weights, pulled on their fins and sat ready to go. It was a “stride entry,” a walk off the end of the boat rather than a backwards plunge. Your columnist puffed up his BCD but forgot to put his breathing regulator in his mouth before jumping in – a beginner’s error – and realized there was something wrong when underwater. “Regulator in mouth,” someone shouted from the boat. A poor start. A shell-encrusted rope dangled from a buoy and we descended hand-over-hand, pinching the nose every few meters to equalize pressures, getting that comfortable little squeak in the Eustachian tubes. Monad Shoal is like an underwater Lost World, a massive log plonked onto the ocean floor, the top surface of the log some 70 feet down. The others had gone, swimming to the cliff’s edge where the sharks were. Renelo kept looking around and giving me the diver’s OK sign (tips of the index finger and thumb pressed together like a Frenchman giving approval to a fine wine).

Huge spiny starfish on ocean floor, discovered by "dive master" Paterson, after remembering his regulator belongs in his mouth.

We swam in the murky light of dawn descending to about 34 meters to the edge of the wall. Colors change at this depth – reds become black, oranges brown, blue predominates. And glory be, some thoughtful divers had set up a rope you could cling to. The thresher shark loomed out of the gloom, a primordial, graceful creature, about nine-feet long with a six-foot-long tail. It swerved away and down, then another above us, seemingly curious, wheeled away. They catch prey by whacking them with their tails and reminded me of the Apatosaurus at the Royal Tyrrell Museum – those dinosaurs with the long tails – though their heads were shark-like, not micro-cephalic. The sharks come to the edge of the cliff to take a morning clean up. Small fish nibble tasty bits off their skin and clean them up after a night in the depths – not a smart plan if you’re a little fish. Six or seven of these magnificent creatures cased us: who were these strange animals with one eye and bubbles blowing from their heads with silver balloons on their backs?

Thresher shark approaching. (Felt like an aircraft about to land.)

Thresher sharks are not interested in humans as fodder – or so they say. In fact, that goes for most sharks, which have had a bad rap from sailors, 19th century writers and modern media. We watched enrapt for 10 minutes as these creatures approached and wheeled away. Then they just left. The sun was up.

Now as a shark whisperer, I felt I must board gracefully. I threw off the regulator mouthpiece, laughed and shouted: “That was great” – which no one heard. A wave washed over me and I inhaled a mouthful, no, a lungful of salt water. The crew leapt into action and it became the usual extraction from the ocean of a flailing old dog gasping for breath.

We ascended slowly, leisurely almost, took the 15 feet stop for three minutes and surfaced. I have never managed to board a dive boat gracefully. You know – grasp the bows, duck down and launch upward, sliding over and straddling the side, goggles over the forehead, throwing off your BCD

Even though there was a warm breeze, being under at that depth, you get chilly and hypothermia is not uncommon. We towelled off and sipped hot tea. Perhaps it was the nitrogen in the blood but everyone was elated >

and tank. For me, it’s more like a 19th century whaling crew manhandling an unwilling, struggling whale aboard. In my limited experience of scuba diving around the world, Filipino boat crews are easily the most helpful to boarding old geezers – taking your tanks, weights, BCD, even ducking under water to help you off with your fins. Americans and Brits bark out fairly useful instructions but don’t physically help you; Malaysians ignore you; Australians laugh at you (“Up you come, mate. Feels like you’re walking on Jupiter, eh, ha-ha” – as you stagger and totter on deck, tank on your back).

MAY – JUNE 2016

magnetic north, then head out keeping north between the index marks and following the lubber line. To return, you rotate the bezel 180 degrees, swivel around so the index marks are again over magnetic north and head back. Simple. For distance you use the number of kicks of your fins or if you’re on the bottom the number of arm spans. Got all that?

Now, listen. It’s different 70 feet down. The brain works sluggishly – mild cognitive impairment. In previous dives, I’ve been happy focusing on staying alive, checking the air left in the cylinder and looking at corals and fish, content to follow whoever was with me. Where are we? Not my problem.

A handsome crab on the sea floor, apparently awe-struck by Dr. Paterson's attempts at underwater navigation.

> – you don’t always get to shimmy with the sharks even after rising at 4 a.m. We arrived back at the resort for a hearty breakfast of bacon and eggs, full of tales of the wonders of the deep. Diving memories … a tight ball of wriggling blennies (little black and white fish), the outsiders fighting their way into the middle, an easy mouthful for a hungry predator … the roar of bubbles brushing your ears … waving green fronds on the sea floor (and knowing your own comb-over would be waving like that) … huge, fat, white starfish with black spikes … silver, translucent jackfish shoals with a thin blue stripe down their sides … yellow angelfish, clownfish, triggerfish – it’s like swimming in a giant aquarium … tubes of waving sea anemones … barrel sponges and chunks of chalky coral like a cerebral cortex … black, spiny sea urchins (don’t touch them) … the tap-tap of Renelo’s baton on his tank to point out some tiny worm-like creatures with red or blue dots on them … beasts the size of your thumb that poke their head out of the sand to see if anything edible is passing … a sea snake curled up on the sand, easy to step on … the tiniest of pygmy sea horses like a snow flake clinging to a twig of coral … a fish (maybe a boxfish) like an armoured humvee … a scorpion fish like a USA marine camouflaged against the sand and rocks … buoyancy exercises on the sea floor, the tips of your fins lying on the bottom and you, stretched forward like a frog, breathing in and out, gently moving up and down with each breath. A few words about navigation. Seventy feet down on the seabed, the brain responds sluggishly. Brain fog. Renelo’s explanation of the diver’s compass was easy on land. Unlike the sailor’s compass on the helm, where you keep the lubber line on the compass bearing you want, the diver uses the rotating bezel. Say you want to go 240 degrees, so, you turn the lubber line on the rotatable bezel cover to 240 degrees and swivel your body so the index marks on the glass bezel are over

AMA - ALBERTA DOCTORS’ DIGEST

The navigation test: I must swim out 100 feet, turn 120 degrees, do another 100 feet and turn 120 degrees, and return. So I head out, do 75 kicks (each kick about two feet) following the lubber line and stop. And look round. Ray has disappeared. Must be behind that rock in the distance. Now the turn. Fiddle with the compass bezel. What’s 270 degrees (my original direction) plus 120 degrees? That’s 350 degrees, no, 390 degrees. Then minus 360 degrees. No, hang on ... I fudge it. Turn to about 30 degrees, twiddle with the compass, move the lubber line to where I want to go … no, that’s not what you do … OK calm down … why can’t I do these simple sums? To hell with it, swim 100 feet and stop. Which way do I turn? Right again. Or is it left? Now what’s 30 degrees minus 120 degrees? No, if I’m turning right it would be plus 120 degrees. Which is 150 degrees? Oh, never mind the compass, just head off. I end up at least 30 feet from Ray. Cardinal rule number one: “Always trust the compass.” “I never use compass. Always more difficult under water,” says Renelo, who has been diving since he was five. “I know every rock, coral and sand bank on this sea floor.” On shore, I take the exam. Ray is trying to make the Guinness World Records book for the oldest geezer to pass the advanced exam. If only some of my professional exams had been like that. Tabes optica … help! Takayasu syndrome … um? This was a pleasant discussion. “What kind of fish is this?” “It’s quite ugly,” I say. “Would you say looks like scorpion?” “Yes, I think it’s a scorpion fish.” “Correct.” Wendy emails the kids at home: “Dad is now a dive master. My son dryly replies: “He’ll have to do a lot more dives before that …” Hey, the plastic card saying “Advanced Diver” arrived yesterday.

MAY â&#x20AC;&#x201C; JUNE 2016

CLASSIFIED ADVERTISEMENTS

LOCUM WANTED GRANDE PRAIRIE AB Locum needed this August for a busy family practice in Grande Prairie (Dr. Wilhene Zwanepoel). Clinic hours are 9 a.m. to 5 p.m., Monday to Friday, but flexible and Thursday hours are 5 p.m. to 10 p.m., primary care network shifts optional. We use Wolf electronic medical records, and have very friendly and helpful medical office assistants. Contact: Rozaan Labuschagne Office Manager T 780.538.4770 gpwic@hotmail.com

PHYSICIAN WANTED AIRDRIE AB Family Medical Centre in Airdrie is seeking part- and/or full-time family physicians. We offer flexible hours, attractive overhead, experienced staff and a comfortable office space. Our clinic is a member of the Highland Primary Care Network. Physicians licensed to practice in Alberta and new graduates are welcome. Contact: Julie Turvey T 587.775.1887 julie_lavita@outlook.com 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

AMA - ALBERTA DOCTORSâ&#x20AC;&#x2122; DIGEST

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 Family physician, pediatrician or internal medicine specialist needed part- or full-time for well-established south side practice. Stable patient population for more than 40 years, new and modern office with dedicated staff. Pharmacy and medicentre in the same mall location. Excellent opportunity for all types of practice. Contact: T 780.435.3648 (doctor line only) F 780.435.3691 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 Are you looking for a clinic that will accommodate flexible hours? Are you just returning to practice after starting your family? Talk to us. We may be able to help. Justik Medical Clinic takes pride in accommodating flexible, diverse practices. Physicians are able to set their hours and participate in various areas of interest. Evening hours can

be accommodated and several of our physicians are already taking advantage of this flexibility. Our clinic has many benefits for physicians, whether a full-time practice or a more condensed practice. A collegial, learning environment is maintained through hallway consultation and formal meetings. Our clinic provides a high staff-to-physician ratio with a full billing/referral service. The electronic medical records are a clinic cornerstone and the network is supported by a local IT firm. Remote log-in permits access from the comforts of home. The clinic is professionally managed, thereby allowing physicians to devote their clinic hours to medicine. Monthly associate meetings are held to address any clinic concerns and set clinic policies. Contact: pmceachnie@justikmedical.ca EDMONTON AB White Oaks Medical Clinic is looking for a family/walk-in clinic physician. Best overhead deal, guaranteed.

This is an opportunity to build your new family practice or relocate an existing practice in an area potentially in need of doctors. We are in the White Oaks Square, next to a pharmacy. Other health practices in the building include the Foot & Ankle Clinic, audiology clinic, optometrist, dentist, chiropractor and a psychologist. The clinic is fully furnished with a physician’s office, six examination rooms, nurse’s station, reception and waiting room. Located on the main floor, the clinic has a separate outside entrance and generous free parking area for patients. We are in easy walking distance from the area’s main bus routes and the Disabled Adult Transit Service (DATS) bus stops right beside our building’s main doors. We look forward to hearing from you soon. Contact: White Oaks Medical Clinic 116-12222 137 Ave NW Edmonton AB T5L 4X5 T 780.970.0047 F 780.970.0048 drs2002@gmail.com >

PHYSICIAN(S) REQUIRED FT/PT Also locums required

ALL-WELL PRIMARY CARE CENTRES MILLWOODS EDMONTON Phone: Clinic Manager (780) 953-6733 Dr. Paul Arnold (780) 970-2070 >

MAY – JUNE 2016

> 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.

AMA - ALBERTA DOCTORS’ DIGEST

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

RED DEER AB Family practice has an immediate opening for a physician or part-time physicians. Clinic uses TELUS Med Access electronic medical records, primary care network support, varied patient population and every day patients phone looking for a family physician. Potential for increased income from hospital privileges, optional obstetrics, hospitalist work, operating room assisting, long-term care and hospice. Red Deer provides fantastic specialist support. We are not a walk-in clinic and we strive to provide same day appointments. Red Deer is a thriving community with great recreational and educational opportunities. Contact: Parkland Medical Clinic T 403.346.4206 Dr. L. Ligate lora.l@shaw.ca Dr. B. Benson blben@shaw.ca 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 >

SPRUCE GROVE AB Flexible, part-time/casual work in a welcoming, relaxed environment. I Have a Chance Support Services (IHACSS) Ltd. is seeking a physician responsible for providing medical services at our head office in Spruce Grove. IHACSS is a well-established Spruce Grove/Stony Plain agency, that prides itself on being one of the only local organizations dealing with community mental and physical health needs. Equipped with licensed psychological and nursing services, we are looking for a lead physician to complete our multidisciplinary team. Our vision at IHACSS is to strive to support and encourage individuals en route to independence, in order to enhance abilities, facilitate personal growth, achieve a sense of pride and accomplishment, and enhance well-being/quality of life. This position will be a part-time/casual permanent position. A few of the many benefits of working with IHACSS is no overhead, no cost to access administrative, psychological and nursing support services, access to discounted medical equipment and services, a positive and exceptionally supportive work environment, the opportunity to provide services alongside highly dedicated and informed professionals in a modern facility/agency with a well-established reputation within the community. Contact: Greg Worms Executive Director gworms@ihacss.com

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 to submit your CV in confidence corporate@imaginehealthcentres.ca www.imaginehealthcentres.ca OLDS AB Parkside Medical Clinic in Olds is looking to expand. Olds is one-hour north of Calgary on Highway 2 with many community amenities. Olds is a college town with over 8,000 residents and a full-service hospital with surgery and obstetrics. We are looking for family practitioners who are interested in family practice with or without hospital call, obstetrics and hospital privileges. We are also looking for short- or long-term locums. A summer locum would be very welcome. Contact: Dr. Clarence Graff T 403.556.3318 gjcgraff@hotmail.com >

AMA Physician Locum Services

Locums needed. Short-term & weekends. Family physicians & specialists. Experience:

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.

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Flexibility – Practice to fit your lifestyle.

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Variety – Experience different Alberta practice styles.

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Provide relief – Support rural colleagues and rural Albertans.

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Travel costs, honoraria, accommodation and income guarantee provided.

CONTACT: Barry Brayshaw, Director, AMA Physician Locum Services ®

barry.brayshaw@albertadoctors.org T 780.732.3366

TF 1.800.272.9680, ext. 366

www.albertadoctors.org/pls

MAY – JUNE 2016

> SHERWOOD PARK AB The Sherwood Park Primary Care Network is looking for several physicians to cover a variety of locum periods in a variety of Sherwood Park offices. Practice hours vary widely. Majority of practices run electronic medical records. Fee splits are negotiated with practice owners. Some practices are looking for permanent associates. Contact: Dave Ludwick T 780.410.8001 davel@sherwoodparkpcn.com SHERWOOD PARK AB 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 SHERWOOD PARK AB Medical Spa Director: We have a great opportunity for you to join our well-established, premier medical spa as medical director. We are looking for a motivated physician for a flexible part- or full-time permanent position that will require some travel between our Sherwood Park, St. Albert and Spruce Grove locations. Training in facial injectables and a variety of the latest laser treatments will be provided. Staff oversight is required. We feature state-ofthe-art equipment in a modern, upscale facility and have a significant marketing budget. Generous salary and benefit package based on experience. Submit detailed resume to: True Balance Medical Spa hr@mytruebalance.ca

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 AMA - ALBERTA DOCTORS’ DIGEST

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

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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 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

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DISPLAY OR CLASSIFIED ADS TO PLACE OR RENEW, CONTACT:

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

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MAY – JUNE 2016

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