SMA Digest - Summer 2016 | v. 56, i. 2 by SMA Communications

A publication of the Saskatchewan Medical Association Volume 56 | Issue 2

DIGEST

SUMMER 2016

LEADING THE PROFESSION THROUGH PIVOTAL CHANGE

HEALTH-CARE REDESIGN

MAKING SASK. THE BEST PLACE TO PRACTISE MEDICINE

MEDICAL ASSISTANCE IN DYING and what it means for your practice

REWARDS OF RURAL PRACTICE Three physician perspectives

Overcoming medicine’s “skeleton in the closet” Summer 2016 | VOLUME 56 ISSUE 2 SMA Digest is the official member magazine of the Saskatchewan Medical Association. It is published twice per year and is distributed to nearly 90 per cent of practicing physicians in Saskatchewan.

Mental health issues are the medical profession’s “skeleton in the closet,” according to Dr. Jim Cross. He explains the struggles that many physicians face, and why they so often go unaddressed. The Physician Health Program’s Brenda Senger offers tips for physicians on how they can better support themselves and each other.

Upcoming issues The next issue of SMA Digest will be distributed in Spring 2017. Advertising The deadline for booking and submitting advertising for the next issue is Monday, January 23, 2017. Rates for display advertising are available upon request. Classified ad placement is free for members promoting physician, locum and practice opportunities; ads should be submitted via email and must not exceed 150 words. Feedback Member feedback is valuable and encouraged. Please direct comments, letters, ideas and advertising inquiries to: Maria Ryhorski Communications Advisor Saskatchewan Medical Association 201-2174 Airport Drive Saskatoon, SK S7L 6M6 (306) 244-2196 maria.ryhorski@sma.sk.ca SMA mission The SMA is a member-based organization that promotes the honour and integrity of the profession. We: • Provide a common voice for physicians • Support the educational, professional, economic and personal wellbeing of physicians • Advocate for a high-quality, patientcentred health-care system

Syrian refugees integrated into Saskatoon’s health-care system In the fall of 2015, the federal government committed to expedite the resettlement of 25,000 government-assisted and privately sponsored refugees from Syria. Physicians in Saskatoon, including Drs. Yvonne Blonde and Mahli Brindamour, moved into high gear to respond to health needs as refugees began arriving in the city late last year.

CONTENTS

2 4 7 8 11 13 14 16 19 22

YOUR SMA President’s message New initiatives well received at spring RA Improvements to RA resolutions process continue SMA president leads profession through pivotal change Physicians explore reinventing the health-care system Modernization: next steps Perspectives on modernization Overcoming medicine’s “skeleton in the closet” 2016 Physician of the Year on the privilege of rural practice When doctors face disability

HEALTH CARE

24 26 33 34 37 41

Syrian refugees integrated into Saskatoon’s health-care system Broken Earth: local team provides medical care in Haiti LINK phone consultation service ready for calls Medical assistance in dying and what it means for your practice The rewards of rural practice Tips for reviewing lab results

STUDENTS & RESIDENTS 42

Sask. medical students staying in province for residency

44 UPCOMING COURSES & CONFERENCES 46 ANNOUNCEMENTS & CLASSIFIEDS 48 IN MEMORIAM Health-care redesign: making Sask. the best place to practise medicine This topic has been top of mind since the spring RA, generating much discussion and an abundance of ideas. It is a key focus of this issue. Read more in:

•

SMA president leads profession through pivotal change (p. 8)

•

Physicians explore reinventing the health-care system (p. 11)

•

Modernization: next steps (p. 13)

•

Perspectives on modernization (p. 14)

PRESIDENT’S NOTE

PRESIDENT’S MES Welcome to the summer edition of the SMA Digest! I hope you are enjoying your summer and some time off. It’s important for us to recharge properly, but the reality is that we are often guilty of looking after our own health needs last. While this irony is perhaps rooted in good intentions, the results can be negative. Please look after yourselves! Your patients and your families will appreciate it. One of the goals of the SMA is to promote medical professionalism. As president, I am interested in promoting the values that the SMA and the Canadian Medical Association have endorsed as being critical to our growth as a profession. One of the enduring purposes of the SMA is to promote a collegial, respectful, collaborative learning and work environment in which we, as medical professionals, can thrive. We should continue to work as physician leaders and participate fully in the management of the health-care system.

SMA DIGEST | SUMMER 2016

Most importantly, every day is an opportunity for us to interact with each other in ways that support patient care and express sincere collegiality with our partner caregivers in the health-care system. A better workplace is a goal we all have. A healthy work environment is a place where there is teamwork, there is a common goal of patient care, and there is respect and professional fellowship. We are all, as the saying goes, in this together. On the pages of this issue you’ll find many stories that touch upon SMA values. For example, our Physician of the Year, Dr. Crystal Litwin, is profiled on page 19. She is an exemplary physician, and I think it is fair to say that her success and the recognition she is receiving has much to do with her professional values. Our ongoing modernization discussions have also been a key focus and the theme is touched upon in a series of articles beginning on page 8. The SMA continues to explore this topic, and I

YOUR SMA

SSAGE encourage you to read the article. I also ask that you consider getting involved by expressing your opinions. The SMA leadership cannot bring about the changes that we hear members want, without your help and engagement. Communication with members is key. In my last President’s Letter, I asked for feedback and received some useful comments back from some of you. Keep these comments coming. I look forward to the President’s and Vice-President’s Tour later this fall. These are all opportunities for me and others to hear what you think on a range of issues. The SMA exists to serve you, the members. We do this in obvious ways, and sometimes, in some ways that may not be entirely visible. At our recent Board of Directors retreat, we explored ways in which we can focus on thinking about the kinds of changes which are coming to our profession. We did this in the spirit of wanting to better serve the profes-

sion, and you, the members. The SMA is here to support you, and to promote the profession and ensure that the health-care system is delivering the very best care to our patients while you enjoy a professionally satisfying career. I look forward to working with you all in the coming year. I do hope you enjoy reading this issue of the Digest. Have a safe and happy summer. Sincerely,

DR. INTHERAN PILLAY SMA President president@sma.sk.ca

SMA DIGEST | SUMMER 2016

NEW INITIATIVES WELL RECEIVED

at 2016 Spring Representative Assembly by Lana Haight Innovation and engagement from physician leaders abounded at the 2016 Spring Representative Assembly in Regina as the 72 delegates in attendance tackled the issue of health system sustainability, and explored how to make Saskatchewan the best place in the world to practise medicine. (Read more on this on page 11) The meeting began with addresses from SMA President Dr. Mark Brown and Saskatchewan’s minister of rural and remote health, the Honourable Greg Ottenbreit. Dr. Brown spoke about the importance of health system reforms to reflect current medical practices. He told the assembly that Ministry of Health officials are encouraging the SMA to proceed with conversations within the profession. Those discussions began at the RA as board members took first steps in engaging with members. After his address, Minister Ottenbreit took questions from physicians. They raised several issues including the implementation of the physician resource plan that the minister explained is a tool to be used in planning; the lack of laboratory services in smaller centres; the availability of generic OxyContin as an illegal street drug; disjointed pain management services; and inadequate mental health services particularly in northern Saskatchewan.

SMA DIGEST | SUMMER 2016

Thirty resolutions were brought forward throughout the assembly. All the resolutions, including those that were not carried, can be found at www.sma.sk.ca/ spring2016resolutions. “The RA is an important meeting for physicians. It’s the equivalent of a parliament,” says Dr. Intheran Pillay, president of the SMA. “It provides a forum for physicians to exchange and share ideas, recognizing there are multiple perspectives, with the goal of building consensus.” In addition to the debate on resolutions, delegates turned their attention to other business that included a review of the 2015 Fall RA resolutions and reports from the Board of Directors, the Finance Committee and the Canadian Medical Association. A total of 48 guests attended the Representative Assembly including several health region CEOs, Dr. Karen Shaw, registrar of the College of Physicians and Surgeons of Saskatchewan, and Dr. Alan Beggs, president of the college’s council. The CMA was represented by past-president Dr. Chris Simpson and Dr. Jeff Blackmer, vice-president of medical professionalism.

Delegates were asked if they found it beneficial to have guests at the Representative Assembly. All but one of the 34 people who responded to the question on the evaluation form agreed with inviting health-care stakeholders to the meetings. The benefits noted by delegates ranged from “enhanced communication and relationships and to dispel misconceptions about the SMA” to “exposure and networking is great.” “It’s important for our colleagues to see some of the process, what works, what doesn’t work, the debate that takes place for resolutions and why resolutions do and do not pass,” wrote one delegate. Concurrent sessions, something new at this spring’s assembly, were well-received by delegates who said they appreciated the opportunity to participate in workshops. Three options were offered: Effective Clinical Teaching Strategies by Dr. Kalyani Premkumar from the University of Saskatchewan; CDM-QIP – Using Accuro and Med-Access Flow Sheets by Drs. Stefanie Steel and Tessa Laubscher; and Medical Professionalism by Dr. Blackmer and Emily Gruenwoldt Carkner from the CMA.

Also new was the opportunity for physician delegates to “bring a colleague.” To encourage this initiative, the SMA provided lunch at no charge for colleagues who accompanied delegates. All but one of the 31 delegates who answered the evaluation question about bringing a colleague said they would welcome the opportunity to have a physician join them at a future assembly. Many cited “time constraints” and difficulties in taking time off as reasons for not bringing a colleague to the spring assembly. “Somehow we still have to convince our colleagues that it’s time well spent, away from work,” wrote one delegate. “People need to know how progressive the SMA is and how important it is for physicians to be engaged with this organization,” wrote another. The 2016 Fall Representative Assembly will take place on Nov. 4 and 5 in Regina.

Resolutions from the 2016 Spring RA can be viewed at www.sma.sk.ca/spring2016resolutions

SMA DIGEST | SUMMER 2016

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IMPROVEMENTS

to the RA resolutions process continue By Ivan Muzychka SMA staff members continue to work to improve the process for submitting and voting on resolutions at the Representative Assembly (RA). Just prior to the 2016 Spring RA, staff circulated a tip sheet (Prescription for a Better Resolution) and a revised resolution submission form. Both initiatives were well-received, but delegate feedback indicates there is still room to improve the process. More carefully thought out resolutions, that are well-worded, concise, and focused on the strategic priorities of the SMA are needed. “We are hearing that there is insufficient time to thoroughly think about and debate the topics or issues presented by a resolution,” said Bonnie Brossart, CEO of the SMA. “We are also hearing that some resolutions are too broad to be effectively implemented. We are testing a few changes to the process to address these issues.”

that will allow draft resolutions to be checked against resolutions passed in previous years. The goal is to avoid duplication. Muzychka also expects to have a new resolutions resources web page up on the SMA website. Brossart said that another aspect of the revamped resolution process involves having the SMA Board of Directors review the resolutions passed at an RA so they can give some direction to staff on the level of effort that should be expended on implementation. “What we get after an RA is a range of resolutions,” said SMA President Dr. Intheran Pillay. “We need to look at them from the perspective of strategic priority and, in some cases, at the cost of implementing a resolution. Providing the staff with this direction makes sense if the SMA is to achieve its goals. If everything is a priority, then nothing is a priority.”

Ivan Muzychka, senior communications advisor, will be working to communicate the need to submit resolutions in advance, and will be reaching out to regional medical association presidents and delegates to remind them that SMA staff are available to help with the drafting of resolutions. Over the summer, SMA staff will also be creating a system

POINTS TO KEEP IN MIND for RA resolutions

STRATEGIC

1. Resolutions should be submitted in advance of the RA.

priorities

Continue to be a strong, memberbased organization Enhance the physician role in the health-care team model

Enhance physician well-being

2. A resolution should address one specific issue, not 10.

Improve physician participation and leadership in health-care design

4. Providing sufficient background for your resolution may help get it passed.

3. Resolutions should be worded in precise, concise language that is free of grammatical errors.

5. Ideally, resolutions should be focused on a strategic priority of the SMA. SMA DIGEST | SUMMER 2016

SMA PRESIDENT LEADS PROFESSION

through period of pivotal change By Maria Ryhorski The sun beats down through the windshield as I follow Highway 2 where it tumbles over green hills that stretch out to Gravelbourg, the “cultural gem of Saskatchewan” that captured the heart of the SMA’s newest president, Dr. Intheran Pillay, more than 23 years ago. I’m driving to meet with Dr. Pillay, on his home turf, a town that boasts a nationally-renowned cathedral dating back to 1918, and the gentle scent of lilacs that seems to emanate from everywhere. He greets me at the hospital with his usual infectious smile, proudly introducing me to his team, and brimming with energy despite coming off a largely sleepless, five-day oncall shift. It is easy to see why he is so well-loved. I think back to his presidential inauguration which set off a social media firestorm of likes and comments from his patients, colleagues and the community. His staff have posted news clippings to bulletin boards along the hallway. The SMA’s new leader is off to a strong start. Since leading a groundbreaking discussion on health-care redesign at the spring Representative Assembly, he has been called upon by media outlets multiple times per week to lend the unique and valued perspective of Saskatchewan’s physicians. He explains that there is a patient who needs his attention, but he’ll be with me as soon as he can. True to his word, he arrives in the conference room that a friendly staff member arranged for me, a few minutes later, and we begin.

SMA DIGEST | SUMMER 2016

MR: As you know, your presidential inauguration received an unprecedented response on social media, largely from patients and members of your community, sending congratulations and saying what a treasure you are to the community – how does it feel to hear that from the people that you serve? IP: It feels great. You know, my patients are close to my heart and in a small town we get to know them really well. Lots of them are friends of ours, so hearing those remarks makes me feel good. It probably means I’m doing a reasonable job [laughs]. It’s reassuring that I made the right decision to stay in rural Saskatchewan. MR: Now that you mention it, how did you end up in rural Saskatchewan? Specifically Gravelbourg. IP: It was an adventure [laughs]. It was an adventure 23 years ago. It was customary at the university that I trained at, in South Africa, that we took a hiatus and went to Europe or North America – worked, earned some money and traveled through Europe or wherever you wanted to travel. And then usually, would return home to take a job. So my wife and I came to Gravelbourg for a three month job and we’re still here. We made good friends and it was a recipe to stay. MR: You really seem to love rural practice. What are some of your favourite things? IP: My wife and I have practised here for 23 years. During that time we really had the opportunity to get to know our patients and their kids, and the kids of their kids. So typically three generations is what we see in our practice. And we

YOUR SMA

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WHAT WE’D LIKE TO SEE IN A REDESIGNED SYSTEM IS A CONTINUUM OF CARE, WHERE CARE IS SEAMLESS FROM CRADLE TO GRAVE IN TERMS OF LOOKING AFTER PATIENTS. WHERE QUALITY, ACCESS, TIMELINESS OF CARE, AND HEALTH EQUITY ARE ALL CORNERSTONES OF THIS REDESIGN, AND WHERE THE SYSTEM IS SOLID AND VERY SUSTAINABLE GOING INTO THE FUTURE.

deal with an aging population as well so sometimes we see the great-grandkids, which is amazing. We get to see our patients grow from little kids to adults and see their personalities develop. It’s really heartwarming to me to practise in an area where I know everyone. MR: Now you’re transitioning into an additional role as the SMA president and you’ve come into it during a time of great change. What are some of the key issues you see on the horizon? IP: Well firstly, I think health system sustainability is in question. We, as a nation, have been talking for the last three decades about the sustainability of the system. It’s come to a crunch with the fiscal challenges that the country has plunged into, where we see that the system may not be sustainable going into the future. In addition to that, access to care is a huge problem. Fragmented care is a huge problem. And timeliness of care is a huge problem as well. I feel that we can do much better. Furthermore we have an aging population and we would like to take really good care of them but the system, which was designed in the 60s, does not accommodate for the large number of elderly patients that we are going to see in the next 10 or 20 years. If the system is not geared up for that challenge, then we’re going to see the system fall apart. I feel it’s imperative – and similar conversations are going on elsewhere in the country – that we all get together as health-care professionals and figure out a way forward with

the different stakeholders in terms of redesigning the system so that it can meet these challenges. I’m also really passionate about population health and selfcare. I feel that, for a first world country, we do really poorly in that area, both from a health system point of view as well as from a public point of view, and I feel that we can do better. We need to redesign a system that helps patients better look after themselves. In addition to that, I think that we need to have a multi-sectoral approach to public health where we are more proactive with teaching our kids selfcare and preventative strategies that will help them maintain good physical as well as psychological health. If we can achieve that as a nation, I think the burden on the healthcare system, in terms of disease, will be much less. What we’d like to see in a redesigned system is a continuum of care, where care is seamless from cradle to grave in terms of looking after patients. Where quality, access, timeliness of care, and health equity are all cornerstones of this redesign, and where the system is solid and very sustainable going into the future. MR: What are some next steps in terms of this redesign? IP: I really think that as a first step we need to talk to our membership. We need to engage with our membership. I think our membership needs to be involved with this process. I don’t think this process should be brought about by

SMA DIGEST | SUMMER 2016

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EVEN IN OUR URBAN AREAS, WE HAVE MARGINALIZED COMMUNITIES THAT DO NOT RECEIVE EQUITABLE CARE AND WE AS AN ORGANIZATION SHOULD BE ADDRESSING THAT.

others who are not intimately involved in the health-care system. It is an opportune time for physicians to get involved. Physicians know the system best. They know what works and what doesn’t. We can tap into that expertise, in terms of assisting others to redesign the health-care system. What we learn in this step will inform what comes next. MR: Medical assistance in dying (MAID) is something that has been dominating the news over the last few weeks. Talk to me about that. IP: The Canadian Medical Association has gone through a huge process of consulting with the people of Canada and with its physician community. What the CMA found is that physicians are divided in terms of whether they are willing to provide assistance in dying or whether they would rather remain as conscientious objectors. I feel very strongly that we should support our membership in whatever viewpoint they hold. No physician should be forced to participate in something that goes against his or her conscience, and the current guidelines from the College of Physicians and Surgeons support that. However, patients must be cared for regardless of their end-of-life decisions and given access to these services in a timely manner. As physicians, our focus must always be on our patients and providing them with optimal care. The CMA as well as the SMA feel strongly that we should have a national framework that does not cause confusion. Currently the RHA working group is engaged with a number of stakeholders, including the SMA, to try and develop that process so that there is a great deal of clarity around Bill C-14, and a great deal of clarity around what physicians need to do, and what patients need to do when they seek medical assistance in dying.

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MR: You’ve also mentioned health inequities, specifically in the North, as an area of focus for you. Can you tell me about that? IP: Last fall on the President’s Tour, we took tours of some northern communities including Ile-a-la-Crosse and La Loche. I was particularly saddened to see the state of health inequity in these communities and the lack of programming, and the lack of the determinants of health that actually drive good health. Access to mental health and addictions services is something that is really badly done in our northern communities. The hardworking physicians in those communities expressed their concern in this regard. I think it’s important that we have conversations with First Nations leaders and the communities to see what we, the Saskatchewan Medical Association, can do to improve the health inequities that exist in our northern communities – to engage with these First Nations and community leaders, as well as patient advocates, and learn what the building blocks are to bring these services into those communities. And furthermore, we want to see that these services actually evolve with the needs of those communities so they are sustainable for the long term. I think that’s the most important thing. In addition, we need to be culturally respectful and keep in mind that what we think may work within those communities may not necessarily be what the community needs. In addition, I feel that even in our urban areas, we have marginalized communities that do not receive equitable care and we, as an organization, should be addressing that. I think that all Canadians should have equal access to good, high quality care. That’s something that’s close to my heart. During my year as president, I will advocate for that.

YOUR SMA

PHYSICIANS EXPLORE REINVENTING

the health-care system By Lana Haight

Delegates to the 2016 Spring Representative Assembly (RA) in Regina took the first step toward modernizing the healthcare system and making Saskatchewan the “best place to practise medicine.” “Over the two days of the RA, we had great conversations about how to move toward a better health-care system that reflects the current realities of medicine,” said Saskatchewan Medical Association (SMA) President Dr. Intheran Pillay. Modernization was a theme that ran throughout the meetings on May 6 and 7. Introduced by outgoing president Dr. Mark Brown in his address, the concept of modernization was discussed during a one-hour overview presentation and panel discussion. That open discussion was followed the next day by a one-hour in-camera session. Steven Lewis of Access Consulting facilitated the panel discussion asking questions of Dr. Jeff Blackmer, vice-president of medical professionalism at the Canadian Medical Association; Dr. Pillay, then vice-president of the SMA; Dr. Janet Tootoosis, member of the SMA Board of Directors; and Dr. Werner Oberholzer, SMA director of physician advocacy and leadership. The panelists agreed that the current system is not sustainable, in part, because medicare was designed more than 50 years ago for episodic care and not more comprehensive primary care that includes chronic disease management. Spending more money on the system will not necessarily result in the kind of system change that is required.

“Patients get shuffled around through the system to where the money is, and not to the best place where they will receive the kind of care they need at that point in time,” noted Dr. Blackmer. “How we fund physicians is inefficient and inequitable. There is no system in place to measure outcomes of care or relevance of care,” he added. The physicians on the panel suggested several top reforms that are needed. The current payment schedule does not support the shift from episodic care to chronic disease management. Team work and collaboration between physicians themselves and between physicians and other health-care

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PATIENTS GET SHUFFLED AROUND THROUGH THE SYSTEM TO WHERE THE MONEY IS, AND NOT TO THE BEST PLACE WHERE THEY WILL RECEIVE THE KIND OF CARE THEY NEED AT THAT POINT IN TIME.

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providers is still lacking with many working in “silos.” Patients must be included in any discussion of system change. More emphasis at all levels on improving population health is also needed. When asked what is different now and why raise the issue now, the panelists were unanimous. Given the fiscal restraints facing governments across Canada, physicians

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IF WE DON’T CHANGE THE SYSTEM, THE SYSTEM MIGHT CHANGE US.

need to take a lead role in reforming the health-care system. Changes in technology and how medicine is practised are occurring very rapidly. If physicians don’t participate in the change and lead the discussions, decisions will be made without them.

The panelists expressed great optimism that now is the time and Saskatchewan is the place to reimagine medicare. “This is a really big ask. My fear is that our membership will think this is too big of an ask for us to tackle. I hope that’s not the case. I hope that we understand collectively that we are in a very good position to create this change. We have a reasonable relationship with our government and we have strong leadership,” said Dr. Tootoosis. “We are a relatively small medical community and news travels fast. We need to use that advantage and make it work in our favour.” Feedback from delegates on the evaluation form indicated now is the time to embark on such discussions with the expectation that change is needed. Some expressed concern that the time allocated at the RA was insufficient, while others said the panel discussion and the in-camera session provided a great start on a complex and overwhelming issue. “This needs multiple events. Try to engage as many physicians as possible,” wrote one delegate. The introductory sessions at the RA were just that – introductory. More discussion on modernization will occur in the coming months, at the SMA board and during the President/Vice-President’s Tour in the fall.

“If we don’t change the system, the system might change us,” said Dr. Oberholzer.

Dr. Werner Oberholzer, SMA director, physician advocacy & leadership

SMA DIGEST | SUMMER 2016

Dr. Jeff Blackmer, CMA director of medical professionalism and Dr. Intheran Pillay, SMA president

MODERNIZATION: NEXT STEPS By Ivan Muzychka At the 2016 Spring Representative Assembly (RA) held in May, delegates agreed that a discussion about the need to fundamentally rethink the health-care system might be worthwhile. Part of the discussion centred on the need to act now, rather than delay, and on the need for physicians to lead the change that is inevitably coming. “If we don’t change the system,” noted Dr. Werner Oberholzer, member of the modernization discussion panel and the SMA’s director of physician advocacy and leadership, “then the system might change us.” A discussion paper and cover letter from then-president of the SMA, Dr. Mark Brown, circulated in advance of the RA, urged physician leaders to get involved and drive change so that Saskatchewan could be the “best place in the world to practise medicine.” The discussion paper has been tweeted about and otherwise circulated around health-care circles inside and outside Saskatchewan. It is available at http://www.sma.sk.ca/kaizen/ content/files/RA003-RA%20Discussion%20Paper.pdf. A motion at the RA was subsequently passed that read “The SMA leadership will begin discussions with the Ministry of Health on major system redesign to make Saskatchewan the best place to practise medicine.”

and the 2016 Fall RA itself. I am hoping that by then I’ll have more specifics on what discussions on modernization might mean for physicians. By then I will have had more dialogue with the Ministry of Health on what will be possible.” A drive for more specificity is a welcome direction for Dr. Allan Woo. He’s a member of the SMA Board of Directors and has heard from colleagues that, while there is an appetite to talk about the issue of modernization, there’s also a desire on the part of doctors to know more details. “I have been hearing that they see the importance of the discussion, but they also want to know what the discussion means for me as a physician on things like, how I will practise and what this discussion could mean for physician well-being,” he said.

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WE WANT TO GET IN FRONT OF THIS CHANGE AND STEER IT. WE KNOW THAT WE’LL LIKELY REACH MORE EFFECTIVE OUTCOMES IF PHYSICIANS ARE LEADING THIS CHANGE RATHER THAN SIMPLY REACTING TO IT.

NEXT STEPS

“The health-care system is going to have to change,” said Dr. Intheran Pillay, 2016-2017 SMA president. “This system was designed more than 50 years ago, and it has not adapted to changes that have come as a result of technology, and the changing nature of medicine. Today, we need to be more focused on treating chronic illnesses and not just dealing with episodic care. We need to look at outcomes and look at overall population health. We believe we can do this by focusing on better teams, by borrowing the best practices of other countries and health-care systems, and by rolling up our sleeves and trying to work with all stakeholders to arrive at a more effective and sustainable health-care system.” Dr. Pillay said that next steps will include discussions with physicians and physician leaders to hear more about the challenges they face and how they’d like to get involved in making change. “I am keen to hear from my colleagues,“ Dr. Pillay said. “There are a number of opportunities coming in the fall, including the President’s and Vice-President’s Tour

SMA CEO Bonnie Brossart says that further discussions will likely yield more details and perhaps more questions. “The modernization initiative is really about making changes over the long term,” she said. “I think we need to be ready for change. We can see that it’s coming and it’s already happening in other jurisdictions. We want to get in front of this change and steer it. We know that we’ll likely reach more effective outcomes if physicians are leading this change rather than simply reacting to it.”

Do you have a comment on modernization and what it may mean to physicians in Saskatchewan? Please send along your comments to sma@sma.sk.ca.

SMA DIGEST | SUMMER 2016

PERSPECTIVES ON DR. MELANIE FLEGEL

Note: Interviews have been

Family physician, Ile-a-la-Crosse Why is the current system not sustainable? Our current system really doesn’t have good value. We spend a lot of money per capita and we’re not seeing the results that are deserved of that amount of money. Spending more money isn’t really going to have those desirable effects. We also overly prioritize spending on acute care whereas our money is probably better spent upstream from there, focusing on preventative care and primary care. What changes need to be made to the health-care system? The most urgent changes that I see as being a priority would be shifting our focus to preventative care, to primary care, rather than spending in-hospital after someone has already deteriorated or suffered an adverse effect. Smoking rates are still outrageously high and making improvements in that regard would have big effects downstream. We were speaking about how one of the most common conditions to be admitted to hospital is the exacerbation of COPD. By catching those people before that became a problem by having them quit smoking, we would see a significant decline in that condition. The other reform I would make immediately would be improving accountability and stewardship in the system with regard to physicians, other health-care practitioners as well as patients, making sure everyone is focused on improving the health of patients but also the health of the system as a whole. 14

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DR. NICOLAAS BOTHA

DR. JOSEPH BUWEMBO

Family physician, Oxbow

Neurosurgeon, Regina

Why is the current system not sustainable?

Our focus in this system is at-the-end care and not on the preventative care.

It’s a big challenge actually and a very interesting question. It’s a big problem because of the escalating costs that we encounter. The costs are largely because of the technology. The technology is costing a lot. Producing our equipment and producing our medications is becoming very expensive.

We should prevent rather than fix the problems. What I mean by that is, when we look at diabetes, for instance, we can start spending more time and money to prevent the development of the disease by telling people to exercise and what to eat - correct living from youth. With the financial model that we have, we fix the problems, and the people who get the most pay are the ones like the specialists who have to sort that out… if we can change the model and put more money at the beginning where we prevent rather than to fix. What changes need to be made to the health-care system? I feel that centralization of, for instance lab services, is not really to the benefit of the population. We [need] more access in smaller centres than just in the bigger centres. The quality of care and the quality of the tests is supposed to be much better if it’s done in bigger amounts and in bigger centres. But do we really think that the benefits of taking the patients to travel an hour and a half for blood work and do tests is really for the benefit of the patients, or can we still have satellite labs?

There is sometimes some misunderstanding of what is required on the part of the patients and on the part of the physicians. The patients think that sometimes an investigation is necessary to make a diagnosis and they demand it. The physicians may fear because of the patient’s pressure and so they may request a test which may not really be necessary to make a diagnosis. All these things go together to create an increase in cost of health care. What changes need to be made to the health-care system? Communication and education are top priorities. And I think that we need to probably develop efficient teams that would work to make sure things flow smoothly, eliminating waste, and improving our appropriateness. The system is there. We need to make it more efficient to reduce costs and to avoid waste and to improve outcomes.

MODERNIZATION DR. KEITH CLARK

edited for grammar and clarity.

Family physician, Saskatoon Why is the current system not sustainable?

DR. JOHN DOSMAN

DR. MARY KINLOCH

Family physician, Saskatoon

Pathologist, Saskatoon

Why is the current system not sustainable?

It’s not sustainable due to demographic pressures and new technologies putting strain on the system and the outdated emphasis on acute medicine.

Pathologists are not working optimally in their role in the lab and we feel that we understand the level of change that needs to happen but we are not heard as a physician voice in enacting that change.

What changes need to be made to the health-care system? One of them is changing compensation to move away from volume-based incentives to care, to value- and quality-based assessments. That would help by taking the incentive off of pumping as many patients through or doing as many procedures as possible, to focusing on actual outcomes of health and well-being. This is harder to measure which is probably why we haven’t done much of that. It’s much easier to measure numbers and people-seen and procedures-done than it is to measure the big picture stuff but I think we need to move that way.

If there was an investment in technology to support the rural labs specifically within laboratory medicine, we would get better timely tests out to the labs with increased quality improvement. We also feel more reliable automation within the lab would decrease costly lab errors and would decrease the reliance on having human input. What changes need to be made to the health-care system? From the lab perspective, an urgently needed reform is to explore sub-specialization so that we are getting the most accurate diagnosis and the most timely diagnosis that can be done by a sub-specialist quicker, with up-to-date information, and meaningful knowledge back to the clinician. The second piece that can be done to revolutionize the lab system would be implementing a workflow and workload management system that accurately captures the quality improvement and the quality assurance that the pathologist does every day within their workload assessment.

The demands on the health-care system are accelerating rapidly and those demands are evermore resource intensive. Putting those two together, as time goes on, the well is going to run dry. That’s what we have to address. The intense demand on the system. There’s a lot more very intense technologies available, especially interventional radiology and other things. People are living longer. And consumers are requesting services and that’s appropriate, that’s fine, but we have to find a way to balance that. What changes need to be made to the health-care system? Information technology needs to be made a priority at all levels because it’s been seen in high functioning medical systems in the U.S. like Kaiser Permanente. They have a very comprehensive information technology and EMR-eHR integration which can bring so much information about a patient to the practitioner. It’s the way of the future. I have access to my own EMR and the lab results and emerg reports. But, for example, a patient tells me, “I was at the mediclinic and I got a prescription and I can’t remember what it was.” I have to log on to the eHealth viewer, which is good but it’s a separate log-on and it takes time or I get my staff to do it. It would be nice to have that information all integrated. The systems have to be a lot more automated and a lot of work still needs to go into them to make them really helpful for the practitioner. SMA DIGEST | SUMMER 2016

overcoming medicine’s

“SKELETON IN THE CLOSET” By Maria Ryhorski Mental health issues are the medical profession’s “skeleton in the closet,” according to Dr. Jim Cross, retired emergency physician and keynote speaker at the spring Representative Assembly. He would go so far as to say they are the “skeleton in the closet” of society. “If you have heart disease, you get sympathy. If you have cancer, you get sympathy. But if you’re depressed, people look at you and shorten down the conversation considerably,” he says. “Because they’re uncomfortable with that. Because there is a stigma associated with mental health issues, even though there shouldn’t be.” The problem is particularly difficult among physicians who work in one of the most high stress professions and are part of the “suck-it-up” culture of medicine that exalts overwork, perfectionism, and the sacrifice of self-care for the sake of patient care. While intentions behind the “patient first” mantra are admirable, the outcome of putting patient needs above your own, as a physician, may do more harm than good in the long run. “It’s part of the culture and it always has been,” says Dr. Cross. “You’ll hear it over and over again, ‘the patient first’… and often that is the case, but it’s not a 100-per-cent rule because the first priority is to look after yourself. Because if you can’t look after yourself, you can’t look after your patient. In fact, you can do harm.”

SMA DIGEST | SUMMER 2016

Evidence shows that one out of 10 physicians will become dependent on alcohol or psychoactive drugs, and that physicians under the age of 40 have three times the suicide risk of the general population. In addition, 40 per cent of the next generation of physicians (medical residents) reported impaired performance secondary to anxiety and depression. Among the contributing factors to the rate of mental illness in the medical community are the pressures on physicians to practise perfect medicine, and the expectation that they be immune to the stresses and demands of the job. Left unaddressed, mental health issues may emerge, for which many physicians are often reluctant to seek help because of concerns over the future of their career, and the stigma associated with mental illness. This is something that Brenda Senger sees on a regular basis through her work as the director of the SMA’s Physician Health Program. “In medicine you have to wear armour to survive,” she says. “The problem is, medicine expects it to be impenetrable armour and you’re never given permission to take it off. And that creates holes in people’s souls, which they then try to fill by doing more work. “For physicians, the last area to be affected by these issues is often their work. They will give up their spouses, their children, their friends, their colleagues, their community involvement, their self-care – all of that. They’ll give all of that up, but they’ll keep going to work.” This type of practice isn’t good for anybody: not for patients, not for the physician’s family and relationships, and certainly not for the physician. So how do physicians stop the cycle? How do physicians promote a culture of self-care and wellness in medicine? Senger has some suggestions.

YOUR SMA

“

A PHYSICIAN, AT THE VERY HEART OF THE HEALTH-CARE SYSTEM AND SURROUNDED BY RESOURCES, CAN BE SUFFERING WITHOUT RECEIVING APPROPRIATE CARE. THIS DEFIES BELIEF AND CHALLENGES US TO EXPLAIN HOW SUCH A THING CAN OCCUR. - Programme D’Aide Aux Medecins Du Quebec

1. Start early.

3. Combat the stigma.

We only change culture by the way we train and educate our students. I’m a firm believer that you never expect something from a student or resident that you cannot role model yourself. We need to make sure that we are healthy and well-enough mental healthwise, addiction-wise, physical health-wise, to be role models. We need to start challenging some of the old beliefs in the culture of medicine and say, “this is no longer acceptable.” And we need to develop a culture of compassion where we care for the caregiver as well.

We need to stop looking at mental health and addictions through a lens that is negative about these illnesses. All through medicine, we talk about these being medical conditions, but inside we still think they are moral issues. It’s that sort of thinking that perpetuates shame and secrecy about mental illness. We need to change that. And part of that is being mindful about the language that we use when talking about mental illness. Stay away from terms that are demeaning, disrespectful or derogatory, even in an informal or humorous context.

Resiliency training is also important. “Yes, you’re absolutely stressed being in medicine. There is little we can do to take away all the stress. That comes with this profession. Let’s fill your toolbox with the skills you need to navigate through the stress.”

2. Promote a culture of permission. We need to promote a culture of permission, because there isn’t one. There is no permission to be physically ill, mentally ill or simply in need of support. There is no permission for self-care in medicine and that’s really important. We also need permission to set boundaries and create sustainable practices. We need permission to say “this is my capacity” and have that respected.

4. Create collegial opportunities to process trauma. We need to create opportunities, within the health-care system, for physicians to process the things they’re exposed to. They need collegial opportunities to debrief and discuss issues with people and get clinical supervision and support from colleagues. You just need to give people the opportunity to take care of each other. These people know how to take care of each other because they take care of patients all the time. But there’s no permission to take care of each other in the workplace.

Tips 5 to 7 » SMA DIGEST | SUMMER 2016

5. Get a family doctor. Physicians need to have a family doctor, and not someone they meet in the hallway. They actually need to have a trusted person who takes care of their physical and mental health needs.

6. Be brave. Reach out. We intervene day in and day out with patients, and yet those skills seem to vanish when it comes to our colleagues. Be brave. Reach out. How long does it take to say to someone, “How are you doing?”

7. Offer a safe place to get help. Ensure that when you reach out, it is from a place of genuine compassion and concern that is free from judgment. Under those circumstances people will be more likely to get help. They have to know that coming forward with mental health and addiction issues is not going to result in punishment, it’s going to result in help.

It is important to note that things are changing for the better. Dr. Cross and Senger noted that medical students and residents are placing an increasing focus on self-care and taking proactive steps to good mental and physical health. The Physician Health Program reports that 53 per cent of referrals to the program in 2015 were self-referrals, a significant increase from 29 per cent in 2007. More physicians are identifying that they need support and taking the initiative to get help. That is the first step to personal recovery and a healthier medical community.

Traditionally, physicians in need of care feel guilty about accepting care and shame for needing it. Many physicians struggle with undiagnosed, untreated or self-treated mental health issues. Many others struggle with relationship and family issues, and substance abuse and addiction. There are a number of factors that predispose physicians to these challenges including occupational factors like sleep deprivation, excessive workload, potential for complaints/ litigation and witnessing trauma and human suffering.

Let’s start the conversation. Contact the Physician Health Program. Brenda Senger

Director, Physician Support Programs

306.244.2196 brenda.senger@sma.sk.ca

SMA DIGEST | SUMMER 2016

HEALTH CARE

DR. CRYSTAL LITWIN SMA’s Physician of the Year on the privilege of rural practice

By Ivan Muzychka Dr. Crystal Litwin says she knew from an early age that she wanted to be a physician. The Wynyard-based family physician, who was recently named the SMA’s Physician of the Year at the 2016 Spring Representative Assembly, says that when she thought of medicine, the thought of the rural context was not far behind. “Medicine was the only career choice I ever thought of in high school,” Dr. Litwin recently told the SMA Digest. “I liked the challenge of it. I was very interested in science and medical things. I knew I wanted to practise in a rural setting right from the get go, and felt I could benefit a small town along the way. I think it was both the interest and the challenge.” “I remember [the TV program] Quincy ME. He was a medical examiner, and that show was probably my first exposure to medicine on TV. It was fascinating.” Today, when her colleagues speak of Dr. Litwin, they use words such as commitment, dedication and passion - words that are, for those who can recall, reminiscent of that famous late 70s TV character. Dr. Litwin was raised in Foam Lake and moved to Wynyard when she began to practise medicine. Others have come and gone, but Dr. Litwin has remained for more than 20 years, and has made a lasting impact on that community and surrounding area.

health-care model being brought to the Wynyard Community Clinic in 2003. Since then, the model has been extended to the on-reserve clinic at Day Star First Nation. An advocate of rural practice, her passion for that context goes beyond medicine. “The relationships that you build with your patients are different,” she explains. “I think you get deeper connections with your patients than you would in an urban setting. You get to know them on a professional level but also on a personal level.”

“

I THINK YOU GET DEEPER CONNECTIONS WITH YOUR PATIENTS THAN YOU WOULD IN AN URBAN SETTING. YOU GET TO KNOW THEM ON A PROFESSIONAL LEVEL BUT ALSO ON A PERSONAL LEVEL.

She’s the chief of staff at the Wynyard Integrated Hospital and was one of the driving forces that led to the primary SMA DIGEST | SUMMER 2016

“

IT IS NOT UNCOMMON FOR STRANGERS TO COME UP TO MY HUSBAND WHEN HE’S CUTTING GRASS OR JUST OUT IN THE COMMUNITY AND SAY ‘I KNOW YOU - YOUR WIFE SAVED MY LIFE.’ THOSE SENTIMENTS WARM MY HEART. WHAT A PRIVILEGE.

In conversation, it’s clear that she’s a person who enjoys working with people, whether she’s treating them, or just being one member of the community with the same bonds that others have. Her colleagues, nurses Cheryl Brewster, Michael Jordan and Debra Koshinsky, writing in support of her nomination, commended Dr. Litwin for her commitment to her rural roots, noting her involvement with her husband and two children in several community activities including the Wynyard Skating Club, the Quill Plains Music Festival and the Hopak Ukrainian Dance Club. “The best thing about Wynyard is that it’s quiet and peaceful,” Dr. Litwin says. “It’s a wonderful community, people help you and it’s a place where it feels safe. I never felt isolated, and if you need to go to a concert, or something like that, you don’t have to go far.” Dr. Litwin continues to give back to the profession, and has worked on a number of SMA committees as an evaluator for the Saskatchewan International Physician Practice Assessment (SIPPA) program, and as a mentor to many medical students and JURSIs. Through her work with the Committee on Rural and Regional Practice, she’s familiar with the challenges of recruiting physicians to rural areas. To prevent the unsatisfying and impractical churn of personnel, she says it’s about finding the right fit and the right match the first time. So, she’s asked, how does one find that match? “That’s the million dollar question,” Dr. Litwin says with a small laugh. “I think monetary incentives have been tried, and that might get people here, but does not keep people here.”

SMA DIGEST | SUMMER 2016

She feels that having larger groups of physicians is an important factor for prospective rural doctors because it helps with the pace. “Family and personal priorities are much more important than they were for generations past,” she notes. “Things are much different now. Lifestyle issues are key, and how we can provide employment for spouses.” She agrees that rural practice might be more appealing for someone coming from a rural area. She is positive about programs such as the SMA’s Roadmap Program, which has helped expose medical students to rural practice. She says only time will tell if these kinds of programs are going to make a difference. “I hear that family medicine, and rural practice, is much more popular now, and so we’ll see what they choose,” she says. ”Exposure is never a bad thing. They all seem very keen and they seem open to the idea. It puts rural practice on their radar.” Her caring attitude shines through when she’s asked about advice she would give young physicians just entering practice. The advice is practical, warm and is given much like a prescription to a patient. “Work-life balance is extremely important,” she says. “Don’t get so involved in work that you get stressed out and burned out. Do things that are fun and good for your health, and things that take you away from work so you can return refreshed, and you can enjoy the work that you do.” Reaching out is also key. “Physicians sometimes think that they need to know it all and do it all, and sometimes we need help. Students are trained in a centre where there are MRIs, CT scans and specialists. Maybe you don’t have to rely as much on your clinical skills…and in a rural area you potentially are the only person in town and have to manage whatever comes in the door. Don’t be afraid to ask for advice. We very much work as a team, and that’s very important if you are going to work in this environment.”

YOUR SMA

Asked about one of her enduring memories of past practice, Dr. Litwin recounts a story that sums up both Crystal Litwin, and rural medicine itself. “I do recall shortly after starting work here a gentleman presented to the ER in third degree heart block,” she explained. “We had to pace him and I accompanied him in the ambulance to the city (prior to the days of STARS or advanced care paramedics). He’s now in his nineties and doing well. We still talk about that trip from time to time. If he only knew how anxious I was during that trip! There have been many similar trips in the ambulance to the city when you’re not sure if your patient will make it and they do, and get the treatment they need and are back in town, continuing their life and thanking you for your service. “It has been extremely gratifying to practice in a rural community,” she said. “It is not uncommon for strangers to come up to my husband when he’s cutting grass or just out in the community and say ‘I know you - your wife saved my life.’ Those sentiments warm my heart. What a privilege.”

“I was and still am completely surprised and honoured by this experience,” she says of receiving the Physician of the Year award from her peers. “I feel so undeserving of this acknowledgement. The recognition has been somewhat overwhelming. The well wishes I have received have been fabulous. It is wonderful and gratifying to feel valued.” The SMA Physician of the Year award, first presented in 2002, recognizes the valuable contribution and service of an outstanding Saskatchewan physician. The nominee must be an SMA member and be living in Saskatchewan at the time of the nomination. The physician’s contributions can be made in the medical profession or volunteer sector and can be to a community or district, or at the provincial, national or international level, either during a particular time or throughout that physician’s career.

WARMAN CLINIC SEEKS

FAMILY PHYSICIANS

GAMA Medical Center is looking for physicians to join our practice located in Warman. We are a family practice which also provides walk-in services to a growing community in our 12,000 square-foot state-of-the-art facility. Our clinic is fully equipped with EMR and staffed with friendly, efficient staff. We offer on-site x-ray, lab services, and urgent care services. A full service pharmacy adjoins our office and an ultrasound center is located nearby.

Please apply with submission of CV by email to: gama@sasktel.net.

Further inquiries Contact Dr. M. Singh at 306-220-1841 or 306-374-8082.

SMA DIGEST | SUMMER 2016

WHEN DOCTORS FACE DISABILITY by Ivan Muzychka What happens when you spend a long time training to be a doctor and then a medical issue prevents you from working? Doctors see themselves as the people who help others with disability prevention and care, not the other way around. Such a dramatic role reversal can leave a physician in a challenging and lonely place. Dr. Ulla Nielsen knows the scenario first hand. Shortly after entering the medical profession as a paediatrician, multiple sclerosis caused her to reduce her working time. Eventually the illness developed to the point that she had to stop working altogether. “Doctors are trained to look at what’s wrong and how to fix it,” Dr. Nielsen recently told the SMA Digest. “With disability you have to mitigate it, but then the focus has to be on what the person can do, not what they can’t do. For physicians, particularly outside the rehab area, that’s a different mindset. There aren’t any quick fixes.”

PHYSICAL AND SOCIAL Today, Dr. Nielsen is a retired physician who contributes to her profession and to the community, including playing an active role in the newly created retired physicians section of the Saskatchewan Medical Association (SMA). She says a major disability has two components: the physical and the social. “It was really a matter of coming to terms with the disease, and coming to terms with what I could and could not do,” she said. “They are two separate issues. When I think about disability, I see that there’s not a lot of discussion about the coming to terms, not just with the disease, but also with the issues around what you are going to do next.” 22

SMA DIGEST | SUMMER 2016

Fortunately, Dr. Nielsen took out SMA disability insurance when she was an intern. In hindsight, it was a pivotal decision because the benefits she received shielded her from severe financial hardship. She says that she actually had plans to cancel her coverage, but never got around to doing it. When her illness struck, she found the plan to be easy to access and beneficial in numerous ways. For example, her benefits were non-taxable since she was paying the premiums herself. As she navigated life with her illness, she learned to adjust to life as a non-practicing physician. The wording she uses – “non-practising physician” - is carefully chosen as it describes precisely what can happen to a physician with a serious disability. “Physicians as a group don’t deal well with disability amongst their own,” she said. “If they are disabled, physicians can be made to feel ignored within the profession. As soon as they can’t practise…it’s like they don’t exist.” “And physicians as a group, certainly in the past, have not been terribly open to the discussion of disability amongst physicians,” she says. “In the early 2000s, I was part of the Canadian Association of Physicians with Disabilities (CAPD), and that’s a group that continues to this day. It was the first group of this kind in Canada. “Disability in physicians is not something that is talked about. It’s ignored,” she says. “CAPD did a survey across the country some years ago and we found no one was tracking physicians with disability. No one knew how many disabled doctors there were.”

YOUR SMA ONCE A DOC, ALWAYS A DOC Things are improving, and the SMA’s retired physician section now recognizes physicians who are disabled, thanks largely to the efforts of founding member Dr. Nielsen, herself. She recognizes the importance of keeping disabled doctors in a community of their peers.

Home is where the heart is.

“I have to give a lot of credit to the Board of Directors at the SMA,” she says of the retired physicians section. “I raised it periodically and the SMA board took it and ran with it and have been very supportive. What we’ve done is use the definition of retirement. Retirement means retirement from practice for any reason. “The definition of retired can mean so many things. It can be changing your scope of practice, or gradually cutting down on days. There are a variety of ways to retire. “I am functioning as vice-chair of that section, and I see that collegiality has to be maintained. You don’t quit being docs when you retire,” she says. “They are retired docs, but they are still docs.”

SUPPORT IS KEY

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She notes too, how it is important for physicians to have other kinds of support as they work through the issues surrounding disability. “Physician support services at the SMA are a tremendous source of information and support for doctors who are moving out of active practice,” she said. “When I was going through it, there were few supports in place for anyone going through the process. I did not know what questions to ask the College of Physicians and Surgeons of Saskatchewan. I did not know who to talk to at the SMA.”

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Today Dr. Nielsen is an active member of the community. Among other things she is the honorary chair of the Easter Seals Saskatchewan, a long-time director on the board of the Saskatchewan Abilities Council, chair of the Legislation and Policy Committee of the SMA, and vice-chair of the new Section of Retired Physicians of the SMA. She received the Saskatchewan Centennial Medal in 2005 and the Sterling Award for outstanding community contributions in 2012.

The Personal

Her service to the SMA, and to her fellow SMA members, does not end with these recent activities. Dr. Nielsen tells the SMA Digest that if there are physicians out there struggling with disability they should feel free to contact her through the SMA office or contact her directly.

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Dr. Nielsen says she’d be happy to help. For further information about disability insurance through the SMA, please email insurance@sma.sk.ca or call 306-244-2196. Dr. Ulla Nielsen can be reached at ulla.nielsen@usask.ca.

The right fit. The Personal refers to The Personal Insurance Company. Certain conditions, limitations and exclusions may apply. Auto Insurance is not available in Manitoba, Saskatchewan and British Columbia due to government-run plans.

SMA DIGEST | SUMMER 2016

SYRIAN REFUGEES

integrated into Saskatoon’s healthcare system By Lana Haight

Dr. Mahli Brindamour (left) and Dr. Yvonne Blonde (right)

Physicians and other health-care providers in Saskatoon moved into high gear late last year to respond to health needs as refugees from Syria began arriving in the city. “There is a huge gap in the care that we provide to the refugee population,” said Dr. Yvonne Blonde, a family physician and a clinical teacher with the Department of Family Medicine, College of Medicine at the University of Saskatchewan.

and privately sponsored refugees from Syria. Between Nov. 4, 2015 and March 31, 2016, 1,158 Syrian refugees arrived in Saskatchewan. Of those, 93 per cent were government-assisted. The other seven per cent involved private sponsors.

“There were no services in place for a clear route upon arrival (for the refugees) to cope with health needs. There wasn’t even an understanding of what the basic health needs would be or what our approach should be.” Dr. Blonde and Dr. Mahli Brindamour, a paediatrician and clinical assistant professor with the Department of Paediatrics, U of S College of Medicine, were part of the health-care collaborative committee that developed and implemented a plan to provide immediate and longer term care to the Syrians. In a 10-week period from Jan. 9 to March 19, 400 refugees received an initial health screening at the Saskatoon Community Clinic at special evening and weekend clinics. “I am quite proud of what we were able to accomplish. I have to say, it was really teamwork. The only reason we were able to accomplish so much was we had strong partnerships,” said Dr. Brindamour. Staff members with Saskatoon Health Region (Population and Public Health), Saskatoon Community Clinic and the University of Saskatchewan’s College of Medicine (family medicine and paediatrics), including public health nurses, nurse practitioners, health sciences students and settlement workers, were part of that team. In the fall of 2015, the federal government committed to expedite the resettlement of 25,000 government-assisted 24

SMA DIGEST | SUMMER 2016

Syrian refugee settlement in Sask. Source: Immigration, Refugees and Citizenship Canada

In Saskatoon, the goal was for every Syrian refugee to be seen by a physician within two to four weeks of arrival to deal with urgent issues, minimizing visits to emergency departments and walk-in clinics. Physicians followed CMAJ clinical guidelines for immigrant and refugee health. The refugees who moved to Saskatoon were relatively healthy considering the migratory life they have had since leaving their home country, say the physicians. They point out that prior to the conflict in Syria, the country’s health system functioned well. Dr. Brindamour, who examined many of the children, was surprised at the high number of children with significant dental health issues. “There was very severe decay, lots of abscesses, lots of cavities, lots of dental pain. They couldn’t eat because of dental

HEALTH CARE

pain. And decay was so severe that you could see the root tip,” she said, adding that a few dentists in the city provided care for those with the most urgent needs. Dr. Brindamour also saw many children with developmental delays and chronic, complex, multi-system health issues. “It’s been a bit difficult to find the appropriate resources for these children in a system that is already strained. We’re not used to seeing children who are older with developmental needs that have not been picked up,” she said. “I have several children with seizure disorders, some of them with cerebral palsies, some of them with what we call ‘global developmental delay not-yet-diagnosed.’ Children are behind in development and we don’t really have a good reason for it.” Dr. Blonde conducted health screening with both adults and children. As much as possible, families were seen at the same time, first the parents and then the children, benefitting the families and the health providers with a more streamlined and centralized service. “Refugees are some of the most vulnerable people because they are forced to flee. The barriers to good health begin at the time of the initial experience, the war or whatever the trauma might have been, but they continue as they migrate and even re-settle,” said Dr. Blonde. “As trauma in itself is an independent risk factor for diabetes and hypertension, my adult patients have a lot of diabetes and hypertension. Even though they had some medical care along the way, there was a paucity of diagnostic capacities and the medication wouldn’t necessarily be continuous and because of that their chronic diseases were not appropriately cared for.” While language is the most obvious barrier to accessing good health services, understanding the systems in various countries is also a barrier. Even the steps to renewing medication vary from one place to another. The influx of refugees from Syria to Saskatoon has prompted the physicians and other health-care providers to work at securing a permanent refugee clinic for the city. The Saskatoon Refugee Health Collaborative has applied to the provincial Ministry of Health for funding to operate a one-year pilot project for a new refugee clinic to be housed at the Saskatoon Community Clinic. All the refugees from Syria have been accepted into the practices of family physicians and paediatricians in Saskatoon.

Drs. Brindamour and Blonde expressed how honoured they were and continue to be as they provide care for the Syrians. “I’m feeling very privileged to take care of this population as I feel privileged with my other patients. I think when people have gone through such hardship and put their trust in you, it can be a bit emotional, especially as time evolves and I get to know people better. They open up more. The hardship that they’ve been through is hard to imagine. It’s not something that I encounter every day,” said Dr. Brindamour. Dr. Blonde shares that sentiment. “I was so impressed, as someone new to Saskatchewan, to be part of a community collaborative experience to improve something that was identified as a need in the community,” said Dr. Blonde, who moved to Saskatoon less than two years ago to work. “It’s been a pleasure to watch and be part of their re-settlement in Canada. It’s humbling and it’s educational. You are always reminded of the massive challenges of this population, but they are very resilient.”

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REFUGEES ARE SOME OF THE MOST VULNERABLE PEOPLE BECAUSE THEY ARE FORCED TO FLEE. THE BARRIERS TO GOOD HEALTH BEGIN AT THE TIME OF THE INITIAL EXPERIENCE... BUT THEY CONTINUE AS THEY MIGRATE AND EVEN RE-SETTLE.

Dr. Blonde is also the principal investigator for a project that is evaluating the temporary clinic organized for the refugees from Syria. In addition to analyzing the data, researchers are conducting interviews with health-care providers and the refugees to gauge their perspectives on what worked and what didn’t during the 10 weeks last winter.

SMA DIGEST | SUMMER 2016

Photo credit:

Photographer Travis Horn, Thorn Images, traveled to Haiti with the team to document their work. All images are courtesy of Thorn Images (except for the team photo on page 32). www.thornimages.com

SMA DIGEST | SUMMER 2016

BROKEN EARTH

Local team provides much needed medical care in Haiti

n March 11, 2016, 28 health professionals, including 15 physicians, arrived in Port au Prince, Haiti, as the first ever Saskatoon team for Broken Earth. Broken Earth is a volunteer health-care task force, with teams from across Canada, who travel to Haiti to provide medical relief and help rebuild the countryâ&#x20AC;&#x2122;s health-care system in the wake of the devastating earthquake of 2010. Teams treat patients and provide acute care to the people of Haiti, but also work with Haitian medical professionals to train and improve their skills in best practices, and educate the Haitian people on matters of public health.

The physician contingent of Team Saskatoon included orthopaedic surgeons, general surgeons, and a plastic surgeon, as well as anaesthetists, emergency physicians, an internist and a pathologist. They provided the full spectrum of patient care at the Bernard Mevs Hospital, including primary care, emergency/trauma care, clinical care, operations, pathology and teaching. Bernard Mevs is the only trauma, critical care and rehabilitation hospital in Haiti as well as the home of the countryâ&#x20AC;&#x2122;s only paediatric ICU and neonatal ICU.

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Previous spread: Top left: Orthopaedic surgeon Trent Thiessen, anaesthetist Alena Stirling, and plastic surgeon Chris Thomson in the Bernard Mevs operating room (OR). Right: 12-year-old Rudy had stopped attending school due to the stigma over his deformed leg. Following a complex orthopaedic surgery last November, Rudy has been fitted with a prosthesis and is back in school and doing well. Team Saskatoon`s anaesthetist Shefali Thakore follows up with Rudy.

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Above (pictured left to right): OR nurse Bernie Cruikshank, orthopaedic surgeon Elliot Pally, anaesthetist Alena Stirling, orthopaedic resident Scott Mollison, OR nurse Judy Churchwell Below: ER physician Tony Brilz (right) with Haitian physician and EMT. Left: ER physician Mark Wahba performs a bedside ultrasound on a patient with a plural effusion.

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Above: Wilfrid Macena (fourth from left) lost his leg during the 2010 earthquake and was one of the first amputees to be treated and fitted with a prosthetic by the Healing Haiti`s Children program. Soon after he was walking and playing soccer and is now the founder and captain of Team Zaryen, a team of amputee patients. He currently runs the prosthetics lab and works to encourage other amputees to overcome the challenge of losing a limb. Left (pictured left to right): Team lead and orthopaedic surgeon Huw Rees, OR nurse Bernie Cruikshank, and orthopaedic resident Scott Mollison at the teamâ&#x20AC;&#x2122;s daily rooftop planning meeting.

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Above: ER physician Tony Brilz and ER nurses Stephanie Walls and Tracey Wahba rush a patient into the emergency department at Bernard Mevs Hospital. Top right: ICU nurse Renee Tetu cares for a patient. Right: Education is an important part of the work undertaken by the teams in Haiti. Here, nurses Andrea Chennette (left) and Renee Tetu (right) teach infant resuscitation. Left: Vince DeGennaro, Miami internist/hematooncologist (second from left), and general surgeons Sarah Mueller and Fred Oleniuk discuss treatment of Haitian patient presenting with an abdominal mass (left). Surgery was done to remove the mass and pathologist, Henrike Rees, determined it to be a benign ovarian cyst weighing 28 pounds. 30

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Top: (Back row from left) Paul Labelle, ER physician; Scott Mollison, orthopaedic resident; Lee Kolla, orthopaedic surgeon; Ted Tilbury, physiotherapist; Heather Ward, internal medicine physician; Elliot Pally, orthopaedic surgeon; Trent Thiessen, orthopaedic surgeon; Shannon Hey, ICU nurse; Fred Oleniuk, general surgeon; Edith Drury, OR nurse; Renee Tetu, ER nurse; Chris Thomson, plastic surgeon; Alena Stirling, anaesthetist; Sarah Mueller, general surgeon. (Front row from left) Stephanie Walls, ER nurse; Andrea Chennette, ER nurse; Tony Brilz, ER physician; Tracey Wahba, ER nurse; Mark

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Wahba, ER physician; Lorrie Dobni, PACU nurse; Shefali Thakore, anaesthetist; Henrike Rees, pathologist; Huw Rees, orthopaedic surgeon; Bernie Cruikshank, OR nurse; Aimy Thiessen, public health nurse; Judy Churchwell, OR nurse; Tammy Guse, OR nurse; (Missing: Chris Prendergast, orthopaedic equipment rep) Bottom left: ER physician, Paul Labelle, with Haitian mom and son. Bottom right: Orthopaedic surgeon, Elliot Pally (left), and pathologist, Henrike Rees, examine a tumor.

To learn more about Team Saskatoon`s mission to Haiti, or to make a donation in support of their next mission planned for January 2017, please visit: www.brokenearth.ca/mission-teams/saskatoonsaskatchewan or e-mail team lead Dr. Huw Rees at rees.h@shaw.ca.

LINK NON-URGENT

phone consultation service ready for calls By Melissa Kimens, Ministry of Health Saskatchewan recently welcomed a new provincial telephone consult service called LINK (Leveraging Immediate Non-urgent Knowledge), to connect family physicians with specialists. LINK enables quick consultations on issues that are non-urgent, yet important, especially from the point of view of a patient who might otherwise face a referral or emergency department visit. Adult psychiatry is the first specialty service offered through LINK, with a specialist on call from 8 a.m. to 5 p.m. weekdays. “LINK provided me with immediate advice that I could use to improve the care of my patient,” says Dr. Direse Coetzee, who recently accessed the service from La Ronge. To support physician work flow and the opportunity for patient participation, calls are typically answered right away, or returned within 15 minutes. In Dr. Coetzee’s experience, “The service is easy to use and I was connected in a timely fashion.” Dr. Gene Marcoux, an adult psychiatrist providing the service states, “Callers are grateful when you answer immediately.”

on next steps to consider. I am now confident that I can apply the same advice to future patients as well.” Family physicians can access LINK through the Acute Care Access Line (ACAL) service in Saskatoon Health Region and Bedline in Regina Qu’Appelle Health Region. Callers simply identify they are requesting a “LINK non-urgent call” so the call can be directed to the LINK specialist on-call.

LINK IS QUICKLY BECOMING THE MODERN DAY PHYSICIAN LOUNGE, PROVIDING FAMILY PHYSICIANS WITH SUPPORT TO WORK TO THEIR FULL SCOPE OF PRACTICE.

LINK is quickly becoming the modern day physician lounge, providing family physicians with support to work to their full scope of practice. The consultation is an opportunity to help patients get answers to their health concerns sooner. The call with the specialist can help confirm the family physician’s treatment plan, help determine whether a referral to a specialist is appropriate and if it is, ensure that the patient is being sent to the right specialist with the right clinical information included in the referral.

“I will use LINK again,” Dr. Coetzee says after her first experience with the service. Similarly, Booth says she is “passionate about the benefits of LINK, and can’t wait until we have other services on board.”

Mickey Booth, a patient and family advisor in Saskatoon, considers the LINK service “great, especially if it means patients can avoid waiting for a referral or having to travel to a specialist because their issue is handled in a phone call.”

Physicians wanting more information (or specialists interested in joining) should contact Melissa Kimens, the project manager responsible for LINK at the Ministry of Health: (306) 787-7647 or melissa.kimens@health.gov.sk.ca.

An added benefit for family physicians using the LINK service is the educational value of the conversation with a specialist. As Dr. Coetzee notes, “The LINK specialist took time to explain the rationale behind his advice and even advised SMA DIGEST | SUMMER 2016

MEDICAL ASSISTANCE IN DYING

and what it means for your practice By Maria Ryhorski On June 17, 2016, Bill C-14 was passed, leaving many physicians across the country in a state of uncertainty as to how to adapt their practices, and continue providing the best possible care to their patients in this new environment.

Current state With the passage of Bill C-14, it is now legal for physicians and nurse practitioners to provide medical assistance in dying (MAID) to patients who have a grievous and irremediable medical condition, and whose death is reasonably foreseeable, taking into account all of the patient’s medical circumstances. The patient must be over 18 and mentally competent at the time of the request and at the time of delivery, and must have given informed consent to receive medical assistance in dying. It is the physician’s responsibility to ensure that the patient understands their medical condition and prognosis, and the available treatment alternatives such as pain management and palliative care. A number of additional criteria govern a patient’s eligibility to receive medical assistance in dying and these are listed on the Government of Canada’s website atohttp://healthycanadians.gc.ca/health-systemsysteme-sante/services/palliative-pallatifs/medicalassistance-dying-aide-medicale-mourir-eng.php.

CLARITY NEEDED The passage of Bill C-14 marks a pivotal shift from a system in which physicians strove always to preserve and extend life, to one where actively assisting certain patients to die is a potential part of the cycle of care. Health-care leaders in

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Saskatchewan have surged into action to gather information and develop resources that will give physicians much needed clarity in terms of process and their professional obligations. Bryan Salte, associate registrar for the College of Physicians and Surgeons of Saskatchewan (CPSS), is a member of the regional health authority (RHA) working group developing these resources. The working group also includes representation from the Saskatchewan Medical Association (SMA), the Ministry of Health, regional health authorities, the Saskatchewan Cancer Agency, the College of Pharmacists, the Saskatchewan Registered Nurses Association and patient advisors. “The goal, for me at least…would be to have almost a onestop-shop so that physicians don’t have to go and read legislation and then go and read something else,” says Salte. “There would be one document that would say, ‘If you are assessing, this is what you need to follow and this is what you need to know. If you are implementing it and actually administering the medications, this is what you need to know. This is how you need to implement it. This is where you have to report.’ “These are the kinds of things that I would hope will be in the single document that a physician can look at and say, ‘I understand what my role is. I understand what my responsibilities are, and I understand how this process will unfold in order to make it easier for the patient and for the family of the patient.’” Salte anticipates this document being ready in the near future. The CPSS guidelines regarding physician assisted dying provide further guidance and they are currently being updated to reflect the passage of Bill C-14. In the meantime, physicians can contact the CPSS or the SMA for support and information as there are a number of draft materials which may be helpful.

“

HEALTH CARE

WE SUPPORT OUR MEMBERS IN THEIR RIGHT TO FOLLOW THEIR CONSCIENCE... BUT IT IS IMPORTANT, AS ALWAYS, TO PUT OUR PATIENTS FIRST – TO ENSURE THAT THEY HAVE TIMELY ACCESS TO THE INFORMATION AND RESOURCES THEY NEED... AND TO BE TREATED AT ALL TIMES WITH DIGNITY, RESPECT AND COMPASSION...”

CONSCIENTIOUS OBJECTION AND YOUR RESPONSIBILITIES AS A PHYSICIAN Based on the town hall discussions that the Canadian Medical Association held on end-of-life care, the physician population is divided when it comes to medical assistance in dying. Some physicians do not wish to provide medical assistance in dying because it goes contrary to their moral or religious beliefs. The new law, together with the SMA and the CPSS, support physicians’ right to act according to their conscience so long as patients are provided with timely access to the information that they need. “We support our members in their right to follow their conscience when it comes to providing medical assistance in dying,” says SMA President Dr. Intheran Pillay, “but it is important, as always, to put our patients first – to ensure that they have timely access to the information and resources they need to make an informed decision regarding end-oflife care, and to be treated at all times with dignity, respect and compassion, regardless of their care choices.” An informed decision is key and, whether or not a physician intends to provide medical assistance in dying, it is their responsibility to ensure the patient has access to adequate information regarding all the available options for end-oflife care. “So it’s not just medical assistance in dying,” says Salte. “Maybe it’s palliative care, if available; maybe it’s pain control; maybe it’s community resources that may be available – a variety of other things that might potentially, for the patient, be an option as compared with medical assistance in dying.” Providing this information may mean counselling the patient themselves or putting the patient in touch with an alternate care provider. Regardless of which, it is important

that the physician continue to provide compassionate care to their patient throughout the dying process, irrespective of the patient’s choices with regard to end-of-life care.

WHAT ABOUT PALLIATIVE CARE? Palliative care is an integral piece of the end-of-life care discussion, and one that has been overshadowed by the national discussion of, and reaction to, the legalization of medical assistance in dying. Dr. Pillay feels strongly that palliative care must be made available to patients and in order to accomplish that for all patients who need it, including those that live outside of major centres, changes will need to take place on a provincial and national level. “Research has shown that less than a third of Canadians dying from terminal illness actually receive high quality palliative care,” notes Dr. Pillay. “It is imperative that we develop a robust palliative care network in Canada which, in my opinion, will drastically reduce the need for patients to seek medical assistance in dying. It is critical that, as physicians, we strive to ensure that our patients have access to a full range of end-of-life care and support, including palliative care.” Until a national framework is in place, it is possible for physicians to incorporate a palliative approach to care in their practice, even in the absence of formal palliative care services in their community. This means engaging in honest discussions with patients nearing the end of life, around the goals of care and, if appropriate, a shift in focus from prolonging life to enhancing the quality of life through a focus on pain and symptom management and addressing the mental, emotional and spiritual distress that terminal patients often experience.

End-of-life resources »

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END-OF-LIFE RESOURCES MEDICAL ASSISTANCE IN DYING SASKATCHEWAN MEDICAL ASSOCIATION

PALLIATIVE CARE CANADIAN VIRTUAL HOSPICE (CVH)

www.sma.sk.ca/MAID

www.virtualhospice.ca

The SMA has developed a comprehensive page of resources for medical assistance in dying. This page is being continuously updated to provide the most up-to-date physician resources.

CVH is the most comprehensive online collection of peerreviewed palliative and end-of-life resources available (Fassbender, 2015). It provides credible information for you and your patients from an interdisciplinary team of palliative care experts. It includes: • Tools for practice: Protocols, standards, assessments and education tools. • Ask a Professional: An interdisciplinary team of palliative care specialists confidentially answer your practice questions. • Patient Teaching Tools: Topics articles and videos support patients, families and caregivers. • The Exchange: Experts share latest advances and best practices in palliative care. • Methadone4Pain.ca: A free, accredited online training course on prescribing methadone for pain management in palliative care.

COLLEGE OF PHYSICIANS & SURGEONS OF SASK.

www.cps.sk.ca

The CPSS policy on physician assisted dying is available at www.cps.sk.ca. More resources are currently being developed. The CPSS is also available as a resource at (306) 2447355.

CANADIAN MEDICAL ASSOCIATION

www.cma.ca/en/pages/education-eol-care-medicalassistance-dying.aspx In order to provide physicians with the information they have requested, the CMA has developed training for physicians regarding medical assistance in dying: an online offering and a more in depth, face-to-face course that will be offered Sept. 15-17 in Vancouver, and November 3-5 in Toronto.

GOVERNMENT OF CANADA

http://healthycanadians.gc.ca Learn about medical assistance in dying, including the request process, who is eligible and who can provide the service. Also find out how the service is being carried out across Canada. This page includes a link to Bill C-14.

SASKATCHEWAN MINISTRY OF HEALTH

www.saskatchewan.ca

Learn about medical assistance in dying, including the request process, who is eligible and who can provide the service, all within the context of Saskatchewan.

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PALLIUM CANADA

http://pallium.ca

Pallium Canada provides training for health-care providers on the essential practical knowledge, attitudes and skills needed to apply a palliative care approach in their practice. It provides both online learning opportunities as well as courses accredited by the Canadian College of Family Physicians and the Royal College of Physicians and Surgeons of Canada.

SASKATCHEWAN HOSPICE PALLIATIVE CARE ASSOCIATION (SHPCA)

www.saskpalliativecare.org

The SHPCA is a non-profit organization that exists to assist palliative care service providers through education, networking, research and advocacy. Through its website, there is access to palliative care contacts for each health region.

Photo by Kyoo Yoon Choi, class of 2018

THE REWARDS OF RURAL PRACTICE

By Ivan Muzychka

There are probably as many opinions about the advantages and disadvantages of practising medicine in a rural area as there are physicians. A prevailing view, borne out by evidence, is that it’s difficult to recruit physicians to rural practice. And yet, those who practise in smaller places often have an obvious passion for it, and could not imagine practising in any other context. The late Scottish novelist Muriel Spark could have been talking about rural practice when she wrote “For those who like that sort of thing, that’s the sort of thing they like.”

WHAT’S NOT TO LIKE? Saskatchewan offers some of the most scenic communities in the country. The province’s geography and culture is not the only draw, however. In most cases it’s the community itself, the people themselves, that are an even stronger pull for physicians embarking on their careers. In conversations with physicians who either work in rural areas or plan to, the message is the same: deep connections to patients and families, and a strong bond to place are a definite added value to a satisfying medical career. On a more technical note, rural practitioners often note the availability of a wider scope of practice as another strong benefit.

FRESH OUT OF SCHOOL Dr. Ankit Kapur studied medicine in Ireland and is a recent medical graduate. This summer he completed his two-year residency in La Ronge, Sask. Based on the positive experience he had, Dr. Kapur plans to return to a small town in the province as soon as he’s finished a residency in emergency medicine in Regina.

“One of the highlights of my residency experience was I got to spend a week living in Wollaston, on Wollaston Lake,” Dr. Kapur recently told the SMA Digest. “I was supposed to be there two days, but because of weather I spent a week there. At Wollaston, I was the only doctor in 400 kilometres. I got to care for this community and got to know the patients. Afterwards, when I returned to Wollaston for my regular clinics, I knew everyone…When you live in a rural area you get to know the people, the people get to know you, and you develop a sense of trust and that leads to really rewarding care.” His extra emergency training is actually part of an overall strategy to return to rural practice, which he clearly enjoys. “The reason for training in emergency was to bring that training to the rural context,” Dr. Kapur explained. “I found, working in La Ronge, that the scope you see there is as broad as you see in a rural area. I thought additional training would help me in that rural setting.” Undoubtedly, if you’re going to practise in a remote location, you have to know how to deal with anything that comes in the door. It’s a common theme among residents and even experienced physicians. A wider scope of practice can be a draw but it can also intimidate. Responding to a 3 a.m. call where you are the only doctor around to deal with a serious situation, far from a trauma team, advanced equipment, and specialists, is not for the faint of heart. Still, many rural physicians point to the vast learning and experience one gains in situations like that as invaluable.

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BUILDING TRUST IS THE BEST MEDICINE While developing a wide spectrum of technical skills is rewarding, Dr. Kapur emphasizes other nuances. Building trust is important, and he returns to this notion several times. He sees it as a touchstone of his practice. “I think the first thing is developing trust,” he said. “Doctors come and they go. Patients have to have a sense that you are going to be there a while, then they’ll share,” he said. “Otherwise they just think you’ll read their chart. I have to prove to the community that I’m going to be there a while and that it’s worth it for them to get to know me and be part of their care plan.” Dr. Kapur tells a story about his departure from the community which illustrates for him why it was so good to go there in the first place. “One of the most telling things about a community like La Ronge was that on my last day a few patients stopped me on the road and they were saying ‘Oh, Dr. Kapur we weren’t able to get in to see you, and we heard you were leaving town and we wanted to say good-bye.’ They talked about their experiences, and it took me a half an hour to get across the block because people were stopping me and just wanted to say good-bye. And that’s what I mean when I say that you are part of a community, you develop trust, and you are part of that care network. It was quite rewarding and I could not have imagined a better way to say good-bye.”

SMALL TOWN CALLING Dr. Amber Grunow was born and raised in Saskatoon and is a recent graduate of the University of Saskatchewan’s College of Medicine. She grew up in the city but she intends to practise in a rural setting. “After first year I spent two weeks in Rosetown,” she told the SMA Digest, “and that was my first exposure to a full scope kind of practice.”

After a rural placement in La Ronge, she decided that she wanted to practise, for a time anyway, in a rural area. Dr. Grunow also wanted to experience life outside her home province so she opted for a residency in Fort St. John, B.C. “I was drawn to the remoteness of it,” she says of her choice to go to the northern B.C. community. She’s finished her residency and is now actively looking to land back in La Ronge or Prince Albert. She’s also joined Northern Medical Services and sees the locum opportunities as a way to fully develop her skills in a context she enjoys. “What drives people to rural practice is the opportunity to practise full scope,” she explains. “You do general practice to obstetrics and surgical assist. It’s just a gratifying experience to be able to keep all of those skills alive. To be competent in emergency one day and then go over to obstetrics the next day and still have those skills sharp. You are practising everything all of the time. It keeps things exciting. Even in the clinic. It’s a challenge, too, in that you have to keep up to date with all the research happening in those areas.”

GETTING TO KNOW YOUR SMALL TOWN Dr. Aimee Seguin grew up in St. Walberg, Sask., and is an experienced physician who has been working in Meadow Lake for the past four years. Like her colleagues, she also sees the wider scope of practice as a definite draw to rural practice. “Every day is different,” she says. “It’s fun and infuriating at the same time. I am currently the only doctor that does endoscopies, and I do small lumps and bumps and emergency medicine. You are covering the shifts 12 hours at a time here.” Dr. Seguin notes that while scope of practice is wider, the hours are longer and reminders of work are all around you. “You are on call all the time for the in-patients,” she says. “It’s very challenging. Mentally leaving your work is tough. You see your patients everywhere. I think that’s different from the urban practice.”

CHANGING YOUR PERSPECTIVE IS KEY “I had a negative view of rural family medicine because I grew up in a small town,” said Dr. Seguin, “and I saw family practice and my perspective was, ‘My goodness, there’s no way I am doing that! How can you practise by yourself in a little town?’”

Dr. Grunow on a hike with her preceptor (at the time), Dr. Charles Helm, to Kinuso Falls, near Fort St. John.

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She changed her mind when she was exposed to the dynamics of international medicine and saw that one could expand their scope of practice in a remote area regardless of where that area was located. “You make those links to Saskatchewan and you see that you can do those things if you are far enough away from the tertiary care centres.”

HEALTH CARE

Drs. Aimee Seguin, Stephen Loden and their daughter Annelie Loden find time to enjoy their surroundings in the midst of busy lives as rural physicians. Still a rural practice can keep you busy, perhaps too busy. Dr. Seguin and her partner Dr. Stephen Loden try to truly get away from time to time. “We do lots of on-call,” Dr. Seguin says. “My husband and I do lots of call time…and when we do take time we try to carve out time where we are truly disconnected [from work]. That is a huge challenge and I would say that it ebbs and flows…When we started we just worked all the time…You have to take care of yourself if you want to survive in rural medicine. It may be as challenging in other areas too. You have to take care of yourself for sure.”

COME SEE FOR YOURSELF So, how to recruit more physicians to rural areas? Dr. Seguin thinks the best approach will be as simple as showing students rural Saskatchewan. “I think it comes down to exposure early…Medical students from rural Saskatchewan are more likely to stay,” she explains. “Come check it out and see what it’s all about,” Dr. Seguin advises students and residents. “See what kind of doctor you can be in these settings where you get to push yourself. You get to use all of your capabilities, all aspects of medicine. You won’t get to shy away from that.” Dr. Grunow feels the SMA’s Roadmap Program is a good idea because, without exposure to rural practice, it’s difficult to really know it. “I remember my classmates raving about the bus tour,” she said. “It’s necessary to address people in their medical school years. I think they are doing a good job of that. There is a locum program. I think the best way is to get them in the communities and have the experience. It’s hard to sit at home in Saskatoon and read about rural programs.”

Dr. Loden and his daugter head out for a walk. Dr. Seguin notes that rural versus urban is a bit of a one way door. “If you don’t try it, you won’t go back later,” she says of trying out rural practice. “I have seen it with my cohorts. If you get in a practice in the city and don’t do obstetrics and emergency medicine, you won’t do it in five years. You’re really cutting yourself off from those things early. You are not going to do it after residency. You are at your peak in terms of energy and book knowledge.” Of course, there’s lots to like about rural life and life is not all about work. “Certainly if you love the outdoors it may be for you,” Dr. Seguin observes. “We can literally put on our skis in our back door and hit the trails.” And what’s not to like about that?

Editor’s note: A review of The Surprising Lives of Small Town Doctors, edited by SMA member Dr. Paul Dhillon, appears on page 40.

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THE SURPRISING LIVES OF SMALL TOWN DOCTORS Edited by Dr. Paul Dhillon | University of Regina Press By Ivan Muzychka The Surprising Lives of Small Town Doctors, unsurprisingly, is a sneak peek at snippets from the lives of rural physicians. The book’s vignettes are not only about medicine; the little narratives provide interesting glimpses into the inner lives of physicians who populate rural Canada. As editor Dr. Paul Dhillon points out in his preface, these physicians are “human and suffer from pain like our patients. We have doubts and fears. We don’t know everything. And we are tasked with some very difficult decisions.” The stories illustrate these points superbly. Dhillon notes that the book’s “wonderful tapestry of stories” is an excellent representation of Canada. It took a year to assemble the samples which came from as far as Newfoundland and Labrador and the Northwest Territories to British Columbia, Saskatchewan, Quebec and points in between. Of course rural docs, in particular, will likely enjoy this book, and all physicians will relate in some way to the funny and, at times, poignant stories. Dr. Dhillon has done a masterful job of engaging many talented physicians who have some great stories to tell and who tell them well.

Family physicians Opportunity with a difference... Tired of the rat race? Want to practise the kind of medicine that drew you to become a physician in the first place? Are you interested in having a meaningful practice that will make a real difference to the community’s health? Northern Medical Services has many opportunities in several communities throughout northern Saskatchewan. We offer a practice that emphasizes work-life balance, integrated team approach, relationship building, respect and reciprocity. You will have an opportunity to practise in a variety of settings including clinic, hospital, emergency department and community (health promotion).

Most readers will be left with a cast of characters and images which will be hard to forget. Whether it’s Dhillon’s prescription, offered to a an elderly patient with a skinned shin, to “stop chasing stray cats”, or the interesting insights offered by other Saskatchewan docs like Dr. Kevin Wasko on the deeper meanings of rural practice, or Dr. Ryan Meili’s thoughtful meditation on medical practice, readers will be left with images of medicine, but also with vivid portraits of small town life.

Our positions vary as well, including locums, part-time, full-time, global health and itinerant positions. Our rates are competitive and include fixed daily rates ($1,510$1,820 per day), and salaried ($263,500-$283,100 per annum depending upon qualifications and employment location) plus additional personal and professional benefits too numerous to mention. We offer an excellent employee benefit plan: relocation assistance package, furnished housing, six weeks of vacation and three weeks of education leave including financial support for CME.

You can’t go wrong with this gem of a book. It makes for great summer reading. Structured as a series of essays grouped by province, the book invites readers to visit a place, stay awhile, and then move to another town and to hear another voice.

The flexibility, ongoing physician support and desire to make things work to fit your needs is what sets us apart.

WIN A

FREE COPY!

To win a free copy of The Surprising Lives of Small-Town Doctors, write to sma@sma.sk.ca with the name of this year’s Physician of the Year recipient. You must be an SMA member to win and we’ll award one book to each of the first three e-mails with the correct answer. Deadline is Sept. 12, 2016. Good40luck! SMA DIGEST | SUMMER 2016

www.northerndocs.com Contact: Kerri Balon Recruitment Coordinator P: (306) 665-2898 E: balon.nms@usask.ca F: (306) 665-6077

HEALTH CARE

TIPS FOR REVIEWING LAB RESULTS With the advent of electronic medical records, the management of lab results has changed both in delivery and in how physicians process them. Incoming lab results, which always had the tendency to build up, now come in automatically and this does not stop overnight or on weekends. Combine this with the competing priorities and responsibilities of a medical practice and reviewing lab results in a timely manner can become a challenge. Dr. Werner Oberholzer, family physician and the SMA’s director of physician advocacy and leadership, shares tips that he finds useful in his practice.

1. Review results every day if possible With results being delivered directly into the EMR, it is not as visible as a heap of paper, and can become unmanageable very quickly if not reviewed and interpreted regularly. Review the tasks in the EMR at regular intervals.

4. If you’ve delegated action relating to an 4. abnormal test result, close the loop. When paper results were used, a follow-up was delegated to a staff member, if that staff member was unavailable/on holiday/ill, the paper could easily be noticed by another staff member. Within the EMR context however, results can sit in the inbox of an absent staff member for an inappropriate amount of time, without being noticed. Always close the loop.

2. Ensure all results are received and reviewed When reviewing results on a smaller screen – make sure that you scroll down to the bottom of the document – some abnormal results can easily be missed if the full document is not viewed.

3. Some abnormal results are not shown as flagged 3. in the EMR Certain tests do not show a flag in the EMR when an abnormal result is found. For example, abnormal FIT results are not flagged, as the test has no reference range. An abnormal hemoglobin might be shown in red, but tests that fall outside of this mechanism will not be obvious to the reviewer, so look carefully.

5. Type clear instructions into delegated task box Make sure staff has clear instructions as to what should happen with a delegated lab result. Designate these with direction such as “appointment - urgent,” “appointment – routine,” “inform patient all normal,” etc. This will ensure that the staff member is clear about what action to take.

Remember that when a physician requests a laboratory test, he or she is legally responsible for the follow-up. As physicians, we have a moral and ethical obligation to ensure that patients are managed safely and effectively. Managing lab results effectively is part of this.

SMA DIGEST | SUMMER 2016

SASK. MEDICAL STUDENTS CHOOSING TO STAY in the province for residency

By Lana Haight More than half of this year’s College of Medicine class graduating from the University of Saskatchewan is staying in the province for residency training. “I know I will get very good training and I eventually want to set up practice here. So where better to do training?” said Dr. Cassie Fehr, who has started the first of five years in the neurology residency program at the U of S. “I have spent a lot of time in the residency programs and have found the residents are very competent.” Dr. Fehr was one of 86 U of S grads matched in the first round of the Canadian Resident Matching Service (CaRMS). Altogether, 53 U of S grads chose to continue their specialty training at the U of S while others matched with universities across Canada, including the University of British Columbia, the University of Toronto and the University of Alberta, according to the U of S College of Medicine. Dr. Fehr, who grew up near Aberdeen, just east of Saskatoon, knew she wanted to stay in the province she calls home. “My family is from Saskatchewan and I just got married in June. I married a farmer so he obviously can’t move his farm to another location. It’s important for me to stay here to be with him. And I love it here,” she said. When she entered medical school, Dr. Fehr had set a path toward becoming a family physician but she found she was drawn to neurology. Her interest was piqued right from the start when she began learning about the neurological sys-

SMA DIGEST | SUMMER 2016

tem in class. Because of that, she did some shadowing on the wards. Wanting to further explore neurology, Dr. Fehr began a research project with the help of Dr. Gary Hunter. “I love the correlation between the anatomy and the physical exam. I just think it’s an interesting field and it’s a developing field with treatments of stroke and that kind of thing.” To augment her training, Dr. Fehr travelled out of the province for a two-week neurology elective in Edmonton and another two-week elective in stroke rehabilitation in Toronto. “I don’t think I’ve had enough clinical experience to choose a sub-specialty. I like pretty much all of neurology at this point so I’m going in pretty open minded and I’ll see where it takes me.”

I KNOW I WILL GET VERY GOOD TRAINING AND I EVENTUALLY WANT TO SET UP PRACTICE HERE. SO WHERE BETTER TO DO TRAINING?

STUDENTS & RESIDENTS It was only a few short weeks ago that Dr. Fehr learned that her dream to train to be a neurologist in her home province had come true. On CaRMS match day, she was working on the psychiatry unit. When 11 a.m. rolled around and the match results were released, she was given the rest of the day off. “I went and sat in my car. I opened it and started crying. I was so happy and so relieved. It’s a lot of relief. It’s four years of anticipation in one minute.” Dr. Fehr had kept options open in the event that she was not matched in neurology. She had also interviewed for family medicine as well as physiatry (physical medicine and rehabilitation). As part of her preparation leading up to her interviews, she participated in mock CaRMS interviews held at the Saskatchewan Medical Association office in Saskatoon.

“I think I would have been happy in any of the three specialties that I applied for, which is a good problem to have, to struggle to choose one because you like them all.” Overall , the U of S deems this year’s CaRMS match a success. Dr. Preston Smith, dean of the College of Medicine, is particularly pleased that the U of S family medicine program attracted 22 Saskatchewan graduates and was filled in the first round with grads from other Canadian medical schools. “This is significant, given that 120 of the remaining 213 firstround vacancies across the country are within the family medicine program,” he said in an article posted on the college’s website. CaRMS is the annual competitive process of matching medical students in their final year to residency training programs across Canada.

TAYLOR STREET MEDICAL CLNIC

SEEKS FAMILY PHYSICIAN

Full- or part-time family physician sought to join well-established, fully- computerized, staffed and state-of-the-art family medicine practice in Saskatoon. The clinic is located in the vibrant and growing southeast section of this beautiful city. Obstetrics and on call are optional. Enjoy generous compensation in one of Canada’s most friendly and livable metropolitan areas. Saskatoon has more hours of sunshine annually than any other major Canadian city. MORE ABOUT SASKATOON - Saskatoon isn’t just Canada’s sunniest city anymore. Visitors and residents from far and wide delight in the city’s beautiful parkland setting. Riverbank parks and trails make jogging, biking and casual hikes easy, right in the heart of the city. Enjoy delicious local cuisine in one of the many fine restaurants, play a round of golf at our award-winning courses, watch Shakespeare under a tent or explore 6,000 years of First Nations culture. Saskatoon is the place to experience fine dining, bustling nightlife, beautiful trails and outdoor spaces as well as cultural institutions such as the Mendel Art Gallery.

For more information about this opportunity please contact either Sarah Dovell or Dr. Madhuri Singh at: (306) 374-8082 (office), (306) 220-1841, or by email at taylormed@sasktel.net.

SMA DIGEST | SUMMER 2016

UPCOMING COURSES & CONFERENCES SEPTEMBER

OCTOBER

PLI COURSE: CRUCIAL CONVERSATIONS (13.5 MAINPRO-M1 AND MOC) Sept. 10 - 11, 2016 – Saskatoon, Sask. For more information, go to www.sma.sk.ca/pli

5TH ANNUAL GLOBAL HEALTH CONFERENCE Oct. 1, 2016 – Saskatoon, Sask. For more information, go to www.usask.ca/global-healthconference

PLI COURSE: CRUCIAL ACCOUNTABILITY (7 MAINPRO-M1 AND MOC) Sept. 12, 2016 – Saskatoon, Sask. For more information, go to www.sma.sk.ca/pli

SASKATCHEWAN EMERGENCY MEDICINE ANNUAL CONFERENCE (SEMAC) VIII Oct. 14 - 15, 2016 – Regina, Sask. For more information, go to http://medicine.usask.ca/ department/schools-divisions/continuing-education/cme. php

DRUG THERAPY ANNUAL CONFERENCE Sept. 23, 2016 – Saskatoon, Sask. For more information, go to www.usask.ca/cmelearning/ drug-therapy.php

PLI COURSE: INFLUENCING BOARDS (13.25 MAINPRO-M1 AND MOC) Oct. 28-29, 2016 – Saskatoon, Sask. For more information, go to www.sma.sk.ca/pli

NOVEMBER

SMA REPRESENTATIVE ASSEMBLY November 4 - 5, 2016 – Regina, Sask.

! ! Clinic Location:! !

Grosvenor Park Centre! #19-2105 8th St. East! Saskatoon, SK!

! !

Hours:! M-F! 9am to 6pm!

! !

Helping your patients get back to the important things in life. 44

SMA DIGEST | SUMMER 2016

Ready to start your new medical, dental, physio, or chiro practice? Let ICR Commercial Real Estate help with your own turnkey office, fully built-out at no cost to you. Saskatoon Downtown, 8th Street, and Stonebridge locations available now!

For more information, please call 306-933-2929

Phone: 306-343-SIMS (7467) Email: info@sasksims.ca

Educational Opportunities: • Advanced Cardiac Life Support (ACLS) • Pediatric Advanced Life Support (PALS) • International Trauma Life Support (ITLS) • Basic ECG Interpretation • 12 Lead Interpretation • CPR-‐Healthcare Provider • Medical Simulation Including: o Trauma Simulation o Code Blue Simulation o Pediatric Simulation o Obstetric Simulation • Custom Course Development • And much, much more!

Website: www.sasksims.ca

Give us a call for more information on any of our courses. We offer

courses throughout the province and will come to you!

SMA DIGEST | SUMMER 2016

ANNOUNCEMENTS & CLASSIFIEDS SMA to celebrate its

50 ANNIVERSARY! th

The Saskatchewan Medical Association is celebrating its 50th birthday this year. The SMA has a storied history dating back to 1905, but in 1966, a motion was passed at a CPSS meeting, marking the official founding of the SMA. The association held its first Representative Assembly in 1967. The current president, Dr. Intheran Pillay is the 50th SMA president. Over the next several months the SMA will mark the anniversary in various ways, including use of the, soon to be released, commemorative logo. Anniversary celebration activities will be announced on the SMA website and culminate with a gala at the 2016 Fall RA. Do you have memories or pictures that could be used to mark this anniversary? Send them to SMA Communications at sma@sma.sk.ca.

WELCOME TO THE SMA

The SMA is pleased to welcome a variety of new talent to our organization! To the accounting team: • Jason Loseth, accounting technician To the physician services & benefits team: • Samantha Thoen, coordinator, membership & benefits To the economics team: • Andrea Kohle, senior compensation analyst To the senior leadership team: • Marcel Nobert, director, physician services & benefits • Dr. Werner Oberholzer, director, physician advocacy & leadership • Dr. Susan Shaw, director, physician advocacy & leadership

MCC QE PART II SEEKS PHYSICIAN EXAMINERS

Physician examiners are needed for the MCC QE Part II on Oct. 29-30, 2016, in Saskatoon. Saskatoon will also be hosting the MCC QE Part II in Spring 2017 on May 6-7, 2017. For further information please contact Nicole Kopp at nicole. kopp@usask.ca or by phone at (306) 966-6769. 46

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Qualifications: • Licentiate of the Medical Council of Canada (LMCC) and should be two years post LMCC. • Two years of Canadian independent practice. • Unrestricted licence, not under professional investigation and currently practising medicine. • Should have the ability and stamina for the task. • Should not examine in the three years prior to anyone in their immediate family or household’s eligibility to take the Medical Council of Canada’s Qualifying Examination Part II. • Should not examine for a minimum of three years before and a minimum of three years after participating in a preparatory course. • Should not have a conflict of interest. • SIPPA graduates must be three years on full licensure in an unsupervised practice.

PERMANENT FULL TIME - NORTH BATTLEFORD Looking for physician in large, busy family practice of 30 years, to work as partner with a commitment to take over practice completely in due course. Practice involves hospital in-patient care and on-call for in-patients, obstetrics, minor surgery, surgical assists in hospital are optional as well. Practitioner can adjust working hours accordingly. Interested physicians please contact: Dr. M. C. Khurana Phone: (306) 446-4303

PHYSICIAN OPPORTUNITY It’s time to cut back a bit so I am looking for someone who wants to join my clinic •

Eastside clinic in busy, growing neighbourhood

•

Exceedingly low overhead over last 10 years

•

Remarkably few after hours calls in 10 years

•

Practice average age around 28, many children/newborns

•

Opportunity to build your own/bring practice too

•

Attractive clinic interior with clean, modern, warm feel

•

Fully paperless system (Accuro)

•

Opportunity for full ownership in future

Email if interested to medicalclinic115@gmail.com

MEDICAL CLINIC LOCATION FOR LEASE

Steve Jordan

steve.jordan@icrcommercial.com

Linely Schaefer

linely.schaefer@icrcommercial.com

Excellent location for a Medical Clinic in the fast growing communities of Emerald Park and White City. Join Shoppers Drug Mart in this 15,000 ft2 location adjacent to Sobeys, Boston Pizza and Tim Hortons. Landlord will assist with tenant improvements.

374 Albert Street, Regina SK

306.721.6116

icrcommercial.com

New to Saskatchewan and craving a taste of home?

Safari Market serves the grocery needs of South Africans, West Africans (Ghana, Nigeria etc.), East Africans and people from Caribbean nations living in Saskatoon and the surrounding area

Store Hours:

Monday-Friday 10:00 am - 7:00 pm Saturday 9:30 am - 8:00 pm Sunday 1:00 pm - 6:30 pm

Find us:

Location - Unit #270-2600 8th St. E - Saskatoon Phone - (306) 374 – 0411 Email - info@safarimarket.ca Like us on facebook - Safari Market

We’d love to help you find what you’re looking for so stop by the store or call with your request and we will ship to wherever you are in Saskatchewan. We aim to please! SMA DIGEST | SUMMER 2016

IN MEMORIAM Dr. Kanapathippillai Balakrishnan 1947 – 2016

Dr. Kanapathippillai (Bala) Balakrishnan passed away on April 18, 2016, at the age of 68. He was predeceased by his parents and brother. Bala will be remembered and deeply missed by his loving wife, Mathi, and daughters, Lakshmi (Kyler) and Divya, as well as his sisters Thevi, Chandra and Kamala. Bala was born and raised in Puloly, Jaffna, Sri Lanka. He earned his medical degree at Peradeniya University in Kandy, Sri Lanka, and then pursued further training in urology in the United Kingdom, obtaining his Fellowship of the Royal College of Surgeons (FRCS) London. Bala lived and worked in Nipawin, Sask., for the past 27 years. He was a loving husband, doting father, dedicated doctor and surgeon, avid golfer and proud member of the Nipawin community. A celebration of his life was held on April 23 at the Evergreen Centre in Nipawin. In lieu of flowers, the family requested donations be made instead to one of the following: Nipawin Town Square Project, Nipawin Hospital, or Parkinson Society Saskatchewan.

Dr. Teertharaj Krishna Belgaumkar 1936 – 2016

Dr. T.K. Belgaumkar passed away on May 25, 2016, in Victoria, B.C., as the result of cancer. Left to remember and cherish a life well lived are his wife of 48 years, Vijaya, his children, son Vivek and daughters Anu (Jon), and Uma (Paul) as well as six grandchildren Mira, Sona, Ashwin, Anaka, Rekha and Kiran.

SMA DIGEST | SUMMER 2016

TK was born and raised in South India. He received degrees, including an M.D., from Bombay University and a Diploma of Child Health from the College of Physicians and Surgeons in Bombay. TK immigrated to Canada in 1968, arriving in Halifax, N.S., where he was joined a year later by Vijaya, who also was a paediatrician. During his time in Halifax, he was clinical and research fellow in neonatology, lecturer at Dalhousie University and a staff neonatologist at Grace Hospital. In 1976, the Belgaumkar family moved to Regina where TK set up the Regina General Hospital’s first neonatal unit, which he then helped redesign to reflect his vision of a new separate up-to-date neonatal unit. As the single neonatologist, he provided care for premature and newborn babies. Academically, TK was an associate professor of paediatrics and subsequently clinical professor of paediatrics with the University of Saskatchewan, actively teaching physicians, medical residents, students, nurses, and respirologists. He served as the head of the Department of Paediatrics in Regina; chairman of the Perinatal Education Committee (U of S); chairman Perinatal and Maternal Mortality Committee (College of Physicians and Surgeons of Sask.) Following his immigration to Canada, TK was proud to receive his Canadian citizenship. TK had a very adventurous spirit and soon became involved in golf, downhill skiing, and curling, all very different for someone from small village in India. He maintained a strong family commitment, and was a devoted husband and a proud and supportive father and grandfather to his three children and grandchildren. Cremation took place and a memorial service was held in Victoria, B.C., on May 28.

IN MEMORIAM

Dr. Neil Cowie 1952 – 2016

Dr. Neil Cowie passed away on June 18, 2016, at St. Paul’s Hospital in Saskatoon, from complications resulting from cancer. He was 63 years old.

Neil delighted in telling and hearing clever silly jokes. He had a generous spirit and a kind heart. He will be remembered as a friend to all. In the words of his sister-in-law, Maritza, “Neil showed a lot of courage and fought valiantly. He was a very fine and honourable man who led an exemplary life.” A celebration of Neil’s life was to be held at a later date.

He is survived by his wife Monique, children Jeremy and Jennifer (Ben), in addition to many other family members. Neil was born and raised in Saskatchewan, moving from Saskatoon to Regina, with a stint in Brandon, Man., and to Moose Jaw. After graduating from the College of Medicine at the University of Saskatchewan, Neil worked in general practice in Inuvik, N.W.T., for a year. He then trained in internal medicine in Akron, Ohio, followed by another residency in anaethesiology at the University of Manitoba in Winnipeg. In 1987, Neil moved back to Saskatoon where he worked as an anaesthesiologist, first at Royal University Hospital and then at St. Paul’s Hospital. Until his death, Neil was also an assistant professor at the College of Medicine, the head of the Chronic Pain Management Clinic at Royal University Hospital, the academic anaesthesia resident coordinator at St. Paul’s Hospital, and the director of the Medical Simulation Program at the College of Medicine. From 2006 to 2015, Neil was the chairman of the quality assurance committee of the Department of Anaesthesiology. In Neil’s limited free time, he was passionate about the lives of his children. He was involved in Saskatoon’s Bluegrass music scene and thoroughly enjoyed practising and performing Bluegrass clawhammer style banjo. He spent a great deal of time over the years developing their acreage, taking prairie and turning it into the Cowie Forest. Neil was a great neighbour assisting other property owners in snow removal and grass mowing.

Dr. Barrie Davidson 1934 – 2016

Dr. Barrie Davidson passed away on June 30, 2016, at the Southeast Integrated Care Centre in Moosomin, Sask. He was 81 years old. Barrie was the loving husband of Jan and of the late Alice Davidson. He graduated in 1961 from the University of Manitoba medical school. A memorial service was held at the Moosomin Convention Centre on July 12. The family requested that memorial tributes be made to the Moosomin and District Health-care Foundation or to Strays That Can’t Pay.

Dr. Colin McLean Hewat 1924 – 2016

Dr. Colin Hewat of Saskatoon passed away on June 16, 2016, following a short stay in hospital. Colin served with the British army in World War II before studying medicine in London. In 1963, he moved to Saskatchewan where he joined the newly established healthcare system. He later became the chief medical officer for the Workers’ Compensation Board. He retired from that position in 1984.

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Colin was a master gardener, loved to read and enjoyed rambling to out-of-the-way places in Saskatchewan. His close companion in his later years was Bertha (Bert) Saxton, with whom he shared many happy days. He will be missed by family and friends including his children Andrew, Robin (Lin), Nikki (Blake) Rooks and James; stepchildren, Finlay, Stephen, Robin, Fiona and Angus Sutherland; as well as several grandchildren and greatgrandchildren.

Dr. Barry D.L. Hubbard 1943 â&#x20AC;&#x201C; 2016

Dr. Barry Hubbard passed away on March 19, 2016, at the age of 72. He was surrounded by family in the palliative care center at the Battlefords Union Hospital, following a brief struggle with cancer. Beloved husband, father, brother, uncle, grandfather, and good friend, Barry grew up in various Saskatchewan communities and studied medicine at the University of Saskatchewan. He completed his residency at the Foothills Hospital in Calgary. During this time, Barry and his wife Gail grew in their relationship with each other and in their faith in Jesus Christ, which sustained them through 46 years of marriage. Barry was in general practice in Regina for six years before he returned to the U of S to study pathology. In 1980, the family moved to Prince Albert where Barry worked as a general pathologist at Victoria Union Hospital. Another move took Barry, Gail and their three children (Brian, Jill and Glenn) to Ontario where Barry obtained his fellowship in pathology at McMaster University in 1985. He then accepted the position of director of pathology at Battleford Union Hospital where he worked until his retirement in 2009. Barry was active in the Territorial Drive Alliance Church in North Battleford. He also enjoyed gardening, flying his Cessna 172, playing tennis, travelling and learning. An avid reader and consumer of knowledge, Barry was fueled with a desire to understand the world around him. The funeral service was held on March 24 at Territorial Drive Alliance Church. Memorial donations may be made to the Global Advance Fund of The Christian and Missionary Alliance in Canada.

SMA DIGEST | SUMMER 2016

Dr. Douglas Thomas Hunter 1947 â&#x20AC;&#x201C; 2016

Dr. Douglas Hunter passed away peacefully on April 7, 2016, at the age of 68 years. He was born and raised in Paisley, Scotland, attended the University of Glasgow medical school, and completed his training with medical, surgical, and obstetrical residencies at large teaching hospitals. During residency he met the love of his life, Judith. They moved to Regina to join the general practice group at the Medical Arts Building. There he served as a dedicated family physician for 37 years, alongside his Glaswegian colleagues and dear friends, Drs. Brian Laursen and Stewart McMillan. Douglas was an outstanding athlete, playing for the junior national cricket team for Scotland, and as a member of the Canadian national team. He played squash with fierce competitiveness. He also excelled in rugby, soccer, and boxing. He coached innumerable teams for his children, including hockey, despite his total inability to skate. Douglas also had a passion for nature, specifically for Waskesiu, where he spent the summers of his retirement. He looked forward every year to his annual golf trip with the usual suspects. He had a gift for storytelling. Douglas spent his final winters renewing his passion for gardening in Costa Rica, surrounded by an incredibly caring contingent of Saskatchewanians, and many new local friends as well (despite his insistence that Spanish was, in fact, a Scottish dialect). He is survived by his wife Judith; sons Bruce (Laura) and their children Summer, Elisabeth and Kyra; Gary (Kimberley); Greg (Kandis); and Rod (Britt); and his brother Andy (Sheena); his sister Jean (Ian), as well as his nieces and nephews. Douglas will be missed forever as an incredible husband, father, grandfather, brother, uncle, physician and friend. A private service for friends and family took place on April 16. In lieu of flowers, donations toward a memorial bench in Waskesiu are very gratefully received at www.gofundme. com/uey5f3ys.

Dr. Robert Wheaton 1928 – 2016

Dr. Robert “Ross” Wheaton was born June 22, 1928, in London, Ontario. Soon after the Wheaton family moved to Saskatoon where they had a garden that encompassed thirteen city lots and Ross would deliver cobs of corn and other vegetables by bicycle to anywhere in the city for 25 cents. Ross was a brilliant student, graduating from Nutana Collegiate when he was 15 years old. He studied biology at the University of Saskatchewan where he also played basketball for the U of S Huskies. In 1957, he graduated from the College of Medicine. Ross married Ritva Pohjavouri in 1958 and they established Mark II Farm, a standard-bred racehorse farm, and home to Ritva’s german shepherds. Ross kept up to forty horses, the most famous of which was Mark Majestic, who at one time held the track records at Regina and Edmonton, and was the racehorse of the year in Alberta in 1977. Ross trained and raced the horses himself while running a family medical practice. Ross started his medical career at the Medical Arts Building and delivered more than 3,500 babies over the course of it. He retired in 1972. Ross served as the head of the Saskatoon City Hospital emergency department for many years. He also worked at the Cancer Clinic and served as the health officer at Intercontinental Packers and Marquis Downs. He enjoyed doing surgical assists with Drs. Robert Shannon, Graeme McIvor, Jack Reilly, Jeff McKerrell, and others and mused that he would have been an orthopaedic surgeon if he could have started again. Ross was a great curler and won the Canadian Medical Bonspiel in 1965 with Drs. G. Kinsmen, E. Baergen, and J. Mann. He later teamed up with Drs. Trevor Treen, Briane Scharfstein, and Ernie Klassen wearing wacky overalls, two brimmed hats, and curling sweaters to show everyone just how enjoyable curling could be. Ross lived a great and full life and whatever he did, he did with great gusto. Ross worked very hard over the years and was loved by his family and all who knew him. Ross is survived by his daughter Leslie (Radovan), his three granddaughters Jovana, Mara, and Tatijana, Leslie’s mother Ritva Wheaton, and numerous other family members. A Celebration of Life service was held on May 7 at Saskatoon Funeral Home. Ross was a City Hospital man through and through. His family would appreciate memorial donations to the Saskatoon City Hospital Foundation in lieu of flowers.

FAMILY PHYSICIANS Pharmacy Interaction Limited is looking for family physicians to practise in a newly built medical clinic adjoining The Medicine Shoppe Pharmacy at 2553 Quance Street East in Regina. The clinic space has 6 exam rooms, one specialized for minor procedures, an injection room, reception area, waiting room, as well as a private learning centre for physicians and ample free parking. Our pharmacy team delivers patient-focused care in a friendly, caring and relaxed atmosphere. The pharmacy offers: •

a weight loss program

•

an on-site diabetes educator

•

smoking cessation programs (PACT trained pharmacists)

•

warfarin management with a collaborative prescribing agreement

•

free automated PACMED packaging

We are looking for physicians to care for many of our current pharmacy patients, to enhance patient care and to collaborate with. This is a great opportunity to quickly grow a practice alongside an established business. FOR MORE INFORMATION, PLEASE CONTACT: Allana Reaume Pharmacist/ Owner (306) 550-4812 ms0304@store.medicineshoppe.ca

SMA DIGEST | SUMMER 2016

PLI

No matter where you are in your career - practicing physician, medical student or resident - the CMA Physician Leadership Institute (PLI) will prepare you to be a more effective leader.

CRUCIAL CONVERSATIONS (CCV) Sept. 10-11 | Saskatoon

CRUCIAL ACCOUNTABILITY Sept. 12 | Saskatoon

INFLUENCING BOARDS Oct. 29-30 | Saskatoon

This course will help you master the skills you need to step up to high-stakes issues, while remaining candid and respectful, to achieve better results and establish better relationships.

The course builds on the principles taught in CCV and teaches skills to help leaders and staff hold each other accountable. Participants must have previously completed CCV.

Boards make decisions that influence health-care leaders’ professional lives. This course explores practical ways for health-care leaders to work effectively with their boards.

To learn more or register please visit

www.sma.sk.ca/pli

Or contact:

OPHTHALMOLOGY PRACTICE FOR SALE

Well-established medical ophthalmology practice for sale. •

Three lanes, 2-HFA, Zeiss OCT, Kowa Camera, YAG and SLT lasers on site

•

Excellent staff

•

Beautiful office, centrally located in downtown Saskatoon, close to bus depot

•

Grossing over $1,000,000.00 per year

IF INTERESTED OR FOR FURTHER INFORMATION, CONTACT: Dr. Thomas Blackwell or Peggy Watts E: tblackwell@sasktel.net | P: (306) 244-6149

SMA DIGEST | SUMMER 2016

Delilah Dueck

delilah.dueck@sma.sk.ca 306.657.4568

MD GIVES FINANCIAL ADVICE THAT EVOLVES WITH

MY LIFE. Dr. Edward Kucharski, Family Physician

Trust your MD As a CMA company, we understand physiciansâ&#x20AC;&#x2122; finances better than anyone. For personalized advice, call 1 800 267-4022 or visit md.cma.ca. MD Financial Management provides financial products and services, the MD Family of Funds and investment counselling services through the MD Group of Companies. SMA DIGEST | SUMMER 2016 For a detailed list of these companies, visit md.cma.ca.

Photo by Diphile Iradukunda, family physician

Return undeliverable Canadian addresses to:

SASKATCHEWAN MEDICAL ASSOCIATION 201-2174 Airport Drive Saskatoon, SK Canada S7L 6M6

Mail to:

40007031