Alberta Doctors' Digest Nov/Dec 2014

Alberta Doctors'

DIGEST November-December 2014 | Volume 39 | Number 6

Fall Representative Forum/Annual General Meeting Hard at work on the road to a better health care system

Emerging Leaders in Health Promotion Grant recipient focuses on obesity and children Don’t just stand there!

The AMA Youth Run Club 2014 fall launch is happening now

Tarrant Scholarship focuses on rural commitment Two medical students step up to the challenge Patients FirstÂŽ

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CONTENTS DEPARTMENTS

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

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

Editor: Dennis W. Jirsch, MD, PhD

4 From the Editor 1 8 Health Law Update 20 Mind Your Own Business 26 Dr. Gadget

Co-Editor: Alexander H.G. Paterson, MB ChB, MD, FRCP, FACP

FEATURES

Editor-in-Chief: Marvin Polis

President: Richard G.R. Johnston, MD, MBA, FRCPC

President-Elect: Carl W. Nohr, MDCM, PhD, FRCSC, FACS Immediate Past President: Allan S. Garbutt, PhD, MD, CCFP 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

28 PFSP Perspectives 34 In a Different Vein 39 Classified Advertisements

6 Fall Representative Forum/Annual General Meeting Hard at work on the road to a better health care system

22 Don’t just stand there!

The AMA Youth Run Club 2014 fall launch is happening now 24 Tarrant Scholarship focuses on rural commitment

Two medical students step up to the challenge 30 Emerging Leaders in Health Promotion Grant recipient focuses on obesity and children 32 The role of Alberta physicians in the formation of the Medical Council of Canada

January-February issue deadline: December 12

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

The Alberta Medical Association assumes no responsibility or liability for damages arising from any error or omission or from the use of any information or advice contained in Alberta Doctors’ Digest. Advertisements included in Alberta Doctors’ Digest are not necessarily endorsed by the Alberta Medical Association. © 2014 by the Alberta Medical Association Design by Backstreet Communications

COVER PHOTO:

Dr. Richard G.R. Johnston was installed as Alberta Medical Association president on September 20. ( provided by Curtis Comeau Photography)

CORRECTIONS:

In the September-October issue of Alberta Doctors' Digest cover story regarding influenza immunization for health workers, Dr. Kevin Hay was said to be an MD. This is incorrect. His correct credentials are MB, BCh, BAO, MRCPI, CCFP.

In the September-October issue of Alberta Doctors' Digest we carried a survey regarding results from a recent Readership Survey. Due to a production error, the explanatory legends were missing for the charts included in the story. We apologize for the error. If you have any questions regarding the survey, please contact shannon.rupnarain@albertadoctors.org and she will happily provide any information you desire.

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.

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FROM THE EDITOR

Contingency plans Dennis W. Jirsch, MD, PhD | EDITOR

I

saw recently in the newspaper that Dr. Duckett had been in town.1 The same Dr. Duckett (PhD) who was chief executive officer (CEO) of Alberta Health Services (AHS) from its inception in 2008 until his untimely departure in the spring of 2010. The same Dr. Duckett who mapped out closures, amalgamations, terminations and so on. Most remember the “cookie episode” in which he balked, peevishly, at reporters trying to grill him, with, “I’m eating my cookie.” It’s still on YouTube, but it was the end for Dr. Duckett and he was canned forthwith.

Since then we’ve had three premiers, as many ministers of health and a couple of AHS CEOs. The Duckett cookie incident seems ancient, given our rate of change, and we presently have a shiny new premier fighting “entitlement” and bearing glad tidings. Add to the mix an ex-mayor health minister bringing promises of quick solutions to interminable health system challenges. “This isn’t rocket science,” he says.2 So much and so little has changed. I wonder why former CEO Duckett has returned, even to lecture. The time he spent here several years ago must seem like a bad trip on a rocket.

I gather Dr. Duckett spoke at the University of Alberta.

Newspapers covering the lecture said he cautioned his audience that Alberta’s inattention to things fiscal and the healthy income from oil were hampering, nay interfering, with innovation or creativity.

Pretty self-evident, I think, and this warrants a “Duh” response. Still, I wish I could have heard him myself, hoping for something juicier in his recollections of rattlesnake country.

What keeps him coming back? Real estate that won’t sell, friendships, university ties or maybe an acquired fondness for snow? Or is Dr. Duckett urged back by academic types to give us the view from a remove, as it were?

AMA - ALBERTA DOCTORS’ DIGEST

I want to know what it was like riding the juggernaut of massive systemic change. His marching orders were clear: pull, and pull hard at the levers of change ¬ the “r’s” of regionalization, restructuring, reengineering, rationing, rostering and so on. The notion of course is that the “r’s” would all save money. Dr. Duckett was looking for a billion dollars in savings as I recall, $250 million a year for four years.

I wonder why former Alberta Health

Services CEO, Duckett has returned, even to lecture. The time he spent here several years ago must seem like a bad trip on a rocket.

He was well on his way, and the truth is that the good economist was doing things that would save money, would save money without a doubt, and he was beginning to grapple with the daunting administrative behemoth he’d been saddled with.

Whether the public and the professions could swallow his bitter pills of restructuring and so on was another question. They couldn’t and they reacted loudly. The tumult became too strident, too bitter and too prolonged.

The honchos in charge pulled the plug and he was gone.

Consider for a minute, however, that Duckett, his board chair, the health minister, and the premier too must have had frank discussions in camera ¬ yes most assuredly in camera, regarding Duckett’s plans for change. I bet hours were spent mulling the likely “pushback” from the professions and the proletariat too. I suspect they thought it wouldn’t go too badly, would dissipate in time.

I can see the general clapping of hands, tub thumping and thumping on shoulders too that attended these sessions, with assurances all round: “Duckett, man, we’re with you all the way.” >

> They were with him that is until the going got rough, with headlines trumpeting the agony and mischief that would attend this or that amalgamation of services.

Consider for a moment the power structures at play for the CEO. First, there’s the obvious ¬ “political” ¬ power: the government and the echelons of ministers and party faithful. Consider that these same worthies were eager short years ago, that something be done to right past wrongs, in which the two largest duchies and their princes and princesses ¬ Edmonton and Calgary ¬ had become too autonomous, too powerful and too littlekingdom-ish in their own right. Imagine the cries for a stop to this evil. And curb expenses too. I hear the faint echoes of former premier Klein and his cryptic promise of a Third Way. Imagine the politicos and their cries for change and cost savings. Imagine too their twitchiness, their pistol-at-the-hip readiness.

Whether the public and the

professions could swallow his bitter pills of restructuring and so on was another question.

They couldn’t and they reacted loudly.

takes ¬ with the most assertive members of each of the groups. Still it’s often a short ride for CEOs, especially for the ones that are more open, more candid, less ardent students of Machiavelli.

Back to Dr. Duckett. I heard him just once. He stood down a lion’s den of doctors, apprising them of things coming down the pike. I didn’t like the things he said.

I didn’t like the inattention to living, breathing souls with this or that disruption, but as I’ve said, they were initiatives that hell-or-high-water would save money and the doctor-economist stood his ground. He didn’t flinch.

He’s most assuredly come to know the perilous nature of power.

It’s my memory of this presentation that makes me want to cozy up to him for tea. In particular, I want to know what he learned from his (assumed) bad trip, if that’s not too personal a question. He’s most assuredly come to know the perilous nature of power. I see that Dr. Duckett is now employed by the Grattan Institute, a public policy think tank in Australia.

I like to think this means he likely had a “plan,” an escape hatch all along.

If the politicos have power, so too do the professions. All of them. Think front-line folk ¬ nurses, docs and the like.

Feeble maybe in ones and twos but when they clamor in unison they can bring things to a standstill. Think strikes, walk-outs, sick days, etc. Poke a stick at the professions, rile them sufficiently to unite, march on the legislature, and if they point at him, a CEO can be gone at the drop of, well, a cookie crumb.

The need for a plan “B” is, I think, the main thing to learn from this saga. Whether one is CEO, a lower-tier executive, a new hire in one of the professions, or something in between, it’s just good sense to have a plan B and possibly plans C and D. Bureaucrats learn this early, knowing that with the next putsch or the one after, they will be looking at jobs in Waskabush, remote territories, even junkets to Sierra Leone. The band plays on.

People ¬ the electorate ¬ are the main source of power.

Their representation on the evanescent uber-board of the AHS (now you see it, now you don’t), has been at all times missing, and the token gesture of AHS community advisory groups must annoy them thoroughly. But don’t underestimate the citizenry. Rankle them in sufficient number, get them to howl in protest in headline-making numbers, and the politicos will sense the resolve of rank-and-file democracy, will act pronto to stop the clamor.

Docs should listen too. Medicine has long been a harbor of sorts, but as displaced gynecologists, ophthalmologists and others can attest, the “times they are a changing.”

It’s no real push to imagine the CEO as potential lamb in this knotty undertaking. See him then, trying to cut costs whilst holding at bay nervous political masters, unruly professions, and a public wary of being hoodwinked, and experience the crucible of Duckett’s former world.

There’s nothing new here. Past CEOs, the wily ones, the ones with atavistic tribal tendencies, will have found that it is helpful to develop pacts, relationships ¬ whatever it

So get a plan B. It’s one of life’s biggest lessons.

That’s it. I want to have tea with Dr. Duckett and I’d like to talk of plan B. I’ll bring the cookies.

References 1. http://www.edmontonjournal.com/Alberta+wealth+politics+ blame+rise+health+costs+Duckett/10192812/story.html 2. http://www.calgaryherald.com/news/politics/health+minist er+targets+long+term+care+crunch/10229383/story.html

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Hard at work on the road to a better health care system

Change, progress and looking forward Highlights follow from the valedictory address of outgoing President Dr. Allan S. Garbutt. Dr. Garbutt’s term began September 28, 2013 and ended September 20.

was not exactly the kind of change we were hoping and looking for.

Turmoil at the top resulted in paralysis in the ranks. Few of our desired changes came to pass, not because we did not try, but because we could not get commitments from our partners in government.

Hopefully, the new premier and health minister will bring stability and constructive engagement.

I have had some contact with Premier Prentice. I am hopeful that he will work with the AMA and all the other stakeholders to propel our health system forward through the multiple changes that will be required to provide the health care system Albertans will need in the second and third decades of this century.

Dr. Allan S. Garbutt ( provided by Curtis Comeau Photography)

Last year, as I assumed the presidency, I spoke about the ways in which the Alberta Medical Association (AMA) would work with government to change the way health care is delivered in Alberta. I spoke about “a lot of change.”

Well, we certainly got change. So far this year, there have been three premiers, two health ministers and numerous heads of Alberta Health Services (AHS). Unfortunately, that

AMA - ALBERTA DOCTORS’ DIGEST

As I already said, this past year did not provide us with the change we had been hoping for.

But, that is not to say we did not get some progress on many fronts. The AMA has many good people, both in our professional and volunteer groups, working hard to advance the ideas that we believe will help us create the health system that we will need in 10, 15 or 20 years when the baby boomers move from being providers of health care to being consumers of health care.

For example, the Physician Compensation Committee (PCC) has

spent much of the past year working out the ground rules on how it will operate. It has made some rulings in areas where decisions absolutely had to be made, such as the allocation for this past year. It is now beginning to look at some (fewer than 1%) of the codes in the Schedule of Medical Benefits (SOMB). Even that baby step has provided a predictable degree of angst and anxiety among those who are affected.

So far this year, there have been three premiers, two health ministers and numerous heads of Alberta Health Services (AHS).

Unfortunately, that was not exactly the kind of change we were hoping and looking for.

PCC is working hard, and your representatives are an integral part of that effort, to fairly review and evaluate more than 3,400 codes in the SOMB. There will undoubtedly be some growing pains as we move along the path to a revised billing schedule that is appropriate for the evolving health care system we are working to deliver. >

> When the work is completed, and that will take several years, we should have a new SOMB that will fairly remunerate all physicians, regardless of where or how they work. This will undoubtedly mean that some groups see payment decreases while others get increases. The processes we use to make those decisions have to be fair, transparent and based on good evidence and input from those who will be affected. While these changes will be painful for some, it is a process that must be completed so we can match physician work to the changing needs of a changing society.

Primary care networks (PCNs) and PCN Evolution are a start on this, and they will continue to evolve so that primary care moves forward to a team-based care model designed to deal with chronic diseases. This will require that we bring secondary and tertiary care into coordinated work with what has been thought of as primary care.

Further changes will be needed for our system of primary care, if we are to care for our aging population. That need is not unique to Alberta. Indeed the Canadian Medical Association recently put out a call for a national strategy to care for the seniors of the future, which includes, (I hate to admit) myself.

The AMA vision draws heavily on the medical home model, which was endorsed by the national bodies for both family physicians and nurses. There are dedicated physicians working on all of these, and many more, areas. The AMA is supporting them, and will continue to do so, with expertise, technical skills, and finances.

Alberta Health has finally released its Primary Care Strategy, after many years in development. This looks as if it will blend well with the AMA’s efforts in primary care evolution.

Hopefully, the new premier and health

minister will bring stability and constructive engagement.

When we combine our vision and ability with willing partners in Alberta Health, AHS, the College and Association of Registered Nurses of Alberta, United Nurses of Alberta, Alberta Pharmacists’ Association and many others, I am sure we can create the health care system that the next few decades will require.

Finally, I would like to welcome Dr. Rick Johnson to his new role as AMA president. I hope you will enjoy your year. It is an unforgettable experience.

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Hard at work on the road to a better health care system

Enhancing patient care, increasing physician satisfaction Highlights follow from the installation comments of President Dr. Richard G.R. Johnston. Dr. Johnston’s term began September 20.

As many of you know, I have been very involved in negotiations and agreement implementation for the Alberta Medical Association (AMA) for 20 years. The opportunity to represent the doctors of Alberta at the highest level will be a privilege and a delight.

The recent changes in government will certainly bring challenges and opportunities in the next months. I look forward to working with those new members of government, the new members of Alberta Health and Alberta Health Services, and the physicians of Alberta to create changes that will enhance patient care and improve physicians’ satisfaction with the practice of medicine.

Dr. Richard G.R. Johnston ( provided by Curtis Comeau Photography)

I would like to thank the members of my profession for entrusting this position to me for the next year.

AMA - ALBERTA DOCTORS’ DIGEST

I have always considered the practice of medicine to be an enormous privilege and a lot of fun. I would like to find a way to make every physician feel this way. I truly believe that if we focus on doing what is best for our patients that we will be able to find a way to work with government to maintain our professional

I look forward to

working with those new members of government, the new members of Alberta Health and Alberta Health Services, and the physicians of Alberta to create changes that will enhance patient care and improve physicians’ satisfaction with the practice of medicine.

independence and provide a good standard of living for our families.

Editor’s note: For more thoughts from the AMA’s new president, please view his video at http://youtu.be/PTOSzxQPI7Y

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Hard at work on the road to a better health care system

Dr. Richard G.R. Johnston

Dr. Carl W. Nohr

2014-15 PRESIDENT

2014-15 PRESIDENT-ELECT Dr. Richard G.R. Johnston, an Edmonton-based intensivist, is the Alberta Medical Association’s (AMA’s) 2014-15 president.

Dr. Johnston received his MD, with distinction, from the University of Alberta in 1977. In 2002 he received an MBA from the Ivey Business School at the University of Western Ontario.

His awards include the Mewburn Memorial Gold Medal in Surgery, the University of Alberta Undergraduate Prize, the Allan Coates Rankin Prize in Bacteriology and the Sam Fefferman Memorial Gold Medal in Honors Physics.

Dr. Johnston is a clinical professor in the Department of Anesthesiology and Division of Critical Care in the Faculty of Medicine and Dentistry at the University of Alberta. He is also a member of attending staff in adult intensive care at the Royal Alexandra Hospital.

Previously, his positions included Chief of Critical Care at the Royal Alexandra Hospital and Director of the University of Alberta’s Division of Critical Care Medicine.

An active AMA member, Dr. Johnston has served as: • Co-chair, Secretariat of Trilateral Agreement (2008-11) • Chair, AMA Negotiating Committee (1997-2013) • Member, committees administering the negotiated agreements (1993-2012) • Representative to Canadian Medical Association, Health Policy and Economics Committee (1993-98) • Member, Board of Directors (1993-96) • Chair, Finance Committee (1998), Co-chair, Finance Committee (1999-2003), member, Subcommittee on Finance (1993-96) His contributions to the association and the profession have been recognized with the AMA’s Long-Service Award (2004).

Medicine Hat surgeon Dr. Carl W. Nohr is the Alberta Medical Association (AMA) president-elect. He assumed the office during the annual general meeting September 20 in Calgary.

Dr. Nohr has had a notable record as a general surgeon, clinical teacher and administrative leader. Clinically, he is active in practice, and is the site chief for general surgery and endoscopy for the south-east zone.

He has a diverse record of service to the profession.

He has been heavily involved in his local medical staff association for many years. He has served as a member of council of the College of Physicians & Surgeons of Alberta (CPSA), sitting on the college’s Finance, Medical Informatics and other committees. He served in the Physician Achievement Review Program of CPSA for over a decade. He was the chair of the Legislation Committee of the college until resigning to assume the office of president-elect of the AMA. AMA members will know him as the respected Speaker of the Representative Forum (RF) since 2012, and chair of the RF Planning Group. He was the AMA co-chair of the joint AMA-Alberta Health Services (AHS) working group to establish the AHS Medical Staff Bylaws and Rules. He has been an AMA representative on the Provincial Physician Liaison Forum and Canadian Medical Association General Council delegation. Other service included the Physician and Family Support Program Advisory Board, Nominating Committee, Council of Presidents of the regional medical organizations and geographic delegate to the Representative Forum.

Service to the profession is both a duty and an honor, says Dr. Nohr. “It is a privilege to counsel with colleagues and other leaders about our health care system, and how it can best be managed to put Patients First®.”

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Recognizing outstanding achievement in health care

T

he Alberta Medical Association (AMA) Achievement Awards were created to honor physicians and non-physicians alike for their contributions to quality health care in Alberta. The Medal for Distinguished Service and the Medal of Honor are the highest awards presented by the AMA.

Medal for Distinguished Service The AMA Medal for Distinguished Service is given to physicians who have demonstrated an unwavering commitment to their communities and passion for their work. This year, three recipients have made outstanding contributions to the medical profession and to the people of Alberta and, in the process, have raised standards of medical practice for our province.

Dr. Donald E.N. Addington Credited with putting Alberta “on the map” with his development in 1989 of the Calgary Depression Scale for Schizophrenia, Dr. Donald Addington has contributed immeasurably to the art and science of medicine in Alberta for the past 33 years. His scale has been translated into 36 languages and is the international gold standard measure for research

AMA - ALBERTA DOCTORS’ DIGEST

on depression in schizophrenia, with over 1,000 citations.

He has helped raise the standards of quality health care, particularly with respect to programs of psychosis, in Alberta, Canada and around the world. Dr. Addington works to improve patient outcomes by integrating research, advocacy, education and clinical practice.

Teaching and mentorship have been professional and personal priorities for Dr. Addington.

Dr. Steele C. Brewerton Since he began his medical career in rural Alberta in 1948, general practitioner and obstetrician and gynecologist Dr. Steele Brewerton has had a distinguished medical career and life. Dr. Brewerton has lived the classic image of the country doctor.

He rode in a horse-drawn sleigh a mile in a snowstorm to deliver a baby by a kerosene light, saved a drowned child and carried an ailing, elderly woman on his back one kilometre through a blizzard to his car parked down an impassable road.

Wanting health care accessible to all, Dr. Brewerton and his partners in the Raymond and Magrath practices initiated an early version of a health care insurance plan, whereby a family could purchase a contract for $25 a year. This covered the

costs of any medical care needs that could arise for the families, and those who couldn’t afford to pay the whole amount at once could pay in instalments.

Dr. Brewerton lives in Cardston, Alberta.

Dr. Thomas E. Feasby Dr. Tom Feasby has been recognized as one of the country’s most notable neurologists, scientific directors and medical leaders. He has worked to create nationally and internationally recognized clinical/research programs and has recruited clinical and scientific talent to Alberta.

Dr. Feasby has contributed frequently to the public debate on key health issues through opinion-editorial submissions to major Canadian newspapers, as in numerous board advisory roles.

In 1993, Dr. Feasby founded the internationally recognized Calgary Stroke Program, as well as Calgary’s Neuromuscular Clinic and the ALS Clinic. He recruited renowned clinician scientists to the Calgary Multiple Sclerosis Clinic resulting in Canada’s leading MS program.

As dean of the Faculty of Medicine at the University of Calgary >

> (2007-12), Dr. Feasby worked to improve Albertans’ access to family physicians by increasing the undergraduate medical class enrolment. Dr. Feasby continues to practice medicine at the Urgent Neurology Clinic and the Neuromuscular Clinic at Foothills Medical Centre.

Medal of Honor The AMA Medal of Honor is presented to non-physicians who have made significant personal contributions to ensuring quality health care for the people of Alberta.

Samuel Weiss, PhD From his office at the Hotchkiss Brain Institute (HBI) on the University of Calgary campus, Dr. Samuel Weiss oversees the creation of groundbreaking programs in neuroscience research, the resourceful pursuit of new avenues of philanthropic support for neuroscience and the building of new provincial networks, all of which benefit Albertans and their families who are struggling to live with the many health issues associated with disorders of the nervous system.

After attaining his PhD in chemistry from the University of Calgary in 1983, Dr. Weiss pursued post-doctoral studies in France and the US before returning to the University of Calgary in 1988 as an assistant professor in the Faculty of Medicine.

An accomplished neuroscientist, Dr. Weiss is well known for his seminal discovery in 1992 that neural stem cells are present in the adult mammalian central nervous system.

Dr. Weiss’s discovery triggered aggressive research activity and excitement about the potential therapeutic roles of neural stem cells in treating neurological disorders.

Dr. Weiss’s leading role in the establishment and operation of the HBI has raised the standards of health care in Alberta and influenced brain and mental health study and

treatment around the world. Known for his infectious enthusiasm, Dr. Weiss serves as an inspiring guide and mentor, as he supervises a pair of post-doctoral fellows, two Master of Science students and a PhD candidate.

Recognizing outstanding service Each year the Alberta Medical Association (AMA) and Canadian Medical Association bestow awards on a group of dedicated physicians whose service and contributions to the association and the profession have made a significant difference. In the entries below we highlight the 2014 recipients, along with their personal reflections on the value of service.

AMA Long-Service Award The AMA Long-Service Award recognizes physicians with 10 years of AMA service who contribute their knowledge, skill and time to the advancement of the profession.

Their work, whether on the Board of Directors or its committees, supports and encourages the association’s development.

Dr. Richard G. Bergstrom Cardiac anesthesiology, Edmonton (No photo available)

What I have found most rewarding is the integrity of the staff at the AMA and their hard work at providing a forum for physicians to advance the care they provide to patients.

Representative Forum is a respectful and effective group in which physicians can debate, discuss and decide. It is instrumental in helping the greater physician community focus on what we do for patients. I also believe the work on the Council of Presidents helped with a greater understanding of the provincial challenges that the physician community experiences.

Physicians have an honored profession in serving patients and this is enhanced in so many ways by the work of the AMA. The most important thing I learned from the AMA is the idea of “service” and the focus on a physician community.

The one thing I would tell physicians early in their career is “get involved with the AMA” – only good things will happen.

Dr. Steven M. Edworthy Rheumatology, Calgary (No photo available)

I particularly enjoyed my time as the co-chair of the Physician Office System Program Committee and as a member of the Information Management and Information Technology Committee. I also found the work as co-chair of the Information Sharing Framework Governance Committee rewarding.

The entire process of helping to bring information technology to physician offices, including the introduction of electronic medical records, while addressing the issues and challenges of medical professionalism in the new area of electronic communication, was exciting and interesting. In addition, I enjoyed representing physician views to other stakeholders such as Alberta Health Services, Alberta Health and the Canada Health Infoway.

Being part of the AMA has allowed me to develop a broader connection with my profession beyond patient care. I have deepened friendships with colleagues across the province.

AMA service has allowed me to feel a stronger sense of satisfaction with my career.

Dr. R. Michael Giuffre Pediatric cardiology, Calgary My 2012-13 term as president occurred during a pivotal time for the AMA and for Alberta physicians.

Together we achieved a seven year, $25 billion agreement that created certainty, allowed for long-term planning and defined programs of critical importance to patients and physicians going forward. The AMA/Alberta Health agreement emphasizing three critical areas is a renewal effort going forward including: a provincial framework for electronic medical records; primary care evolution through primary care networks; and creating efficiencies in our health care system with tools such as “Choosing Wisely Canada.” >

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> In Alberta there are only two major influences on the overall delivery of health care, the AMA and Alberta Health Services. Since AHS is now governed and run by the Alberta government, AMA is the important counterbalance and the true voice of physicians, representing all doctors, rural and urban, primary care, specialist and subspecialist, academic and non-academic. The AMA is the best at giving a voice to physicians and at “putting Patients First®.”

Dr. Robert A. Halse General practice/anesthesia, Ponoka (No photo available)

The Council of Zonal Presidents presented an opportunity to network and obtain feedback from other regions, which had distance issues. We were then able to share those experiences with a wider group of like-minded physicians and AMA staff.

The AMA is our organization and works for us. It is our responsibility as physicians to support the AMA and work for the association as it works for us.

Dr. Kevin M. Hay Specialist in family medicine, Wainwright Being a part of Representative Forum was a lot of fun and seeing how issues move through the AMA process was enlightening.

The most recent one that has been really engaging was the Voluntary Physician Influenza Immunization Program. I’ve learned so much through my involvement with the AMA, but most importantly to enjoy the dynamism and debate that comes with the process.

One of the biggest benefits of being involved in the AMA is the collegiality. It’s refreshing to realize that many doctors are facing the same problems and trying to figure out solutions. It teaches you that you’re not alone. We need to remember that even though some health care issues seem bleak and seem to change for the worse as each year goes by, they will not improve at all unless we stay involved.

AMA - ALBERTA DOCTORS’ DIGEST

Dr. Susan J. Hutchison General practice, Edmonton

hardworking and knowledgeable staff of the AMA.

I have enjoyed the opportunity to serve the profession through my participation in the AMA. The experience has allowed me to understand how the changing health care environment impacts on physicians’ ability to deliver medical care in Alberta.

Dr. Douglas M. McCarty Family practice, Edmonton

I hope that I have contributed to improving the ability of physicians to deliver quality medical care. I believe we have a good health care system, but am of the opinion that we have the ability to make our system excellent.

Dr. Alan N. Lin Plastic surgery, Calgary (No photo available)

My longest service on an AMA committee is as a member of the AMA/Workers’ Compensation Board (WCB) Advisory Committee.

Understanding the challenges facing physicians in dealing with the WCB and recognizing the WCB’s requirements for managing claims for injured workers is an endeavor both challenging and rewarding.

I believe the committee’s work thus far has achieved positive outcomes for both physicians and the WCB and I believe additional cooperative changes in the future will benefit all the parties involved. I hope that eventually this will create a better working relationship with the WCB and that it will lead to a more timely provision of health care to workers and the safe return of workers to their job sites.

Serving with the AMA has many benefits for physicians at any stage in their careers.

Hands-on committee work provides a physician with greater understanding of the issues that collectively impact our profession than can be realized solely in one’s practice and provides an opportunity for a serving physician to advocate for positive actions and outcomes.

However, the most valuable benefit of AMA service is in meeting and working with the wonderful,

(No photo available)

I’ve been a member of the Workers’ Compensation Board (WCB) Negotiating Committee for the last three contracts and worked to ensure there was fairness to everyone on those negotiations.

Dealing with the WCB can be a complicated process, and it’s important that physicians are fairly compensated for their time. But more than that, I wanted to be there for my patients so that they get the care they need and get back to work.

It was a valuable experience because you get different perspectives and different opinions. It helps you see beyond your own cocoon and realize what other physicians are dealing with. I tell physicians that if you’re not involved, then your opinion isn’t heard and if enough people are heard, things can change.

Dr. Christine P. Molnar Radiology/nuclear medicine, Calgary My most meaningful long-term accomplishment – which started in 1993 with advocacy and participation on a ministerial task force – has been working through the AMA Section of Diagnostic Imaging to bring about a comprehensive provincial breast cancer screening program. Serving on the AMA Board of Directors allows me to advocate for our profession and quality patient care. I learned a lot from other physicians and the AMA staff and hope we helped to shape the future of medicine in some small way.

Service to our profession is enlightening, instructive and rewarding. I believe it is also our professional obligation. With the AMA you can share and learn from physicians apart from the groups that one would typically be aligned with. Start with what makes your heart sing. >

> Dr. Rowland T. Nichol General practice, Calgary The highlight of serving the AMA was representing it as its president.

The trust and responsibility of guiding the organization at that point of its journey, acknowledging its history and the values that the AMA represents and then translating them into the solutions to the challenges then facing it, was an honor.

The AMA works to validate the individual communities of physicians while addressing the systemic issues that face the profession.

The challenge was making sense of these issues and finding ways for physicians to see that success could be achieved by staying united. The AMA is exemplary in its capacity to stay focused and is disciplined while maintaining a values and principle-based organization. Being true to your values while striving to manage the tensions between self and serving others is one of the most difficult aspects of leadership.

Participating with the AMA supports that journey.

Dr. Jasneet K. Parmar Geriatric medicine, Edmonton I have served as the Edmonton Zone Medical Staff Association (EZMSA) representative at the AMA Representative Forum for two years in my position as president of the EZMSA and then for a year as Edmonton Zone representative at the RF. This opportunity has served as a medium for advancing many issues requiring advocacy for the medical staff in Edmonton, including the physician Practitioner Advocacy Assistance Line (PAAL). The RF is a very good example of a democratic process.

I see the AMA as physicians helping physicians to provide the best

advocacy for patients. I have very much enjoyed my participation with the AMA and have grown as a professional and as an individual.

The AMA is one of the finest organizations I have ever worked with and it allows me to advocate for patients, physicians and for a better health care system.

Dr. Patrick M. Pierse Pediatrics, Edmonton What stands out most for me was working towards attaining more equality between all physician groups. It demonstrated and formalized that all physicians had equal worth. There was a lot of collaboration, as each group within the AMA helped define what it meant to be a physician in that area and it taught us all a lot.

The AMA is one of the most fantastic organizations I’ve ever been involved with in my career, in that their interests are that of the profession. Everyone at the AMA is truly working on behalf of members and committed to you and your future.

Dr. Jeffery S. Pivnick Family practice, Calgary The time I spent on the AMA Board of Directors gave insight into the workings of our membership organization.

Participation in decision making and in the shaping and interpretation of government policy that impacts the medical profession was both intellectually stimulating and satisfying. Contributing to computerization of medical practice in Alberta is also both instructive and rewarding.

The AMA Board of Directors’ decision-making process is remarkable. It brings together credible and broad-based

information, focused intelligence, and a willingness to solve problems with openness to insights. It is interesting to see how many different informed opinions from physicians contribute to final decision making. Collectively, physicians are the individuals most aware of how medical care in Alberta can be best optimized and what needs to be done. The AMA is the expression of this collective voice.

Dr. Daniel R. Ryan Family practice/addiction medicine, Edmonton Although I had done some committee work for the AMA in the past, the most important was the time leading up to the formation of the Section of Addiction Medicine. The small group of us that were working in this area had been trying for years to involve physicians in the front-line treatment of these diseases and also at the policy making level. Becoming an “official” part of the AMA to give us credibility and some influence with the government was very exciting.

I also really enjoyed being the first Representative Forum delegate for my section and the total immersion I experienced at RF. I am amazed at how well a large group of doctors can get along and play by the rules.

We as a profession must stay united to be strong advocates for our colleagues and our patients.

Dr. Judith K. Ustina Child and adolescent psychiatry, Edmonton The AMA is an organization that has inspired relationship building to further patient care. During my term as section head of Child and Adolescent Psychiatry, I created an affiliation agreement between the Section of General Psychiatry and the fledgling Section of Child and Adolescent Psychiatry, strengthening the ability of both to > NOVEMBER - DECEMBER 2014

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> make an impact on mental health issues in Alberta.

The process that the AMA works through to forge relationships and build networks in order to further physicians’ standing in this province and improve patient care is exemplary. I have carried with me the AMA philosophy of respect for all, encouragement, and truly hearing all voices, as I know it is often the dissenting opinions that guide us to the best decisions.

Dr. Robert S. Warshawski Diagnostic radiology/nuclear medicine, Edmonton (No photo available)

Working on the Negotiating Committee was especially rewarding, as was my role as Edmonton representative to the RF and subsequently chair of the Section of Diagnostic Imaging with involvement with RF. I was involved in the computerization of community delivery of health care (with emphasis on radiology) and in educating third parties about care delivery.

AMA is an advocate for patient care and has a clearly defined goal of appropriate health care. We each have an individual responsibility to our patients, but we also have a collective responsibility to the system as a whole. I came away from my experience with a much better understanding of our responsibility for the welfare of individual patients and the entire health care system.

Dr. Eric A. Wasylenko Rural family medicine/palliative medicine/clinical ethics, Okotoks My first experience with the AMA working on the Professional Review Committee as a resident 31 years ago still stands out for me. I also really enjoyed being the AMA co-chair on four or five iterations of the Physician Workforce Planning Group and representing the AMA as a member

AMA - ALBERTA DOCTORS’ DIGEST

and chair of the Canadian Medical Association’s (CMA’s) Committee on Health Policy and Economics. I helped lead the physician workforce efforts in the 90s and 2000s to reverse government efforts to restrict physician numbers and opportunities; our groups worked diligently to protect graduating physicians from the practice restrictions, billing numbers and return for service arrangements experienced in other provinces.

Being part of the solution, learning how to advocate with the support of a strong organization, and working together with excellent staff and physicians at the AMA for the betterment of our patients and colleagues, has enriched me as a physician.

AMA Member Emeritus Dr. William W. (Bill) Anderson Diagnostic imaging, Edmonton My presidential year involved negotiations, job action and eventually a two-day “locked down” negotiation directly with the minister.

That long-term agreement set up our relationship with the government for the next decade, and saw the establishment of both the Physician Office System Program and primary care networks. The job action proved that if physicians speak with one voice and are willing to demonstrate our commitment, we can achieve significant improvements in the system. It hasn’t occurred since, but it shows future generations how important the AMA is for physicians and patients. My two years on the Standing Policy Committee gave me a glimpse into how government really works – influencing policy at that level was exciting.

Advocacy is a critical role for physicians and we must continue to demonstrate to the government, the public and our patients the benefit of our health care system and ways to improve it for future generations.

Health competes with all other

government services for budget and is always in the spotlight for reductions.

Dr. Daniel J. Hryciuk Emergency medicine, St. Albert I go a long way back with the AMA and I know some people at the AMA wonder why I don’t just have an office there.

I sat on several committees over the years and have participated in the re-alignment of the after-hours compensation for physician services and in the development of a transparent allocation process for the AMA. It is an honor to have worked with the many exemplary physicians who volunteer their time to the committees of the AMA, the RF, and the AMA board. I am grateful for the respect and personal friendships that I have had with everyone that I have worked with over the past 20 years and continue to work with now. I’ve learned so much about the professionalism of Alberta physicians in their dedication to the AMA and would encourage all physicians to volunteer their time at the AMA. Dr. Richard G.R. Johnston Critical care and anesthesiology, Edmonton My involvement in negotiating the long-term agreements that allowed us to create new practice models like primary care networks, new payment methods such as alternative relationship plans, and the benefit programs to fund electronic medical records are some of my proudest achievements. In 1993 the government cut payments to doctors, even though payments had been falling behind inflation for many years. Since then, we have been able to negotiate >

> increases in fees and funding while demonstrating the value of physicians to the public, to the government and to the members themselves.

I tell young physicians that if physicians won’t make time to manage and run the system, someone else will. If you choose not to be involved, you can’t complain about the outcome. It’s much like a requirement of democracy, and we have to get involved.

Dr. D. Jill Konkin Rural family medicine, Edmonton I had the privilege of being a board member right after the major reorganization that created the Representative Forum and, along with it, a much smaller Board of Directors. It was a stimulating and creative time.

The AMA was in transition with a new governance and organizational structure during the time of upheaval in our health care system after the first regionalization experiment. That board accomplished many things of importance, including the transition of the AMA to the smaller board.

The implementation of these changes produced a nimbler, more responsive organization.

Advocacy is an important role for a physician. Clearly, advocacy for our patients, the populations and communities we serve is paramount.

However, it is also important to advocate for our colleagues and for our profession. Back seat criticism is easy. Finding a way to be constructively critical and to engage with one’s colleagues – particularly those who don’t agree with you – to find ways to make positive change is hard work, but also fun and rewarding.

Dr. Dale C. Lien Internal medicine/pulmonologist, Edmonton I have been involved with the AMA since I started practice here in Alberta and have been continuously involved in AMA activities since 1986, when I began as the AMA representative for Respiratory Medicine. Since then, I’ve served as fees representative for our section, was involved in the Relative Value Guide process, and more recently served as president of the Section of Respiratory Medicine and delegate to the Representative Forum. Being the voice for respiratory medicine is an honor and I have tried to represent my colleagues to the best of my ability.

Alberta physicians are privileged to have this effective professional organization. The AMA’s strength lies in its members and their willingness to champion the interests of our profession and our patients through both good and difficult times. I encourage all members to participate, as this is the key to maintaining our strength.

Dr. Fredrykka D. Rinaldi Family practice, Medicine Hat (No photo available)

I have had the privilege of working with the most amazingly talented and dedicated physicians and AMA staff. My service on the AMA Board of Directors and Section of General Practice Executive has reaffirmed the power of a united and engaged professional voice in advancing the working environment of physicians and their ability to provide and define excellent patient care. I hope that the impact of the work I’ve been involved in will result in a proactive approach to patient care where we can embed the value of putting patients first into everything.

I encourage all physicians to look beyond the walls of your practice setting for ways of advancing your profession. Never sacrifice your professional autonomy; it is what enables us to put patients first.

Dr. Ernst P. Schuster Family practice, Edmonton I have been actively involved with the AMA since I joined the Board of Directors in 1993. I served on the board then and was re-elected to the board in 2013. I have been the chair of the Government Affairs Committee and was the AMA representative to the CMA’s Political Action Committee.

It was an honor to have served as the speaker and deputy speaker of the Representative Forum for a total of 14 years. I have also served on the Nominating Committee and have attended numerous CMA General Council meetings on behalf of the AMA, and had the opportunity to be an AMA representative to the government’s Standing Policy Committee on Health in the 90s.

The ability to advocate for physicians and their patients has been key during board involvement.

My message to younger physicians is that besides providing excellence and compassion in clinical practice, AMA involvement helps shape the health care system through leadership and advocacy. It may seem like added work, but it broadens the perspective and brings variety and system thinking into your professional life.

Dr. Wendy L. Tink Family medicine, Calgary (No photo available)

Opportunities to inspire and work with thoughtful, compelling physicians and staff leaders defined my AMA experience. It has been an honor to represent physicians who care deeply about their patients and discipline, and to make a difference locally, provincially and nationally. I’m especially proud of having advanced a comprehensive, coordinated primary care system to keep care closer to home and reduce emergency visits and hospital admissions. >

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> To early career physicians: your perspective matters. Juggling career and family? Find the best fit, a little or a lot; make time to reap the rewards of personal development, to engage with leaders and contribute to direction setting.

Dr. Patrick J. (P.J.) White Psychiatry, Edmonton My years with AMA were a wonderful experience for me. My time as deputy speaker stood out for me because it was always a challenge to keep the meeting running efficiently so we could make sure we stayed focused on the decision at hand.

Providing leadership while our negotiations were going on was a challenge because it was stressful and controversial but it brought the doctors together. The future of primary care is assured by the reorganization initiatives, which will protect this valuable service for everyone. The focus on primary care networks brings a front-loading of resources, which will serve our patients well in the future.

I would encourage young doctors starting out to become engaged and informed about the issues we face.

We can never underestimate the role of providing an active voice from our profession to ensure patient care is always the first priority. I intend to continue to advocate for mental health care and for my patients in the future. Our patients rely on us to advocate for them since they cannot advocate for themselves.

Dr. Josephine M. Wilson Family medicine, Canmore My work with the AMA was a very valuable experience.

Working on the Health Issues Council – looking towards the future and planning

AMA - ALBERTA DOCTORS’ DIGEST

for preventative measures – is a novel and exciting process. My time on the Board of Directors was an eye-opener, as I had not appreciated until then how well-run the AMA was. I was also involved in the initial integration of regional medical staff organizations with the AMA structure and believe the project’s overarching concepts benefitted us all. My participation in the AMA made me realize how much leverage we have in our profession.

The public looks to us for guidance on their individual care and on issues that affect the entire health care system. Our influence should never be underestimated. What I learned at the AMA has made me a better advocate for my patients.

Canadian Medical Association (CMA) Honorary Members Dr. Robert A. (Bob) Burns Physician executive/administrative medicine, Nanaimo BC I was privileged to be a part of the leadership of medical associations during times of huge change.

Negotiations outcomes with AHCIP in 1988 were covered in a one-pager – and parts of them were agreed to on a dance floor! (Thanks, Ruth Collins-Nakai and Minister Moore!).

By 2000, they were volumes long and required skilled lawyers to both negotiate and to interpret. I was a Canadian Medical Association General Council delegate from 1988 to 2004 and saw great Alberta physicians play a leading role in the affairs of the national physician association.

Most satisfying was the work on the Task Force on Governance, and its legacy, the Representative Forum, the best physician governance structure in the country, followed by the acquisition of outstanding professional staff – many of whom still work for the AMA. A voluntary professional association is only as strong as its members.

Dr. Ken Chow Family practice, St. Albert (No photo available)

Being a member of the Negotiating Committee and the Subcommittee on Finance at the same time was most memorable. I saw the good and the bad negotiated and then implemented. Although there was plenty of good, I also recall the capped budgets, the clawbacks and the delisting of lab services.

I was involved with two major accomplishments during my time with the AMA, first with negotiations, where we started the dialogue to have the AMA recognized as the representative for all Alberta physicians. Secondly, I was involved with the creation of alternate payment models.

My experience has taught me that, as a profession, to remain strong we must remain united. The AMA/ CMA provide us with the vehicle to remain strong. In the words of Benjamin Franklin, we must all hang together or assuredly we shall all hang separately.

Dr. Ruth L. Collins-Nakai Pediatric cardiology/adult congenital cardiology, Edmonton Being president of both the AMA and CMA is, for me, especially memorable.

With the AMA, I was delighted to spearhead the initiative to make seat belts mandatory, to have mandatory reporting of shaken babies, and to bring in a new era of principled negotiating with the Alberta government. With the CMA, I made the motion to ask Air Canada to become a smoke-free airline – the first in the world. Our focus on early childhood also drew awareness to the need for supportive and nurturing early childhood development and care. Going to Afghanistan focused attention on the need for quality health care services for our Canadian Forces and brought honor to the CMA. >

> Along with opportunities to learn leadership, the AMA and CMA help physicians focus on what is important to patients in a health care system that is in constant flux and often in chaos. They teach about group dynamics and arguing for one’s position, while respecting and listening to other perspectives. Finally, they create friends and a supportive “family” to help during life’s vicissitudes.

Dr. Allan S. Garbutt Family medicine, Crowsnest Pass I’ve been involved with the Section of Rural Medicine for what seems like forever, as its president, past-president and then president again.

We’ve done a lot that I’m proud of, but two of the biggest things were establishing the Dr. Michael Tarrant Scholarship for third-year medical students at the University of Alberta and the University of Calgary and creating the Enhancement Program that helps rural students apply to medical school.

This past year, as AMA president, I was left with a new appreciation for how hard previous presidents must have worked and the sacrifices their families made to allow them to do that work. It showed me that you can’t do this job without the incredible support of everyone at the AMA. It also reaffirmed my belief that you have to make time to be involved in organizations like AMA and CMA if you want to improve the system.

Dr. Wayne M. MacNicol Obstetrics/gynecology, Whitehorse, Yukon I was always amazed by the extraordinary commitment of the board to improving the quality of medical care and working conditions for the physicians of Alberta. During my time on the board, we dealt with the outfall of the Barer-Stoddart Report and the beginnings of a Relative Value Guide to address disparities in physician earnings.

Government had also begun the move towards regionalization and payment models for hospital/facility services based on severity of illness/ output formulas. These issues had huge implications with respect to physician services and access to medical care and our focus was on keeping the membership working toward common goals.

It’s important for physicians to recognize their strengths, knowledge and skills and to become a part of the broader medical community to improve the standards of medical care, access to medical services and working conditions of physicians.

Dr. Dennis L. Modry Cardiothoracic surgery, Edmonton During my time with the AMA, I’ve served on two Relative Value Guide (RVG) committees and for me the most interesting part was the process of understanding what RVG really means, its purpose and its risks and benefits. Everyone involved with RVG contributed to

the discussions to improve health care delivery. I’ve also worked to influence the implementation of retention benefits with government, and provided a rationale as to why they shouldn’t cut $100 million from fee for service. In dealing with multiple physicians you get multiple perspectives, and when it works you get people aligned on how to resolve a problem.

I think the AMA and the CMA have done an excellent job and are a force for good. They listen to divergent opinions on patient and professional (individual sections) advocacy and make a legitimate attempt to be fair.

It’s important to get involved if you want your opinion heard.

Dr. Harvey P. Woytiuk General practice, St. Paul After implementing an electronic medical record in 2000, a career milestone occurred in 2006 with the opportunity to be involved in developing and nurturing a primary care network (PCN) in our community. A six physician community PCN blossomed to 30 physicians when the opportunity to join our PCN was extended to the surrounding communities. It has been a pleasure to be involved in the provision of medical services to rural Albertans.

Significant progress has taken place, but more work remains before a home grown sustainable program for rural health care delivery can be acknowledged.

If you want to make a difference, get involved and stay involved.

The rapport and relationships you make through your involvement will stay with you throughout your career and it’s always good to have other people who can commiserate and understand the issues you’re dealing with.

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HEALTH LAW UPDATE

Conflicting regulations?

Alberta court rules third-party records to be “health information” Jonathan P. Rossall, QC, LLM | PARTNER,

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n a decision issued in mid-September of this year, Justice T.W. Wakeling of the Alberta Court of Queen’s Bench1 has arguably expanded the scope of what has been commonly understood to be health information as that term is defined in Alberta’s Health Information Act (HIA). The case arose from a judicial review of a decision of the Office of the Information and Privacy Commissioner (OIPC) relating to a family member’s request for information regarding her parents’ care.

Background Briefly, the family member in question had her visitation privileges restricted by Covenant Health, allegedly to protect the health care regime provided by Covenant Health for her parents in one of its long-term care facilities. The conditions imposed limited the times she could visit, prescribed permitted activities during visits and identified certain Covenant Health representatives with whom she could discuss her parents’ care. Her parents had appointed a different family member to be their agent under the Personal Directives Act, so she had no status in that regard. She had taken numerous steps to cause Covenant Health to remove these conditions, to no avail. Ultimately, she filed an access request under the Freedom of Information and Protection of Privacy Act (FOIPPA) for “… everything and anything that Covenant Health has a record of, relating to me.”

The response from Covenant Health was to disclose those parts of the records, including excerpts from the parents’ health records that Covenant Health regarded as responsive to the request. The family member, in turn, contested the lawfulness and completeness of Covenant Health’s response and filed a complaint under the FOIPPA which also brought into play the provisions of the HIA relating to the request.

AMA - ALBERTA DOCTORS’ DIGEST

MCLENNAN ROSS LLP

The OIPC ruled that the HIA did not apply to any parts of the records disclosed by Covenant Health and ordered Covenant Health to conduct a new search for producible records. That decision was then brought before the court for judicial review.

The Health Information Act The HIA is focused on the protection and privacy of “health information,” and prescribes circumstances where such information may be disclosed to third parties in the absence of patient consent. As the court advised in this decision, “…(o)penness is not the goal of the HIA. The preservation of the privacy of an individual’s health information is one of the purposes of the Act.”

Even if it is accepted that the family

member’s information is part of the parents’ health record, and therefore immune from disclosure under the Health Information Act (HIA), is that family member’s information nevertheless “personal information” as defined in Freedom of Information and Protection of Privacy Act (FOIPPA) and therefore subject to disclosure?

Necessarily, then, one of the questions posed by the court was, “(is) some” of the information in Covenant Health’s records that refers to (the family member) the health information of her parents and subject to the disclosure principles in the HIA?” >

> Health information is defined as either diagnostic, treatment and care information, or registration information. The definition of “diagnostic, treatment and care information” is as follows: “… information about any of the following: (i) the physical and mental health of an individual; (ii) a health service provided to an individual…. and includes any other information about an individual that is collected when a health service is provided to an individual…”

The act goes on to define what health services are, but does not touch on what “any other information about an individual” might be.

The decision Recall that the request put forward by the family member was for “… everything and anything that Covenant Health has a record of, relating to me.” Presumably the family member seeking the information recognized that she was not entitled to information regarding the physical or mental health of her parents or the health services provided to her parents in the absence of their consent or the consent of the agent (neither of which were forthcoming).

However, Covenant Health’s response was that where records of the family member’s actions/activities formed part of the parents’ health records, those third-party records were the parents’ health information and could not be disclosed. The OIPC disagreed with this approach and directed that these records were not part of the parents’ health information and therefore fell within the broader confines of the FOIPPA. The court, in reviewing this decision, pointed out that the OIPC had failed to address the phrase “… and any other information about an individual….” that forms part of the definition of “diagnostic, treatment and care information” and posed the following questions: “Obviously, health information also includes “any other information about an individual that is collected when a health service is provided to the individual.”

What does this phrase mean? What are the boundaries of its meaning?”

Utilizing traditional principles of statutory interpretation, Justice Wakeling pointed out that it must mean something other than information about either the physical and mental health of the individual or health services provided to an individual, as those aspects are expressly provided for in the definition. In attempting to define this phrase he relied on hypothetical examples, including a scenario where a physician documents that a patient’s sleep disorder is caused, in part, by her husband’s excessive snoring. He analyzed that scenario as follows: “If A tells the physician or another member of the sleep-disorder team that B, her husband, snores

loudly and interferes with her sleep, and the doctor records this information in her chart, is the information about the snoring husband the health information of A? I think so.”

His analysis was that, even though the information is about B, it helps the doctor in the course of treatment, and therefore in this context, the information about B is actually information about A. Applying this logic to the existing fact situation, his conclusion was that the information about the family member’s interactions with her parents on the parents’ health record was, in fact, the parents’ health information and therefore could not be disclosed.

Discussion While at first blush this may seem needlessly technical and impractical, it makes sense when viewed in the context of the HIA. Recall that the court correctly points out that the HIA is about protecting the health information of patients from unwarranted or unauthorized disclosure.

The focus, therefore, must be on what information is in the patient’s health record that relates to the patient’s diagnosis, treatment or care. If some of that relevant information specifically refers to, and identifies third parties, it is no less information about the patient. Had the legislature intended to exclude third-party information from the scope of “… other information about an individual that is collected when a health service is provided to an individual,” it could have done so.

The question was raised: Even if it is accepted that the family member’s information is part of the parents’ health record, and therefore immune from disclosure under the HIA, is that family member’s information nevertheless “personal information” as defined in FOIPPA and therefore subject to disclosure? The answer to that question is simple: The disclosure regime in the HIA and under FOIPPA, are mutually exclusive; FOIPPA does not apply to the disclosure of health information, and the HIA does not apply to the disclosure of information that is not health information. Once the determination is made that the family member’s information in the parents’ health records is “health information” as that term is defined, then FOIPPA has no application.

Having said that, likely this is not the last word on this issue. It is anticipated that the family member affected by this decision may appeal Justice Wakeling’s ruling to the Alberta Court of Appeal. There is already before the Court of Appeal a question of the scope of the OIPC’s right to challenge a decision such as this. But until either of those matters is resolved, the law would seem to favor the restriction of disclosure of third-party information found in an individual’s health record.

Reference 1. Covenant Health vs. Information and Privacy Commissioner and Shauna McHarg, 2014 ABQB 562.

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MIND YOUR OWN BUSINESS

Fraud alert!

Does your business have immunity?

Practice Management Program Staff

F

raud will never happen in my business. We’re much too small. We’re immune.

few employees, basic controls and procedures can protect your assets and detect mistakes.

Think again.

Awareness of scams that occur with small businesses is the first step in prevention. Educate your employees about basic fraud protection and how easily scams are committed on unsuspecting employees. Common scams include phoney invoices sent to a business for website listings or subscriptions that were never authorized or do not exist, and office or medical supplies that were never ordered and were not received.

Small businesses are particularly vulnerable to fraud because they have fewer resources and often fewer controls. In July 2014, ATB Business Beat reported that 25% of small businesses in Alberta had experienced fraud or attempted fraud in the past year. According to the Association for Certified Fraud Examiners, small organizations with less than 100 employees experience the highest rate of fraud of any business category at 31.8%.

Not all frauds are reported because of embarrassment, family members being involved or no chance to recover losses. Most businesses absorb the losses as a cost of doing business.

Fraud can take many shapes and forms. Some types of frauds that are attempted include credit card fraud, actual theft of property, phishing or email hacking, supplier fraud with fake invoices or advertising scams. It’s a scary world.

The majority of fraud cases are committed by one person, acting alone, trying to conceal the crime from everyone, including family members. They often are in good standing, have worked for a company on average of four to five years and are mostly first time offenders. Given the opportunity and the need when faced with personal stress, sometimes even the best employees will commit fraud.

They also “rationalize” that they will only temporarily borrow the money and return it later. Small business owners who have experienced fraud will almost always tell you that it was someone they trusted.

Or mistakes happen. Sometimes, undesirable activities occur that cost you money or result in other items of value disappearing.

You can do some things to reduce the chances of fraud happening to you. Even in small organizations with only a

AMA - ALBERTA DOCTORS’ DIGEST

Be aware of scams that target small businesses

Protect your business with a few simple rules. Never give out business information unless you know what the information is to be used for. If it sounds too good to be true, it likely is. Always ask for a proposal in writing. And always check that goods or services were both ordered and delivered before you pay an invoice.

Set a tone for success Model the behavior that you want in your business.

If the owner is seen borrowing from petty cash, neglecting to record a cash payment from a patient, or charging personal expenses through the business, an atmosphere is created where “if the boss can do it, so can I.” Always follow the procedures that you have established for your employees.

Ask for and review financial reports regularly and randomly Awareness of the financial status of your business can reduce the possibility of fraudulent activity occurring.

Having a budget in place, reviewing actual expenses on a regular basis, asking questions about the financial reports, and taking action can lead to predictable results, less stress about your finances and greater success in your practice.

Occasionally ask for back up documentation for a bill being paid ¬ especially if you don’t remember why the purchase was made or were not involved in placing the >

> order. Inquire about new vendors and why the change was made. Review payroll reports on a regular basis for overtime and vacation payments.

Divide the work wherever possible Even in small offices, it is possible to have more than one person handle different aspects of any financial transaction. Consider where more than one person could be involved. Or rotate job responsibilities for financial transactions.

An example of all activities required for an expense in your business are ordering the service or supplies, negotiating the price, validating that the materials were received or the services completed, writing the cheque, signing the cheque, recording the payment in the accounting records and reconciling the bank account.

Split up the work and reduce the opportunity for fraud and errors in your business. Where possible, have a different person recording the transaction than the one who authorizes a payment.

Have all bank and credit card statements mailed directly to your home or go on-line regularly to review the bank and credit card account. Look at the transactions for unusual amounts or payees that you do not recognize. Do you know what the payment is for? Ask for backup. Look at the cheques that cleared for altered payees or amounts.

Review all automatic payments for your bank account and validate that they are only for valid business expenses.

Prevention is the key Medical practices are not immune to fraudulent activities.

Safeguard your practice and protect your assets. Just as you lock your doors, set up some basic controls to detect or prevent fraud. Sleep better knowing your cash and assets are safe.

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 phone 780.733.3632.

Treat cash with extra care Establish a process to record all payments that are made directly in your office. Have a policy with signage that receipts are issued for all payments. Use pre-numbered receipts and review occasionally to ensure that all cash is recorded. Cash and cheques should be deposited in the bank as soon as possible ¬ at least weekly.

Ann Dawrant RE/MAX Real Estate Centre

Treat blank cheques like cash

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Limit the number of people who have access to blank cheques. Keep them locked up. Use pre-numbered cheques or have the accounting software print the cheques if possible.

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

Have all cheques require two signatures. Don’t pre-sign cheques. The convenience of having the ability to issue a payment without being present eliminates any control that you intended to establish.

Pay attention to what is happening Trust ¬ but verify. Notice when employees complain consistently about financial problems. Be aware of employees who appear to live beyond their means or employees who refuse to take vacation because when an employee is away changes in certain patterns can become apparent.

“Please call me to experience the dedicated, knowledgeable, and caring service that I provide to all my clients.”

Website

www.anndawrant.com

• 29 years as a successful residential realtor in west and southwest Edmonton • Born and raised in Buenos Aires and has lived in Edmonton since 1967 • Bilingual in English and Spanish E-mail

anndawrant@shaw.ca

NOVEMBER - DECEMBER 2014

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22

FEATURE

Don’t just stand there!

The AMA Youth Run Club 2014 fall launch is happening now

¬ has taken on two new partners: the Running Room and Physiotherapy Alberta, both of whom helped get the YRC off to a running start, in early October.

At the McKernan School launch, YRC coach (and teacher) Jennifer Klein, husband and co-coach, Dr. Doug Klein, principal Mary-Lou Cleveland, other school staff and EAS representatives corralled over 200, rambunctious K-6 run participants and joined them in two laps around the school field, culminating in a sprint across the finish line to receive gold medals donated by the Running Room: one for everyone! Preceding the run with some encouraging words and cheers were Dr. Richard G.R. Johnston, AMA President; John Stanton, Founder and chief executive officer the Running Room and Brian Torrance, Director of EAS. And they're off! Over 200 McKernan School students got the fall 2014 season of the AMA's Youth Run Club off to a running start October 1. ( provided by Ever Active Schools)

I

n typical Alberta fashion, the 2014 fall session of the Alberta Medical Association (AMA) Youth Run Club (YRC) launched on a beautiful, warm and sunny October 1 at McKernan School in Edmonton. In contrast, the very next day it launched amidst blustery winds and wintery-cold temperatures at Panorama Hills School in Calgary.

Unpredictable weather aside, both events echoed with the resounding pitter-patter of hundreds of small feet (and some big ones) as the booming bass of the Running Room’s “Get Moving!” tunes put an extra jig and wriggle into everyone’s step and made it impossible to stand still (helped along by the cold in Calgary, of course!).

It’s been 1.5 years since the birth of the AMA YRC, modelled after the Kids’ Run Club, started by Doctors Nova Scotia 10 years ago. AMA’s YRC is a collaborative effort of the AMA and Ever Active Schools (EAS), a provincial organization that promotes and supports healthy, active school communities. And what a year of growth it has been: from the program’s start in spring 2013, with 74 schools and 4,000 participants, the AMA YRC has blossomed to include 233 schools and 11,000 participants.

In the process, the YRC ¬ which strives to get students K-12 out from behind electronic screens and gadgets and into their running/walking/jogging gear and the fresh air

AMA - ALBERTA DOCTORS’ DIGEST

It was “Take Two” for AMA, EAS and Running Room representatives bright and early the next morning at Panorama Hills School in Calgary, where coaches Sara Laslo and Chris Fenlon-Macdonald and principal Sherry Goldenberg gathered approximately 100 K-3 participants and, fueled by rousing warm-up exercises led by EAS’s Megan McKinlay, led the little troops around the school field and over the gold medal finish line.

Calling all physicians and looking for champions For everyone involved, the AMA YRC is a feel-good-dogood double dip, serving as a thoughtful reminder of the real need that exists today to create opportunities for physical activity for youth, as all our lives ¬ young and old alike ¬ become increasingly comprised of technologydriven, sedentary activities.

Having observed the quiet playgrounds and school fields in her Edmonton neighborhood, Dr. Kim Kelly is the original physician champion of the AMA’s YRC and continues to be involved with the program at Belgravia School in Edmonton.

“The YRC presents a perfect opportunity for our physician members to get involved with their communities and serve as healthy, active role models for youth. Whether as a coach, joining the kids on a run, speaking to them about healthy lifestyle choices or even sponsoring a local run club, any and every effort counts,” Dr. Johnston commented at the launches. >

23

(L to R) Dr. Richard G.R. Johnston, AMA President, Leanne Loranger, Physiotherapy Alberta, John Stanton, Running Room Ltd. and Brian Torrance. ( provided by Ever Active Schools)

> Edmonton family physician Dr. Klein is putting in that effort and reaping the rewards of being a YRC physician champion. The YRC is a family affair for the Kleins, who have three children attending McKernan and participating in the school’s YRC. Both Doug and Jennifer Klein appreciate being able to set a good example of active and healthful living for the kids.

(L to R) Dr. Doug Klein (YRC coach), Alexandra Teboul, Esperance Siwe Siwe, Jamie Bruce (McKernan School teachers), Jennifer Klein (McKernan School teacher and YRC coach). ( provided by Ever Active Schools)

“Seeing the kids laughing, chatting and having fun as they run two-to-three kilometres before school is one of the highlights of my week,” says Dr. Klein. “I hope that more parents and physicians get involved with this great program.”

To view a video on how to get involved in the AMA Youth Run Club, please visit: www.albertadoctors.org/yrc/resources.

We want your feet!

Like to run? Have an interest in healthier kids and healthier communities?

We’re rolling out all kinds of resources to help you get kids running where you live. If you’d like to participate in a school have other suggestions to get kids’ feet moving, we can help.

You don’t need to be a parent of a school-aged kid to participate. Your willingness and interest are all you need.

hayley@everactive.org

Ready to get involved? Drop us a line: runclub@

albertadoctors.org

NOVEMBER - DECEMBER 2014

24

FEATURE Tarrant Scholarship focuses on rural commitment Two medical students step up to the challenge

I

n its 11th year, the Tarrant Scholarship was awarded to third-year medical students from the University of Alberta (U of A) and the University of Calgary (U of C) who have demonstrated a strong interest in focusing their medical career and undergraduate studies on rural medicine and related issues. As one of Alberta’s largest unrestricted medical school undergraduate awards, the scholarship provides a full year’s tuition for both recipients.

The 2014 Tarrant Scholarship recipients are U of A medical student Adam Mildenberger from Beaverlodge, AB and U of C medical student Darby Ewashina from Barriere, BC. “We always have strong candidates for this scholarship and this year is no exception,” said Dr. Tobias N.M. Gelber, President, AMA Section of Rural Medicine. “There are ongoing concerns with the current state of health care in rural Alberta so it’s reassuring and heartening to see the rural commitment of these bright, young and talented medical students. Like the Tarrant Scholarship winners who preceded them, Darby and Adam will be true assets to the rural communities in which they may choose to practice medicine.”

The scholarship is named in honor of the late Dr. Michael Tarrant, a Calgary family physician who championed rural medical undergraduate education.

Since its inception in 2004, the Tarrant Scholarship has been awarded to 29 medical students and has provided close to $300,000 to its recipients.

Adam Mildenberger (U of A) Adam was born and grew up in Beaverlodge, AB. He was actively involved in his high school and community as a member of the school leadership club, a player on the school’s football team, a volunteer at the hospital, a youth basketball and soccer coach, and the organizer of a weekly youth drop-in activity night.

AMA - ALBERTA DOCTORS’ DIGEST

During his undergraduate studies at the U of A, Adam joined the Golden Key Society, an academic, leadership and service organization to which students who achieve an academic standing in the top 15% are invited to join. Adam served as vice-president and president of the U of A chapter, during which time he worked on numerous events, including organizing an annual tour of the university by inner-city junior high school students, for purposes of introducing them to the world of post-secondary education. Since joining the Golden Key Society, Adam has served at national and international levels with the organization.

Since its inception in 2004, the

Tarrant Scholarship has been awarded to 29 medical students and has provided close to $300,000 to its recipients.

Over his summer breaks, Adam worked on projects involving chemistry, and Aboriginal and global health and educational initiatives developed by the Department of Family Medicine. Adam has volunteered with the Campus Food Bank and with the Alberta Hospital, Edmonton.

In medical school, Adam has volunteered with the Faculty of Medicine, the Medical Students’ Association and the Canadian Federation of Medical Students. The student representative on the AMA’s Health Issues Council, Adam lives in Peace River while he participates in the Integrated Community Clerkship program.

“I appreciate the strong feeling of community that comes with rural medicine and I’m interested in working with communities that don’t have easy access to health care,” says Adam. >

> Darby Ewashina (U of C)

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Darby grew up in Barriere, BC, just outside Kamloops.

She participated in many sports and outdoor activities through her childhood, enjoying the active, communityfocused life of a small centre.

For her undergraduate studies in Cellular, Molecular and Microbiology, Darby attended Thompson Rivers University in Kamloops. Initially leaning towards a career in veterinary medicine, a volunteer stint as a physician assistant in Guatemala influenced Darby to pursue her medical degree.

In addition to her studies at the U of C, Darby has been involved with the local community, as a clinician at the Student Run Clinic and as the initiator of a literacy campaign ¬ Rewards of Reading ¬ that provides books and activities to children staying at the shelter where the clinic operates.

Through the course of her involvement with other university groups and rural electives, Darby has found the “one-on-one teaching and learning that occurs when removed from the larger centres” to be the most rewarding.

(L to R) Adam Mildenberger, U of A recipient; Dr. Tobias N.M. Gelber, President, AMA Section of Rural Medicine; Darby Ewashina, U of C recipient. ( provided by Vanda Killeen)

“There’s a sense of cohesiveness and community that comes with smaller towns,” says Darby, who plans to acquire advanced skills training in emergency medicine and addictions medicine, and apply these skills one day in a rural community practice.

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DR. GADGET

Dog or fob?

Wesley D. Jackson, MD, CCFP, FCFP

A

few weeks ago, at the conclusion of a periodic health exam of one of my overweight patients, we were discussing the benefits of a healthy lifestyle and particularly the importance of exercise. He told me that a well-meaning physician had given him an exercise prescription a couple of years ago and that, despite his best efforts, it had failed miserably. So, based on an article1 I had read pointing out the fitness benefits of dog walking, I suggested that he consider this option. The next minute or so is a blur as I vaguely remember words like ‘carpet stain,’ ‘pooper scooper’ and ‘yappy’ along with others that I cannot repeat in this venue, leading me to believe this solution would not be ideal for my patient.

We then began to discuss the possibility of wearable devices as a motivational tool for exercise and weight loss.

Pedometers have been available for several years and have been shown to improve fitness, particularly with long term use,2 and have been generally adopted by runners and others interested in fitness. Inexpensive, highly portable and readily available health tracking wearables (HTW) combined with apps that can also monitor dietary intake have the potential to significantly increase motivation and therefore compliance with daily diet and exercise.3,4,5 These devices come in many shapes and colors, including fobs, wrist bands, smartphones and, coming soon, headphones.6 All HTWs contain motion detector chips, which through complex algorithms, estimate steps and stairs fairly accurately. Some algorithms also attempt to estimate active vs. passive or slower exercise. Most apps associated with these devices allow for personal goal-setting and connection to secure social media, promoting friendly competition and encouragement from close friends and family. Personalized reminders, while not as cute as the large puppy eyes or annoying as scratching at the door, help users to meet their own goals. Newer devices are combining functionality, allowing for control of music, emails, texts, etc., as well

AMA - ALBERTA DOCTORS’ DIGEST

as monitoring other vitals such as pulse and oxygen saturation when paired with a nearby smartphone, making them very appealing to the general North American population.

In the United States of America, HTWs generated more than $1.6 billion in sales last year, a number projected to rise to $5 billion by 2016. Software and hardware providers have been keenly aware of both the need and the scope of this rapidly growing industry, producing many fitness related apps that utilize the data created by the various HTWs.

Pedometers have been available for

several years and have been shown to improve fitness, particularly with long term use.

Google Fit (Google) and HealthKit (Apple) are new offerings that consolidate data received from hardware and other apps to provide a more complete, personalized health profile of the user. Proactive businesses have been actively promoting the use of HTWs, while many physicians believe that smartphone applications for medicine are going to be a part of mainstream medical practice in the coming years.7,8 Health care institutions and electronic medical record providers, including Mayo Clinic, Epic, Stanford, Kaiser Permanente, Harvard and others are currently conducting trials using data obtained from HTWs. This technological advance, although very promising, is not without risks. Recently the US Food and Drug Administration has stated that apps that are not marketed to monitor a disease or condition, or to treat or diagnose a patient will not be regulated. As far as I am aware, there is no regulatory body in Canada. The quality of data can vary considerably between devices and the software is far from flawless at this point in time. >

> Privacy Rights Clearinghouse, a California based non-profit corporation with a mission to provide consumer information and advocacy around issues of privacy, in a recent report9,10 noted that of 43 health-tracking apps studied (2012-13), only 15% send encrypted data to servers and approximately 25% had accurate privacy polices to which they adhered. This report also noted that advertisements in apps increased the privacy risk, suggesting that users be cautious with free offerings. On the positive side, this group published a how-to guidebook for future use for developers of health-related apps. Other resources are available to guide users on how to safely use HTWs and associated apps.11

27

While HTWs may not yet be ready for useful integration into medical care because of these and other concerns, they are still very useful for significant positive lifestyle change and can certainly be promoted by physicians for this purpose. Comparisons and reviews of several of these devices can be found on the Internet.12,13,14 If only the next health tracking wearable could warm my feet and fetch my paper ‌ References available upon request.

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PFSP PERSPECTIVES

The beginning of wisdom Jared D. Bly, MD, CCFP (EM) | ASSESSMENT

PHYSICIAN, PFSP

O

nce when Frederick II, an 18th century king of Prussia, went on an inspection tour of a Berlin prison, he was greeted with the cries of prisoners, who fell on their knees and protested their unjust imprisonment. While listening to these pleas of innocence, Frederick’s eye was caught by a solitary figure in the corner, a prisoner seemingly unconcerned with all the commotion.

doctor.3 Or a good nurse, social worker or counsellor.

Or if you want healthy development as a child. Or if you want effective social interactions, etc.

Knowing our weaknesses When Alice in Wonderland came to a fork in the road, she was pretty lost.

“Why are you here?” Frederick asked him.

“Which road do I take?” she asked.

”Armed robbery, Your Majesty.”

“Where do you want to go?” responded the Cheshire Cat.

“Were you guilty?” the king asked.

“Oh yes, indeed, Your Majesty. I entirely deserve my punishment.”

At that Frederick summoned the jailer. “Release this guilty man at once,” he said. “I will not have him kept in this prison where he will corrupt all the fine innocent people who occupy it.”1 Why is this funny? A criminal actually accepting his punishment? An administrator actually recognizing his institution’s inept policies and procedures? Would it be as surprising for any of us to recognize our mistakes, shortcomings or idiosyncrasies? Whatever the reason, honesty about oneself seems rare.

Becoming more self-aware is a subject of literature throughout history. Ancient Greek philosophers (thank-you to Aristotle for the title of this article), religious leaders, business executives and educators have all praised this attribute. It’s relevant in the professional life of medicine, but no less important in personal life.

Fulfilling relationships, satisfying workdays and effective personal development all require a high degree of self-awareness.

Is soul-searching that important? Well, it is if you want to be a successful leader.

“Leadership searches give short shrift to ‘self-awareness,’ which should actually be a top criterion. Interestingly, a high self-awareness score was the strongest predictor of overall success.”2 Not concerned about being a good leader? Well that's a topic for another article, but okay. Even if you don’t believe that leadership is somewhat intrinsic to being a physician, it’s independently important for being a good AMA - ALBERTA DOCTORS’ DIGEST

“I don’t know,” Alice answered.

“Then,” said the Cat, “it doesn’t matter.”4 Like Alice, to know where we want to get to, it helps to have some idea of where we are. If we want to improve, it helps to know what we need to improve upon.

There’s a story of a woman who goes to see her doctor about losing weight. First, the physician has her step on a scale. “I can’t believe I weigh that much,” she protests, seeing the needle soar.

“Look down at the scale and tell me whose fat feet those are standing on it,” the physician answers.

Maybe insensitive, but illustrative of the need to own one’s problems.

To become more self-aware, you

have to be self-aware enough to realize how self-aware you are not.

Knowing our strengths Hopefully in our years of schooling we have understood how we learn. Because if we know how we learn or how we work, we can understand how we might contribute best in an organization or relationship. We contribute best when we work from our strengths. >

> I had a medical school classmate that came to every lecture, sat on the front row, didn’t write a word of notes, but remembered, apparently, everything that was taught.

Other classmates took volumes of neat, well-organized notes, even kept them through clinical years and residency. Some didn’t go to class at all, preferring to spend the time in the library reading the material. “(United States of America president) Lyndon B. Johnson destroyed his presidency in large measure, not knowing that he was a listener. His predecessor, John F. Kennedy, was a reader who had assembled a brilliant group of writers as his assistants, making sure they wrote to him before discussing their memos in person. Johnson kept these people on staff ¬ and they kept writing. He never, apparently, understood one word of what they wrote. Yet as a senator, Johnson had been superb because parliamentarians have to be, above all, listeners.”5

29

Our reflections can say a lot about who we are. (

provided by David Bly)

Then he worked with a counsellor who delivered some hard truths: “The good news is you do not have a wife-selection problem. The bad news is you have a husband-behavior problem.”

Some people, then, are listeners. Some are readers. Some people need to talk about things to process them. Some learn best by doing. Some people write. William Faulkner said, “I never know what I think about something until I read what I’ve written on it.”

Now what?

It’s especially important to be aware of relationship dynamics if one partner is a talker and one is a writer, or a doer, for example. And it’s an important part of self-awareness to know how you learn and work.

Developing self-awareness starts with introspection. This can be difficult for the naturally self-ignorant. “To become more self-aware, you have to be self-aware enough to realize how self-aware you are not.”7

Knowing our influence on others

Introspective practices can help you identify and evaluate your emotional responses to various life events.

Journaling, meditation, prayer, taking a moment to reflect after a day at work, or sitting on the porch with a warm beverage at the end of the day all fall into this category.

Knowing how you learn may be most useful in planning your Continuing Medical Education (CME) activities, or planning what you expect to get out of CME activities (maybe a suntan is the only realistic outcome from a didactic conference in a sunny locale if you are a doer and not likely to get much out of a morning lecture).

For clinical practice we all need to be listeners to some extent. And understanding how we are perceived and what influence we have on others is an important aspect of self-awareness.

One business leader’s rocky road to self-awareness involved seeing his impact on others. Here’s his story as told in Discovering Your Authentic Leadership.6 “Dave, your colleagues do not trust you.”

As Dave recalled, “That feedback was like a dagger to my heart. I was in denial, as I didn’t see myself as others saw me. I became a lightning rod for friction, but I had no idea how self-serving I looked to other people. Still, somewhere in my inner core the feedback resonated as true.”

Feedback is important. An honest answer can be hard to get ¬ friends might say what they think you want to hear, enemies might only aim to wound. Probably both are important as well as anything in between. Feedback from all angles, like a larger study sample, can increase overall accuracy. The term ‘360 degree’ assessment encompasses this concept.

And if you know your strengths, build on them. Try to find the environment where you are likely to flourish.

“Only when you operate from a combination of your strengths and self-knowledge can you achieve true and lasting ¬ excellence.”5 “And you may find yourself.…” - Talking Heads References available upon request.

[He] realized that he could not succeed unless he identified and overcame his blind spots.

This same executive discovered similar blind spots in his personal relationships. It was only after his second divorce that [he] was finally able to acknowledge that he still had large blind spots.

“After my second marriage fell apart, I thought I had a wife-selection problem.”

PHYSICIAN AND FAMILY SUPPORT PROGRAM

NOVEMBER - DECEMBER 2014

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FEATURE Emerging Leaders in Health Promotion Grant recipient focuses on obesity and children

B

eginning last January, Dr. Maryana Duchcherer took her concerns about the increasing number of overweight children in Alberta and, as part of the Alberta Medical Association’s (AMA’s) Emerging Leaders in Health Promotion Grant program, she developed a multi-faceted project that focused on increasing children’s awareness of: • Healthy eating habits • The power of physical activity

manifest themselves as an entire generation of Albertans who can expect poor quality of life and a shorter life expectancy than their parents.”

By developing this three-step, school health promotion program for a segment of Alberta population facing a growing risk for health issues, Dr. Duchcherer fulfilled the requirement of the Emerging Leaders in Health Promotion grants program: to promote development of the physician’s role as an advocate for healthy populations.

• The importance of mental well-being Working with 183 K-6 students (five-to-12 years old) from Edmonton’s St. Martin Elementary School, Dr. Duchcherer and her project team developed and delivered the program in three steps via presentations on: the health outcomes of obesity and the importance of emotional well-being; a debate about why obesity should be prevented; and whole school activities (healthy breakfast school initiative and physical activity promotion).

Childhood obesity is a rapidly

emerging health concern in Alberta that has been steadily increasing over the last decade.

Her team included Dr. Sandip Gandham (project mentor), Yanina Vihovska (elementary school teacher), Taras Podildky (school principal), Natalie Harasymiw (school vice-principal), Kathy Kachmistruk (learning coach), Natalia Tyschuk (volunteer teacher) and Sharon Kyrzyk (yoga instructor).

“Childhood obesity is a rapidly emerging health concern in Alberta that has been steadily increasing over the last decade” says Dr. Duchcherer. “You can look around and see its effect, as it translates into various chronic medical conditions in children. Ultimately, these trends can

AMA - ALBERTA DOCTORS’ DIGEST

You can look around and see

obesity’s effect, as it translates into various chronic medical conditions in children.

“With this program, because of the varying ages of the students, I needed to adapt the tools ¬ the presentations, the activities and exercises ¬ to the various audiences,” Dr. Duchcherer explains. “As a physician, I went in and worked with the staff and volunteers at St. Martin Elementary School to engage them in the three steps that would help create an awareness of health (eating, physical activity and mental well-being) among the young school population.”

The program’s first step was to host a 30-minute interactive “Food Fun” session identifying the benefits of nutrition and healthy eating, supporting that with the serving of a healthy and nutritious snack to the students.

For the second step of the program, Dr. Duchcherer and members of her project team educated the students on the value of emotional well-being and self-esteem, using self-regulation exercises, relaxation tools, creativitybased activities and interactive games enhancing the cognitive and sensory systems used in behavioral regulation. Participants were broken into age groups, based on level of attention and comprehension. >

In the mentored and supportive environment provided

by Dr. Sandip Gandham, Dr. Duchcherer met the third requirement of the Emerging Leaders grant program, as she acquired strong leadership and advocacy skills while overseeing the members of her project team and interacting with the elementary school children.

“I plan to collaborate further and expand upon this project, including sharing the results with primary care providers across the country via a poster at the Family Medicine Forum this fall,” Dr. Duchcherer comments.

“My project team is confident that we’ll be able to successfully develop and improve this program for long-term sustainability, which is one of the mandates of the interventions in primary care medicine.”

(L to R) Yanina Vihovska and Dr. Maryana Duchcherer. ( Dr. Maryana Duchcherer)

provided by

> The last step of the program was physical activity, with children again broken into two age groups and provided with a couple of age-appropriate yoga lessons, delivered by a licensed yoga instructor with the Bikram Yoga East Edmonton Studio.

Through the course of the program, Dr. Duchcherer learned the importance of being aware of children’s level of development, comprehension and attention span when designing any type of primary care retention programs for children.

The experience I acquired from this

program, particularly with respect to health promotion, is something I know I’ll be applying to my medical practice in the future.

As she comments on the second requirement of the Emerging Leaders grant program ¬ to provide experience in health promotion as integral to medical practice Dr. Duchcherer says, “The experience I acquired from this program, particularly with respect to health promotion, is something I know I’ll be applying to my medical practice in the future.”

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31

32

FEATURE The role of Alberta physicians in the formation of the Medical Council of Canada J. Robert Lampard, MD

T

he most prolonged debate in the history of the Canadian Medical Association (CMA) has been over the establishment and implementation of a national medical licensing examination.

It took from 1867 to 1913 to secure the approval of all the medical associations, legislatures, House of Commons and CMA, for the Canada Medical Act to be created. The act created the Medical Council of Canada (MCC).

The two official histories of the MCC (Kerr, Vodden) make no mention of the pivotal role of western Canadian and particularly Alberta physicians in its formation. As 2014 celebrates the 100th anniversary of the knighting of Sir Thomas Roddick for his leadership in passing what was then known as the “Roddick” Act, it is time their role was recognized.

The saga began in 1867 when the British North America (BNA) Act assigned health as a provincial responsibility.

That meant physicians could only move from province to province by being re-registered.

The most prolonged debate in the history of the Canadian Medical Association (CMA), has been over the establishment and implementation of a national medical licensing examination.

The first attempt (1867-72) by the CMA’s first president Dr. Charles Tupper, to pass a national act, failed. A national act was a perennial CMA topic, but it was not until 1894 that another CMA committee was appointed under Dr. Roddick, to revisit the topic.

The issue had not come to a head when 40 physicians from the east participated in the NW/Riel Rebellion of 1885 under Deputy Surgeon General Dr. Thomas

AMA - ALBERTA DOCTORS’ DIGEST

Roddick. At that time, the Northwest Territories did not require medical registration.

As a new MP elected in 1896, Roddick proposed the Canada Medical Bill be passed in 1901. Roddick pointed out that military, penitentiary and Northwest Mounted Police (NWMP) physicians could not move from province to province. Interprovincial incidents were already arising.

A Quebec physician treating a patient across the bridge in Ontario was fined three times. The public, Roddick said, were dismayed as “these barriers existed in no other country under the sun. Even between France and Germany there was a 15 mile neutral zone for medical care.”

When Prime Minister Sir Wilfred Laurier realized that any province could opt out, he acquiesced. The act was passed in 1902, subject to every provincial legislature and medical association approving it.

In 1903 the Manitoba, Nova Scotia and Prince Edward Island Medical Associations and Legislatures approved the act, as did the NWTMA and assembly in 1905. An enabling act was included in the Medical Profession Acts of Alberta and Saskatchewan of 1906. Enthused, Manitoba physicians began the Western Canadian Medical Journal (WCMJ) in January 1907. One of its two objectives was to have a western Canadian licensing authority approved, to allow licentiates to move throughout the west. The problem was partially resolved when NWT physicians were grandfathered into both Alberta and Saskatchewan in 1906.

At the 1908 Alberta Medical Association (AMA) annual meeting in Banff, three of the four western provinces agreed to support the Western Canadian Medical Federation concept. British Columbia (BC) physicians feared inundation by doctors from the rest of Canada.

They also favored a national federation over a western one. At the same time, Quebec physicians asked their legislature not to pass an enabling act.

In anticipation of the CMA’s 1909 annual meeting in Winnipeg, Dr. George Kennedy of Fort Macleod wrote a letter in the January 1909 WCMJ recommending the concept be readdressed. Dr. J. Patterson of Manitoba suggested Kennedy lead the charge as the “Western >

> Roddick.” A month later Dr. Robert G. Brett of Banff, addressed Winnipeg physicians on the need to “weed out quacks and illegals, and avoid legislatures licensing physicians through private member bills.” Manitoba’s Dean Dr. Henry H. Chown agreed with the concept so long as Manitoba graduates did not have to write two examinations.

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The seminal contributions of

Alberta physicians to the establishment of the Medical Council of Canada and the national licensing examination system we now have, has been buried for over a century, until now.

Members of the first Dominion Medical Council, November 7-9, 1912. Dr. Kennedy is third from the left and Dr. Brett fifth from the left in the back row. Dr. Roddick is fourth from the left in the front row.

Finally, after meeting with Dr. Roddick, the proposed amendments were approved at the 1910 CMA convention.

In July 1909 a team of four doctors (Brett, Kennedy, T.N. Mulroy and J. Patterson) visited BC to present their rationale. A curricular was sent out to all BC physicians.

Dr. Mulroy of Manitoba wrote to the CMA outlining the western proposal. The Ontario Medical Association was asked for a reciprocity agreement. In their reply, the Ontario Council demanded a BA or BSc and successful passage of the western exam, or five years’ experience and passage of the Ontario exam. The westerners threw the reply out of hand.

At the Winnipeg CMA meeting the western initiative was discussed. It led to a renewed interest in the Roddick proposal by eastern physicians. A committee was struck to suggest amendments and then secure Dr. Roddick’s approval.

At a committee meeting that fall, BC and Saskatchewan physicians suggested a 10-year grandfathering clause.

The premedical entrance requirement was dropped.

Homeopathic doctors were included. Writing the exam was made voluntary. Each province could continue to require their own exam be passed. As the BC representatives still wanted to circulate the proposed amendments to their members, the bill was delayed for another year.

In April 1910 Kennedy summarized the progress. He noted his eastern colleagues held a debt of gratitude to the westerners for “stimulating life into the project.” If the CMA failed, he said, the fallback would be a western federation. His Alberta colleague, registrar Dr. James Lafferty, noted, “it’s unlikely the opportunity will present itself again.”

Drs. Braithwaite, Brett and Kennedy visited the Saskatchewan Medical Council in July 1910 and persuaded them to support the western federation movement, because advancement toward a national examination again stalled.

In November, BC physicians responded positively to the second circular. So on January 23, 1911, Dr. J.B. Black presented the amendments, as a private members bill in the House of Commons. They were passed.

But the deliberations weren’t over. In February 1911 Manitoba, Alberta and Saskatchewan physicians met because they felt under-represented on the Dominion Medical Council, as they had only one medical school.

They asked, and every association agreed, that two of the three federal cabinet appointees could be from the three western provinces. The first ones were Drs. Kennedy (AB), Baptie (BC) and Roddick. The three remaining provinces passed enabling acts in BC (February 1912), Quebec (April 1912) and Ontario (April 1912). Royal assent was given on May 19, 1912. Authority to grant a license to practice was still left to the provinces, while writing the national exam remained voluntary.

At the annual CMA meeting in Edmonton on August 12, 1912, retiring CMA President Dr. Harry G. Mackid of Calgary, accepted a motion to appoint Dr. Roddick as the honorary president of the CMA for the rest of his life. The motion was passed with a chorus of cheers and a standing ovation.

By June 1913, the regulations to the act were passed and the federal government began contributing $15,000 per year, which they did until 1917, to support it.

The first LMCC examinations were held on October 7, 1913, in French and English in Montreal; 41 out of 71 passed. By then 85 physicians had applied for registration under the grandfathering clause.

On June 16, 1914, Dr. Roddick resigned as the first MCC president (and registrant number one), and was made its honorary president for the rest of his life. He was knighted that spring.

The seminal contributions of Alberta physicians to the establishment of the Medical Council of Canada and the national licensing examination system we now have, has been buried for over a century, until now.

NOVEMBER - DECEMBER 2014

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IN A DIFFERENT VEIN

The union and the re-union Alexander H.G. Paterson, MB ChB, MD, FRCP, FACP | CO-EDITOR

“Twas the Scots that built this country, It should never be forgot.

In each Canadian family Somewhere there is a Scot.”

(Bowser and Blue, Montreal Song Book 1994)

E

dinburgh! My 45th anniversary medical school re-union! Edinburgh, dour city of Scots law, medicine, famous writers and regiments; city of sceptics who must be won over to achieve any recognition in arts or sciences ¬ Athens of the North, Edina the Capital ¬ the seat of the enlightenment, the fortress that must be taken and secured to control the Kingdom of Scotland.

Forty-five years! My God, a milestone reached in a twinkling since strutting around the quad of the old medical school in a rented cap and gown, glowing faces with a few blobs of fresh acne, priggishly calling each other “doctor” and receiving a diploma in the McEwan Hall that actually indicated that we were only Bachelors of Medicine and Surgery, not real doctors.

It’s disturbing and invigorating to see old friends, acquaintances, rivals and enemies again after so many years ¬ the safety of slow, imperceptible change in people you see all the time contrasting with the shock, laced with a cackle of amusement, at seeing young faces become old, hair greying, balding with a fattening of facial features and thickening of bone structure like a PowerPoint slide presentation of before and after 45 years, youth and age. Racial characteristics seem to become emphasized with age, faces becoming craggy, losing the softening effect of young bone and sex hormones ¬ wrinkled faces reflecting the sadness or harmony of their preceding life, with fleeting behavior characteristics that you remember ¬ an inane grin, a tilting of the head, a silly laugh.

I was also there two days after the Referendum for Independence ¬ a vote that had taken the world, and certainly the London politicians, by surprise. There

AMA - ALBERTA DOCTORS’ DIGEST

was an atmosphere of fatigue ¬ like the morning after a raucous party ¬ and also a sense of relief, at least in the capital ¬ that the UK had survived. It was the same feeling Canada had in the days after the second Quebec referendum, a feeling that the 300 year old Union of the United Kingdom ¬ just as the unity of Canada had survived by the skin of its teeth, a feeling that the leadership had been caught napping, realizing too late in their conceit and arrogance that they could go down in history as fools and losers in a great tidal wave of change.

And the irony of David Cameron (an ancient Scots family) the British Prime Minister ¬ just as Jean Chrétien (the French Canadian) the Canadian Prime Minister both unpopular in their home territory and unable to sway the vote away from independence.

It’s disturbing and invigorating to see

old friends, acquaintances, rivals and enemies again after so many years.

Scots ¬ whether in Scotland or Canada ¬ can be tiresomely nationalistic. They know there is more expected of one when claiming Scots descent ¬ the extra mile that has to be walked, the extra effort to see the job completed. This curse has been instilled by a Scots granny, a fearsome disapproving arbiter lurking in the subconscious, whose body language and pithy comments conveyed approval or disapproval. Scots also believe that they are known throughout the world as thrifty, adaptable people who invented pretty much everything that the Chinese forgot to invent.

And in the rest of the world there is a bemused agreement that this might be so, and often a feeble effort to join the club by offering up a great grandmother who was from Bogandreip or a second cousin from Strathkipper. >

> Well ... not all. Try telephoning and booking an Avis rental car for an Edinburgh airport pick-up:

35

“Your call is important to us. This call may be used for quality purposes…”

“My name is Wanda. How can I help you?”

“I’d like to book a rental car September 29th for a week from Edinburgh Airport.”

“Edi-burr? Where’s that? ....Sc-ah-tland? Zat Sc-ah-tland, Texas? Can you spell that?”

Not everyone has a Scottish granny.

The world, then, was taken by surprise that trouble was brewing, that a free vote, a referendum on complete independence, a break-up of the historic UK, had been set for September 18, 2014, the 700th anniversary of the Great Battle of Bannockburn (1314) outside Stirling when the Scots (outnumbered three to one) sent packing homeward a mighty army under Edward the Second of England “tae think again.” By the beginning of September, the world was indeed hanging on the battle of the Scottish independence referendum with implications for Catalonia, Quebec, Brittany, Flanders and many other wannabe sovereign regions.

James Bond OO7, Sean Connery, growled “It-sh about bloody time Sh-cotland threw off the Sh-assh-enach yoke.” David Bowie and David Beckham supported the “No ¬ Better Together” campaign, with Harry Potter (funded by J.K. Rowling) putting up $2 million to help.

On the day of the referendum, people reported seeing a cloud formation of the face of Bono hovering over Edinburgh Castle.

But in this sad, brutal world the referendum was perhaps an event to be proud of ¬ although wariness is now creeping in. No one was stuffed into the boot of a car and killed; no one was beaten up or shot by the police; no one was sent to prison for life like Illham Thoti (a Uyghur economist asking for dialogue between the Han Chinese and the Uyghur population in China’s Xinjiang Province); and no one publicly had their head hacked off. It’s true that in Glasgow some discussions ended with the “Glesca nod”1 outside pubs and several discussants received a “Glesca smile”2 but statistically the incidence of punch-ups was no greater than an average month. It was only the topic of dispute that had changed.

This was a nice demonstration of a civilized democracy at work with only a few gatherings getting out of hand.

It showed (as in Quebec) that it is possible to consider major shifts in power without resorting to the gun or knife. This is a jab in the eye to the promoters of pseudo-democracies.

Our medical school re-union intertwined with the referendum on the Union not only in political discussions but in a feeling of unexpected and too rapid change, change that had crept up on us without our realizing that the old ways of thinking were gone, that we were no longer the instruments of change, that a younger generation was forcing us to think differently.

Dr. Paterson beside Greyfriars Bobby, symbol of Loyalty, decked in the Saltire, the St Andrew's Cross, the flag of Scotland. ( provided by Dr. Alexander H.G. Paterson)

The Yes campaign for Independence, led by the non-telegenic Alex Salmond, a fairly quick-witted chap with beady eyes, surged ahead in the closing days with promises of a better life for all ¬ paid for by North Sea Oil. He has what in Glasgow is called “the patter” ¬ a cousin of “the blarney” but with an aspect of showmanship that leaves opponents or doubters gobsmacked. The “patter merchant” has a ready answer for everything and what is more, he looks like he has already won the argument.

The No campaign, led by the more telegenic but patter-lacking Alistair Darling, an Edinburgh lawyer and ex-Labor Party Chancellor of the Exchequer (uncomfortably taunted by the Yes side of being an “Edinburgh toff”) struggled with trying to warn the electorate that difficult financial negotiations would take place if they voted for an isolated socialist paradise.

While money from North Sea Oil may keep things going for a year or two, he said, it was not a great gift to bequeath to the coming generations. All influence on the financial system, the military, immigration and foreign affairs would dwindle. Nationalistic Socialism did not have a happy history.

Scotland however, unlike Quebec, is a ready-made country with its own legal system based on Roman law, its own religion, its own education system, and its banks even print their own bank notes with pictures of the Forth Bridge and Adam Smith. It does not, however, have a Central Bank having given that over to the Bank of England in 1707 at the time of the Union. The bank of dad would be pretty small given the population of five million in an independent country. Canada’s own Mark Carney, > NOVEMBER - DECEMBER 2014

36

> now the governor of the Bank of England, made that clear. Scotland would be on its own. The Yes side sneered that it was all fear mongering.

The Union of Parliaments in 1707 had resulted from the wishes of a Dutch king (William of Orange) tired of dealing with two separate, troublesome parliaments and a financial disaster when half the available capital in Scotland was invested and lost in a forlorn attempt to set up a colony in Panama ¬ an idea of a trading port between the Atlantic and the Pacific 200 years ahead of its time.

The aristocrats who lost money in the Darien Scheme were compensated from the English national debt: “We’re bought and sold for English gold Such a parcel of rogues in a nation!”3

I was also there (in Scotland) two days after the Referendum for Independence – a vote that had taken the world, and certainly the London politicians, by surprise.

Union Jack still flying on Edinburgh Castle the day after the Independence vote was defeated. ( provided by Dr. Alexander H.G. Paterson)

If you ask people in Scotland what new tax powers they want, they usually say they don’t want more tax powers, they want more tax transfers. Like Quebec, the issue is a feeling ¬ not supported by statistics ¬ that money collected from Scotland was staying in London just as Ottawa is the bogeyman here in Canada.

But few think this is the end of the story. In contrast to Quebec where most of the young have eschewed fighting another sovereignty referendum provided they have cheap education, in Scotland it was the young who voted in favor of independence and the old who voted “better together” ¬ the safe but uninspiring slogan of the “No” campaign.

“You’ll hear a lot more from us,” said Gordie, an old friend who voted 'Yes.' “There’s a growing youth movement called Radical Scotland that will come of age as old bozos like you, worried about your pensions, kick the bucket.

That’ll swing the vote at the next referendum.”

In a panic, the three mainstream British political parties offered up “devolution maximum” with few details (where the devil lives). Independence was defeated in a vote 55% for “No” versus 45% for “Yes.” But now the mud-wrestling will begin.

“The UK treasury will resist ¬ and not without reason ¬ ceding fiscal policy. The result is likely to be an unsatisfactory patchwork of reforms that decentralizes some minor aspects of tax policy but puts in place a complex formula beloved of lawyers and accountants that appears to give new powers without really ceding anything.”4 How could it have all come to this?

AMA - ALBERTA DOCTORS’ DIGEST

Wreaths on Covenanters execution block Grassmarket. ( Dr. Alexander H.G. Paterson)

provided by

I had not been to a re-union dinner for years and you tend to stick with the people you knew well at school.

Seeing the ravages of time was unsettling. It was also fascinating to catch up with the peculiar turns in careers of some acquaintances. Mary, a shy girl, had become a well-known forensic psychiatrist and medical director of the State Hospital for the Criminally Insane; she deals with the most hardened psychopathic rapists and murderers. I imagined her tiny presence interviewing a >

> Silence of the Lambs psychopath with two burly guards standing behind her.

And Elspeth had become a palaeontologist of quaternary fossils. I asked Elspeth why she had voted “Yes.” “Simple. We’d be able to influence our own lives better,” she said.

It was the same feeling Canada

had in the days after the second Quebec referendum, a feeling that the 300 year old Union of the United Kingdom – just as the unity of Canada – had survived by the skin of its teeth.

retirement cottage with a boat, appearing pinched and sallow. He was dying of aggressive prostate cancer.

I am ashamed to admit, I didn’t have the heart to sit with poor Rob. As my dear old friend, John, in Edmonton, says: “You never know what’s coming round the corner.”

There was Gollock, the class comedian, in a fancy scarlet dinner jacket and waistcoat, now a successful general surgeon. (“He’s so amusing,” my mother-in-law had said before he took out her colon.) And Pam, a radiologist who had just been diagnosed with an asymptomatic lung cancer: “It was only 3.3 centimetres,” she said. “So I guess I’m lucky. I’m a bit breathless though. Probably the lobectomy.”

Only 3.3 centimetres! I said nothing.

An old friend, Robin, a radiation oncologist, and I compared plastic snoring gizmos. And John, an endocrinologist, who has made a fortune after founding Shire Pharmaceuticals ¬ now a take-over target of AbbVie Corporation who are attempting to avoid United States of America corporate taxes by “inverting” as they call it in the accounting business. And Rocky, hale and hearty with a full head of hair ¬ even covering his Friar Tuck crown, with the merest tinge of grey flecks.

But underneath it all was an undercurrent of death, that this might be the last time we would see each other ¬ the dark spectre of the Man with the Scythe looking over all of our shoulders. Roger, Cliff, Jim ¬ grey haired old men in glasses ¬ I barely knew them then and still don’t know them.

All this was in The New Club (named so in 1787) overlooking the Castle and Princes Street. You enter by an unnoticeable door on Princes Street and walk through the narrow entrance hallway which then magically expands into massive halls, rooms and landings with magnificent oil paintings like the wardrobe entry to the Land of Narnia in “The Lion, the Witch and the Wardrobe.”

"Yes" signs in tenement house windows. (

provided by Dr. Alexander H.G. Paterson)

The politics of “Yes” was a mix of anglophobia, resentment and suspicion that North Sea Oil money was staying in the London area, the notion that decision-making and “social justice” would be served better by an Edinburgh parliament, all salted by an appeal to noble, ancient Scottish traditions. The Saltire5 was draped everywhere (see photograph) even round the neck of the statue of the little dog, Greyfriars Bobby, symbol of loyalty.

And there was Rob, just retired as a consultant obstetrician and gynecologist and settled in his

It was a re-union of medical friends, most of us fairly successful, grown old and a bit weary meeting in an ancient land where the young and the poor had grown tired of a successful Union. A new generation was taking over, willing to risk a lot for the illusion ¬ or possibly the reality, who knows? ¬ of a better life, turning inwards and back to an old regime, in a world where it seemed to us greybeards that this was a mistake, that the way to turn was outwards, looking fearlessly at an increasingly connected, increasingly brutal and rapidly changing world. But the 'Yes' side has momentum. We’re pseudoconnected by technology, but people, nearly half of the Scottish voters, are looking for palpable, real connections.

We have not heard the last of this.

References available upon request.

NOVEMBER - DECEMBER 2014

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CLASSIFIED ADVERTISEMENTS LOCUM WANTED CALGARY AB Internal medicine locum required for busy multidisciplinary clinic from December 12 to January 26, 2015.

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PHYSICIAN WANTED CALGARY AB Part- or full-time physician(s) needed for a new walk-in/family clinic project on Macleod Trail S and Heritage Drive. Physicians would be able to sublease their space or for a good split of 80/20. Great location and visibility facing Macleod Trail. On-site pharmacy. Sublease rate negotiable.

Contact: Rafik T 403.796.4441 CALGARY AB MCI The Doctor’s Office™ has family practice options available in Calgary.

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Contact: Margaret Gillies TF 1.866.624.8222, ext. 133 practice@mcimed.com CALGARY AB Dr. Neville Reddy is recruiting family physicians and specialists for his two medical clinics, Innovations Health Clinic SE and Innovations Health Clinic SW. Competitive expenses offered.

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CALGARY AND EDMONTON AB

EDMONTON AB

Imagine Health Centres in Calgary and Edmonton have an immediate opening for a psychiatrist certified or eligible for certification with the College of Physicians & Surgeons of Alberta (CPSA).

Physicians with compassion for the population of downtown Edmonton are encouraged to apply at the Hope Mission Health Centre. Part- or full-time are welcome.

Imagine Health Centres are dynamic multidisciplinary clinics with a large array of services including family physicians, specialists and many other allied health professionals such as pharmacists, physiotherapists, psychologists and more. Imagine Health Centres is dedicated to promoting the health of patients utilizing the most up to date preventative and screening strategies.

The successful candidate will work closely with our multidisciplinary team to optimize management of our patients with mental health issues.

Collaborate with our large network of family physicians and their referrals to maximize outcomes for your patients.

Opportunities for group therapy and corporate health are available. There are also opportunities to help develop leading programs for mental health at all levels of primary care within our multiple sites located throughout Calgary and Edmonton.

An attractive compensation package will be offered to the successful candidate.

All candidates must be immediately eligible for licensure or already licensed with the CPSA and provide proof of malpractice insurance from the Canadian Medical Protective Association. Compensation is fee-for-service.

All inquiries will be kept strictly confidential and only qualified candidates will be contacted.

Contact: Submit your CV to: Joanne Oliver joanne.oliver@imaginehealthcentres.ca

Physicians will be salaried through Alternative Relationship Plan funding from Alberta Health Services at competitive rates.

Contact: Clinic Manager T 780.422.2018, ext. 278 karen.nelson@hopemission.com EDMONTON AB All Healthy Medical Clinic is a new clinic inside the Great Canadian Superstore at 12350 137 Avenue.

We are looking for a family physician who can work part- or full-time with flexible hours. We offer a 75/25 split, use Healthquest electronic medical records and member of the Edmonton North Primary Care Network.

We have three specialists on site, rheumatologist/internist, neurologist and pediatrician. We operate by appointments and walk-ins.

Contact: Dr. Mohamed Albrbar 12350 137 Ave NW Edmonton AB T5L 4X6 T 780.293.9394 T 780.406.5514 (clinic) zliten1975@yahoo.com EDMONTON AB Urban Medical Clinic in vibrant southeast Edmonton is a new state of-the-art medical clinic that is rapidly expanding. The clinic uses TELUS PS Suite electronic medical records.

Our team currently includes two family physicians and we are part of Edmonton Southside Primary Care Network with full-time nurse and dietician. We have 8,000 patients registered. The clinic is growing and we are recruiting part- and full-time physicians. Competitive overhead for long term commitments. We have eight examination rooms, one procedure room and one specially designed wheelchair room. > NOVEMBER - DECEMBER 2014

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>

Contact: Dr. Oshean Naidoo onaidoo@telus.net or Dr. Dhanakodi Rengan drengan@telus.net T 780.757.9545 EDMONTON AB North Town Medical Centre is looking for part- and full-time family physicians and specialists to join our team. North Town Medical Centre is a multidisciplinary clinic with three family physicians, two specialists and two chiropractors. The clinic is in a strip mall with plenty of free parking, close to medical imaging, pharmacy and laboratory. Modern well-equipped facility with highly trained staff allow for no administrative burdens, electronic medical records, no hospital on-call, plenty of examination rooms, offices for physicians and competitive fee split. Flexible schedule can accommodate physicians who are looking to pick up extra shifts or a new physician wanting to open their practice to new patients.

If interested in knowing more regarding this great opportunity, please contact us.

Contact: Dr. Hassen Taha T 780.905.0027 or Dr. Ataher Mohamed T 780.298.2986 thamad73@yahoo.com EDMONTON AB Beverly Medical Clinic is a new state-of-the-art medical clinic that is rapidly expanding. Our team currently includes three family physicians, two internists and a pediatrician.

The clinic is growing and needs more dedicated family physicians as one of the physicians is planning on slowing down. Competitive overhead for long term commitments; 75/25% split.

We have 10 examination rooms, one treatment room and one specially designed pediatric room.

Contact: Dr. A. Elfourtia or Dr. Z. Ramadan Beverly Medical Clinic 4243 118 Ave Edmonton AB T5W 1A5 T 780.756.7700 C 780.224.7972

AMA - ALBERTA DOCTORS’ DIGEST

EDMONTON AB Ellerslie Medical Centre in southwest Edmonton is seeking part- and full-time physicians. The busy clinic is in a prestigious and fast-growing community which has a high public demand for family physicians. The physician income will be based on fee-for-service with an average annual income of over $300,000. The physician must be licensed or eligible to apply for licensure by the College of Physicians & Surgeons of Alberta (CPSA). For the eligible physicians, their qualifications and experience must comply with the CPSA licensure requirements and guideline.

Contact: Walid 11140 Ellerslie Rd SW Edmonton AB T6W 1A2 T 780.884.4124 walid@ellersliemedicalcentre.com EDMONTON AB Evansdale Medical Clinic, 8214 144 Avenue in Edmonton is looking for a part- and full-time family physician to be part of our community to support and help with patients continuing health care needs. We are looking for a doctor on a permanent basis. We are a growing busy clinic in north Edmonton with friendly, supportive and outgoing staff. Income per year depending on fee per service would be approximately $300,000. Our clinics offer pleasing working conditions with well-equipped modern facility and electronic medical records in each room.

Contact: Dr. A. Aradi T 780.478.0975 F 780.478.0976 Evansdale Medical Clinic 8214 144 Ave Edmonton AB T5E 2H4 Send résumé to: evansdaleclinic@gmail.com EDMONTON AB Two positions are immediately available at the West End Medical Clinic/M. Gaas Professional corporation, located at unit M7, 9509 156 Street, Edmonton AB T5P 4J5.

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 at west end and provide care to all patients of different age group, pediatric, geriatric, antenatal and prenatal care.

The physician income will be based of fee-for-service payment and the overhead fees are negotiable. The physician must be licensed and eligible to apply for the licensure by the College of Physicians & Surgeons of Alberta (CPSA). Their qualifications and experience must comply with the CPSA licensure requirements and guidelines. If you are interested please contact us.

Contact: Dr. Gaas T 780.756.3300 C 780.893.5181 F 780.756.3301 westendmedicalclinic@gmail.com EDMONTON AB Alberta Health Services in partnership with the University of Alberta, Faculty of Medicine & Dentistry, Department of Family Medicine, is inviting applications from family physicians with expertise in geriatrics to join the Glenrose Rehabilitation Hospital Geriatric Inpatient Rehabilitation Program in the Edmonton Zone.

The Glenrose Rehabilitation Hospital is the largest free-standing tertiary rehabilitation center in Canada serving patients of all ages who require complex rehabilitation to enable them to participate in life to the fullest. As a leading-edge academic teaching hospital, the Glenrose participates in educational training programs for health sciences professionals and offers an array of research and technology development opportunities.

The successful candidates will join an integrated group of health care professionals. Geriatric patients are the focus of our service. Treatment includes an integration of medicine, nursing, rehabilitation, social work and pharmacotherapies. These patients have had acute physical, cognitive and social decline in the past two to three months and have reduced independence. The responsibilities for successful individuals would include clinical rehabilitative care for six >

> in-patients, working collaboratively with the interdisciplinary team, participating in an on-call roster (average one in eight second call), completing all administrative data related to cared-for patients, and participating in regular meetings related to patient care and quality improvement. Remuneration is competitive and based on a clinical alternative relationship plan.

The successful applicants shall have a MD or be eligible for certification in family medicine with the Royal College of Physicians and Surgeons of Canada or with the College of Family Physicians and be eligible for licensure with the College of Physicians & Surgeons of Alberta. Training in geriatrics and/or experience in the care of the elderly would be an asset.

We offer core geriatrics training to anyone interested. A proven track record of collaboration and mentoring trainees is preferred. This individual will be encouraged to apply for a clinical academic colleague appointment in the Department of Family Medicine, University of Alberta, which will be considered through a separate process with the Faculty of Medicine & Dentistry.

Edmonton, with a growing population of over one million, is the cosmopolitan capital of Alberta. With an abundance of services, beautiful river valley, community activities and attractive and financially reasonable living accommodations, this energetic city has something for everyone.

Edmonton boasts a superior public education system for school-aged children through Edmonton Public Schools. For more information, visit http://www.epsb.ca/ Details about the University of Alberta, Faculty of Medicine & Dentistry and the Department of Family Medicine can be found on the faculty’s web site at www.med.ualberta.ca; Alberta Health Services can be found at www.albertahealthservices.ca and the City of Edmonton is available at www.edmonton.ca.

Interested candidates should submit a curriculum vitae outlining their current clinical and leadership experience, and three reference letters. We will begin reviewing applications as soon as they are received however the competition will remain open until the position is filled.

All qualified candidates are encouraged to apply; however, Canadians and permanent residents will be given priority. The University of Alberta and Alberta Health Services hire on the basis of merit. We are committed to the principle of equity in employment.

We welcome diversity and encourage applications from all qualified women and men, including persons with disabilities, members of visible minorities and Aboriginal persons.

Contact: Dr. Hubert Kammerer or Dr. Elisa Mori-Torres Co-facility Chiefs, Geriatrics Glenrose Rehabilitation Hospital 10230 111 Avenue NW Edmonton AB T5G 0B7 T 780.920.4773 or 780.910.2509 F 780.735.8846 hkamm@yahoo.com or elisa.mori-torres@ albertahealthservices.ca EDMONTON AND FORT MCMURRAY AB MD Group, Lessard Medical Clinic, West Oliver Medical Centre and Manning Clinic each have 10 examination rooms and Alafia Clinic with four examination rooms are looking for six full-time family physicians. A neurologist, psychiatrist, internist and pediatrician are required at all four clinics.

Two positions are available at the West Oliver Medical Centre in a great downtown area, 101-10538 124 Street and one position at the Lessard Medical Clinic in the west end, 6633 177 Street, Edmonton.

Two positions at Manning Clinic in northwest Edmonton, 220 Manning Crossing and one position at Alafia Clinic, 613-8600 Franklin Avenue in Fort McMurray.

The physician must be licensed or eligible to apply for licensure by 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.

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 lessardclinic@gmail.com LEDUC AB Exciting opportunity for family physicians wanting to start or relocate his or her practice in Leduc. We are an established family medical practice closing due to retirement. Office, medical equipment and supplies included. Office staff willing to continue with practice.

Contact: Jodie (Office Manager) T 780.986.1714 RED DEER AB Well-established family practice clinic with four physicians has an opportunity to add a part- or full-time physician. Diverse patient population, electronic medical records and primary care network support. Hospital privileges necessary, obstetrics optional. Excellent support regarding on-call schedule.

Contact: Dr. L. Ligate F 403.346.4207 lora.l@shaw.ca >

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> SHERWOOD PARK AB Well-established clinic with five family physicians recently expanded and has opportunities for one to two part- or full-time physicians. Flexible hours and competitive fee split. We are in a professional building with laboratory and X-ray on site. We have current electronic medical records, primary care network nurse support and excellent support staff.

PHYSICIAN(S) REQUIRED FT/PT Also locums required

Contact: Dr. Lorraine Hosford T 780.464.9661 lorrainehosford@gmail.com

PHYSICIAN AND/OR LOCUM WANTED CALGARY AND EDMONTON AB You require balance ‌ you demand the best. Join the fastest growing medical group in Alberta to practice medicine the way it was meant to be.

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 available in Calgary or Edmonton. Physicians will enjoy extremely efficient workflows allowing for very attractive remuneration, no hospital on-call, paperless electronic medical records, friendly staff and industry-leading fee splits.

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

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 ownership of our innovative clinics.

We currently have three Edmonton clinics with a fourth coming to

AMA - ALBERTA DOCTORS’ DIGEST

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

Dr. Paul Arnold (780) 970-2070

Windermere (southwest Edmonton) in early 2015. The current clinics are near South Edmonton Common, Old Strathcona and West Edmonton.

We currently have one clinic in southeast Calgary with a second clinic that opened downtown in September.

If you are interested in learning more about our exceptional clinics, please contact us. All inquiries will be kept strictly confidential.

Contact: Joanne Oliver T 780.907.3777 joanne.oliver@imaginehealthcentres.ca EDMONTON AB Summerside Medical Clinic and Edge Centre Walk-in Clinic require part-time and full-time physicians.

Locums are welcome. The clinics are in the vibrant, rapidly growing communities of Summerside and Mill Woods. Examination rooms are fully equipped with electronic medical records, printers in all examination rooms and separate procedure room.

Contact: Dr. Nirmala Brar T 780.249.2727 nimmi@theplaza.ca

PRACTICE FOR SALE CALGARY AB Well-established group family medicine practice for sale in northwest Calgary. Part of the Calgary Foothills Primary Care Network co-located with physiotherapy, rehabilitation, dentist, optometrist and pharmacies. Turn-key solution, furnished, all equipment and new computer hardware included. Large patient base and sufficient Physician Office System Program funding remaining to assume. Ten examination rooms, five physician practice, leased premises, clinic manager with experienced staff including registered nurse and licensed practical nurse.

Contact: Dr. Virani drvirani@shaw.ca >

>

COURSES CME CRUISES WITH SEA COURSES CRUISES • Accredited for family physicians and specialists • Unbiased and pharma-free • Canada’s first choice in CMEatSEA® since 1995 • Companion cruises FREE AUSTRALIA AND SOUTH PACIFIC January 16-30, 2015 Focus: Rheumatology, gastroenterology and infectious diseases Ship: Oosterdam ANTARCTIC AND SOUTH AMERICA February 3-24, 2015 Focus: Explorations in medicine Ship: Seabourn Quest EASTERN CARIBBEAN March 14-22, 2015 Focus: Primary Care Update Ship: Independence of the Seas TAHITI AND TUAMOTUS March 18-28, 2015 Focus: Geriatrics, physician health Ship: Paul Gauguin HAWAIIAN ISLANDS April 20-May 1, 2015 Focus: Improved patient care Ship: Celebrity Solstice DALMATIAN COAST May 28-June 9, 2015 Focus: Cardiology and dermatology Ship: Celebrity Constellation EXOTIC ASIA June 15-24, 2015 Focus: Women’s health and endocrinology Ship: Quantum of the Seas BRITISH ISLES July 15-27, 2015 Focus: Endocrinology, gastroenterology and infectious diseases Ship: Celebrity Silhouette

ALASKA GLACIERS August 2-9, 2015 Focus: Cardiology and respirology Ship: Celebrity Infinity MEDITERRANEAN September 19-October 2, 2015 Focus: Challenges in medicine Ship: Celebrity Equinox ST. LAWRENCE September 19-27, 2015 Focus: Third annual McGill CME cruise Ship: Crystal Symphony FIJI TO TAHITI November 10-21, 2015 Focus: Endocrinology and diabetes Ship: Paul Gauguin SOUTH AFRICA November 24-December 9, 2015 Focus: Adventures in medicine Ship: Regent Seven Seas Mariner CARIBBEAN NEW YEAR’S December 27, 2015-January 3, 2016 Focus: Dermatology and women’s health Ship: Freedom of the Seas AUSTRALIA AND NEW ZEALAND January 5-19, 2016 Focus: Caring for an aging patient Ship: Celebrity Solstice For current promotions and pricing, contact: Sea Courses Cruises TF 1.888.647.7327 cruises@seacourses.com www.seacourses.com

SERVICES

RECORD STORAGE & RETRIEVAL SERVICES INC. Closing your practice? RSRS provides free paper and electronic record storage, retention, notification, transfer and shredding for Alberta doctors. RSRS is physician-managed since 1997. We also provide scanning and storage services for active practices.

Contact: RSRS TF 1.888.563.3732, ext. 2 F 1.877.398.5932 info@rsrs.com www.rsrs.com RUTWIND BRAR PROFESSIONAL ACCOUNTANTS With an established medical PC clientele, we are able to efficiently and effectively meet all of your financial needs. Our services include PC incorporations, tax planning specifically designed for physicians, their families and their PCs, as well as full accounting services.

Contact: Rutwind Brar Professional Accountants T 780.483.5490 F 780.483.5492 rbadmin@rbpa.ca www.rbpa.ca

DISPLAY OR CLASSIFIED ADS TO PLACE OR RENEW, CONTACT:

DOCUDAVIT MEDICAL SOLUTIONS

Daphne C. Andrychuk

Retiring, moving or closing your family or general practice, physician’s estate? DOCUdavit Medical Solutions provides free storage for your paper or electronic patient records with no hidden costs. We also provide great rates for closing specialists.

Communications Assistant, Public Affairs

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

Alberta Medical Association T 780.482.2626, ext. 275 TF 1.800.272.9680, ext. 275 F 780.482.5445 daphne.andrychuk@ albertadoctors.org

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“I INVEST WITH MD BECAUSE THEY’RE EXPERTS.” − Dr. Ralph Jones, Family Physician

MOST CANADIAN PHYSICIANS CHOOSE MD AS THEIR PRIMARY INVESTMENT FIRM.1 MD is the only financial services firm created to meet the specific needs of physicians. We offer personalized, objective advice on everything from investments and incorporation, to insurance, banking, borrowing and estate and trust.

WHY WILL YOU INVEST WITH MD? CONTACT AN MD ADVISOR TODAY TO DISCUSS YOUR INVESTMENT NEEDS.

1 877 877-3706 | md.cma.ca/invest

1 MD Physician Services Loyalty Survey, June 2014. Respondents (MD clients and non-MD clients) asked to identify their primary financial institution (MD or Other), and then rate their level of trust associated with that institution.

MD received the highest trust rating compared to all other firms rated.

MD Physician Services provides financial products and services, the MD family of mutual funds and investment counselling services through the MD group of companies. Incorporation guidance limited to asset allocation and integrating corporate entities into financial plans and wealth strategies. Professional legal, tax and accounting advice regarding incorporation should be obtained in respect to an individual’s specific circumstances.

Banking products are offered by National Bank of Canada’s Partnership Branch through a relationship with MD Management Limited.