Alberta Doctors' Digest September/October 2016 by Alberta Medical Association

Alberta Doctors'

DIGEST September-October 2016 | Volume 41 | Number 5

Stewardship in an integrated health care system What it means for physicians and patients

Emerging Leaders in Health Promotion grant program

- Addictions & Teenagers - CalgaryRefugeeHealth.com

North/South Doctors’ Golf Tournament a swinging success 89th annual tournament raises nearly $40,000 for medical student bursaries

It’s that time of year!

Alberta Medical Association Youth Run Club hits its stride Patients First®

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 14 Health Law Update 16 Insurance Insights 20 Dr. Gadget

Co-Editor: Alexander H.G. Paterson, MB ChB, MD, FRCP, FACP Editor-in-Chief: Marvin Polis President: Padraic E. Carr, BMedSc, MD, FRCPC, DABPN President-Elect: Neil D.J. Cooper, MD, FRCPC, Dip. Sport Med. Immediate Past President: Carl W. Nohr, MDCM, PhD, FRCSC, FACS Alberta Medical Association 12230 106 Ave NW Edmonton AB T5N 3Z1 T 780.482.2626 TF 1.800.272.9680 F 780.482.5445 amamail@albertadoctors.org www.albertadoctors.org

28 PFSP Perspectives 35 In a Different Vein 39 Classified Advertisements

FEATURES

6 Stewardship in an integrated health care system

What it means for physicians and patients

10 Emerging Leaders in Health Promotion grant program

Addictions & Teenagers: Junior High Health Promotion

12 Emerging Leaders in Health Promotion grant program

CalgaryRefugeeHealth.com

19 North/South Doctors’ Golf Tournament a swinging success

89th annual tournament raises nearly $40,000 for medical student bursaries

November-December issue deadline: October 13

22 Serving in the Great War. Surviving diabetes. Making an outstanding contribution to medicine in Alberta.

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.

The amazing life of Dr. J.J. (Johnny) Ower, University of Alberta Dean of Medicine (1945-48)

25 It’s that time of year! Alberta Medical Association Youth Run Club hits its stride

32 New infection prevention and control general standards now in effect

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

To request article references, contact:

daphne.andrychuk@albertadoctors.org

COVER PHOTO: Alberta Medical Association Immediate Past President Dr. Carl W. Nohr SEPTEMBER - OCTOBER 2016

FROM THE EDITOR

On luck Dennis W. Jirsch, MD, PhD | EDITOR

“People generally get what they deserve …”

heard this remark from an after-dinner speaker at an awards ceremony a while ago. It was a general congratulatory comment that seemed innocent enough but it stayed with me – “stuck in my craw,” as they say. Mulling it over I realize the phrase bothers me because it’s wrong. Though hard work and intelligence are doubtless needed for career accomplishment, they aren’t enough. Many talented people don’t get what they deserve. What’s missing? Well, luck is missing. Most of us got our big break when we were born into middle-class families in the developed world, into circumstances which nurtured achievement. We’re often oblivious to this, perhaps in the same way that fish may disregard water. Philosopher Arthur Schopenhauer reminded us that sagacity, strength and luck are the great three powers in the world. Most would agree, but not everyone. “I don’t believe in luck,” a visiting doc once told me, adding, “I make my own luck!”

Most of us got our big break when we

were born into middle-class families in the developed world, into circumstances which nurtured achievement. We’re often oblivious to this, perhaps in the same way that fish may disregard water.

AMA - ALBERTA DOCTORS’ DIGEST

I’ve heard this from a few others, too, and wonder whether it connotes a certain insensitivity, arrogance, or at least a very thick skin. Ask others – the majority – about the arcs of career, livelihood or mate and they will readily agree that luck (good and bad) has figured prominently in their lives. The same luck-denying fellow, I recall, went on to tell me, “I don’t get ulcers, I give them.” We often consider our society as a meritocracy or a society built on achievement. The term was coined nearly 60 years ago by sociologist Dr. Michael Young who reasoned that a pure meritocracy, getting people to attribute their successes solely to individual effort and ability, is tantamount to self-aggrandizement.1 The notion of merit raises questions not only regarding measuring achievement (by whom, when, how often, etc.), but also concerns regarding social equity and fairness. We can expect, moreover, that individuals, once selected, will try to keep their positions through the use of influence or the biases inherent in corporate culture. Very quickly a meritocracy will morph into a self-sustaining elite. A meritocracy, moreover, failing to appreciate the role of luck or chance in our lives, promises to make us more reluctant to deal with the problems of “the commons” (poverty, hunger, disadvantage and so on) and divides us into winners and losers. Woe betide the designation “loser.” On the other hand, we celebrate and fete winners in an extraordinary way: the CEO’s of our largest corporations are paid 400 times more than the average worker, up from the 40-fold gap noted in 1980.2 Luck is an old concept and games of chance date to prehistory. The astragalus or ankle bone from goats and horses has a characteristic cuboid shape and, in sets of two or three and suitably marked, was likely the forerunner of dice. The oldest board game, known as Senet,3 has been found in burial chambers dating to 3500 BC, including four found in Tutankhamen’s tomb. The Royal Game of Ur,3 another game of chance in which a throw of dice is used to move pawns toward a goal, was discovered in Iraq in the late 1920s and dates to around 2600 BC. We have the goddesses Fortuna from Roman times, Tyche from Greece and recall that many ancient religious tracts advise on the drawing of “lots.” Recall Ecclesiastes 9:11, “… chance happeneth to them all.” >

> The English noun luck came to us from the German “luk,” a short form of “gelucke” that likely found its way into English as a gambling term. The evolution of our cerebral hemispheres has meant that we look for patterns and associations everywhere. Accordingly, many supernatural beliefs regarding luck or chance persist and we have good luck associations with horseshoes, four leaf clovers, rabbit’s feet, etc. and, similarly, we think darkly of black cats, cracks in the sidewalk and so on. My own notable stroke of luck occurred in medical school one late evening when I heard a knock at the door and a caller told me I had won a car. I didn’t believe the first caller, or the second, and considered it a hoax or practical joke. But it wasn’t, and I had won not only a car but an accompanying trailer too. Once I believed the news I was exhilarated, but on further thought I was disturbed and found myself wondering if my good fortune had come all at once and was now gone.

Our ability to understand and

predict the workings of the world may be limited. This is uncomfortable. We would like the world to be more comprehensible, but it isn’t, and recent notions from physics have reinforced the role of chance.

I wasn’t thinking clearly. The notion that an event – in this case, my stroke of luck – may be more or less likely to occur because it happened recently is akin to the notion that if you flip a coin 10 times and eight times it comes up “heads,” that the next tosses are likely to be “tails” in order to “catch up,” is just wrong. A streak of good luck doesn’t jinx anything and a bad run of things doesn’t mean good luck is due. It’s called the “gambler’s fallacy.” Our understanding of probability mathematics in fact owes much to persons seeking to understand games of chance. Probability theory began in 17th century France when Blaise Pascal and Pierre de Fermat corresponded regarding games of chance and went on to influence others, including Huygens, Bernoulli and DeMoivre. Indeed the science of mathematical gaming odds might have developed earlier than the late Renaissance, if Christian theologians since the 4th century had not condemned gambling of all types. Today probability theory is a well-established branch of mathematics with many applications such as weather prediction and risks of new treatment procedures. We are all acquainted with the so-called “butterfly effect” whereby a thunderous storm might conceivably have its beginnings in the remote flapping of a butterflies wings. The notion, developed by meteorologist Edward Lorenz,4

has become a metaphor for small and seemingly trivial events that can accumulate into large consequences. This has been largely misinterpreted to mean that the job of unravelling all these connections is just a bigger one, but this isn’t what Lorenz had in mind. Lorenz felt that initial conditions may be impossible to determine in the countless interconnections with nature and these may defy measurement. The implications are enormous: certain systems, in this case the weather system, are inherently unpredictable. In turn, our ability to understand and predict the workings of the world may be limited.

Our worldview then must

accommodate a tangled skein of both determined events, where cause can be pinpointed, and randomness, which figures largely in our lives.

This is uncomfortable. We would like the world to be more comprehensible, but it isn’t, and recent notions from physics have reinforced the role of chance. Though Einstein famously suggested that God doesn’t play dice with the universe, his own work on wave-particle duality, along with Heisenberg’s uncertainty principle and Max Planck’s work on quantum mechanics, show that chance is an elemental force in nature. Our worldview then must accommodate a tangled skein of both determined events, where cause can be pinpointed and randomness, which figures largely in our lives.

It behooves us to be humble since

there are things we can neither comprehend nor do much about.

The point of the exercise is two-fold. It behooves us to be humble since there are things we can neither comprehend nor do much about. Secondly it reinforces our need for equanimity and here I’m reminded of that old Oslerian tome: Aequanimitas.5 Physicians, on familiar ground here, can relate. “Doctoring” can be an arduous thing, given the mysterious and erratic nature of illness and the need for unruffled, committed care. Still, in a capricious world, good luck is always welcome. References available upon request.

SEPTEMBER - OCTOBER 2016

COVER FEATURE Stewardship in an integrated health care system What it means for physicians and patients Carl W. Nohr, MDCM, PhD, FRCSC, FACS | AMA

he SeptemberOctober issue of Alberta Doctors’ Digest (ADD) coincides with the end of Dr. Carl W. Nohr’s term as Alberta Medical Association (AMA) president. Many physician leaders were present at the fall Representative Forum and Annual General Meeting September 23-24 when he gave his valedictory address. We thought this particular ADD issue would be an appropriate space for him to explore some important thoughts he would like to leave with the profession. What do we mean when we talk about physician stewardship in an integrated health care system? A steward is responsible for the care and prudent use of the property of another. In this case we are talking about both of the important professional relationships we have with government and with patients.

It is our professional

responsibility to be effective stewards over the resources we use on behalf of patients.

The decisions we make account for a large percentage of health care expenditures. There is a balance between authority and accountability. Beyond the fiscal considerations, our decisions also obviously have a major impact on the health of patients. We also have a significant influence on how patients spend their time and resources, and in that sense, we could consider ourselves stewards of the property of our patients. Why is this an important subject for us? It is our professional responsibility to be effective stewards over the resources we use on behalf of patients. There are also benefits for the steward in return for effective stewardship. I believe that effective stewardship is

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IMMEDIATE PAST PRESIDENT

also intrinsically rewarding and is a great source of professional satisfaction and happiness. This relationship is more fully expressed as the social contract between the profession and society, which I will say more about later. First, I will describe our relationship to the payer. In a public health care system, resources are owned by society and dispensed by government. We usually think that the only thing a doctor should consider in making decisions is the need of the patient to whom he or she is immediately attending. That must always be the primary concern, but we must also remember that, in the choices we make for one patient, there is an element of stewardship for all health resources. Physician decisions drive about 70% (or more) of the costs in the system. There is a fiscal reality to consider in health care costs. That is why stewardship is one of our professional responsibilities. To be effective as stewards, though, certain conditions must be met. To be trustworthy, a steward must be trusted. To live within his/her means, a steward must have the authority to manage resources assigned to him/her. To manage resources, a steward must have the necessary tools, for example, current information about costs and how one’s choices compare with others across the system. There must be a mechanism for the steward to report back to the owner about how the resources have been managed. This requires exchange of information between the profession and government. Stewardship is also embedded in the social contract between society and physicians. Society provides us with autonomy, trust, self-regulation, monopoly, status and rewards. In turn, we provide compassion, availability and accountability, working for the public good with altruistic service. There is an obligatory relationship between society and physicians in this regard. If either society or physicians vary their terms in the contract, there is an unavoidable and corresponding variance by the other party. The link between these two parties in this contract can be described as professionalism. See an illustration of this concept accompanying this article. >

> Every time you see a patient, think of it is an opportunity to reshape the health care system. We can do this by positively shifting the social contract equation to improve the relationship, not only with that patient, but also with society in general. Ultimately, this will create a positive patient experience, provide happiness and system success. Management changes cannot do this. We can do it only through the individual choices each of us makes, every time we interact with a patient. Integration is an approach to health care that involves a high degree of communication, collaboration and coordination among providers and patients to meet the needs of the whole person. Integration around the individual patient or a defined population creates a seamless patient experience. This is the most effective approach to prevention, acute care and chronic illness management. It also affords opportunities to address social determinants of health. The need for an integrated health care system is based on changing patient attitudes and demographics, advances in technology, the increased need for chronic illness management and, importantly, on the failure over recent years to improve health outcomes by simply doing more of the same. Among Commonwealth countries, Canada ranks 5th of 11 in expenditures and 10th in performance. While the introduction of Medicare was a significant social event that has become a pillar of Canadian society, we cannot continue in the belief that yesterday’s success is sufficient to meet tomorrow’s challenges. Instead of regarding the patient as a consumer of health services produced by providers in a system managed by the providers, we must shift our thinking toward the concept of co-production of health services by providers and patients working together to create what the patient values, in a co-managed system. We should move from viewing health care as a commodity produced by a system of providers to the view that it is a collection of services co-produced by patients and providers, based on the values of the patients. This will lead to patient-centered integration. There are several global trends that require these changes. They include: • Cost. Health services generated by the system must have a justifiable value to patients, be affordable by the payer and be cost effective. • Shift from acute care to health maintenance and prevention. The system must continue to provide “fixes” when health is damaged, but must do more to develop and maintain health of individuals and populations. • Technological innovation. Using self-monitoring devices and apps, patients can now generate their own value for some health services. The role of providers will need to evolve to co-manager of such services. • Generational changes in needs and expectations. There is an evolution in generational thinking regarding connectedness, convenience, choice, value, access to information and use of time.

To serve today’s patients the system must focus on what they value by providing connectedness, convenience and choice while maintaining acceptable cost. The traditional quadruple aim of health care (patient experience, population health, per capita cost and provider experience) is system-focused, and should evolve to a model where patient and provider co-produce health outcomes that the patient values. This new model would meet the definition of the oft-repeated motto of “patient-centered” care.

Among Commonwealth

countries, Canada ranks 5th of 11 in expenditures and 10th in performance.

How are physicians involved in integrated health care? The principles of integrated care that relate to physicians are stewardship, professionalism and co-management. I have written before about stewardship as part of the social contract between the medical profession and society. For these principles to be realized, the role of providers in several areas needs to evolve. They include: • Information management • Communication • Physician compensation and equity • Definition of value • Definition of autonomy • Precision self-regulation The traditional role of physicians as medical experts will continue. How we exercise that role will change based on evolution in patient expectations, value systems and fiscal realities. Information management, particularly patient access to it, will change. The traditional view of comprehensive autonomy in all aspects of physician life, including clinical work, information management, as well as business arrangements and compensation models, will adapt to the population and payer requirements of convenience and value as well as fiscal realities. Regulatory bodies will move to data-enhanced precision education and regulation of members.

Do we have integrated health care in Alberta? We have facility integration through a single health authority, but we do not have complete integration of the patient’s path. Primary care networks and strategic clinical networks have done pioneering work to link pieces of the continuum of care, but more is needed. Attachment to a primary care provider is the entry level of integration. Beyond that, we must address many >

SEPTEMBER - OCTOBER 2016

> challenges. Today, patients experience episodic, poorly coordinated care in multiple locations without effective coordination. We have fragmented care pathways, with a blend of traditional referral patterns. There are inconsistent protocols, isolated triage tools, some common intake approaches blended with specialty clinics and clinicians practicing independently at multiple sites that the patient must visit in sequence. We have patient information in multiple locations, often inaccessible to providers and likely leading to error, inefficiency, repetition and redundancy. We move patients around from site to site rather than moving their information. We have weak linkages between community and facility-based care, and between primary and specialist providers. We have complicated branching pathways with built-in delays that require the use of navigators to get a patient through the system.

What about the patient perspective? This is a description of what I imagine my experience would be like as a patient in an integrated system: • All my providers and I will have convenient access to my health information. • I am no longer the medium through which information is exchanged between multiple providers. • I do not have to repeat myself; my medication information is updated in real time and available to all providers and me. • I will not have diagnostic tests unnecessarily repeated. • I have convenient access to information to help me make informed choices, so I am a member of my own health care team. • I can choose among providers, accessing care simply, effectively and in a relevant time frame.

Historically, health care was

something that was done to patients. Currently, it is something we do for patients. We need to move to an era where health care is something we do with patients. When this happens, we will have achieved integration around the patient.

How will we know when we have an integrated system? From the physician’s perspective, integration will provide: • Easy access to necessary medical information, clinical decision support tools, documentation that creates context for decision-making, clinical reminders, access to care pathways (into secondary care and back) and effective provider-to-provider communications. • Access by physicians to data about their own patterns of practice that can identify if they are trending away from best practice, revealing opportunities to improve service to defined patient populations. • Ability to communicate with patients through several means, reducing the need for short in-person visits to provide services that could be provided through more modern methods. • Assistance from patients to monitor their own health conditions through the use of technology. From the government’s perspective, integration will provide better measures of accessibility and quality. Tracking and studying population health needs through secondary usage of data will facilitate budgeting. Resource planning with provider associations will support geographically equitable access.

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• I can make, confirm and change appointments with multiple providers with a single call, website or app. • Members of my health team and I communicate in a variety of ways that meet the clinical need and respect my time. • I can find my way through the system without navigators. • I can help to monitor my own conditions with technology and my providers have access to that information. Historically, health care was something that was done to patients. Currently, it is something we do for patients. We need to move to an era where health care is something we do with patients. When this happens, we will have achieved integration around the patient.

All health care system designs are

imperfect, but some are good enough to get started on the path to integrated care.

What’s next? For decades, we have planned to reform the system, producing endless designs and redesigns. We have engaged in pilot projects, but failed to upscale success. There are several reasons for this: lack of alignment of authority and accountability; a desire for a single solution with agreement by all stakeholders; and disjointed leadership are among them. It is time to act definitively. Building consensus is useful, but when agreement on a direction is not achievable, leadership is required to move forward. There will be failures; the appropriate response to this is not fear. >

There is an obligatory relationship between society and physicians. lf either society or physicians vary their terms in the relationship, there is an unavoidable and corresponding var¡ance by the other party. The link between these two parties is professional¡sm.

Instead we should expect them, recover from failures quickly and learn from the experience. All health care system designs are imperfect, but some are good enough to get started on the path to integrated care. There are some positive indicators. The three pillars of integrated health care are information, innovation and interest. The Government of Alberta is investing significantly in an integrated health information management system. The need for innovation is increasingly obvious and is inevitable. When I say interest is the third component, I refer to the interest of the physicians and society in meeting the terms of the social contract that exists between us. There is an increased emphasis on medical professionalism, which I applaud, as I have written about before. We need to ask some hard questions of ourselves. Are current methods of compensation optimal for effective stewardship, or are they in the way? Is the

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business model of medical practice compatible with stewardship and fiscal sustainability? Would equity in physician compensation be more consistent with the terms of the social contract we have with society? How do we practically engage patients in co-production and co-management of health services they value? How do we manage our health records so that they can be readily shared with multiple providers in the circle of care and be accessible to the patient? I know I live in a world of imagination and hope. These things sustain me as I seek to make a little difference in the lives of a few patients. I appreciate the interest of those of you who have been so kind as to read this. I ask you to be thoughtful in your day-to-day work; if you make some small progressive changes toward a stewardshipbased, integrated approach to care, I know we will have better patient outcomes and achieve fiscal sustainability, while also gaining greater personal and professional satisfaction, and a happier life.

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SEPTEMBER - OCTOBER 2016

FEATURE

Emerging Leaders in Health Promotion grant program Addictions & Teenagers: Junior High Health Promotion Vanda Killeen, BA, DipAd/PR | SENIOR

COMMUNICATIONS CONSULTANT, AMA PUBLIC AFFAIRS

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

o you remember the last time you were approached on the street and offered drugs? Probably not. But many 12-year-olds attending Edmonton’s inner city Spruce Avenue Junior High School are unfortunately all-too-familiar with this situation, because it’s an almost daily occurrence. And therein lies the real “eye-opener” moment during his Emerging Leaders in Health Promotion grant program project – Addictions & Teenagers: Junior High Health Promotion – for Dr. Reji Thomas, a resident in psychiatry at the University of Alberta (U of A). “This project opened my eyes to how much of an issue drugs are and at a much earlier age than I ever imagined,” says Dr. Thomas. “It’s terrible that 12-year-olds have to be prepared to decline drugs on their walks to-and-from school on a daily basis.” With its location in a high-risk, low-income area of Edmonton, along with the school’s increasing rate of substance abuse and possession-related offences by students (as many as 40 in one month), Spruce Avenue was a prime venue with a student population ideally suited to Dr. Thomas’s ELiHP project, which sought to: • Increase awareness among junior high students about drugs and the sequelae of drugs, by educating about positive lifestyle choices and knowledge translation; • Familiarize students with addiction and mental health resources – what’s available and where to find it; and

AMA - ALBERTA DOCTORS’ DIGEST

• Encourage students to take an active role against drugs and teach them how to help each other (peer support) and be safe in an environment of drug abuse. Having reached the school’s entire population of 267 grade seven-to-nine students during the school’s mandatory-attendance events of Health Week, Dr. Thomas comments, “While we hoped to prevent future addictions-related harm through education and example (through impactful speeches and presentations), we realized that just focusing on addictions themselves was not enough.” “It’s equally important to show the students activities and habits that can replace the substances, which are often taken and abused in an effort to fill a void (or voids) in life. They’re an ‘easy out’ with temporary benefits, such as providing a peer group (though obviously not a beneficial one) and an escape.” “So we focused on other avenues of healthy living,” continues Dr. Thomas, “such as yoga, healthy eating and potential careers in emergency medical services, health-related fields and the police service, in an attempt to provide some direction.” Over two days during Spruce Avenue’s Health Week last February, as part of his “Boot Camp,” Dr. Thomas arranged for speeches and presentations from a variety of related health authorities, including U of A dietician students, a gang affairs expert, representatives from the Edmonton Police Service and Emergency Medical Services, a representative from Alberta Health Services (Youth Addictions Services Edmonton), a patient advocate and a yoga instructor. “One of our most inspiring speakers was the patient advocate, who was related to a teacher recovering from a crystal meth-use disorder,” he explains. “The students were obviously very inspired by her.” The feedback Dr. Thomas received on his health promotion project was reassuringly positive, as students commented, “I will think about this the next time I’m asked about drugs;” “I didn’t know it was that bad;” and “The gangs are not for me.” >

> Motivated by his own beliefs that “a life without drugs is much better than escaping to a life with drugs, and help is available if you think and feel otherwise” and that “this message needs to be shared and supported by community, family, school, society and health care professionals,” Dr. Thomas attributes much of his inspiration to his mentor, Dr. Glen Ming, a family physician with special interests in addictions prevention. “Dr. Ming helped me stay focused on the goals of the project. His knowledge of addiction issues in adolescents and the power of prevention were inspiring. He was vital in giving the project the appropriate scope and his enthusiasm certainly helped!” Dr. Thomas commented. Reflecting on the health promotion advocacy skills he gathered from his ELiHP project, Dr. Thomas adds, “I’m motivated to help youth and I know this project has provided me with a better perspective of what they go through. When I see a patient in emergency with substance abuse issues, I will be sure to enquire about the root of the issue and how it started, because the community is such an important factor, as is the need to more healthfully fill the void that drugs are currently filling.”

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

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FEATURE

Emerging Leaders in Health Promotion grant program CalgaryRefugeeHealth.com Vanda Killeen, BA, DipAd/PR | SENIOR

COMMUNICATIONS CONSULTANT, AMA PUBLIC AFFAIRS

arly in March 2014, as they began the initial research with clinicians of refugee clinics for their Emerging Leaders in Health Promotion (ELiHP) grant program project – CalgaryRefugeeHealth.com – Dr. Varun Suresh, project lead, and his project team members, Dr. Misha Bawa, Dr. Haotian Wang and Dr. Richard Chan, quickly realized the under-served health issue that their ELiHP project could address.

CalgaryRefugeeHealth.com

For refugees

“In addition to the opportunities we had to interact with some of the refugees living in Calgary, we interviewed primary care physicians about their experiences addressing health concerns for those new to the medical system,” Dr. Wang explains.

CalgaryRefugeeHealth.com was developed as an online repository for these resources, ranging from health care-related resources for refugees, such as information brochures, health care services (family doctors, dentists, optometrists) and information on the Mosaic Refugee Health Clinic (MRHC) for Newcomers to Calgary, to other “getting settled” resources, including services available to help acquire skills and find work, language resources and community associations.

“We identified two issues: the difficulties refugees face trying to find and access local health resources (such as the refugee clinic and family doctors) as well as the lack of support for primary care physicians who care for refugee populations.”

Several of the resources are available in more than one language, such as the “Find a Family Doctor” resource, with three language preference options (Arabic, French and Farsi) and the information brochures, some of which are available in as many as 14 languages.

Dr. Suresh and his team found that while there were numerous refugee health care resources in and around Calgary and referenced on the Internet, there was no single, central system that compiled these various resources into one easy-to-use, easy-to-find resource.

“We wanted to create a fully functioning website that is both cost effective and easy-to-use,” Dr. Wang explains. “We also wanted to make it the main site for the Mosaic Refugee Clinic and have many of the website’s resources professionally translated into the common languages spoken by refugees arriving in Calgary.” >

AMA - ALBERTA DOCTORS’ DIGEST

> For clinicians

Not to overlook the second under-served issue identified by Dr. Suresh and his team, the website features an area for clinicians, with sections addressing funding and billing (with information on reimbursement for treating refugee patients), checklists and lab requisition forms and cultural profiles, which provides “key health and socioeconomic data for individual countries and tropic diseases by region” sourced from the World Health Organization. In many instances, the cultural profiles are linked to external websites, such as RefugeeHealth.ca, operated by Refugee Health Vancouver.

(L to R) Dr. Varun Suresh, Dr. Richard Chan and Dr. Misha Bawa

RefugeeHealth.ca

Commenting on the clinician-focused content featured on CalgaryRefugeeHealth.com, Dr. Chan adds, “I look forward to contributing my direct experiences as a family medicine resident to make the website a useful tool for the general practitioner.” Many hands are at work behind the scenes of most good websites and CalgaryRefugeeHealth.com is no exception. The development, updating and maintenance of the website reflect the efforts of Dr. Suresh and his project team; University of Calgary medical students; Eric Norrie, MRHC website contact; and the Calgary Catholic Immigration Society. Project mentor, Dr. Annalee Coakley, played a pivotal role in the inception and development of the website. Dr. Coakley is a practicing family doctor and is lead physician at the MRHC, with a special interest in refugee health and tropical medicine. “From reviewing our project proposals, presentations and posters to emphasizing the need for this website in the Calgary area, and her involvement in the design and requirements of the site – particularly its need to address the issues faced by both family physicians and refugees – Dr. Coakley’s support has been invaluable,” Dr. Bawa comments. With the many health care services delivered by CalgaryRefugeeHealth.com to physicians, refugees and

(L to R) Dr. Haotian Wang and Dr. Misha Bawa

immigrants, the website capably addresses the health promotion requirement of the ELiHP grant program, as it “enhances the wellbeing of Albertans through education, advocacy or community service.” Since the website’s launch in June 2015, there has been a lot of interest from other jurisdictions. The project team presented on the development of the website at the North American Refugee Health Conference in Toronto and at the Leaders in Medicine Symposium in Calgary. “I think we’ve all found health advocacy to be an incredibly satisfying experience. The support and encouragement we’ve received from our peers and conference attendees has been tremendous,” notes Dr. Suresh.

SEPTEMBER - OCTOBER 2016

HEALTH LAW UPDATE

More thoughts about the Office of the Information and Privacy Commissioner Custodian vs. affiliate in the world of Netcare Jonathan P. Rossall, QC, LLM | PARTNER,

recent decision issued by the Office of the Information and Privacy Commissioner1 (OIPC) has shed some further light on the sometimes confusing distinction between the role of a custodian and the role of an affiliate as those terms are used in Alberta’s Health Information Act (HIA). The decision is all that much more interesting as in part it brings into issue portions of Part 5.1 of the HIA, dealing with the Alberta electronic health record (EHR) – i.e., Netcare. The facts are relatively straightforward. An individual made a complaint to the OIPC that two physicians had gained access to her health information from Netcare/ Alberta EHR allegedly in contravention of the HIA. There were two separate accesses – one in 2008 and one in 2012. The doctors confirmed that they gained access in 2008 to help prepare for a hearing into a complaint filed with the then Capital Health Authority by the individual who was the subject of the health information. The access in 2012 was to assist in preparation for a College of Physicians & Surgeons of Alberta investigation into the same subject matter. The doctors took the position that the access was authorized under the HIA, as the information was required in the context of “investigations.” Central to the OIPC investigation was the question of who was the custodian of the health information at the time of the accesses – the physicians or Alberta Health Services (AHS)? It was common ground that the portal used to access the information in Netcare was located within an AHS facility and was managed by AHS. It was also common ground that both AHS and the physicians could, depending on the circumstances, qualify as custodians or authorized custodians of health information as those terms are identified in the legislation.

AMA - ALBERTA DOCTORS’ DIGEST

MCLENNAN ROSS LLP

The OIPC adjudicator reviewed the relevant wording of the HIA both in 2008 and in 2012 and noted that the act does not define what a custodian is, but rather who a custodian is (in the sense that it defines the term as an “… exhaustive list of entities” but does not describe the attributes of the entities it lists that result in their being members of a class of “custodians”). The adjudicator went on to look at the ordinary dictionary meaning of the word “custodian,” imparting a notion that a custodian must have responsibilities and duties in relation to whatever is in that custodian’s custody or control. Therefore, in the context of the HIA, a custodian would have responsibilities and duties in relation to health information in the custodian’s custody or control.

… after 17 years of existence, the

distinction in the Health Information Act (HIA) between what a “custodian” is and does, and what an “affiliate” is and does is still hazy.

The ultimate finding was that because the portal through which access was gained was within AHS’ management, the information accessed through that portal was within AHS’ custody and control. As the authorized custodian, only AHS was in a position to protect health information accessible at its site via the Alberta EHR and to create policies regarding that information. Therefore at the relevant times, AHS was the custodian of the complainant’s health information. It followed that the two physicians were acting as affiliates of AHS at the time of access. It was also noteworthy that the HIA actually defines an affiliate, in part, as “… a health service provider who has the right to admit and treat patients at a hospital as defined in the Hospitals Act.” Therefore, by virtue of this definition, at the relevant time these two physicians were affiliates of AHS. >

> Ultimately, AHS was responsible for the actions of its affiliates, but since AHS was not a party to either of the complaints and had not received demands for disclosure of the records, there were no authorized purposes for it to access or use this information. Accordingly, the accesses (and ultimate uses) were found to be inappropriate and AHS’s policies in each instance were determined to be lacking. As of the date of authoring this article, AHS has indicated a desire to seek a judicial review of the decision through the courts.

Regardless, the fact is that the HIA came into force in 1999. The drafters of the legislation made a deliberate choice to deal with the protection of patient information from the perspective of the custodian of that information (as opposed to a more patient-centric approach). This OIPC decision serves as a reminder that even now, after 17 years of existence, the distinction in the HIA between what a “custodian” is and does, and what an “affiliate” is and does is still hazy. It very much depends on the facts of a specific interaction; on where health information is located; on how it is being accessed, used or disclosed; to whom and why.

This would be a golden opportunity

Hearkening back to a comment made in this column in the last Alberta Doctors’ Digest, the HIA requires a periodic review and refresh. This would be a golden opportunity to bring some clarity to this cloudy area.

to bring some clarity to this cloudy area.

Reference available upon request.

SEPTEMBER - OCTOBER 2016

INSURANCE INSIGHTS

New travel insurance option available to Alberta Medical Association members J. Glenn McAthey, CFP, CLU, CHS | DIRECTOR,

e are pleased to announce the availability of additional travel insurance products for Alberta Medical Association (AMA) members, effective September 1. Through Sun Life’s referral network, AMA members have convenient access to a wide range of individual travel insurance solutions at preferred rates from Royal & Sun Alliance (RSA) – a trusted provider of travel protection.

ADIUM INSURANCE SERVICES INC.

For the last 16 years, emergency travel coverage has been available to members through our AMA Health Benefits Trust Fund (HBTF) Core Plan, insured by Alberta Blue Cross. More than 3,200 AMA members are covered by this travel plan. The purpose of adding new travel insurance options is to provide members that are covered by AMA HBTF the ability to purchase, before leaving on their trip, additional days of travel beyond the 60 days provided (non-medical travel insurance options are also available). Members that are not covered by AMA HBTF will have access to individual emergency medical and non-medical travel insurance either on a per-trip or multi-trip basis, at competitive rates.

Type of plan Emergency medical coverage maximum Medical questionnaire required

AMA HBTF (Alberta Blue Cross) Group $5,000,000 per person, per trip No

Multi-trip coverage

Yes – 60 days per trip

Single trip coverage

Not applicable

Top-up extra days

Yes – with Alberta Blue Cross or RSA’s individual offer (by purchasing before you leave)

Deductible

Premium

Included in Core Plan monthly premium

Pre-existing medical condition exclusions

No (only exclusion is travelling contrary to medical advice)

Emergency call centre 24/7 Maximum age Non-medical coverage (cancellation or interruption of a trip, loss of baggage and more) Visitors to Canada coverage

Yes Member’s attainment of age 75

Deductible options available when a medical questionnaire is required Varies by age, duration, deductible and answers to medical questionnaire (if applicable) Yes, varies by age, plan and answers to medical questionnaire (if applicable) Yes No

Yes

AMA - ALBERTA DOCTORS’ DIGEST

RSA Individual $5,000,000 per person, per trip Varies based on plan and age Yes – variety of choices, maximum of 30 days (16 days for ages 80 or over) Up to 182 days (or number of days allowed in home province) Yes

> The range of medical expenses covered by the emergency medical travel insurance policies is extensive and can include coverage for hospital accommodation, diagnostic services, prescription drugs, emergency air transportation and more. Please refer to the policy wording for full details on the terms, conditions, limitations and exclusions that apply. If you would like to enrol for the Outside Province/ Canada Emergency Travel coverage included with the AMA HBTF, the annual open enrolment period ends on October 31. Please contact ADIUM Insurance Services for more information.

If you wish to purchase individual travel insurance, please call the dedicated phone line for AMA members at 1.855.444.9766 and a traveller advocate can help you choose the best plan for you.

T 780.482.0692 TF 1.800.272.9680, ext. 3692 adium@albertadoctors.org www.albertadoctors.org/services/physicians/insurance

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SEPTEMBER - OCTOBER 2016

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

FEATURE

North/South Doctors’ Golf Tournament a swinging success

89th annual tournament raises nearly $40,000 for medical student bursaries

hysicians and health care leaders from across the province teed off on July 11 at the Red Deer Golf & Country Club to support Alberta’s next generation of physicians.

Thank you to our

sponsors

The 89th Annual North/South Doctors’ Golf Tournament, co-hosted by the College of Physicians & Surgeons of Alberta (CPSA), Alberta Medical Association (AMA) and the Canadian Medical Foundation, raised nearly $40,000 for medical student bursaries. Participants enjoyed a day of golf, buffet breakfast, barbecue lunch and great prize draws. Medical students and residents also attended and teamed up with CPSA and AMA staff to network and connect with their colleagues. Thank you to all participants and sponsors for making this year’s tournament a success. See you on the links in 2017!

Presenting sponsor

Birdie sponsors

Par sponsors

The 89th Annual North/South Doctors' Golf Tournament raised nearly $40,000 for medical student bursaries. SEPTEMBER - OCTOBER 2016

DR. GADGET

Made in Alberta medical resources Wesley D. Jackson, MD, CCFP, FCFP

ne of the challenges we face as physicians is to understand how recent studies, reviews, guidelines and other information relate to the person in our examining room who has come to us for help. Much of this information may have been gathered in locations and populations with significant variance from our local environment and therefore may not be applicable. Fortunately, there are several high-quality resources produced in our province designed to aid us in our decision-making process as it relates to our fellow Albertans. Toward Optimized Practice (TOP) (http://www.topalbertadoctors.org/cpgs/) was developed to help “ ... Alberta physicians and practice teams implement evidence-based practices to enhance the care of their patients. In alignment with Alberta’s Primary Health Care Strategy, TOP strives to cultivate a culture of quality improvement to support physicians and teams with the work of building the best medical homes for Albertans.” The clinical practice guidelines developed by the team at TOP are evidence-based, timely, succinct, regularly updated (five new and reviewed in 2016) and offer useful tools focused on local patients’ needs. Tools for Practice (TFP) (https://www.acfp.ca/toolsfor-practice/), sponsored by the Alberta College of Family Practice provide content that “ ... is developed free of industry bias and is based on the best available evidence. Each article is peer-reviewed, ensuring it maintains a high standard of quality, accuracy and academic integrity. TFP is coordinated by Dr. G. Michael Allan (Mike), Associate Professor in the University of Alberta Department of Family Medicine.” These biweekly articles, numbering more than 160, summarize medical evidence on specific clinical questions relevant to daily practice in Alberta.

AMA - ALBERTA DOCTORS’ DIGEST

Practical Doc (http://www.practicaldoc.ca) “... was formed in response to the ongoing need to provide practicing rural physicians with a place where they can access online skills, resources and support. More than a clearinghouse for content, Practical Doc merges the needs of a physician who may be looking for information with the support that can be sometimes hard to find when working in a rural community.” This website, sponsored by the Alberta Rural Physician Action Plan with significant input from Dr. Hugh Hindle, provides clinical and teaching resources as well as an informative blog relevant to all physicians. Primary Care Clinical Resources (PCCR) (http://mypccr.com) is a cross-platform tool designed to allow rapid access to many local primary care resources, clinical pathways, teaching tools, videos, recommended apps and point-of-care tools available to physicians with a goal to improve patient care and learner education. Funded by the Department of Distributed Learning and Rural Initiatives of the Cumming School of Medicine, University of Calgary (U of C), and curated by Dr. Gadget, PCCR was released as a free iOS app (https://itunes.apple.com/ ca/app/pccr/id1128081078?mt=8) in July with a goal to increase the availability of the tools highlighted in this article and many other resources to busy physicians on their mobile devices. Spectrum MD (https://itunes.apple.com/ca/ app/spectrum-md-localized-antimicrobial/ id921339941?mt=8) is a customizable point-of-care app for local antibiotic stewardship developed in Calgary by a working group of critical care, infectious diseases and medical microbiology clinicians and pharmacists. The app is customizable for any hospital, providing local clinical guidelines, antimicrobial data relevant to the local formulary and pathogen data including local resistance patterns as well as a direct communication link to the local stewardship team. The implementation of this app was recognized with the 2016 LEADing Practice award from Canada Health Infoway. >

> Time2Doc (https://itunes.apple.com/ca/app/ time2doc/id1077538850?mt=8), developed in partnership with the South Calgary Primary Care Network (PCN), with significant input by a U of C medical student, now resident, Dr. Jaron Easterbrook, is a free mobile app that increases patient access to primary care, improves patient attachment and engagement, and helps balance resource utilization. The app includes a wait-times module, turn-by-turn directions, hours, upcoming holidays and click-to-call functionality. Also included are a directory of services for self-referral, links to useful tools and the ability to send out public health notices, such as flu shot reminders and heat advisories. Currently, it supports 23 clinics in south Calgary, has been downloaded by more than 1,000 patients and is used by 40-50 patients each day. Relevant, evidence-based, easily accessible information and tools will become increasingly important as we continue to strive for patient centered care and precision medicine. The websites and apps mentioned in this article represent only a small part of the work currently being done in our province by many dedicated and innovative people. I am personally looking forward to what the future will bring.

T 403.986.5321

Registrar ///

College of Physicians & Surgeons of Alberta For more than a century, the College of Physicians & Surgeons of Alberta has focused on one important role – ensuring Albertans can count on their doctors. With specific roles and activities outlined in Alberta’s Health Professions Act, the College works in the public interest with Alberta doctors to help them provide safe and effective medical care to their patients. An opportunity now exists to lead this dynamic, high-performing organization. Reporting to a Council of public and physician members, you will provide operational leadership to implement the College’s strategic plan. Leading a high-performing team, you will build/enhance positive relationships with government, other provincial, national, and international health profession regulatory bodies, educational institutions, and other key organizations to ensure that medical practice is competent, ethical, and meets the standards that society expects. As the ideal candidate, you are a strategic and visionary medical leader with a proven record of instilling organizational excellence and relationship building in organizations with comparable scale, scope and complexity. Your experience could have been gained in a senior leadership role in a regulatory body, association, healthcare organization, the private sector or through experience in a ministry, agency of government or a university faculty. A highly skilled communicator, you are credible in front of any audience, and have the maturity, presence and political acumen to develop cooperation and collaboration across a diverse group of stakeholders. This is an opportunity to serve the public while at the same time make a significant contribution to Alberta’s medical profession.

To explore this exciting opportunity further, please contact 403-410-6700, or please submit your resume & related information online at opportunities@boyden.com. The College of Physicians & Surgeons of Alberta welcomes diversity and encourages applications from all qualified women and men, including persons with disabilities, members of visible minorities, and Aboriginal persons.

SEPTEMBER - OCTOBER 2016

FEATURE Serving in the Great War. Surviving diabetes. Making an outstanding contribution to medicine in Alberta. The amazing life of Dr. J.J. (Johnny) Ower, University of Alberta Dean of Medicine (1945-48)

J. Robert Lampard, MD

t a meeting with University of Alberta (U of A) Dean of Medicine Dr. Thomas J. Marrie in 2004, I was asked if I knew anything about the second dean pictured on the conference room wall – Dr. J.J. (Johnny) Ower. I did – a little. Sir William Osler saw him as a patient in 1916 and diagnosed his acute abdomen as pancreatitis. He predicted Ower might develop diabetes. Ten years later, Ower became an insulin dependent diabetic. The miraculous isolation of insulin by U of A’s Professor Dr. James B. Collip in 1922 saved Ower’s life. Ower became one of the beneficiaries of the $5,000 personal grant from J.D. Rockefeller for the new U of A outpatient diabetic clinic started by Drs. Collip and H. Jamieson. From dean Marrie’s curious question came the book Deans, Dreams and a President.1 It confirmed the first five deans (Rankin, Ower, Scott, Mackenzie and Cameron) all enlisted in WWI and/or II, spending an average of five years in the Canadian Army Medical Corps, most of it overseas. They all survived and brought back wartime experiences, contacts and friendships which would influence them for the rest of their lives. Dr. Johnny Ower was a United Empire Loyalist descendent and the 8th consecutive Johnny Ower. Dr. Earle P. Scarlett described him as “a man of singular directness, energy of mind, sincerity and courage, uncompromising in his standards, and yet with a natural charm and almost boyish spirit.” He maintained a lifelong contact with many of his graduates. Ower was also a diarist and authored two articles for Dr. Scarlett’s Historical Bulletin in 1954, entitled: “Pictures on Memories Walls. Some of the Polychromasia of a Pathologists Life and Times (Parts 1 and 2).” Dr. Scarlett termed the title an

AMA - ALBERTA DOCTORS’ DIGEST

appeal to the medical mind, while sending the uninitiated layman to the dictionary.2 After graduation, Ower chose pathology because he preferred patients who couldn’t talk back to ones who cried on his shoulder. His specialty was performing sensitive Wasserman complement fixation tests, before patients received Ehrlich 606 – the arsenic treatment to limit the wartime spread of syphilis.

Dr. Ower was a man of singular

directness, energy of mind, sincerity and courage, uncompromising in his standards, and yet with a natural charm and almost boyish spirit.

Having attended a summer cadet camp, Ower applied for a commission in Montreal’s 5th field ambulance, about the same time future U of A Dean Dr. Allan C. Rankin left it. He was accepted for a post-graduate fellowship in the Ashoff Lab in Berlin, but in transit, his ship was met by a destroyer off Scotland. War had been declared August 4, 1914. Mobilized, he joined the #1 Canadian General Hospital laboratory staff under Dr. Rankin at Salisbury, in time to help treat the meningococcal meningitis outbreak – and its 50 deaths. Dr. Ower was in France on the Burgoyne coast with the #2 General University of Toronto (U of T) Hospital by February 1915, a month before the Canadian army arrived and two months before the first gas attack in April. He remained with it until he was transferred back to the #1 General in November as the head of their three-man lab. Ower documented what he saw: trench foot; the mysterious trench fever; pneumonia; nephritis; bullet and more serious shrapnel injuries with secondary soil contamination; head, chest and abdominal wounds; >

Deans, Dreams and a President, at the UofA – Dr. John James Ower, MD, FRCPC

> and much more. In the lab he managed the blood transfusion service, tested for the Landsteiner ABO groups, performed other common lab tests, updated vaccinations, examined slides for gas gangrene, performed autopsies and confirmed the ANZAC troops brought parasites from Gallipoli and the Indians troops – malaria.

To stay current, a medical society was organized at the expanding base in 1916. The pathologists led the clinical pathology conferences. But the hospital staff and patients still slept in their fragile Indian Raj donated tents – except for three huts donated by New Brunswickers – until 1917, just before the battle of Passchendale.

Dr. Ower chose pathology because

he preferred patients who couldn’t talk back to ones who cried on his shoulder.

By 1918 the Etaples hospital complex had grown from two to 20 hospitals with a capacity for 23,000 patients. Despite being labeled a colonial hospital, #1 General gained fame for its highly successful treatment of femur fractures. Using pulleys, four-poster beds and Thomas splints, and not transferring the patients to Britain, their fracture census grew from 50 to 300 of their 2,200 beds. In May 1918 observant patients noticed high-flying spotter German planes. They preceded the May 19 nocturnal attack on Etaples. It killed 58 and injured 47 of the #1 General’s 250 staff. Eight patients were killed and 30 wounded. Dispersal of the nearby army camp and some hospital patients came too late. First General was rebuilt just in time for the flu cases that came in by the battalion in June. All recovered in three to four days with few deaths. The Spanish flu epidemic would come to Canada by ship and troop train, unfortunately in a considerably more virulent form. Offered a position as the provincial pathologist, and the professor and head of pathology at the U of A, Ower was to return to Canada July 1, 1918. His return was interrupted when he was assigned to do Wassermans at the new Ste. Anne's Hospital in Sainte-Anne-deBellevue, Quebec followed by flu autopsies in Montreal. He was demobilized in Edmonton in September 1919, but remained in the militia until 1932, becoming the lieutenant colonel of the 13th stationary hospital. Ower was one of the critical mass of pioneers from McGill University (Rutherford, Tory, Rankin, Ower,

4-1

Dr. J.J. (Johnny) Ower was one of the critical mass of pioneers who established the faculty of medicine at the University of Alberta

Dr. John James Ower, MD, FRCPC

Mewburn, Conn and 1885-1962 Wilson) and University of Toronto (U of T) (Revell, Jamieson, Collip and Pope), who established the faculty of medicine at the U of A. Well trained, loyal and dedicated, they all remained in Edmonton, extending the program’s length to four years by 1922. Although knit together by their academic challenges and relative isolation – 1,500 kilometers from the medical school in Winnipeg – Ower was chagrined by the “slow” circulation of medical journals to the faculty. He introduced Osler’s concept of a journal reporting club and formed the first one in 1920. He remained its secretary until 1958, while finding time to incorporate 12 more clubs in all specialties and hospitals, with over 260 members. The program did much to diminish any town-gown conflicts. When the province ordered all operative specimens be examined by a pathologist (1924) because of the high rural post-operative death rate, 80 hospitals began sending in specimens – 9,000 per year. It was the highest in Canada. Dr. Ower remained on staff for 31 years as the head of pathology. He was the acting dean (1939-43) and then dean (1945-48). He compressed the medical year into six months to produce two more classes. He also acted as the surgical pathologist for the Misericordia and Edmonton General hospitals for 25 years and became president of both medical staffs. >

SEPTEMBER - OCTOBER 2016

Avocationally he was a cubmaster, scoutmaster and lone scout commissioner for 40 years. The legislature acknowledged his work and the scouting movement granted him its highest Acorn Award. Linguistically, he could speak French, understand and write in Spanish and German, and quote Latin and Greek.

Dr. Ower was one of the first and

(Front) Lt. Col. J.A. Hutchinson (L), Col. G.E. Armstrong (R), McGill University professors of surgery, with their students. Major Ower (back) 2nd from (left). February 17, 1917.

> After he became dean, Ower sought the board of governor’s approval to seed a medical research program in 1946, the same year as the third post-graduate medical training program in Canada was initiated. Under pressure to take veterans and more University of British Columbia (UBC) students, he increased the class intake to 50. He also advised UBC on their new medical school which began in 1950. Ower was instrumental in having a new provincial laboratory built in 1950. The old lab in the medical school was converted into two labs: the McEachern lab and the Surgical Medical Research lnstitute lab. He recommended to the Senate honorary degrees for Drs. Archer, Collip and Rankin, antedating his own from McGill in 1959. The Ower medal was awarded post-humously to the student with the highest marks after Med 3.

longest surviving diabetics in Alberta. The University of Alberta’s focus on diabetic research has deep roots.

At home he faced challenges. His youngest children, twins, both had severe cleft palates. One could never speak, but became the national parliamentary librarian. Two more sons, including a plastic surgeon and professor of anatomy at the U of T, lived abbreviated lives. His first diabetic complications appeared in 1953 as retinal hemorrhages. Digital amputations and blindness followed by 1958. Each disability he faced, not as an affliction but as a challenge – learning Braille and typing his own letters as if no impediment had arisen. Dr. Ower died in 1962 at age 76 – one of the first and longest surviving diabetics in Alberta. The U of A’s focus on diabetic research has deep roots. References available upon request.

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FEATURE

It’s that time of year!

Alberta Medical Association Youth Run Club hits its stride Vanda Killeen, BA, DipAd/PR | SENIOR

COMMUNICATIONS CONSULTANT, AMA PUBLIC AFFAIRS

Provincial Projects Coordinator with Ever Active Schools, AMA’s partner in the Youth Run Club. During her frequent visits to YRC schools, Hayley often runs with the kids and as a confirmed lover of the crisp air and beautiful scenery of winter running, she notes that: “The kids and coaches who venture out for winter running have adjusted their clothing and footwear, to stay safe and warm, and that makes it a lot more enjoyable.”

Coach's Corner AMA YRC Ambassadors Paula Findlay and Tim Berrett are layered up and ready for comfortable winter running.

t’s that time of year, again! Arguably (well, you can argue if you want, but you’ll lose) the most beautiful season in Alberta: golden prairies, brilliant fall foliage and fresher-than-fresh/perfecttemp-for-running air. October marks the launch of the fall season of the Alberta Medical Association (AMA) Youth Run Club (YRC) at member schools across Alberta. With the school year beginning to settle into place and the certain chill of November just around the corner, new and established AMA YRCs are looking forward to forming (and re-forming) their clubs and then fitting in as many outdoor runs as possible in this short-but-oh-so-sweet fall season. “We encourage our YRC schools to keep their clubs going through the winter,” says Hayley Degaust,

While some schools can accommodate their YRCs running indoors in gymnasiums or hallways during inclement weather, other space-challenged schools take a slightly different tack when the sub-sub-zero temperatures strike, and set up school-based fitness training programs. In addition, most YRC programs include some component of extra-curricular, self-directed/self-monitored running or activity. Using tools from the Coach’s Corner on Ever Active Schools' AMA YRC website, like the Running Log, the online physical activity tracker – UWalk.ca – or the Eat. Move. Play. Guide, YRC participants can stay active with the AMA YRC throughout the entire school year.

It’s not just about running There’s no limit to the creativity being applied by school staff and YRC Champions to Youth Run Clubs across the province. In an article published in the

November-December 2014 Alberta Doctors’ Digest, we told you about the McKernan Run Club – jointly coached and managed by Dr. Doug Klein, family physician and his wife Jennifer Klein, occupational therapist and senior consultant in specialized geriatrics. There are many intriguing components of their club, including Popsicle Stick Tuesdays, boot camps with speed drills and the 100 km Club. In its first year, this club called upon members to (cumulatively) run to Florence, Italy and in its second year to Tierra del Fuego. Then to northern Alberta, where last fall, with a club roster of 25 kids and five parents, the Aspen Primary Care Network (PCN) took the lead on launching an area AMA YRC from a school in Athabasca. Not to be deterred by the onset of those impressive northern Alberta winter dumps of snow, Janene Kargus, Community and Public Relations Representative with Aspen PCN, said they were “on the lookout for snowshoes” for their YRC participants. One way or the other, with creativity and ingenuity, the leaders of AMA YRCs cheerfully tackle the challenges of staying active year-round, come Hell or high snow!

Full speed ahead! Having wrapped up last school year’s YRC season in June with an impressive 22,000 kids and 383 schools, from Fort McKay in the north to Milk River Elementary in the south, the AMA YRC enters > SEPTEMBER - OCTOBER 2016

> this fall/winter (2016-17) season with ambitious goals: 25,000 kids and 400 schools. If your goal is to get more involved and play a health and fitness leadership role in your community, let the AMA YRC help you achieve that goal. For more information, visit “Become a YRC Champion” on the AMA website, or contact Vanda Killeen, AMA Public Affairs at vanda.killeen@albertadoctors.org or 780.482.0675. Partners and sponsors As a successful partnership of the Alberta Medical Association and Ever Active Schools, the AMA Youth Run Club has been steadily growing in numbers and scope since its quiet beginnings of 4,000 kids and 77 schools in 2013. The strong and rapid growth of this valuable, school-based children’s health and physical activity initiative would not be possible without the support of program sponsors. Our most recent sponsor – Alberta Blue Cross – joins earlier sponsors MD Financial Management and Physiotherapy Alberta. The AMA Youth Run Club is grateful for the opportunities to increase capacity and enhance program offerings that the generosity and commitment of these sponsors provides.

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AMA - ALBERTA DOCTORS’ DIGEST

AMA

Makes me feel

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

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

Favorite thing

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

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

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

YRC SPONSORS

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2016-06-15 10:22 AM

PFSP PERSPECTIVES

Our humanity is more powerful than our expertise Vincent M. Hanlon, MD | ASSESSMENT

spoke to 20 individuals during a recent week taking calls on the Physician and Family Support Program (PFSP) help line (1.877.767.4637). Two recurring themes emerged that particular week among the often complicated and compelling stories related by physicians, residents and medical students. A major theme was stress, interwoven with anxiety and depression. The other theme was career dissatisfaction, both early and mid-career.

PFSP big picture 2015 Looking at the bigger PFSP service picture for 2015, over 1,400 people called the help line. The callers included more than 600 physicians, about 200 residents, 100 medical students and 200 spouses. For 41% of the callers, the primary reason for calling was mental health issues (stress, anxiety, depression), followed closely by relationship and family issues (frequently marital and child-rearing problems) 40% of the time. Occupational health issues (8%), psychiatric problems (5%) and addictive disorders (3%) comprise most of the other reasons colleagues call the line. Callers often identify more than one issue.

PHYSICIAN, PFSP

Since the term “physician health” was first coined a generation ago, the concerns of physician health programs have expanded from dealing with drunk doctors to combatting burnout, facilitating individual and organizational wellness, and more recently to fostering job satisfaction and promoting career-long resilience.

The concerns of physician health

programs have expanded from dealing with drunk doctors to combatting burnout, facilitating individual and organizational wellness, and more recently to fostering job satisfaction and promoting career-long resilience.

What was on the agenda? The opening keynote speaker at this year’s conference was Dr. Jon Kabat-Zinn:

In between calls, I looked at the list of keynote and plenary speakers for the International Conference on Physician Health in Boston (ICPH) held this past September. The title of the conference: “Increasing Joy in Medicine.”

The healing and transformative power of mindfulness: Embodied joy and well-being in the practice of medicine and life.

Who attends a physician health conference?

• Resiliency: Building individuals and culture to keep the joy in the job – A train the trainer workshop (C. Dewey, W. Swiggart).

Clinicians, preceptors, academic researchers, students, residents, residency program directors, members of physician health programs, regulatory authorities and others with an interest in the health of colleagues and trainees gather every two years at the ICPH. Conference presenters and participants share a formidable expertise in the realm of physician health.

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Other presentations over the three days included:

• Attitudes and experiences of early and mid-career pediatricians on division of domestic responsibilities and strategies to achieve work-life balance (A. Starmer, M.P. Frintner, K. Matos, B. Byrne). >

> • A randomized controlled trial evaluating the effect of COMPASS (Colleagues Meeting to Promote and Sustain Satisfaction) small group sessions on physician well-being, meaning and job satisfaction (C. West, L. Dyrbye, D. Satele, T. Shanafelt). Dr. Liselotte Dyrbye, internist, Mayo Clinic researcher and physician health advocate also articipated in an international medical education panel: Highlighting innovative changes in American, British and Canadian medical school curricula and their potential to positively impact physician health in the future (other panelists: Debbie Cohen, OBE, MD, FFOM, FRCGP, FRCP, FAcadMEd; Genevieve Moineau, MD, FRCPC; and William Tierney, MD). Surveying the various physician health topics on the agenda, I predict that a conference showcasing physicians’ joy in medical practice won’t happen for a few years yet. In 2016 the focus is on ways to increase joy and job fulfillment, and rediscover meaning in our work. From my conversations with colleagues on the help line, I know that for some of us happiness at work (and home) remains elusive.

Primary reasons for calling the PFSP help line in 2015 5%

3% 3%

8% 41%

40%

Mental health issues Relationship/family issues Occupational issues Psychiatric issues Addictive disorders Other

How do physician health experts meeting at a hotel in Boston influence the work of PFSP? A few members of the PFSP team attend and sometimes present at the national or international physician health conference each year. The distillation and trickle-down of research findings and insights continue after everyone has returned home. As with any conference, physician health or otherwise, the success of participants in applying their new knowledge varies.

Pushback against expertise We are also witnessing the phenomenon these days of a pushback against the authority of experts and the discounting of their expertise. Recall the controversies about climate change science, or the recent failure of expert economic opinions marshalled by the “remain” side in the Brexit referendum [see Rafael Behr in The Guardian Weekly, July 15, 2016]. Examples in health care are not hard to find. Harm reduction programs such as supervised injection sites are only slowly being accepted. The negative perception of palliative care for patients with advanced cancer persists [see Camilla Zimmerman et al in Canadian Medical Association Journal (CMAJ), July 12, 2016] – despite good research in favor of both of these initiatives. Such ambivalence reveals our biases for and against evidence and expertise. What is the basis of our respect for or skepticism of experts, or our patients’ enthusiasm or indifference for what we have to tell them? Why is it often hard to change opinion or behavior despite good quality evidence?

Storm clouds roll in. For some of us, happiness at work (and home) remains elusive.

Many of us do turn to experts – our family doctors, mentors, therapists and psychiatrists – and benefit from their expertise, support, assessment and treatment in times of trouble. Why are we more likely to accept their expertise and assistance in a crisis – our escalating mental health issues, dysfunctional relationships or organizational nightmares – than we are to respond to expert recommendations or guidelines about health promotion and disease prevention? The small world of physician health is one characterized by fluctuating networks of influence. In the July issue of CMAJ, a Canadian Medical Association (CMA) advertisement tells us it is “Creating a new vision for physician health.” (Poking around on the CMA website, I was hard-pressed to find out what that new vision is.) >

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Many things require expertise, like the creation of the marvelous concert hall in Hamburg, Germany and this Roman aqueduct. But there is something even more powerful than expertise: humanity.

> Skills for stress management In an editorial by Roger Ladouceur in Canadian Family Physician (February 2015) on distress among residents, his list of references includes the names of a few of the presenters at ICPH 2016.

I predict that a conference showcasing

physicians’ joy in medical practice won’t happen for a few years yet. In 2016 the focus is on ways to increase joy and job fulfillment, and rediscover meaning in our work.

My week of on-call included conversations with a couple of stressed and anxious residents. That prompted me to visit the Resident Doctors of Canada website (http://residentdoctors.ca). There I found a presentation on skill based resiliency training for residents, presented by Drs. Christina Nowik, Gillian Shaw and Nureen Sumar at the Family Medicine Forum 2015. It includes a tool called the mental health continuum model to help residents be more aware of their mental health needs. It also describes and provides examples of the acquisition of four skills to help deal with stress at work: • Tactical breathing • Goal setting • Visualization • Positive self-talk

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The promotion of such skills in 2016 arises partly from an increasingly robust physician health literature that, in turn, is fostered by conferences like ICPH. The two residents I spoke with on the help line needed more than a referral to a website; at the same time, it is heartening to see proposals for curricular interventions to address the well-being of residents on the resident doctors website.

Something even more powerful than expertise Reflecting on our attitudes toward experts and expertise is a dynamic enterprise. As we refine how we use our own expertise and respond to that of myriad experts around us, we should consider Dr. Rachel Remen’s comment about the relative power of expertise within a service profession like medicine: Fixing and helping are strategies to repair life. We serve life not because it is broken but because it is holy. Serving requires us to know that our humanity is more powerful than our expertise. Reference available upon request.

SEPTEMBER - OCTOBER 2016

FEATURE

New infection prevention and control general standards now in effect control in private, non-governmental medical facilities not accredited by the CPSA (available at http://bit.ly/IPAC0615).

ollowing extensive consultation and piloting, the College of Physicians & Surgeons of Alberta’s (CPSA’s) Infection Prevention and Control (IPAC) Program has released standards for general infection prevention and

The standards replace the Checklist for Physician’s General Office Environment and will serve to clarify the expectations of clinics in topics for which there were previously no minimum requirements. IPAC assessors will start using the new standards immediately to address IPAC-related complaints,

however, clinics will be given a grace period to comply with a few specific standards (clearly highlighted in the standards document available at http://bit.ly/IPAC0615). Meeting the IPAC general standards will help ensure the clinic environment in Alberta is safe for patients and staff alike. If you or your staff has questions, please contact the IPAC Program at ipac@cpsa.ab.ca or 780.969.5004.

Discover your inner sleuth Channel your analytical skills and medical expertise to guide the best medical care for workers injured on the job, and help them return to work and life. If you are a physician with experience treating musculoskeletal injuries in general practice, sports medicine, occupational medicine, or emergency medicine, this may be the career opportunity for you. See our posting at www.wcb.ab.ca/about-wcb/careers/ for more information.

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IN A DIFFERENT VEIN

For better, for worse: a 40-year review Alexander H.G. Paterson, MB ChB, MD, FRCP, FACP | CO-EDITOR

“D

ad, why don’t you write about what medicine was like in the old days when you started and compare it to now.”

“Gen X, Gen Y and Millennials wouldn’t be interested,” I said. “Most of you are tattooed and glued to Facebook. Okay, the biggest change has been the Internet and anti-social media. We used to talk to people eye-to-eye (even to radiologists) and phone them and handwrite letters. You could get all sorts of clues watching an eyebrow flicker and feeling the heat of a blush. By the way, my friend John sent this story. It’s called Facebook for the Senior Generation. Listen.”

We’d discharge most suicidal patients

(after the aspirin or barbiturate levels came down) on the grounds that they were going to take their lives (or not) whatever we did.

I cleared my throat: “For those of my generation who cannot comprehend why Facebook exists, I am making friends outside Facebook while applying the same principles. Therefore, every day I walk down the street and tell passers-by what I’ve just eaten, how I feel, what I did last night and what I’m going to do next. I give them pictures of my family, the dog, me gardening, having lunch and brushing my teeth. I also listen to their conversations and give them the thumbs up and tell them I like them.

And it works just like Facebook. Already I have four people following me: two police officers, a private investigator and a psychiatrist.” My daughter said, “Oh, that’s cute. No, the smarter ones are interested in old medical history.” So bearing in mind the myth of Mao, the Great Helmsman on the value of the French Revolution and his reply (“It’s too early to judge”), I’ve made a personal list of things that are better these days and things that are worse and things unchanged. Not different drugs or new operations. More like procedural changes. If I offend, write to the editor demanding an attitude adjustment session.

Some changes for better Peptic ulcer: We used to use antacids but also stuffed down a naso-gastric tube running in “milk drips” for peptic ulcer patients as punishment for being a Type-A personality and refer them for psychiatric counselling. Operating lists always had one or two patients lined up for “vagotomy and pyloroplasty.” Now we all know about H. Pylori and have proton pump inhibitors and H-2 blockers. Clinical trials: My first was at London’s Royal Marsden Hospital in 1973 in myeloma patients using L-Pam and prednisone. The handwritten protocol was pinned up on the doctors’ lounge notice board. Patients were told they were on a study and getting a new treatment and were asked, “was that okay?” The results were good and the treatment is still used in the developing world – even here, sometimes. Verbal and eye-to-eye consent went out in 1986. Some aspects of clinical trials are now harder than this seemingly patronizing approach. We have 100-plus page protocols and eight-plus page consent forms listing everything from pimples to death. This scares some faint hearts away and employs lawyers and ethicists, but it’s a better way of doing things. Other: We’d discharge most suicidal patients (after the aspirin or barbiturate levels came down) on the grounds that they were going to take their lives (or not) whatever >

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> we did. Alcoholics and drug addicts were dismissed with instructions to pull up their socks. Smoking was allowed on the wards, clinics and outside the operating room – even having a puff while doing rounds was OK. Cancer patients with advanced disease (and sometimes their families) were told they had “inflammation” and nothing could be done. Generally they were ignored on the wards. Morphine was used but palliative care was non-existent (“He’s dying. Double the Brompton Cocktail”). Operable cancer patients (especially breast cancer) were treated as emergencies, the operating room being cleared for radical operations since every minute counted as the malignant cells crawled their way through the lymph channels to burst into the blood stream. Female surgeons were unknown; women became family doctors or occasionally obstetricians, internists, psychiatrists or pathologists. All this has changed for the better.

Alcoholics and drug addicts were

dismissed with instructions to pull up their socks.

Some changes for worse Junk science and journals: There’s always been junk science. There’s just more of it now – 50 to 100 times more judging from the number of journals proliferating. Every day I get three to four daft emails to submit an article (“your choice, doctor”) to “Jacob’s Journal of Enzymology” or to “Integrative Cancer Science and Therapeutics” (“We are enthralled to know about your scientific contribution and would like to invite you …”). I’ve been proposed for the boards of the “Heighpubs Juornall of Biotechnology” (ipse) and Fungal Genomics & Biology and been asked by Rose (Tokyo Rose) to chair sessions at meetings in China, Dubai and Turkey. Hospital noise and unisex beds on wards: Hospitals used to be places of rest and refuge. Now cleaners previously carrying efficient mops and brushes that removed dirt from angled corners are armed with noisy Zambonis hoovering the floors. To accompany this racket, bells and beepers go off in the patients’ rooms, telephones ring and thrice repeated overhead announcements – from code 66’s to “yellow alerts” (somebody escaping from hospital) or that Roman Catholic prayers or an Aboriginal smudging ceremony is about to begin. There is constant chatter accompanied by shrieks of laughter in the corridors and nursing stations. One of the scandals of high-bed occupancy rates is the cramming of male and female patients in beds beside each other, separated by flimsy curtains held together with a safety pin that never completely closes the gap. Why should a young woman in severe pain with bone

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metastases be subject to an old geezer in the next bed farting, snoring and dragging his urine bag and catheter to the shared toilet? While romances might flourish, it’s a demeaning practice. Nursing administration: A young mid-wife I know worked for six years on the obstetric units of a women’s hospital in Vancouver. This work is high-pressure and stressful, and staff turnover is high. She’s now in a 9 a.m. to 4 p.m. public health position checking bouncing babies and serene mothers at her leisure and earning more money. She can’t believe the contrast and wonders how anybody stays in these hard front-line positions. Front-line nursing staff must earn at least as much as soft nursing work and administrative nursing positions. Too many nursing administrators are expert at spinning out simple problems into lengthy exercises involving much drawn out committee work during prime daytime. They need to be on the wards bullying staff and patients. Hospital plumbing: Do you remember the golden age of plumbing – like things on wash-hand basins called “taps”? For younger readers, “taps” were iron metal projections above a sink with crossed bars which you turned clockwise to produce a flow of water and anti-clockwise to stop. There were usually two “taps”: one inscribed “HOT” and the other “COLD.” You could modulate the “taps” to produce the desired water temperature. True, they sometimes dripped with an irritating plip-plop, but this was easily fixed with a new washer – and they worked. We now have in Alberta hospitals heat-sensitive or light-sensitive devices with a unisex pipe sticking up like a snorkel tube which, when fully functional, produces a stream of tepid water. They are rarely fully functional. The one in Tom Baker out-patient room AGE79B, for example, has never functioned. It makes a clunking noise and produces a dribble of water after waving your hand in front of the black thing below the snorkel tube. In another room, you have to bring your hand from behind the snorkel tube with a snake-like movement and surprise it into action. A device in Foothills Hospital has the opposite problem. My friend Liam told me he was in a serious discussion with a patient about joints (the arthritic kind) making the mistake of standing with his back to the sink in question. At a critical part of the consultation and to make an important point, he moved backwards toward the sink and was shocked by a sudden vicious flow of cold water from the snorkel tube, which drenched his pants. What would the handwashing spy count that as? The underlying problem here is government contracting. Ninety percent of billionaires became wealthy through government contracts. You see, there’s no incentive whatsoever within government bureaucracies to negotiate a market price. There’s only extra work, hassle and unpopularity, and it’s not their money so why should they bother? >

> Alberta Health Services (AHS): This organization remains too big and should be folded back into Alberta Health where it always belonged and where political blame should reside. The regions are the functional units. Take AHS accounting. I’ve been trying to transfer funds from a research account in AHS since the end of March. Why? Reports were always three or four months late and data was minimal. Simple transfer you’d think? Wrong. It’s easier to transfer money to Islamic State in Raqqa than from AHS to the University of Calgary (U of C). The Breast Cancer Society of Canada will not transfer money until the U of C account is set up. You’d think with an 8.6% provincial unemployment rate (and rising) getting money working would be a priority. The funds are still not transferred. They may be available for use next month … six bloody months! The cause? No one to blame. You phone, it’s answered, we’ll get back to you, they don’t, phone again, that person has left, who’s in charge? Could be Bob, no it isn’t Bob, it’s Nyla, but Nyla’s on vacation, she returns, it isn’t her, you should talk to Jim and it goes on and on.

Dr. Paterson in the Northwest Territories during Canada’s “dark and painful chapter.”

The military has known for centuries that the size of a functional unit is critical. Send the full army in to sort out something and you have chaos. The best functional size is a regiment where people know each other, trust each other (or not) and have a tradition of duty. If you want a job done, send in the Princess Patricia’s or the Calgary Highlanders – not, for God’s sake, the Canadian Army. It’s the same for organizations. Size is critical. Other peeves: Readable referral letters are a thing of the past, tedious unreadable standardized forms now being au courant.

Smoking was allowed on the wards,

clinics, and outside the operating room – even having a puff while doing rounds was OK.

During Canada's "dark and painful chapter" patients from the Northwest Territories were shipped to Edmonton and segregated at the Charles Camsell Hospital.

Some things never change

But seriously, First Nations health care.

Know-alls who know what’s needed in health care: “A new national health accord needs to be about health first, not money,” the president and CEO for HealthCare-CAN, Bill Tholl, said in a recent interview. He was in Whitehorse with representatives of other national health care organizations to make sure health care doesn’t get lost in the shuffle during the photo-op provincial premiers’ meeting.

On CBC radio, an academic, Professor Maureen Lux, of Brock University, was talking up her new book, Separate Beds: A History of Indian Hospitals in Canada, 1920s-1980s. Edmonton’s Charles Camsell Hospital was mentioned frequently as an example of a “dark and painful chapter in Canadian health care policy.”

Like Hell, Bill, it’s all about money, and Bill, unless you roll up your sleeves and want to volunteer on the front lines, we won’t listen to you.

“It was a racially segregated, parallel health care system that kept Aboriginal Canadians out of mainstream Canadian hospitals; some former patients say they were the victims of abuse and medical experimentation.” >

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> As a participant in the 80s in this “dark and painful chapter” by flying to Inuvik and visiting remote settlements like Tuktoyaktuk and Aklavik in the Visiting Consultant Programme, I can say it was dark during the January visits. But “painful?” No. I do recall arranging for an Inuit with a lung mass to come to Edmonton for investigation and radiotherapy. I did think it odd at the time that we couldn’t admit him directly to the Cross Cancer Institute, but had to bring him to the Camsell and from there arrange daily trips for treatment. I was told this was a federal government contracted arrangement and could not be transgressed, and anyway, the patient would prefer to stay with his “folk.”

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It all started in an altruistic attempt to diagnose and treat tuberculosis, common in the Northwest Territories’ remote communities in the post-war period. But no good deed goes unpunished. The program failed to evolve with the times. This failure is the full responsibility of the Ottawa bureaucracy in what was the “Department of Indian Affairs” and it is galling that attending physicians doing their best at the Camsell are now tainted because of this out-of-date arrangement – so called “racism” – when blame should be squarely dumped on the lethargic, patronizing bureaucrats in Ottawa. If there are any compensation demands, I’ll be in the line-up as well for reputation damage.

We should take First Nations health care and the $2.6 billion budget out of the sleepy, amateurish arms of Health Canada’s bureaucratic “First Nations and Inuit Health Branch” and create an arm’s length KaiserPermanente style agency run by native and non-native professionals with incentives for innovations along the lines of the cancer programs. Is there anybody listening? Of course not. Plus ca change …

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CLASSIFIED ADVERTISEMENTS

PHYSICIAN WANTED CALGARY AB Pain specialist Dr. Neville Reddy is looking to recruit physicians (general practitioners and specialists) to join his team of dedicated health care professionals. Innovations Health Clinic has two locations (southeast and southwest), favorable 30% expenses offered. Contact: Neville Reddy, MB ChB, FRCPC (Anesthesia) T 403.240.4259 C 403.689.4259 nreddy@innovationshealth.ca innovationshealth.ca CARSTAIRS AB Snowy Owl Medical Clinic invites family physicians and general practitioners to join a dynamic and exciting new rural clinic in the growing town of Carstairs. We are looking for fun and positive physicians ready to partner with us in creating a robust medical home for patients. Proactive patient encounters, same-day access, dedicated electronic medical record workflow and close integration with Highland Primary Care Network are all highly valued. Potential for hospital duties including emergency room shifts and inpatient visits are available at the Didsbury Hospital. Carstairs is a family friendly community of 5,000 people with easy access to Calgary. Contact: T 403.807.8864 www.snowyowlclinic.com CALGARY AND EDMONTON AB Retiring? Semi-retiring? Want someone to take over your panel? Imagine Health Centres (IHC) is growing and welcomes semi-retired and/or retired physicians who want to ensure continuity of care of their patients. Come work part-time, full-time and allow us to introduce ourselves to your

patients. Imagine Health Centres are multidisciplinary family medicine clinics with a focus on health prevention and wellness. IHC prides itself in providing the best support for family physicians and their families in and out of the clinic. Health benefit plans and full financial/tax/accounting advisory services are available to all IHC physicians. Do you want your patients to be cared by a team that collaborates with other health care professionals for enhanced patient care? If so, contact us. Contact: Dr. Jonathan Chan to submit your CV in confidence corporate@imaginehealthcentres.ca www.imaginehealthcentres.ca EDMONTON AB Practice opportunity available for two full-time physicians in the discipline of family or internal medicine (other disciplines also possible) at this medical clinic located at the Westgrove Professional Building. This clinic provides interested physicians with the opportunity to build their own practice as they envision it as well as with the option to buy out and own the clinic in the long term. The clinic is fully furnished with five examination rooms that include a room equipped for minor surgical procedures, physicianâ&#x20AC;&#x2122;s office, nurseâ&#x20AC;&#x2122;s station, ample sized reception and waiting room, staff lunch room and a private restroom. Located on the third floor, this clinic has a separate backside entrance, private parking for physicians and medical staff, as well as ample free parking for patients. Additional health services at the Westgrove Professional Building include a pharmacy, DynaLIFE Diagnostic lab patient collection center, various medical specialty practices, medicentre and other non-medical services. This building enjoys a prime location in the city, surrounded by a well-populated residential area and facing a new modern apartment high-rise currently being developed.

If you are interested and would like further information and/or visit the clinic, please contact. Contact: Dr. M.C. Lee T 780.709.4323 EDMONTON AB Oxford Medical Clinic is looking for a part- or full-time family physician/ general practitioner to join our team; very attractive deals and incentives. Contact: T 780.475.1966 F 780.475.1997 oxford.clinic@yahoo.ca

EDMONTON AB Two positions are immediately available at the West End Medical Clinic/M. Gaas Professional Corporation at unit M7, 9509 156 Street, Edmonton AB T5P 4J5. We are also looking for specialists; internist, pediatrician, gynecologist and orthopedic surgeon to join our busy clinic. Full-time family physician/ general practitioner positions are available. The physician who will join us at this busy clinic will provide family practice care to a large population of patients in the west end and provide care to patients of different age groups including pediatric, geriatric, antenatal and prenatal care. Physician income will be based on fee-for-service payment and the overhead fees are negotiable. The physician must be licensed and eligible to apply for licensure with the College of Physicians & Surgeons of Alberta (CPSA), their qualifications and experience must comply with the CPSA licensure requirements and guidelines. We offer flexible work schedules, so the physician can adopt his/her work schedule. We also will pay up to $5,000 to the physician for moving and relocation costs. Contact: Dr. Gaas T 780.756.3300 C 780.893.5181 F 780.756.3301 westendmedicalclinic@gmail.com > SEPTEMBER - OCTOBER 2016

EDMONTON AB Parsons Medical Centre (PMC) and Millbourne Mall Medical Centre (MMMC) want you. To meet the growing needs, we have a practice opportunity for family physicians at PMC and MMMC. Both clinics are in south Edmonton. PMC and MMMC are high-patient volume clinics with friendly reliable staff for billing, referrals, etc., as well as an on-site manager. Enjoy working in a modern environment with full electronic medical records. PMC and MMMC serve a large community and wide spectrum age group (birth to geriatric). Both clinics have on-site pharmacy, ECG machine, lung function testing and offer a large array of specialist services including: ENT, endocrinologist, general surgeon, internist, orthopedic surgeon, pediatrician and respirologist. PMC and MMMC are members of the Edmonton Southside Primary Care Network which allow patients to have access to an on-site dietitian and mental health/psychology/ psychiatry health services. Overhead is negotiable, flexible working hours and both clinics are open seven-daysa-week. Contact: Harjit Toor T 587.754.5600 F 587.754.8822 manager@parsonsmedicalcentre.ca EDMONTON AB Windermere’s newest clinic is looking for physicians to start as soon as possible. Imagine Health Centres (IHC) newest clinic opened in January in the Currents of Windermere. This top-notch, high-profile retail development is within the proximity of Riverbend and McGrath. A multidisciplinary family medicine clinic with a focus on health prevention and wellness, IHC prides itself in providing the best support for family physicians and their families in and out of the clinic. Health benefit plans and full financial/tax/accounting advisory services are available to all IHC physicians. We are looking for part- and full-time family physicians. Imagine Health Centres has excellent opportunity to take over existing patient panels at our Edmonton locations.

AMA - ALBERTA DOCTORS’ DIGEST

Do you want to be part of a team that collaborates with other health care professionals for enhanced patient care? Do you want to make a difference in your patients’ care and take a proactive instead of a reactive approach to health care? Compensation is fee-for-service and inquiries are kept strictly confidential. Only qualified candidates will be contacted. Contact: Dr. Jonathan Chan to submit your CV in confidence corporate@imaginehealthcentres.ca www.imaginehealthcentres.ca EDMONTON AB Registrar, College of Physicians & Surgeons of Alberta. For more than a century, the College of Physicians & Surgeons of Alberta has focused on one important role – ensuring Albertans can count on their doctors. With specific roles and activities outlined in Alberta’s Health Professions Act, the college works in the public interest with Alberta doctors to help them provide safe and effective medical care to their patients. An opportunity now exists to lead this dynamic, high-performing organization. Reporting to a council of public and physician members, you will provide operational leadership to implement the college’s strategic plan. Leading a high-performing team, you will build/ enhance positive relationships with government, other provincial, national, and international health profession regulatory bodies, educational institutions, and other key organizations to ensure that medical practice is competent, ethical and meets the standards that society expects. As the ideal candidate, you are a strategic and visionary medical leader with a proven record of instilling organizational excellence and relationship building in organizations with comparable scale, scope and complexity. Your experience could have been gained in a senior leadership role in a regulatory body, association, health care organization, the private sector or through experience in a ministry, agency of government or a university faculty. A highly skilled communicator, you are credible in front of any audience, and have the maturity, presence and political acumen to develop cooperation and collaboration across a diverse group of stakeholders.

This is an opportunity to serve the public while at the same time make a significant contribution to Alberta’s medical profession. The College of Physicians & Surgeons of Alberta welcomes diversity and encourages applications from all qualified women and men, including persons with disabilities, members of visible minorities and Aboriginal persons. Contact: T 403.410.6700 opportunities@boyden.com to explore this exciting opportunity further or to submit your resume and related information EDMONTON AB Capstone Medical Clinic is a brand-new family medicine clinic in west Edmonton. It is in close proximity to an assisted-living facility, diagnostic imaging and multiple pharmacies. This is an ideal location for family doctors looking to build a new practice, as well as physicians with an existing panel. Both part- and full-time positions are available. Clinic hours are flexible and payment is fee-for-service. We use TELUS Health Solutions (Wolf) electronic medical records. We are part of the Edmonton West Primary Care Network (PCN) and have access to a PCN nurse on site. Interested physicians must be licensed with the College of Physicians & Surgeons of Alberta. Contact: Dr. Christopher Gee T 780.708.3012 info@capstonemedicalclinic.com EDMONTON AND FORT MCMURRAY AB MD Group, Lessard Medical Clinic, West Oliver Medical Centre and Manning Clinic each have 10 examination rooms and Alafia Clinic with four examination rooms are looking for six full-time family physicians. A neurologist, psychiatrist, internist and pediatrician are required at all four clinics. Two positions are available at the West Oliver Medical Centre in a great downtown area, 101-10538 124 Street and one position at the Lessard Medical Clinic in the west end, 6633 177 Street, Edmonton. Two positions at Manning Clinic in northwest Edmonton, 220 Manning Crossing and one position at Alafia >

> Clinic, 613-8600 Franklin Avenue in Fort McMurray. The physician must be licensed or eligible to apply for licensure with the College of Physicians & Surgeons of Alberta (CPSA). For the eligible physicians, their qualifications and experience must comply with the CPSA licensure requirements and guidelines. The physician income will be based on fee-for-service with an average annual income of $300,000 to $450,000 with competitive overhead for long term commitments; 70/30% split. Essential medical support and specialists are employed within the company and are managed by an excellent team of professional physicians and supportive staff. We use Healthquest electronic medical records (paper free) and member of a primary care network. Benefits and incentives of being part of our clinics include the convenience to work at any of our locations, part- or full-time available, attached to a primary care network, nurse for physicianâ&#x20AC;&#x2122;s patients provide one-on-one, on-site diabetic management care and comprehensive medical follow-up visits. Therapists at our clinics provide one-on-one consults. Seminars and dinner workshops credit go toward their licence. Flexible hours, vast patient circumference looking for family doctors, continuing care and learning opportunities for accredited doctors. Full-time chronic disease management nurse to care for chronic disease patients at Lessard, billing support and attached pharmacy are available at the Lessard and West Oliver locations. Work with a nice and dedicated staff, nurse available for doctorâ&#x20AC;&#x2122;s assistance and referrals. Also provide on-site dietician and mental health/ psychology services. Clinic hours are Monday to Friday 8:30 a.m. to 8:30 p.m., Saturday and Sunday 10:30 a.m. to 5 p.m. Contact: Management Office T 780.757.7999 or T 780.756.3090 F 780.757.7991 mdgroupclinic@gmail.com lessardclinic@gmail.com

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

PHYSICIAN AND/OR LOCUM WANTED CALGARY, EDMONTON AND RED DEER AB Imagine Health Centres (IHC) is currently looking for family physicians and specialists to come and join our dynamic team in part-time, full-time and locum positions in Calgary, Edmonton and Red Deer. Physicians will enjoy extremely efficient workflows allowing for very attractive remuneration, no hospital on-call, paperless electronic medical records, friendly staff and industry-leading fee splits. Imagine Health Centres are multidisciplinary health clinics with a focus on preventative health and wellness. Come and be part of our team which includes family physicians, physiotherapists, psychologists, nutritionists, pharmacists and more.

Imagine Health Centres prides itself in providing the very best support for family physicians and their families in and out of the clinic. Health benefit plans and full financial/tax/ accounting advisory services are available to all IHC physicians. There is also an optional and limited time opportunity to participate in equity opportunities in IHC and related medical real estate. Enjoy attractive compensation with our unique model while being able to maintain an excellent work-life balance. We currently have three Edmonton clinics. The clinics are near South Common, west Edmonton and our brand-new clinic opened in January in the Currents of Windermere. We currently have two clinics in Calgary. The clinics are located downtown and south Calgary. We also have compelling opportunities available in Red Deer. All inquiries will be kept strictly confidential. Contact: Dr. Jonathan Chan to submit your CV in confidence corporate@imaginehealthcentres.ca www.imaginehealthcentres.ca SHERWOOD PARK AB Dr. Patti Farrell & Associates is a new, busy, modern family practice clinic with electronic medical records and require locum coverage periods throughout 2016. Fee split is negotiable. Current clinic hours are Monday to Friday 8 a.m. to 4 p.m. are negotiable. Dr. Farrell is a lone practitioner (efficient clinic design built for two doctors) looking for a permanent clinic associate. Contact: C 780.499.8388 terrypurich@me.com SHERWOOD PARK AB The Sherwood Park Primary Care Network is looking for several physicians to cover a variety of locum periods in a variety of Sherwood Park offices. Practice hours vary widely. Majority of practices run electronic medical records. Fee splits are negotiated with practice owners. Some practices are looking for permanent associates. Contact: Dave Ludwick T 780.410.8001 davel@sherwoodparkpcn.com >

SEPTEMBER - OCTOBER 2016

SPACE AVAILABLE CALGARY AND EDMONTON AB Medical offices available for lease in Calgary and Edmonton. We own full-service, professionally managed medical office buildings. Competitive lease rates, attractive building amenities and turnkey construction management available. Contact: NorthWest Healthcare Properties Lindsay Hills, Leasing Manager, Calgary T 403.282.9838, ext. 3301 lindsay.hills@nwhreit.com Shelly Fedorak, Leasing Manager, Edmonton T 780.293.9348 shelly.fedorak@nwhreit.com EDMONTON AB Approximately 2,000 sq. ft. of space available for lease on Whyte Avenue (French Quarter). Ideal location for a medical office with four private offices, board room, lunch room, storage room and reception area. Contact: Nizar Merani T 780.217.8666 merani@shaw.ca EDMONTON AB Prominent, completely new office space at Windermere Plaza is available immediately for tenant occupancy. Newly constructed, high profile, modern building located in one of Edmonton’s fastest growing and affluent communities. Building includes ultra, high-speed Internet, daycare services, reserved underground heated parking space and ample surface parking. Operating costs are $10 per sq. ft. plus water, power and in-suite janitorial. Contact: Sandra Diediw MMM Medical Holdings T 780.221.7436 EDMONTON AB Spacious, comfortable offices available to share with psychiatrist and psychologist in south Edmonton; rooms are large enough to conduct group psychotherapy for up to 12 people. Contact: Dr. David Wong T 780.454.1137 gapwong@shaw.ca

AMA - ALBERTA DOCTORS’ DIGEST

LETHBRIDGE AND ST. ALBERT AB Brand-new medical clinic space located within new London Drugs store locations available for lease in Lethbridge and St. Albert are ready to move in. Our modern, well-equipped offices include six electronic medical record enabled examination rooms. We offer competitive lease rates, quality construction and brand-new amenities in high-foot traffic locations. Contact: Shawn Sangha T 604.312.7067 shawns@gblmedical.com

PRACTICE FOR SALE EDMONTON AB Capilano Medical Clinic, 7905 106 Avenue NW is for sale and sublease. Walk-in and family practice clinic using Healthquest electronic medical records. There are six physician offices, 10 examination rooms and one treatment room. There are four vacant rooms available for use and 20 free parking stalls for patients. There is space available to have your own pharmacy (no restriction in the building to have a pharmacy). Clinic has over 5,000 patients on electronic medical records. Contact: Dr. Gaas C 780.893.5181 gaas2007@yahoo.com

COURSES CME CRUISES WITH SEA COURSES CRUISES • Accredited for family physicians and specialists • Unbiased and pharma-free • Canada’s first choice in CMEatSEA® since 1995 • Companion cruises FREE TRANS-ATLANTIC BARCELONA TO BARBADOS November 5-21 Focus: Mental health in the workplace Ship: Silver Spirit COSTA RICA (ALL INCLUSIVE RESORT) November 7-14 Focus: Physician health and medicine in Costa Rica Resort: DoubleTree by Hilton – Central Pacific

TAHITI AND MARQUESAS November 19-December 3 Focus: Endocrinology and dermatology Ship: Paul Gauguin SOUTHERN CARIBBEAN December 21-January 2, 2017 Focus: Dermatology, pediatrics and emergency medicine Ship: Celebrity Eclipse SOUTH AMERICA January 22-February 5, 2017 Focus: Psychiatry, endocrinology, rheumatology sport medicine and computers in medicine Ship: Celebrity Infinity AUSTRALIA AND NEW ZEALAND February 5-17, 2017 Focus: Psychiatry, dermatology and women’s health Ship: Celebrity Solstice BAHA AND SEA OF CORTEZ February 9-21, 2017 Focus: Emergency medicine, obstetrics, ICU pearls, clinical impairment and injured workers, and neurology Ship: Azamara Quest BALI TO SINGAPORE: MALAY ARCHIPELAGO February 23-March 7, 2017 Focus: Endocrinology, geriatrics and psychiatry Ship: Crystal Symphony EASTERN CARIBBEAN March 12-19, 2017 Focus: Endocrinology, geriatrics and psychiatry Ship: Holland America: New Amsterdam BERMUDA April 30-May 7, 2017 Focus: Primary care and neurosurgery for the non-neurosurgeons Ship: Celebrity Summit SPAIN – CME LAND TOUR May 12-22, 2017 Focus: Internal medicine and medical/legal updates Spanish land tour exploring Madrid, Vigo and Rioja ICELAND – CME LAND TOUR June 3-9, 2017 Focus: Optimizing patient care, chronic pain and urology Iceland land tour >

SCANDINAVIA AND RUSSIA July 6-18, 2017 Focus: Emergency medicine plus diabetes management Ship: Celebrity Silhouette ALASKA August 20-27, 2017 Focus: Pearls in clinical medicine: infectious diseases Ship: Celebrity Infinity RHINE AND DANUBE RIVER September 1-16, 2017 Focus: Cardiology, sport medicine and dermatology Ship: Avalon Illuminations JAPANESE EXPLORER September 24-October 5, 2017 Focus: Cardiology, internal medicine and endocrinology Ship: Celebrity Millennium TUAMOTUS AND SOCIETY ISLANDS TAHITI October 18-28, 2017 Focus: Save the date – topic coming soon! Ship: Paul Gauguin

software. Pick up and drop off for Edmonton and areas, mail or courier options available for rest of Alberta.

DISPLAY OR CLASSIFIED ADS

Contact: N. Ali Amiri, MBA Consultant Seek Value Inc. T 780.909.0900 aamiri.mba1999@ivey.ca aliamiri@telus.net DOCUDAVIT MEDICAL SOLUTIONS Retiring, moving or closing your practice? Physician’s estate? DOCUdavit Medical Solutions provides free paper or electronic patient record storage with no hidden costs. We also provide great rates for closing specialists.

TO PLACE OR RENEW, CONTACT:

Daphne C. Andrychuk Communications Assistant, Public Affairs Alberta Medical Association

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T 780.482.2626, ext. 3116 TF 1.800.272.9680, ext. 3116 F 780.482.5445 daphne.andrychuk@ albertadoctors.org

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PATAGONIA November 25-December 2, 2017 Focus: Adventures in medicine 2017 Ship: Stella Australis SINGAPORE TO HONG KONG December 5-17, 2017 Focus: Rheumatology and pain management Ship: Regent SS Voyager EASTERN CARIBBEAN December 30, 2017-January 6, 2018 Focus: Save the date – topics coming soon! Ship: Royal Caribbean: Harmony of the Seas For current promotions and pricing, contact: Sea Courses Cruises TF 1.888.647.7327 cruises@seacourses.com www.seacourses.com

SERVICES

AMA Physician Locum Services

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

Flexibility – Practice to fit your lifestyle.

•

Variety – Experience different Alberta practice styles.

•

Provide relief – Support rural colleagues and rural Albertans.

•

Travel costs, honoraria, accommodation and income guarantee provided.

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

ACCOUNTING AND CONSULTING SERVICES Independent consultant, specializing in accounting and tax preparation services, including payroll and source deductions, using own computer and

barry.brayshaw@albertadoctors.org T 780.732.3366

TF 1.800.272.9680, ext. 3366

www.albertadoctors.org/pls

SEPTEMBER - OCTOBER 2016

Small change, big difference.

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