Alberta Doctors' Digest March/ April 2014

Alberta Doctors'

DIGEST March-April 2014 | Volume 39 | Number 2

Dr. Gadget likes toys His new column is your guide to tech you can use

Want to be a rural physician?

There’s a scholarship for that!

Application for Dr. Michael Tarrant Scholarship available online

Who ARE those people?

Things you didn’t know about your AMA board members

What’s new online?

Physician Office System Program resources and AMA Youth Run Clubs 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 10 Health Law Update 14 Mind Your Own Business 16 Insurance Insights

Co-Editor: Alexander H.G. Paterson, MB ChB, MD, FRCP, FACP Editor-in-Chief: Marvin Polis President: Allan S. Garbutt, PhD, MD, CCFP President-Elect: Richard G.R. Johnston, MD, MBA, FRCPC Immediate Past President: R. Michael Giuffre, MD, MBA, FRCP, FRCPC, FACC, FAAC 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 May/June issue deadline: April 14

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.

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18 Letters 22 PFSP Perspectives 26 In a Different Vein 29 Classified Advertisements

FEATURES

6 Dr. Gadget likes toys

His new column is your guide to tech you can use.

12 Who ARE those people?

Things you didn’t know about your Alberta Medical Association (AMA)

board members.

13 Want to be a rural physician? There’s a scholarship

for that!

Application for Dr. Michael Tarrant Scholarship available online.

21 Out of options for resolving problems with intimidation in the workplace and patient advocacy?

Call the Practitioner Advocacy Assistance Line ¬ a confidential service now delivered by the Zone Medical Staff Associations.

25 What’s new online?

Physician Office System Program resources and AMA Youth Run Clubs.

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

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.

Cover Photo:

Meet Dr. Gadget (AKA Dr. Jackson). Tech you can use is his passion. ( provided by Marvin Polis)

More WAYS TO GET ALBERTA DOCTORS’ DIGEST We’re using QR codes to enhance your experience. Scanning this code will take you to the Alberta Doctors' Digest page on the AMA website including pdf and ebook versions. There are also QR codes embedded in a few articles in this magazine issue. Scan the codes using your smart phone or tablet device to go to the alternate content. If you don’t have a QR code reader app on your phone or tablet, download one for free from www.scanlife.com.

March - April 2014

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From the Editor

Our digital distractions Dennis W. Jirsch, MD, PhD | Editor

“Where is the wisdom we have lost in knowledge?

Where is the knowledge we have lost in information?”

- T.S. Eliot

S

ome time ago I was involved in a project assessing the extent of computerization of physicians’ offices. I was generally impressed with paperless records, easy access to the latest lab tests and reports, facilitated appointment scheduling and printed prescriptions. Sure, docs said, there had been initial glitches, but now up-and-running most said they didn’t know how they’d put up with the tedium of paper heretofore. Patients too were generally okay with things, but some weren’t so cheery. “I wish he’d stop looking at the screen all the time,” one said.

“I wish he’d look at me.”

The bounty of our technical achievement has never been so evident, but I was reminded that for every technological triumph there are disadvantages as well as advantages. We’re all networked now and the torrent of data we produce and consume in both our professional and personal lives is a true juggernaut. Patients may wish we didn’t spend as much time as we do in front of the flickering screen but the larger question that flows from our connections here, there, and everywhere would seem to attend our data. How do we protect it? Who owns our shared data? Who controls it and with what intent?

The story of this latest advance in practice is a long one and becomes a record of our communications technology that includes the remarkable artwork of prehistoric men at the caves at Lascaux (someone was trying to say something, after all), our inventions of language and writing, papyrus and paper, printing presses, all the way to our current status as “digital natives,” comfortable with smart phones, text messaging, social media and so on.

No one knows where we’ll end up, but most would seem to be ebullient at our prospects, considering that it is only a matter of time till we and our worlds are all codified as vast binary assemblages of zeros and ones, all instantly available, everywhere. I can’t agree.

AMA - Alberta Doctors’ Digest

The counterpoint of every new

abundance, economics instructs us, is a new scarcity – in this case the scarcity of our time and our attention.

One of the most prescient observers was Herbert Simon, psychologist and computer expert, who observed, now 33 years ago, that a fundamental consequence of the ocean of data and information spawned by the digital revolution was a corresponding drop in our attention.1 The effects may be to some extent obvious but they can’t be overstated.

As we flit from voice mail to email (and who among us doesn’t receive 100 or 200 of these each day?) and from this screen to the next one, we run the risk of missing the larger point. The counterpoint of every new abundance, economics instructs us, is a new scarcity ¬ in this case the scarcity of our time and our attention. We’re all about speed now: depth and nuance take time.

It’s a self-perpetuating cycle. Facts can change in a trice.

No one wants to be out of date. We want our stuff “hot off the press,” whatever its meaning. As we become ever more rushed, the market for depth shrivels. We truly know more about less and less. There’s heady talk of the “hive mind,” as we await computer-spawned syntheses from the rolling “just-in-time” data that we mistake so easily for true knowledge.

We’re all instant experts now. The ethic of “free” rules the web and has resulted in a conflation of experts and amateurs. Look up “gout” for instance and note the pages of half-baked hunches from persons out to compete with yesteryears’ snake-oil salesmen, alongside the less common advertisements of more credible institutions it’s one vast porridge. >

> The problems that are engendered may be nowhere more compelling than in education. With all knowledge at our fingertips, why learn facts? Far better, perhaps, to access what one needs to know, when one needs it. The answer of course is that linking to online knowledge (and I include the wheat as well as the chaff) requires a set of concepts in human memory that can link constructively with our online knowledge repository. How to teach in this new world is perhaps the biggest challenge facing educators in medicine and elsewhere.

So we are flush with facts or factoids or wishful thinking or nonsense. We may have grasped, however dimly, that this acceleration in the volume and speed of things means something, but we’ve not gotten much further. It’s as if it is 1905 or 1910 again, and we don’t believe that the invention of the motor car will change our social and political lives as well as the design and workings of our cities.

I would argue further that although the massive collection of data and its retrieval has been of value to large scale organizations, it has solved little of importance to most people and it has created at least as many problems as have been solved. Witness the metadata collected by the United States of America (USA) National Security Agency that has made Edward Snowden a hero to some, a turncoat and villain to others. Witness too the recurring loss of personal data from laptops left here and there, the pirated data from various stores in the USA and Canada.

Can it be that the vast computerization of our world is overrated and with it our favored premise ¬ that the difficulty we have in solving our most vexing problems stems from insufficient data? The reality would seem to be that we are drowning in data, imperilled by it, and largely don’t know what to do with it.

The massive glut of data that should never see the light of day, the social media that threaten to make our lives increasingly banal, the flickering screen that can be somehow more compelling than our patients’ stories all compete for our attention and this is the battle we must win. Our lives, after all, consist of what we attend to, a truism noted a century or so ago by pioneering psychologist William James. We must learn to better commandeer our attention so that we can use the technical tools at our disposal and use them well.

We must not lose ourselves in passive, irrelevant distraction.

We have better things to attend to.

References 1. Simon HA (1971). “Designing Organizations for an Information-Rich World,” in Martin Greenberger, Computers, Communication, and the Public Interest, Baltimore, MD: The Johns Hopkins Press, ISBN 0-8018-1135-X (pp 40-41).

2. Postman N (1985). Amusing Ourselves to Death: Public Discourse in the Age of Show Business. USA: Penguin. ISBN 0-670-80454-1.

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March - April 2014

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Cover Feature

Dr. Gadget likes toys His new column is your guide to tech you can use Wesley D. Jackson, MD, CCFP, FCFP

I

like warm summer days, learning about and practicing medicine, seeing patients, delivering babies, excisions, riding a bike, teaching ¬ and I love my large family. Then there are toys. I really like toys! Especially ones with a practical purpose.

When I was in high school, I learned to use a slide rule then went the extra mile to learn how to use an abacus. I was one of the first to buy a calculator in 1973, learned to program calculators in 1977 and bought my first computer, an Apple IIc, in the summer of 1984. I crashed my first PC hard drive in about 1988 and despite learning that “the cutting edge bleeds” have never looked back. Since then I have owned several PCs and laptops, using Microsoft and Apple operating systems, have enjoyed each one and have watched each reach its early obsolescence. I have come to understand that progress comes with a price, which I am willing to pay.

I have come to understand that

progress comes with a price, which I am willing to pay.

I could be seen in the late 1980s doing rounds in my rural hospital using an Apple Newton, a device ahead of its time, to decipher my handwriting into text. Since then, I have owned a variety of PDAs (personal digital assistants) including Pocket PCs, Palm and Windows

AMA - Alberta Doctors’ Digest

His tablet is one of the many tools Dr. Jackson uses daily in his practice. ( provided by Marvin Polis)

Mobile Classic devices, all of which had rather short lifespans, but provided hours of enjoyment to this toy lover.

I embraced with joy the evolution of the phone, from the party line to rotary dial to touch tone phones, and was absolutely overjoyed when a cellular phone would allow me to leave the confines of my home when I was waiting for the next imminent delivery. My first cell phone was actually a suitcase, which I willingly and happily carried from place to place. I have been witness to the progressive miniaturization of this device to ridiculously small sizes before growing a little and becoming today’s smart phone, combining mobility with computing power, not to mention even more fun! >

> The mid-1990s brought the Internet, opening to me a new, although somewhat limited, world, which grew exponentially over the next few years. Email users, initially comparable to Ham radio operators, became mainstream. My mid-1980s two-piece, 12-pound video camera became much smaller and eventually digital, allowing for significantly easier editing and distribution.

My first digital still camera in the late 1990s was expensive and poor quality, but very “cool.” I was still dependent on strategically placed textbooks and journals for day-to-day reference material in my practice.

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Then, in June 2007, I purchased my first iPhone. This device, which I could carry in my pocket, allowed access to the Internet and email, provided a camera which would take stills and video, allowed for note taking and stored a large library of games, music and audiobooks, while providing the convenience of a cell phone. As time passed, infrastructure and technology improved, providing an improved experience. Digital books, originally patented by Angela Ruiz in 1949, now became much more popular.

Less than two weeks after Stephen Colbert pulled an iPad from his suit during the Oscars on April 3, 2010, I repeated the performance at an orientation meeting for the clerkship program which I direct; this led to several photos of teenagers holding the device while I anxiously watched from a distance. This tablet has improved and extended my experience with my iPhone and has resolved some of the headaches and visual discomfort related to focusing on its small screen. Several iterations of this and other tablets have been introduced since then and brilliant minds have contributed apps that have become so useful that they are almost indispensable.

My toy has become a tool ¬ the best possible scenario.

I now find myself with a very portable device that I enjoy for both personal and professional use. I now carry many electronic textbooks in my pocket. I am able to access the web, collect and search articles and videos of interest, manage email and texts, read books, access my electronic medical records, take pictures and video, check traffic, access a global positioning system (GPS), listen to music and audiobooks, and occasionally play games. Instead of rudimentary drawing, I can now use this device to demonstrate anatomy in 3D, including pathology, to my learners and patients in real time ¬ then emailing them a handout of what was discussed. I can also, among other things, instruct more efficiently using downloaded videos. >

Dr. Jackson was a big fan of the TV series "Get Smart" when he was a kid. Mobile phone tech has come a long way! ( provided by Marvin Polis)

Some innovations will not have a long lifespan, while others will continue to revolutionize our lives and the practice of medicine.

March - April 2014

Who is Dr. Gadget?

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Dr. Wesley D. Jackson is an assistant professor within the Department of Family Medicine at the University of Calgary (U of C) and has been the director at the U of C Longitudinal Integrated Clerkship (a distributed longitudinal clerkship in rural Alberta) since its inception in 2007. He has enjoyed teaching since he started as a rural general practitioner anesthetist in 1984 and continues as the site medical lead of the Sunridge Family Medicine Teaching Centre in Calgary.

When toys become indispensable tools, it's a best case scenario for gadget lovers. ( provided by Marvin Polis)

> Mobile technology in medicine is here to stay. Newer devices, building on this technology, continue to come at a fast and furious pace. Some of these innovations will not have a long lifespan, while others will continue to revolutionize our lives and the practice of medicine. Only time and experience will predict the survivors.

My job as Dr. Gadget is to guide you through technology that’s new and useful, to help make a difference in your practice. Wow, what a great gig!

He has used electronic medical records since 1984 and successfully led the transition to a completely paperless office in his rural site in 1998. He had been involved with the Physician Office System Program since 2003, including work in the Vendor Conformance and Usability Requirements (VCUR) process, various committees and as a physician mentor. He continues his contributions to the development of electronic medical records within the Department of Family Medicine and provincially through his participation in several committees at both levels.

Dr. Jackson has used technology in medical practice throughout his career and is specifically interested in point-of-care tools and distance education. He has presented at local, national and international conferences on the use of mobile devices in preceptor, learner and patient education.

Alberta Doctors’ Digest welcomes Dr. Jackson, AKA Dr. Gadget, to our team.

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Health Law Update Alberta’s new health charter and patient advocate Faint hope for health care reform Jonathan P. Rossall, QC, LLM | Partner,

I

n the January-February 2011 edition of Alberta Doctors’ Digest, I wrote about the then-recently passed Alberta Health Act (“the act”) which was to be proclaimed upon creation of a “health charter.” In accordance with the terms of the act, failure to comply with the principles of the health charter would result in the person “… being dealt with by the health advocate or the minister.” It was not clear then, nor is it clear today, what “dealt with” means. Presumably something more than just being sent to the corner for a time out.

McLennan Ross LLP

and appointed Mary Marshall, QC, a very well-qualified and well-respected health law specialist, to the office of the patient advocate.

Recall that the act empowers the minister to (a) prepare a health charter, and (b) appoint a health advocate to (c) investigate complaints of non-compliance which (d) may result in a recommendation to a person by the health advocate, and (e) a report to the minister who (f) may direct the person failing to comply to (g) comply. That’s it in a nutshell. So, if strict compliance is required, one would expect this draft charter to have some teeth.

This is not, however, the case.

The draft charter is separated into three broad sections, each commencing with a partial sentence:

Perhaps the energy of the drafters

might have been better served in actually addressing the shortcomings of the existing legislation and fixing them.

“When I interact with the health system, I expect that I will.…”

“Taking my circumstances into account and to the best of my abilities, when I interact with the health system, I understand that I will be asked to.…” and

At that time, I suggested that perhaps the energy of the drafters might have been better served in actually addressing the shortcomings of the existing legislation and fixing them, rather than creating more principles to guide the application of this aging and flawed legislation.

Nevertheless, to use an overused phrase, it is what it is.

The path chosen by the minister was to create the health charter and the office of the patient advocate, and rely on these tools to further reform the health care system. And, accordingly, in January of this year, the minister released a draft of the proposed health charter,

AMA - Alberta Doctors’ Digest

“As I work to be a healthy citizen of Alberta, I expect that.…”

Each of these partial sentences is followed by a list of expectations, including things like “be treated with dignity and respect,” “have timely and reasonable access to safe, high quality health services and care,” and “treat health services as a valuable public resource.” None of these are earth-shaking or even surprising and none very new or innovative.

Except one. >

> The last expectation relates to the expectations of a patient when interacting with the health system. It reads as follows: “When economic, fiscal and social policies are being developed by the Alberta government, the impact of those policies on public health, wellness and prevention will be considered and steps taken to ensure that public policy is healthy policy.”

In other words, a not-so-subtle reminder that we remain in a publicly funded system and that any expectations of care must be tempered by budgetary and social constraints.

The provision that the health advocate report to the minister severely

erodes any sense of independence in terms of her powers and procedures.

The health advocate is empowered to establish her own procedures for the conduct of reviews, and provides for certain powers to request access to policies, directives, or health records or other information relevant to her inquiries. The health advocate is required to prepare a report including, if appropriate, recommendations and submit it to the minister.

This last bit is troubling. The provision that the health advocate report to the minister severely erodes any sense of independence in terms of her powers and procedures. A health system inquiry appointed pursuant to the Health Quality Council of Alberta, for example, reports its findings directly to the legislature, which presumably is intended to provide a reassurance that (a) there will be no ministerial influence over its findings, and (b) the findings will be made public.

At the conclusion of the January-February 2011 article, I suggested that the drafters of the act might have been better served to direct their attention to Alberta’s seriously outdated health legislation, and then held out faint hope that one of the principles in the health charter might be that health legislation should be relevant. Based on this draft, I’d say the answer to that is a firm “no.”

In my earlier article I had anticipated a series of motherhood principles. My read of the draft charter is: that is exactly what Albertans will be getting. We will see how the public responds. Government has provided a web-based consultation page by which anyone can comment. Consultation closed March 3 and we will see what emerges.

In terms of the appointment of the health advocate, the minister issued a “notice of the proposed health advocate regulation” in January of this year and, again, invited comments. The proposed regulation would add to the powers of the health advocate as provided for in the act (i.e., review of complaints and enforcement of compliance with the health charter). Those additional powers would include: • Providing education on the charter.

• Assisting individuals in determining appropriate resolution mechanisms to resolve concerns.

• Informing individuals about existing health-related programs and resources.

• Assisting individuals in “navigating” the health care system.

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March - April 2014

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Feature

Who ARE those people?

Things you didn’t know about your AMA board members

(

provided by Curtis Comeau Photography)

Seated, left to right: Dr. Kathryn Andrusky; Dr. Richard Johnston, President-Elect; Dr. Allan Garbutt, President; Dr. Michael Giuffre, Immediate Past President; Dr. Paul Parks Standing, left to right: Christine Fleck, Manager, Executive Office; Dr. Robin Cox; Dr. Padraic Carr; Dr. Sarah Bates; Dr. Neil Cooper; Michael Gormley, Executive Director; Stefan Link, MSA observer; Dr. Ernst Schuster; Dr. Paul Boucher; Dr. Christine Molnar; Dr. Sylvia McCulloch, PARA observer Absent: Dr. Jasneet Parmar

W

The new board biographies put a human face on the people who represent your interests on the board.

We asked each board member to tell us about their involvement with the AMA (many have been AMA leaders since their student days), to describe why they think it’s important to be active in the AMA, and to share a favorite AMA memory and some personal information.

Visit the new pages on the AMA website to find answers to all of the questions at the beginning of this article.

hich Alberta Medical Association (AMA) board member unwinds by “puttering on our quarter section by Wildwood, Alberta, driving my tractor and bobcat, and playing in the dirt”?

Who has three cats, “all named for characters in To Kill a Mockingbird”? Who’s visited more than 55 countries around the world? Whose PhD thesis on the reproductive biology of the ruffed grouse was informally known as “sex and the single chick?”

AMA - Alberta Doctors’ Digest

AMA Executive Office Manager Cris Fleck, who works closely with the board, is amazed by what board members accomplish: “They do so many things ¬ work, family, volunteering, travel … if they’re not out cycling, they’re fixing children’s cleft palates in developing countries or taking a whole planeload of disadvantaged children to Disneyland … it’s such an honor to work with such great people.”

Visit the new AMA board biographies at http://bit.ly/MLGKnl.

Feature Want to be a rural physician?

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There’s a scholarship for that!

Application for Dr. Michael Tarrant Scholarship available online

T

he Alberta Medical Association’s (AMA’s) Section of Rural Medicine created the Dr. Michael Tarrant Scholarship in 2004 to encourage medical students interested in rural medicine to eventually set up practice in smaller communities.

To date, the scholarship has awarded more than $260,000 to 27 medical students. It is one of Alberta’s largest unrestricted medical school undergraduate awards and provides a full year’s tuition to its recipients. It is awarded each fall by the Section of Rural Medicine to third-year medical students at the University of Alberta (U of A) and the University of Calgary (U of C).

The scholarship is named in honor of the late Dr. Michael Tarrant, a Calgary family physician. Dr. Tarrant championed rural medical undergraduate education and helped establish ongoing rural roots for future physicians.

The scholarship is presented to students who have demonstrated an interest in, and dedication to, rural medical issues during their undergraduate years.

A medical student is eligible to apply for the 2014 scholarship if he or she is:

• Entering third-year medical school this fall at the U of A or the U of C. • Interested in a career in rural medicine in Alberta.

• Demonstrating an interest in, and dedication to, rural medical issues in undergraduate work.

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March - April 2014

14

Mind Your Own Business

From babies to aging parents:

An employer’s duty to accommodate Practice Management Program Staff

T

he Alberta Human Rights, Citizenship and Multiculturalism Act protects individuals from discrimination. This act protects individuals in five areas: employment, tenancy, goods and services, publications and notices, and membership in trade unions.

The act also has 13 protected grounds of discrimination (see sidebar) and individuals cannot discriminate against another individual on any one of these grounds. For ease, this article will focus on employment and the legal requirements as an employer to accommodate the diverse needs of employees.

What is your duty to accommodate?

The Supreme Court of Canada ruled that an employer has a legal responsibility to take reasonable steps to accommodate an employee’s individual needs.

Some examples of accommodations include time off for extended illness and fulfillment of religious observance.

What is an accommodation?

Accommodations occur when the employer makes changes to certain rules, standards, policies, workplace cultures and physical environments to ensure they don’t have a negative

AMA - Alberta Doctors’ Digest

impact on an employee because of one of the 13 grounds. For example, an employer may exempt an employee from wearing a standard uniform for a job and permit wearing a head covering even though the covering may conflict with uniform requirements or dress codes.

What would you do?* You have a small clinic and rely on your staff to ensure things run smoothly. You have a clinic manager who is six-months pregnant. She told everyone at work that she is expecting a baby! You know another clinic manager who is looking for work and could start right away.

Do you fire or lay off your expectant clinic manager?

If you answered NO, you are correct!

Expectant mothers are protected because discrimination on the basis of pregnancy is one of the protected grounds (gender).

Expectant mothers and fathers could qualify for maternity and parental leave and would therefore require accommodation.

Who can request accommodation?

Anyone who needs accommodation to overcome a disadvantage caused by a rule or a practice at the workplace can request an accommodation.

Protected grounds of discrimination Employers cannot discriminate against their employees on any of the following 13 grounds: 1. Race 2. Ancestry 3. Place of origin 4. Color 5. Religious beliefs 6. Gender 7. Physical disability 8. Mental disability 9. Age 10. Sexual orientation 11. Marital status 12. Family status 13. Source of income

What would you do?* Your medical office assistant (MOA) had a car accident and was on short-term disability. His absence was felt by everyone in your clinic and you had to hire someone temporarily to cover his shifts. He is back to work but has had to take a number of sick days off in the past few weeks. After seeing a physician he has learned that he has epilepsy as a result of the accident and will need at least one month leave from work to stabilize on medication. Do you fire or lay off your MOA? >

> If you answered NO, you are correct!

Some things to consider when accommodating employees include:

Epilepsy is a physical disability.

Physical disabilities are a protected ground under the act.

If the employee requests time off work, the employer must try to accommodate him. If, as the employer, you feel the employee’s absence will cause undue hardship (see below for definition) the onus is then on the employer to prove this hardship. Expenses for things like overtime or leave do not normally constitute undue hardship.

Having other employees work more hours with overtime pay or hiring a temporary employee are both accommodations that could be considered.

• Purchasing or modifying tools, equipment or aids.

What is undue hardship?

Your receptionist has a gravely ill parent and has requested an eight-week leave to care for her. Do you fire or lay off your receptionist?

Undue hardship occurs if accommodation creates difficult conditions for an employer. There are a number of factors considered when determining undue hardship.

These include: financial costs; the size and resources of the employer; disruption to operations; morale problems and interference of the rights of other employees; ability of the organization to accommodate relocation; and the overall impacts to health and safety.

For example, an employee who, as a result of a disability, cannot climb stairs but may be required to carry boxes up and down stairs as part of his or her job duties. If there is no elevator, it may be deemed an undue hardship to expect the employer to install an elevator to accommodate the employee.

Determining undue hardship is not an easy task. What creates undue hardship for one employer may not cause undue hardship for a different employer. Seeking expert advice is always recommended.

What can accommodation in the workplace look like?

An employer’s duty to accommodate is an obligation to eliminate possible discrimination against employees.

• Altering the premises to make them accessible.

• Offering flexible work schedules.

• Offering rehabilitation programs.

• Allowing time off for recuperation.

• Transferring employees to different jobs.

• Hiring an assistant.

• Using temporary employees.

• Adjusting policies.

What would you do?*

If you answered NO, you are correct!

Compassionate Care is new to Alberta as of February 1. All employees are now entitled to unpaid leave. They have to have worked 52 weeks for their employer and have a signed certificate by the attending physician regarding the grave condition of their family member and their need of care.

Employees meeting this requirement are able to take up to eight-weeks of unpaid, job-protected leave from the workplace. This means they must return to the same or a comparable position.

What is a bona fide occupational requirement?

The law recognizes that, in certain circumstances, a limitation on individual rights may be reasonable and justifiable. Discrimination or exclusion may be allowed if an employer can show that a discriminatory standard, policy or rule is a necessary requirement of a job. For example, in order to perform their jobs safely, people employed as drivers require acceptable vision and an appropriate driver’s license.

A legally blind person would be legitimately excluded from a position as a driver since it’s a bona fide occupational requirement to be able to see to obtain a driver’s license.

What are the potential consequences of failing to accommodate?

If the employer fails to provide accommodation to the point of undue hardship then the employer may be in violation of the Alberta Human Rights Act.

How to resolve human rights complaints?

Employers are responsible for dealing promptly with complaints of discrimination. Strong policies and programs that prevent human rights complaints make good practical sense and often save time and money. Having an anti-discrimination policy and a complaint resolution procedure are effective ways to communicate the rules and define unacceptable behavior.

Where can I get more information?

For more information on duty to accommodate and other human rights issues, contact the Alberta Human Rights Commission.

You can visit their website at www.albertahumanrights.ab.ca or call toll-free in Alberta 310-0000.

For more information about the human rights complaints process and remedies, the commission has produced information sheets which can also be found on their website.

References available upon request. * “What would you do?” examples are for illustrative purposes only. Always seek professional advice.

March - April 2014

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16

Insurance Insights

Protecting your clinic against flood Phil Cunningham, BA (Hons), CIP, PgDip | Senior

How can I protect my business against flood?

F

looding can be a disaster for any business. As well as damage to premises you can lose stock and equipment and find that you cannot open for business while the damage is repaired. You may lose contracts and your patients may go elsewhere. Even if the flood does not impact you directly, you may find suppliers are unable to meet your needs or flooded-out employees cannot get to work.

Understanding what the risks of flooding are for your business will help you decide what to do about it. For example, your losses could be high if you have a lot of expensive stock or equipment such as laser machines on the ground floor of your office. Businesses which have taken action and are prepared can save between 20 and 90% on the cost of lost stock and moveable equipment when there is flooding.

Draw up a flood plan A flood plan is a written document that outlines how your business will respond to a flood. If a flood is imminent, your main priority must be to make sure that your employees are safe. You should review and update your plan annually.

As a minimum, your business flood plan should include: • A list of important contacts including your insurance company, key customers, suppliers and evacuation contacts for staff.

• A map showing locations of key equipment and where to shut off electricity and other services.

• Your procedure to protect your property and minimize business disruption.

• Key procedures for employees.

AMA - Alberta Doctors’ Digest

Vice President, Mardon Group Insurance

Insure your business against flooding Once you have assessed your flood risk, make sure you are properly insured. While home insurance policies in Canada do not cover flood, commercial insurance policies do. Flood damage should be included in standard business insurance for areas of low risk.

However, you may have to buy it as an option, if you are in an area of significant risk. Bear in mind that repairs to flood-damaged premises can be very expensive.

As well as replacing stock, equipment and repairing damaged premises, your business could be disrupted for weeks or months. Check that your insurance coverage includes business interruption and other costs. Business interruption insurance compensates a business for lost income, expenses and profits if a disaster, such as a flood, forces you to close your business. It can be added to your policy if it is not included as standard.

The cost of the policy depends on the type of business and premises, your location and the length of disruption.

By taking risk-reduction measures, you may be able to lower your premiums and deductibles. Discuss this with your broker or insurer who will be able to help identify which measures to take.

Thinking ahead will help make any insurance claim as straightforward as possible. Regularly back-up computer data and store important records and information such as your insurance policy and an inventory of important equipment somewhere safe above flood level, such as an upper story of the building. You may want to keep photographic evidence. An independent appraisal of the potential cost of repairs and replacements can also help.

If you are flooded, contact your insurer immediately and make sure that you keep complete records of everything you do.

Reduce potential flood damage Planning ahead can dramatically reduce the impact of flooding on your business. For example, storing valuable items higher up reduces the likely loss at little or no cost. In high-risk premises, consider investing in floodprotection products. This may help you to reduce your insurance costs. >

> There are many different types of flood protection products and your choice will depend on your level of flood risk and the potential costs of a flood to your business.

There are two ways in which you can reduce the damage to your property.

1. To prevent water from entering the building, install permanent or removable barriers to seal doors, windows and other openings like toilets and drains.

Floodwaters can get into properties by surging through the sewer system, with overflowing toilets a common cause of damage. By installing sewer non-return valves, homeowners and businesses can block off that channel for the floodwaters. Flaps prevent any backflow of sewage into a property and there is also an emergency manual locking mechanism. Some products include a pump allowing the toilet to be used during a flood and waste to be pumped back against the water in the drain.

2. Reduce the damage caused by water entering the building by raising electrical sockets, wiring and controls for ventilation systems, and raising large equipment. Rewiring may be expensive, but can save considerable costs in the event of flooding. Bear in mind that the majority of flood damage occurs at a depth of less than half a meter. Use flood resistant materials in the construction of new buildings or extensions to reduce the damage if a flood does occur.

Finally, you should ensure that you have planned how to recover after a flood.

What to do after a flood Your first priority must be safety. Do not re-enter your premises until you are sure it is safe. Even if a building looks safe, it may have suffered structural damage and could collapse. You also risk a fatal electrical shock if the main electricity has not been disconnected.

Flood water may contain sewage, chemicals and waste matter. Protect yourself and others assisting in the clean up by wearing suitable protective clothing to prevent possible infection. If you are using a pump to remove excess water, place the generator outside the building to avoid the risks associated with the build-up of carbon monoxide fumes.

Once it is safe to re-enter, make a record by photographing flood damage to the building, equipment and goods. Check with your insurance company before you start salvaging goods and repairing damage. They can often recommend suitable tradesmen to help you, and may be willing to make an interim payment to help you get your business going again as quickly as possible.

Local authorities usually provide skips and extra rubbish containers for items that your insurance company has agreed you can throw away.

You may find it quicker and safer to replace damaged items rather than repairing them. You may need expert advice on the best way to repair damage to the building.

You will need to start doing business again as soon as possible. A good flood plan should include a list of key contacts and suppliers. You may also be able to operate from temporary premises while repairs are carried out.

The Alberta Medical Association Commercial Office Insurance Program is offered through Mardon Group Insurance and combines all the most needed coverage into one package while providing a group discounted rate. For more information or to receive a quote, please call Mardon toll-free at 1.866.846.4467.

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March - April 2014

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18

Letters

Re: What should we eat? Just ask a hunter-gatherer.

I

thank you for highlighting in your January-February Alberta Doctors’ Digest article the problem of nutrition in chronic diseases today, and our lack of basic nutritional education as physicians, hampering our ability to offer meaningful advice. This is an issue that is plaguing our society.

As a medical student, I received virtually no nutritional education, other than to be made aware of the need to follow a low-cholesterol, low-salt diet. As a resident, and fellow, my education was a bit more robust and I began to learn about carbohydrates, simple sugars, the importance of fibre, fat and Vitamin D. I think Canada’s Food Guide was mentioned and put up on a slide or two here or there, and I had a shiny copy of my own once or twice.

A couple of decades later, I found myself (recently) as a patient listening to my health care provider loudly complain that we are not teaching our students basic facts such as personal hygiene and the importance of hydration. In the next breath, she lamented the follies of following the Canada Food Guide which was certain to make everyone fat (at which point I nearly fell off of the examining table)!

I opened Alberta Doctors’ Digest and read your advocacy of the Paleolithic diet, while in the same breath admitting that you really also lacked in basic nutritional education outside of progression from NPO to DAT. I think it is time that we lobbied for better nutritional education in our schools and educate ourselves. The Canada Food Guide is an excellent resource for nutritional information and the Government of Canada’s

AMA - Alberta Doctors’ Digest

website is full of free information that is accessible to nearly anyone who can read. As much as possible the recommendations are evidence based.

The food guide offers great advice about servings, portion sizes and there is a detailed list of food options that cover many ethnic palates. In addition, there are sections on specific nutrients, and lots of examples demonstrating how to put together a balanced, healthy meal plan. You can even work with an interactive version and download a customized PDF with your own preferences.

I don’t know why this information is overlooked as often as it is. I would suggest that most physicians have no

idea what a serving size is for any of the food groups, let alone how many servings of each they should have on a daily basis. How on earth are we to help our patients when we lack the most basic knowledge ourselves?

The average age, at death, of Paleolithic man was around the age of peak physical maturity, strength and health. Paleolithic man was very physically active with lots of weight bearing activity, not sedentary as we are today. I don’t know enough about the science behind the suggestion that Paleolithic diets are better, and would challenge the assertion that theoretically they would be healthier if they had lived to age 70 or beyond. >

Calgary, aB The Centre for Sleep and Human Performance (CSHP) is recruiting physicians with an interest in Sleep Medicine with backgrounds in Family Medicine, Internal Medicine, Psychiatry, Respirology and Neurology. The Centre for Sleep and Human Performance is fully accredited as a Level I Sleep Centre by the College of Physicians and Surgeons of Alberta and the American Academy of Sleep Medicine. The Centre is affiliated with the Faculty of Medicine at the University of Calgary as a teaching site and the Institute of Public Health. The Centre’s research agenda focuses > on the relationship of sleep to health and human performance. The Centre’s research program is world renowned, funded by Own the Podium and serves the Canadian Olympic Teams and Sport Canada athletic development programs. The medical clinic is a fully electronic office with excellent managerial and administrative staff that operates efficiently to provide physicians with a supportive working environment. Successful candidates will be trained in the clinical and technical aspects of sleep medicine. Staff physicians will be offered the opportunity to focus their practice in specific areas of sleep medicine.

For further information, please forward Curriculum Vitae to: Dr. Charles H. Samuels, Medical Director Centre for Sleep and Human Performance Fax: 403.254.6693 | dr.samuels@centreforsleep.com

> There are many factors that contribute to our overfed but under-nourished state as a society. We not only lack basic knowledge, but many people do not cook and rely on fast food, or processed prepared foods.

Rather than recommend the high-cholesterol atherogenic Paleolithic diet, it would be much better if you could use your next column to advocate for better nutritional education starting in primary school and intensive education in medical school.

Thanks for letting me bend your ear.

Yours sincerely, Tammy McNab, MD Edmonton AB Dr. Jirsch replies to Dr. McNab

I

’d like to thank Dr. McNab for her letter and would say at the outset that Canada’s Food Guide makes a lot of sense. I’ve reread it several times now, and can hear the voice of my Mum throughout, urging me to eat my broccoli and finish my vegetables.

It’s filled with good guidelines for us omnivores with our predilection to eat too much fat, too much sugar, too much salt and so on.

Perhaps it is the truth-writ-large about what we should and shouldn’t eat, but I’m nevertheless intrigued by recent suggestions that the general

diets we spent countless millennia in our prehistory becoming adapted to were better for us than the sugar and starch laden choices we so often prefer today. I agree with scientist Theodosius Dobzhansky, who said that, “Nothing in biology makes sense except in the light of evolution” and would expect that evolutionary evidence may help us in our search for optimal nutrition.

The Alberta Medical Association welcomes comments about Digest articles and suggestions for future topics. Please contact Daphne C. Andrychuk, Communications Assistant, daphne.andrychuk@albertadoctors.org, or write her c/o Public Affairs, Alberta Medical Association, 12230 106 Ave NW, Edmonton AB T5N 3Z1. The association reserves the right to edit all letters.

I didn’t advocate or recommend a Paleo diet. Indeed I’m the guy who bolted for apple pie at the end of my piece, and I explained why it would be difficult if not impossible to replicate the mix of bugs, seeds, and “nasty bits” along with the living conditions of these early times. That the folk who lived thusly did not all have lives that were nasty, brutish and short, deserves our attention, though, perhaps especially in light of the evidence of the relative absence of the chronic ailments that afflict us today.

We need to know more about our nutrition and should study, investigate and teach the truth as it is revealed to us. I think we have much to learn from our journey.

“Good eating,” I’d say, knowing that this will likely mean different things to each of us.

Again, thank you.

Dennis W. Jirsch, MD, PhD Editor

Look ma, no login!

Want to comment on The President’s Letter or other pages on our website, but don’t want to log into the site? Now you can!

We’ve just produced a new way for you to tell us what you think or to participate in group discussions. We’ll be including this feature with President’s Letters and on other web pages in the coming months.

Give it a try! For example, next time we send you a President’s Letter, click on the link at the top of the email. Scroll down to the bottom of the web page and post your comment. It’s just that easy.

Take a look at our commenting policy for some common-sense advice on keeping the conversation productive.

And, of course, you’ll still be able to contact the president directly by email.

March - April 2014

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Feature

21

Out of options for resolving problems with intimidation in the workplace and patient advocacy?

Call the Practitioner Advocacy Assistance Line ¬ a confidential service now delivered by the ZMSAs

W

hen facing challenges advocating for patients or experiencing intimidation, many physicians are comfortable making a personal call directly to their Zone Medical Staff Association (ZMSA) president or to the Alberta Medical Association.

When an advocacy or intimidation concern is so serious that you need confidentiality, the Practitioner Advocacy Assistance Line (PAAL) is a 24-hour confidential service that you can call to share the issue and obtain advice from the ZMSA (toll-free 1.866.225.7112).

All calls are answered by Confidence Line, an independent provider of 24/7 confidential reporting lines.

When you phone, Confidence Line notifies the ZMSA president in your zone (or a designated ZMSA alternate) who will return your call.

The PAAL service has been transferred out of Alberta Health Services where it used to reside and is now operated at arm’s length by ZMSAs. Scan for more information about PAAL or visit bit.ly/1a4LOsm. More information about ZMSAs is available at: www.albertadoctors.org/ leaders-partners/leaders/zmsas/ get-involved.

Out of options for resolving problems with intimidation in the workplace and patient advocacy?

Call the Zone Medical Staff Association (ZMSA) operated

PractitiOner advOcacy assistance Line (PaaL)

1.866.225.7112



When an advocacy or intimidation concern is so serious that you need confidentiality, the PAAL is a 24-hour confidential service you can call to share the issue and obtain advice from your ZMSA. All calls are answered by Confidence Line, an independent provider of confidential reporting lines.

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

by ZMSAs. Scan for more information or visit bit.ly/1a4LOsm.

March - April 2014

22

PFSP Perspectives

Living better through empathy Jared D. Bly, MD, CCFP (EM) | Assessment

Physician, PFSP

A space to be

“Thanksgiving dinner’s sad and thankless.

Christmas dinner’s dark and blue.

When you stop and try to see it from the turkey’s point of view."

- Point of View, Shel Silverstein

I

have to admit, I often overlook empathy at the dinner table ¬ sometimes, too, in my clinical encounters. And while I’m okay with leaving this virtue undeveloped in regard to my food, I could really benefit from improving it in other aspects of personal and professional life.

Empathy is an important tool in any medical toolbox. It’s the band-aid of a good first aid kit. Any parent knows the value of a cute bandage with a picture of a cartoon character for any bleeding wound and even for those ones that didn’t quite break the skin but hurt a lot. Somehow it eases the pain.

That somehow is empathy. In addition to easing the pain of a superficial skin wound, empathy has also been shown to improve outcomes in diabetic patients, improve medication compliance, decrease the duration of the common cold, improve patient satisfaction and decrease lawsuits. Research, not to mention intuition, contradicts the oxymoron of “a good doctor with a horrible bedside manner.” A review on the so-called “soft skills” of medicine suggested that a “consistent finding is that physicians who adopt a warm, friendly and reassuring manner are more effective than those who keep consultations formal and do not offer reassurance.”

There are courses, articles, chapters, books, even careers based on techniques and tools to develop this virtue. I’ll offer just a few phrases to cultivate empathy: “a space to be,” “the third alternative” and “just listening.”

Humanistic psychologist Carl Rogers described a way of seeing other people, not for their accomplishments, not for what they could do for others, but for their own inherent value as fellow human beings. This “unconditional positive regard” is a foundation for conflict resolution, negotiations, family life and maybe for any interaction with another person.

Dr. Gabor Maté, author and physician in downtown Vancouver, has more than the average amount of experience dealing with people who aren’t used to being appreciated for their inherent worth. In his book In the Realm of Hungry Ghosts, he talks of his experiences in treating people with addictions. Most of his patients would be considered “difficult patients” to many of us.

But like anyone, they need to feel valued or even valuable.

He quotes a nurse colleague: “People just need a space to be. They need a space to exist without being judged and hounded and harassed.” (Liz Evans, nurse, director of Portland Hotel Society.)

We make mistakes when we make assumptions. I learned this when I treated a patient in the middle of the night with a simple scalp laceration.

“What happened,” I asked.

“I just tripped on the stair,” he replied sheepishly.

Taking his embarrassment for avoidance, I assumed alcohol was involved. Luckily, I didn’t say so. I did inquire about his social situation. I usually do with people showing up drunk in the night at my downtown emergency department. It probably came out something like, “So, do you have a job?”

He did have a job. He was a drug counsellor in a downtown clinic that had many of the city’s underserved residents as patients, many of the same people I saw as patients.

We did end up talking about alcohol, but in a very different way than my original assumptions would have led. >

AMA - Alberta Doctors’ Digest

> The third alternative

23

We get stuck in dichotomies. In manufacturing (quantity or quality), politics (increase taxes or decrease social funding), even family life (permissiveness or discipline), we often limit ourselves to narrow choices. Sometimes we can only see “my way or the highway.”

The influential philosopher Immanuel Kant introduced the idea that valuable perspectives sometimes lie outside the range of our usual responses: “I do not approach reasonable objections with the intention merely of refuting them, but that in thinking them over, I always weave them into my judgments, and afford them the opportunity of overturning all my most cherished beliefs. I entertain the hope that by thus viewing my judgments impartially from the standpoint of others some third view that will improve upon my previous insight may be obtainable.”

Have you ever been sure of a diagnosis or treatment only to have the patient himself suggest something you hadn’t thought of? And then to realize that he was right. If you haven’t, maybe you’re really smart and always think of all possibilities. Or maybe you’ve just missed some diagnoses because you were “refuting reasonable objections.”

Another scalp laceration in the night. This on a man in his 40s, assaulted at a bar. In fact, he had more than just a scalp laceration; his face, too, was slashed in four or five places. Nothing serious, but more than a little suturing was indicated.

“Can you put me out?” he asked. General anesthesia didn’t seem to be a reasonable objection, and I refuted it with little thought. As I began to inject local anesthetic, his response was dramatic, to say the least. Not that he wasn’t co-operating; the tiny needle seemed to inflict immense pain. Even once an area was anesthetized, he still seemed to require great effort just to remain on the stretcher.

“I have a thing with needles,” he explained apologetically, as I paused to wonder why this seemed so difficult for him. He described his phobia a little, but was willing to do what he needed to have his gaping wounds repaired. I reconsidered the idea of “putting him out” in this new light.

His objection didn’t seem so unreasonable now. The rest of the procedure was facilitated by a little sedation.

Just listening A 30-something woman was brought by EMS, accompanied by police, to my emergency department during the night. She had been acting violently, even “pulled a knife” on someone, and spit on a paramedic.

She was unclothed, had a mask applied to prevent further bodily fluid exposure to health care workers, and restrained to the bed for the next few hours until seen by a physician. When I did see her I said something about how I thought it didn’t look like much fun to be in her current situation. She swore at me. But we talked and I tried to see

Empathy often means seeing things from a different viewpoint. (

provided by David Bly)

things from her point of view. And she told me her story, which was little more than a night of excessive drinking.

Pulling a knife? The police officer on scene told me she pulled everything out of her purse, including a knife, looking for her identification.

C.S. Lewis said, “What you see and hear depends a good deal on where you are standing.” In my first month of medical school before I was taught how to palpate an abdomen or listen for whispering pectoriloquy, I was taught where to place myself in relation to a patient.

Sitting attentively, not standing impatiently, hand on doorknob. At eye level, not looming above them. Close enough, not too close. You know, all those things I forgot when I became more concerned about heart sounds (was that a pathologically split S2?) and neurological findings (is this sharp or dull? sharp or dull? sharp or dull?). Dull.

C.S. Lewis was right. “… it also depends on what sort of person you are,” he continued. How we are with others is maybe determined by how much we can be with others during times of need.

Not so much in terms of quantity of time, but in quantity and quality of our being present.

“When we honestly ask ourselves which person in our lives means the most to us, we often find that it is those who, instead of giving advice, solutions, or cures, have chosen > March - April 2014

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>

rather to share our pain and touch our wounds with a warm and tender hand. The friend who can be silent with us in a moment of despair or confusion, who can stay with us in an hour of grief and bereavement, who can tolerate not knowing, not curing, not healing and face with us the reality of our powerlessness, that is a friend who cares.”

- Henri J.M. Nouwen, Out of Solitude: Three Meditations on the Christian Life

Empathy is an important ingredient if we would be an influence for good at home or at work. People flourish when they are appreciated simply for who they are (“a space to be”), when their viewpoint is considered important (“the third alternative”) and when they feel heard (“just listen”). And who knows, maybe dinner would even taste better if we considered its origins. At least the turkey might feel better about it.

References available upon request.

Family Physician/GP, Private Family Clinic, Edmonton, Alberta Clareview Medical Clinic, 3504 137Avenue NW, Edmonton, Alberta, T5Y 1Y7, Canada This is your chance to live in a Canadian city ranked among the best places to live in North America. It is a city with education and arts as the center of its cultural life, an outstanding place to raise a family, earn excellent income and enjoy a very comfortable lifestyle.

Edmonton is a vibrant and energetic city. It is diverse and highly connected by a welcoming sense of community. Northeast Edmonton has the advantage of easy access to shopping, cultural events, youth activities and the downtown, while still providing families with space and autonomy. The public school system is second to none featuring a wide variety of programs and extracurricular activities, including sports, the arts, hobbies, and academic pursuits.

Post-secondary education opportunities include the renowned University of Alberta, MacEwan University, and Northern Alberta Institute of Technology (NAIT).

Edmonton is a highly diverse city, exemplified by the numerous religious, ethnic and cultural roots of its citizens. The city has hundreds of churches and religious buildings representing a wide variety of religious sects.

AMA - Alberta Doctors’ Digest

Depending on the size and area, an upscale 3 bedroom, 2500 sq. ft. home within city limits can range from $600,000 to $1,000,000.

The Clareview Medical Clinic: 1) 2) 3) 4) 5) 6) 7)

8)

Physician income is Fee-For-Service, with average annual income of $325,000+.

Revenue is split 70% /30%, physician/ clinic to cover capital costs and operating expenses.

Average patient intake per hour ranges from 6-10 depending on individual physician work style and patient acuity.

The on-call is shared by the physicians, and is not onerous.

Patient records are electronic.

The patient mix is currently 60% appointment and 40% walk-in patients.

The patient population is a cross-section ranging from middle class to low income families, living in detached homes, apartments, and condominiums in the local area. The Clareview clinic is located in the densely populated Clareview community, on a major thoroughfare serviced by several transit bus routes.

The clinic currently accommodates various medical students as part of their curriculum.

Incentives include: -

Practice setup assistance, and advertising.

Immigration assistance and/or referrals for you and your family, if required.

Medical licensing and credentialing assistance.

Housing and travel assistance.

Pre-approved banking services.

Qualifications: -

Canadian or Permanent Residents already holding an Alberta Medical license, CCFP Certified or CCFP Eligible, preferred.

USA Board, UK-MRCGP, Irish-MICGP, or Aus-FRACGP certified are also encouraged to apply.

Other Exceptional IMG General Practitioners may be considered.

In accordance with immigration requirements, preference will be given to Canadian citizens and permanent residents of Canada.

Contact: Phil Jost, HSM,MBA VP Operations & Regional Manager CanAm Physician Recruiting Inc. Office: 902-439-3400 Toll Free - Canada/USA: 866-446-4447 Email: phil@canamrecruiting.ca www.canamrecruiting.com

Feature

25

What’s new online?

POSP resources now on the AMA website

T

he Physician Office System Program (POSP) website will not be available after March 31. To ensure that our members can still access the many valuable POSP resources, we’ve moved many of these to the Alberta Medical Association (AMA) website, including information related to: • The Vendor Conformance and Usability Requirements (VCUR) 2008 Electronic Medical Record (EMR) Funding Extension Program.

• Implementing an EMR system.

Visit the AMA website to access these resources at http://bit.ly/1jqbCFf.

The AMA has recently developed tip sheets for physicians who’d like to present to AMA Youth Run Clubs, especially those in elementary schools: • Physical activity: It’s good for you!

• Run, run, for fun: Without injuries!

• Screen time.

• Sun safety.

Before deciding on a topic, we suggest talking with the run club coach. You can get contact information from AMA Youth Run Club Coordinator Hayley Degaust (email hayley@everactive.org or phone 780.454.4745).

All of our tip sheets include ways to make your presentation both fun and informative for kids at http://bit.ly/1f6LDjj.

New tip sheets for physicians presenting to AMA Youth Run Clubs As you may know, the AMA is sponsoring the AMA Youth Run Club. With help from our partner Ever Active Schools, the club is offered free to schools and students across Alberta.

Over 200 schools have already signed up! To see a list of participating schools, visit http://bit.ly/1do4bxz.

Many AMA members have volunteered to help with their local clubs, e.g., by starting clubs at their schools, by volunteering as coaches or by making presentations to school kids about how to stay healthy.

The Alberta Medical Association is sponsoring the AMA Youth Run Club at schools across Alberta. It’s a great way for you to get involved in your community. ( provided by Megan Hunka)

March - April 2014

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In A different vein

Pilgrimage in technoland Alexander H.G. Paterson, MB ChB, MD, FRCP, FACP | co-Editor

I

’m writing this column from the port city of Kobe, Japan, where my wife’s grandfather Fred was born, educated, lived and worked. He made a fortune in steel then lost it all with the coming of World War II. He was the coolest head of the seven James brothers. There is an area in Kobe called “James-yama” after great uncle Ernest James, once the richest expatriate in Japan. He was a physical exercise nut (founding the Shioya Country Club and the first golf course in Japan), a great gambler (once wagering a tea plantation on the turn of a card) threatening suicide after any big loss and requiring Fred to rescue him.

Another brother, David James, wrote the definitive Rise and Fall of the Japanese Empire1 ¬ the first half of the book as exciting as the Bible’s Book of Kings ¬ but fascinating and well worth reading for the second half. Alas, only Canada compensates victims of war. No compensation will come from the Japanese government for most of those forever alien “foreigners” born in Japan who loved Japan but who were dispossessed and sent to prison and concentration camps. The few who returned were allowed to repossess what was left of their property.

Japan has frantically embraced technology with the enthusiasm of a dog knowing it’s going for a walk and with a self-deprecating sense of humor. But there is also a feeling of big national insecurity, seeking for a lost identity which is comforted by fiddling with smart phones and having over-complicated car dashboard panels ¬ the illusion of control. Is it an over-compensation for their horrifying defeat in World War II and their emasculation with the American enforced constitution? Is there a link between identity loss and over-fascination with techno-gizmos?

In the subway stations, where it seems every third person is wearing a face mask, the young have mastered the art of texting while avoiding a plunge into the path of an oncoming bullet train. Japan, with its 128 million souls in a country the size of California, is a furor of texting and messaging ¬ and yet, we couldn’t check-in by Internet and get a boarding pass for our flights. It just didn’t seem to be done.

Mr. Abe, the prime minister, is making news in Davos (with the same gee-whiz headlines as in Canada: naïve pride and surprise that the world is paying some attention to them) with his restructuring and money printing. And yet the expat business community in the Kobe Club is uncertain whether any real restructuring is happening. There are vast shopping malls empty of shoppers. The wife of the president of an American chemical company worries about how prices have increased in the last two years.

Japan has frantically embraced technology with the enthusiasm of a dog knowing it’s going for a walk.

“It’s not as cheap as it was here, although we still get a shock going to Philadelphia to visit my daughter.

Everything in the United States of America is so expensive now,” she says, sipping a glass of champagne at the Kobe Club where we have been made welcome as descendants of the great Ernest William James.

I was unsure about this visit, trying to find something of older Japan among the explosion of concrete high-rises.

I’d been here 25 years ago on a medical junket and there have been big changes. In 1989 it was hard to get around without a guide speaking broken English. Train stations were a beautiful nightmare of cleanliness and neatly packaged goodies ¬ everything kichinto (neat, orderly) ¬ but not a Roman numeral or letter anywhere. Now (at least in the main cities) there is accompanying English signage in small lettering (though larger than in Quebec) and getting around the subway is straightforward after a few mishaps.

It was in 1989 we heard about, but never tried, the technological prototype of one of the unsung advances of Asian ingenuity: the Japanese toilet seat. It is a fine example of technology contributing to a big step forward in human civilization. >

> On lowering one’s bottom, the sensitive gluteal flesh is surprised and delighted to meet the seat heated to a comfortable temperature (as in a car seat warmer for winter driving in Alberta). There is a fresh flush of water before any action so that one’s droppings can later be inspected without any prior contamination. Afterwards, upon pressing a button on the control console, a heat directed spray of warm water shoots upward at one’s preferred pressure. The temptation is to stay in place too long enjoying the sensation but thereby running a risk of cheek chapping. Some find difficulties with the controls: the squirt of water can catch a novice by surprise and lead to an upwards leap with splashing around the toilet.

The latest Kohler Numi model features a built-in music system, ambient lighting, a touch-screen remote, a motion-activated lid and heated seat, retracting bidet, air deodorizer, feet warming floor vents and optional personalized controls for every member of your household ¬ all for only $6,400. If there were a Docs’ Digest Penelope Award for innovative technology, it would go to the Japanese toilet seat. The company claims it is Zen approved, but that’s straining and stretching it a bit.

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Above and below: The James' mansion at Shioya ("James-tei") once had a family link to Dr. Paterson. It's now owned by Panasonic and serves as a popular spot for weddings and big business retreats. ( provided by Dr. Alexander H.G. Paterson)

All of this got me mulling over really useless gizmos which the Japanese are very much into and which I will call “Calypsos,” i.e., seductive gizmos with no staying power. Calypso (in Homer’s Odyssey) seduced Odysseus into staying on her island for seven years. She is hot but superficial and Odysseus falls for her. But he discovers there’s no depth there, gets bored and wants out. With help from Athena and Hermes, the bag and shoe man, he floats away on a German-built raft back to Penelope and a real life.

I’ve seen a lot of changes in my life

and been against most of them unless I see a clear advantage to myself, the only benchmark that works for me.

I’ve seen a lot of changes in my life and been against most of them unless I see a clear advantage to myself, the only benchmark that works for me. So I dislike techno-gizmos. Most so-called advances involve me working free for a corporation (e.g., Microsoft, learning the useless new Windows 8; and Aria, our cancer services sub-optimal electronic medical record which by general agreement behaves like having two extra difficult patients in one’s clinic).

Time for peasants to revolt against the Silicon Valley scammers? These multi-billionaires hold big parties in the California sun laughing at us. “Occupy Silicon Valley” is the call for this year. These fake, casually-dressed jokers have avoided the wrath against investment bankers and Wall Street swindlers, yet are filthy rich

because they know how to write software and build in obsolescence. Let this be the year of the blowback on tech. We will assemble using Twitter.

And Twitter: Is this not just a digital megaphone for sheep dogs? You can indulge in the illusion that you are not a sheep and are loved and needed, that you are a personal friend of Justin Trudeau or Justin Bieber. You receive a reply using your first name from one of his many minions. You know somebody famous and cool and, wow, they know you.

My son uses Facebook to let his pals know where his band is playing any night. Our band (leader ex-Alberta Medical Association President Dr. T.K. Lee) has long disbanded so this function is useless. Facebook gives you the delusion you have hundreds of friends who like you, but in reality they may not like you. Some will undermine you. It’s a bit egocentric, posing and up-loading pictures of oneself on Facebook. If you want a stalker for the rest of your life, go for it. > March - April 2014

The James' mansion at Shioya ¬ “James-tei” ¬ is now owned by Panasonic and serves as a popular spot for weddings and big business retreats. Guests stroll the gardens and gaze over James-yama and Kobe harbor.

It is a grand setting. Portraits of Ernest stare down at you from several rooms. Masonic signs and symbols are embedded in the wall and ceilings of most rooms.

Ernest and all the James were Freemasons because in the small foreigner Japanese trading community, reliable connections were critical. Membership was necessary for a sense of identity since one was excluded from the greater club of Japanese citizenship.

28

The James' family memorabilia is prominent at the Shioya mansion. Ernest James was once the richest expatriate in Japan. World War II changed all that. ( provided by Dr. Alexander H.G. Paterson)

> There are Calypsos all over the place, like Google glasses and automated customer support systems. These have got to go: “Hello. All our agents are busy. Your call is important to us and may be recorded for training purposes.” This greeting adds to the dismal nature of life. If you are feeling depressed, an automated customer support system will not help. The following would cheer me up: “Hello. Your call is not particularly important to us though it may be to you. We now have an automated system that might annoy you but it reduces our costs a bit. So far we have got away with this and will continue as long as you put up with it. Your call may be recorded so that we can analyze which calls we can transfer to India or the Philippines where we pay one-tenth what we have to pay our staff here.”

And as for Windows 8 ¬ spend valuable time finding your own way around an unnecessary new way of touching the screen, moving stuff around and turning the computer on and off.

Maybe I’m wrong about loss of identity and enthusiasm for the tech revolution, but I think there’s something to it.

Our visit to Kobe turned out to be more than a visit.

It became a pilgrimage ¬ a homage to the ancestors ¬ something that people of all races and backgrounds feel at some point in their lives. The James-yama tale had figured in many home conversations, including a grumbling, low-grade resentment toward some JapaneseCanadian friends and acquaintances who continued to complain of how they were treated. This, despite receiving an apology and some financial compensation from the Government of Canada and seemingly oblivious of how their counterparts in Japan were treated.

War and fear changes everything including peace-time civilized thinking and behavior. Judging the past by the behavior standards of today is naïve, idealistic and often ignorant. With war there is a reversion to tribalism. Your friends and neighbors become suspect if they don’t think and behave like you or have the same physical features as you.

AMA - Alberta Doctors’ Digest

When war broke out after Pearl Harbor, the James family was hounded, rounded up and detained. Friends and relatives formerly at ease in Japanese society were now enemy aliens. And your life depended on who arrested you. If it was the civilian police, you had a chance of survival since they allowed food supplies to be delivered to you. If the military police came knocking, you were suspected of spying and never heard from again. The James brothers were suspected of passing information (and probably did in the innocence of the first few months of a strange new way of thinking ¬ war) and they had to escape fast. A couple, including Ernest, got to Canada (one in a yacht sailing to Mill Bay, Vancouver Island), others getting to Australia. Ernest’s adopted daughter lived in Calgary and died a few years ago.

We visited the “foreigners graveyard” in an area separated from the native dead ¬ in all there were 2,800 graves set in the hills above Kobe. It was snowing, the trees bare. Special permission was required to enter but we went anyway and were taken to a house at the entrance. Six people sat at computers, doing … what?

A girl brought tea. One official searched the records and found the grave of Ernest James. We asked for others but there was some difficulty. Gardeners pottered around, everything well maintained and much better than graveyards in the west. We saw the gravestone, signed the empty visitors’ book and left. By now my wife was getting a little weary of the omnipresent Ernest; her grandfather’s memory, Fred, who did so much for Ernest, being obliterated by the allied bombing. Mr. Abe’s restructuring has not reached at least one department in the Japanese bureaucracy.

All people need the occasional pilgrimage, a time for reflection with freedom from the attention-seeking clamor of Facebook, Twitter and all the other distractions of this decadent age. A time for contemplating one's own mortality in the context of our ancestors, a viewing of the broad stretch of time, the big picture, the things in life which are important. And a pushing aside of that which is not. This was a satisfying pilgrimage.

Reference 1. James DH. The Rise and Fall of the Japanese Empire.

Published London Macmillan, 1951.

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CALGARY AB Med+Stop Medical Clinics Ltd. has immediate openings for permanent full-time physicians to provide primary health care to patients in our four Calgary locations. Requirements: MD degree and must be able to be licensed by the College of Physicians & Surgeons of Alberta. Experience is an asset but not required. Our family practice medical centers offer pleasant working conditions in well-equipped modern facilities, high income based on fee-for-service, TELUS Health Solutions (formerly Wolf Medical Systems) electronic medical records, low overhead, no investment, no administrative burdens and a quality of lifestyle not available in most medical practices.

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> CALGARY AB Braeside on 24th Medical Clinic is recruiting three full-time family physicians and must be eligible to be licensed by College of Physicians & Surgeons of Alberta.

Fee-for-service billing, attractive overhead split and Accuro electronic medical records.

Office hours are Monday to Friday, 9 a.m. to 5 p.m.

Contact: 11466 Braeside Drive SW T 587.296.3363 braesidemed@gmail.com EDMONTON AB Four positions as family practice are available immediately at both West End Medical Clinic and Capilano Medical Clinic. West End Medical Clinic is a busy walk-in and family practice clinic at unit M7, 9509 156 Street; a few minutes to West Edmonton Mall, require part- and full-time family physicians, internal medicine, cardiologist, psychiatrist and gynecologist.

Capilano Medical Clinic at 7905 106 Avenue is a family practice clinic and serves a large community of different age groups. No evening or weekend on-call or hospital coverage.

Full electronic medical records (Healthquest) and have experienced staff taking care of billing, referrals and vitals as well as an on-site clinic manager. Overhead is negotiable.

Work hours are flexible open seven days a week, Monday to Friday 9 a.m. to 9 p.m. and weekends 9 a.m. to 6 p.m.

Contact: Dr. Gaas T 780.893.5181 EDMONTON AB Beverly Medical Clinic is a new state-of-the-art medical clinic that is rapidly expanding. Our team currently includes three family physicians, two internists and a pediatrician.

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

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

Contact: Dr. A. Elfourtia or Dr. Z. Ramadan T 780.756.7700 C 780.224.7972 EDMONTON AB Lymburn Medical Centre, 7526 178 Street is a well-established west end walk-in and family practice medical clinic. The clinic has openings for part- and full-time physicians with attractive terms.

Contact: Mr. Ghani T 780.444.4408 mohghani2003@yahoo.com

EDMONTON AB Ellerslie Medical Centre in southwest Edmonton is seeking part- and full-time physicians. The busy clinic is located in prestigious and fast growing community which has a high public demand for family physicians.

The physician income will be based on fee-for-service with an average annual income of over $300,000. The physician must be licensed or eligible to apply for licensure by the College of Physicians & Surgeons Alberta (CPSA). For the eligible physicians, their qualifications and experience must comply with the CPSA licensure requirements and guideline.

Contact: Walid 11140 Ellerslie Rd SW Edmonton AB T6W 1A2 T 780.884.4124 walid@ellersliemedicalcentre.com EDMONTON 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 >

Care Plus Medical Clinic #102 Lansdowne Shopping Centre | 5124 122 St. NW, Edmonton, AB T6H 3S3 Phone: 780-437-8818 | Fax: 780-439-5557 Care Plus Medical Clinic is located in Edmonton, Alberta. Edmonton is the cosmopolitan capital of Alberta, and is known as the “City of Festivals”. Care Plus Medical Clinic is a fully equipped and fully staffed modern facility.

We have 2 MOA’s, 1 LPN, and an onsite office manager. We are currently using Health Quest EMR for medical records and billing. There is no investment or administrative responsibilities, and we are offering an attractive income split. We are looking for a full time family practice physician. For more details contact the Clinic Manager.

Audreyann R. Conant, Care Plus Medical Clinic #102 5124-122 St. NW | Edmonton, AB T6H 3S3 | Phone: 780 437-8818 | Email: careplusclinic@hotmail.com

AMA - Alberta Doctors’ Digest

> 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.

psychology services. Clinic hours are Monday to Friday 8:30 a.m. to 8:30 p.m., Saturday and Sunday 10:30 a.m. to 5 p.m.

Contact: Management Office T 780.757.7999 or T 780.756.3090 F 780.757.7991 lessardclinic@gmail.com

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

FORT McMURRAY AB Part- or full-time family physician wanted to join an existing walk-in ready clinic. Wonderful staff, flexible hours and schedules, great northern incentives and offer low overhead percentage.

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.

Contact: Dr. Loretta Roberts T 780.370.8425 roberts.loretta@ymail.com HIGH RIVER AB

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

Work with a nice and dedicated staff, nurse available for doctor’s assistance and referrals. Also provide on-site dietician and mental health/

Family physician needed to join a vibrant practice with four friendly and supportive colleagues to cover departing physician’s patient panel of mainly women and children. The clinic has been newly renovated and offers full electronic medical records. Hospital privileges, low-risk obstetrical clinic, emergency room and operating room assist shift available; optional but encouraged.

Contact: Dr. Bonnie Bagdan T 403.422.4296 bbagdan@me.com

HIGH RIVER AB Rural family physicians are invited to join active teaching practices in High River. Opportunities in three different, fully computerized clinics with a collegial group of doctors enjoying a great professional, supportive relationship. Practice opportunities abound at the local hospital with 32 acute-care beds, low-risk obstetrical group, community cancer clinic, active emergency room and two surgical suites, supported by anesthesia, obstetrics/gynecology, visiting surgeons, CT and ultrasound.

Live in a picturesque, growing community 30 minutes from Calgary and the Rocky Mountain Foothills with an abundance of recreational opportunities for the active individual.

Great opportunities for family as well.

Contact: Dr. Stephen Finnegan T 403.601.5470 sp.finnegan@nucleus.com SHERWOOD PARK AB Well-established, busy and recently expanded clinic in Sherwood Park with five family physicians is seeking one to two part- or full-time physicians.

Clinic is in a professional building with laboratory and X-ray on site.

Primary care network family practice nurse support and excellent staff.

Full electronic medical records and competitive fee split.

Contact: T 780.464.9661 lorrainehosford@gmail.com >

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> STRATHMORE AB Excellent practice opportunity in a rural setting only 50 kilometers from Calgary. Invest in yourself and your family. Join six happy physicians in a true family practice and have a life as well. Strathmore is a town of 12,000 people situated on the prairies, but close to all the amenities of the Rocky Mountains and a big city. Our hospital has a 23-bed acute-care ward and an exciting ER (more than 30,000 visits per year). Earning potential is limitless.

Expenses are only 30% of office billings. We are part of the Calgary Rural South Primary Care Network with an array of enhanced services. Our group provides great mentorship for a young physician who wants to practice full-service medicine.

Contact: Dr. Ward Fanning T 403.934.4444 (office) T 403.934.3934 (home)

Physician and/or locum wanted CALGARY AB Rockyview Medical Clinic, 100-1011 Glenmore Trail SW, centrally located within the Rockyview Professional Building is looking for a full-time permanent family physician to join our medical staff. Locums also welcome.

Compensation is fee-for-service with competitive split rates.

hours of work can frequently exceed 40 hours a week.

You will be providing comprehensive, coordinated primary care and services to families.

The area of the clinic has a high needs patient population that has a large number of unattached patients and Rockyview Medical is part of the West Central Primary Care Network.

Examining and discussing with patients in order to diagnose their health conditions and promoting proper health education. Prescribing medicines and carrying out minor surgical procedures.

Skills and specifications required are ability to respond to demanding and complicated patient situations; effective communication with other doctors as well as patients; maintain concise, timely and accurate confidential records of patients; ability to prioritize patients according to their clinical needs; good time management skills to balance the clinical and administrative duties; able to work very long hours, often under tight pressure; ability to solve difficult problems; should be able to challenge decisions; strong decision-making and practical skills.

Education and qualifications are a degree in medicine; licensure with the College of Physicians & Surgeons of Alberta in general practice required.

Working conditions include a pleasant work environment, busy family practice, free parking, Healthquest electronic medical record database, shared practice of three physicians and

Contact: Elaine Perriment, Clinic Manager T 403.663.5974 info@rockyviewmedical.ca CANMORE AB The Bow Valley Medical Clinic is hiring part-time, full-time or locum physicians who enjoy steady and interesting work. Office hours are 9 a.m. to 5 p.m., Monday to Friday, no on-call, hospital privileges are available. Excellent staff, electronic medical records, full hospital with emergency and on-call coverage.

One full time and two part-time doctors currently working, but plenty of work for another full time or two part-time physicians; huge practice.

Contact: Cassie Hall, Office Manager T 403.609.2136 EDMONTON AB Summerside Medical Clinic and Edge Centre Walk-in Clinic require part-time and full-time physicians. Locums are welcome. The clinics are in the vibrant, rapidly growing communities of Summerside and Mill Woods. >

New Medical Office Space Available In Edmonton We are looking for a Physician or group of physicians (family practice or specialists) who are looking for a newly renovated Medical Office Space. We are located in Edmonton, Alberta.

The new medical office is approximately 1,800 square feet. There are 8 exam rooms and 1 procedure room in the current plan, with 2 physician’s offices large enough for 2 physicians to share.

We are located in a flourishing area, not far from University of Alberta and close to Michener Park (graduate student housing) and other large family communities. Most of the clinics in the area are not accepting new patients. This is a great opportunity for a Family Practice group to come in and grow. Since the area is growing Specialist will be also be needed.

Pediatrics, Internal Medicine, Cardiology, OB/GYN, would be a great asset to the area. The opportunities are endless.

We are offering a very low cost per square foot. We welcome the opportunity to discuss this with you.

If you are interested in looking at the space and discussing the costs, we would be happy to set up an appointment with you.

Contact: Audrey Conant | Phone: (780) 437-8818 | Email: careplusclinic@hotmail.com

AMA - Alberta Doctors’ Digest

>

Examination rooms are fully equipped with electronic medical records, printers in all examination rooms and separate procedure room.

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

Practice Wanted CALGARY AB I am a family doctor looking to take over any physician/clinic owner who is relocating or retiring. I would also consider buying a medical building or a retail condo where medical is a permitted use.

Contact: Dr. D. Das T 403.585.6840 drddebasish@gmail.com

Space available EDMONTON AB Bright and new, general practitioner and family practice looking to rent out one office space and two examination rooms. Rent would include use of staff and waiting room. Medical Imaging Consultants (MIC) and DynaLIFE Dx in the same building; across the street is a hospital.

Contact: Danielle Sieswerda T 587.523.6334 tmedcentre@gmail.com

EDMONTON AB Practice available for a part- or full-time physician as present physician is moving to another province. Practice is a well-established teaching practice (over 30 years).

The office is equipped for one to two physicians, long-standing staff and part of the Edmonton Southside Primary Care Network. Office is fully computerized with Med Access electronic medical records. The office is new and beautifully designed ÂŹ the practice is very efficient. A perfect opportunity for one to two physicians to run their own clinic and close proximity to University of Alberta, rapid transit and shopping areas. This offer is available for a limited time until the lease expires in November.

Contact: Dr. Rose Stepanko T 780.436.3422 F 780.436.3441 srurms@telus.net

BURNABY BC Medical practice available in Burnaby.

Five-minute walk to Lougheed Mall and 10-minute walk to skytrain. Two family physicians retiring at end of June from long-established practices and are seeking physician(s) to take over practices.

Contact: T 604.421.1821 brianmonks@telus.net

Equipment for sale EDMONTON AB Used medical office equipment for sale; everything is three-years-old except the tank. One 30 litre liquid N2 tank; one Health o meterÂŽ digital baby scale and stand; one Midmark Ritter 204 examination table; one 36 x 72 inch mobile work table; and nine 20 inch Acer V203HL computer screens (five months old).

Contact: Dr. M. Poitras T 780.455.3311 >

PHYSICIAN(S) REQUIRED FT/PT Also locums required

Practice available EDMONTON AB Looking for a general internist to take over a part-time internal medicine practice with room for expansion.

Office is shared with a second physician with proximity to the Royal Alexandra Hospital and very experienced staff.

Contact: Jim Kutsogiannis 601 Hys Centre 11010 101 Street Edmonton AB T5H 4B9 T 780.450.0453

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

Dr. Paul Arnold (780) 970-2070

March - April 2014

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AMA - Alberta Doctors’ Digest

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