SMA Digest - Fall 2019 | vol. 59: i. 2 by SMA Communications

A publication of the Saskatchewan Medical Association Volume 59 , Issue 2 | FALL 2019

DIGEST DOCS WALK THE TALK

in the fight against climate change

HEALTH NETWORKS

bring team-based care closer to home

A LIFETIME OF CHANGE

reflections on 40 years of practice

SMA PRESIDENT ON A MISSION TO BRING PHYSICIANS TOGETHER AIDS CRISIS

a physicianâ&#x20AC;&#x2122;s account of how the disease shaped the landscape of medicine

THE EVOLUTION OF

MEDICINE

AIDS crisis: Looking back Fall 2019 | VOLUME 59 ISSUE 2 SMA Digest is the official member magazine of the Saskatchewan Medical Association. It is published twice per year and is distributed to practising physicians, students and residents in Saskatchewan.

By the 1980s, infectious diseases were no longer considered a threat to physicians and health workers. But a mysterious new disease started spreading to Canada. AIDS had arrived, killing everyone who contracted it and sparking stigmas borne by the fear of the unknown. It was a time of uncertainty, and even panic, in health care, recalls Saskatoon physician Dr. Deirdre Andres. This is her story.

Editor:

Maria Ryhorski (SMA staff )

Editorial board

Dr. John Gjevre (physician rep) Dr. Susan Hayton (physician rep) Ivan Muzychka (SMA staff ) Girard Hengen (SMA staff ) Delilah Dueck (SMA staff )

Upcoming issues

The next issue of SMA Digest will be distributed in spring 2020.

Advertising

The deadline for booking and submitting advertising for the next issue is Monday, Feb. 17, 2020. 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 (306) 244-2196 maria.ryhorski@sma.sk.ca Saskatchewan Medical Association 201-2174 Airport Drive Saskatoon, SK, S7L 6M6

SMA mission

As the common voice of our members, we serve, represent and unite Saskatchewan physicians. We advance the honour and integrity of the medical profession; advance the professional, personal, educational and economic well-being of Saskatchewan physicians; and promote a high-quality, patient-centred health-care system.

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Physician, teacher, learner

In northern Saskatchewan, where many remote communities struggle to retain physicians, the town of La Ronge is home to a thriving physician group. Most are deeply involved in the local community and each provides support to the other, fostering a healthy and sustainable environment in which to live and work. A thick stack of nomination letters points to the instrumental role Dr. Sean Groves, the SMAâ&#x20AC;&#x2122;s 2019 Physician of the Year, has played in building such a unique environment for medical learners, physicians, their families and patients in this town perched on the rocky banks of Lac la Ronge.

CONTENTS

THE EVOLUTION OF MEDICINE 2 4 8 14 17 20 23 26 28 30 36 38 40 41 42 44 45 46

President’s message On a mission to bring physicians together: Dr. Allan Woo Physician, teacher, learner: Dr. Sean Groves A lifetime of change: Dr. Don Stefiuk AIDS crisis: Looking back “We need all hands on deck” – facing the opioid crisis Working to meet the needs of our diverse population Walking the talk in the fight against climate change The individuality of being well How do you stay whole? Tapping the power of Spectrum Doc in the box Wealth of patient, practice information available to physicians Fluency Direct rolling out in the offices of fee-for-service docs Health Networks bring team-based care closer to home eHealth launches MySaskHealthRecord Know your patients Celebrating our staff: Achievements and milestones

54 EVENTS / CLASSIFIEDS / ANNOUNCEMENTS 56 IN MEMORIAM

Working to meet the needs of our increasingly diverse population

Saskatchewan’s population grows increasingly diverse with every passing year. With that diversity comes unique healthcare needs that physicians like Drs. Megan Clark and Mahli Brindamour are stepping up to meet. Dr. Clark serves the trans and gender diverse community, and Dr. Brindamour serves the immigrant and refugee community. They and other physicians in the province are working to make their practices safe and welcoming places for patients who can often feel vulnerable or marginalized. SMA DIGEST | FALL 2019

PRESIDENT’S MESSAGE “The pessimist complains about the wind; the optimist expects it to change; the realist adjusts the sails.” William Arthur Ward

Greetings colleagues, Welcome to the fall 2019 issue of SMA Digest. In this issue, we explore the concept of change by examining ideas related to the evolution of medicine. When I entered medicine over 25 years ago, the smartphone did not exist and the Internet was just coming to life. Now I find it a little difficult to imagine practising medicine without these modern technologies close at hand. But it’s not just technology that affects us. On page 17 you’ll read a story by Dr. Deirdre Andres about how a disease – AIDS – transformed medical practice. This article will make you reflect on how our work adapts and changes. “HIV-AIDS changed ideas about informed consent, about how we interact with and treat patients,” Dr. Andres notes. “It ignited, or reignited, ethical discussions about refusing care based on factors that had little to do with illness, such as declining care based on sexual orien-

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tation. It changed patients’ involvement in health-care policy.” Yesterday’s leading edge change quickly becomes today’s standard. Climate change was a key issue in our recent federal election. On page 26 you can read a fascinating story about how climate change – something happening on a planetary scale – is also a story about community health itself. As one physician quoted in the story says: “We can get the people who are talking about climate change to understand that this matters … It’s not just about saving polar bears. The impact (of unchecked climate change) is poor health and less vibrant communities.” The leaders of the SMA – the Board of Directors and the staff – must keep abreast of changes affecting medicine. The SMA board often considers what changes mean for our profession and weigh whether they are positive or negative. We do our best to influence the changes happening around us. In the last few years we have been engaged in the creation of the Saskatchewan Health Authority, health system redesign and primary care restructuring, and health networks, to name just a few. As we go to press with this magazine, eHealth

is ushering in MySaskHealthRecord (page 44), an electronic portal where patients can directly access their own test results. It’s the responsibility of your board to scan the horizon and ensure that whatever change comes, it aligns with the principles of patient safety and optimal care. The decisions are not always easy, and we won’t always be listened to. Sometimes our voices go unheard, or heard and unheeded, and that’s frustrating. But we don’t give up. I hope you enjoy this issue of SMA Digest. I have enjoyed the changes I have lived through in medicine. It’s always better to understand where we have come from so we know where we are going. Change is generally positive, but it depends on your attitude. I urge you to read, think and maybe readjust your sails.

“

CHANGE IS GENERALLY POSITIVE, BUT IT DEPENDS ON YOUR ATTITUDE. I URGE YOU TO READ, THINK, AND MAYBE READJUST YOUR SAILS.

Sincerely,

DR. ALLAN WOO SMA President president@sma.sk.ca

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ON A MISSION to bring

PHYSICIANS TOGETHER Dr. Allan Woo is on a mission: He wants to put a face to the name of as many physicians as he can during his year as president of the Saskatchewan Medical Association (SMA). He also wants physicians to connect more with each other instead of working in silos, thinking they have no support or nowhere to turn for guidance and advice.

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By GIrard Hengen

r. Allan Woo is on a mission: He wants to put a face to the name of as many physicians as he can during his year as president of the Saskatchewan Medical Association (SMA). He also wants physicians to connect more with each other instead of working in silos, thinking they have no support or nowhere to turn for guidance and advice. “We need to improve our collegiality,” Dr. Woo says. “We need to understand where each of us is coming from – primary care, specialist care. Since being on the board, I have become more aware that everyone has a different focus and our experiences and training lead us to have different biases. We need to bridge some of those gaps and make everything a bit easier.” To that end, he has vowed to meet physicians wherever they want, whenever he can. “The SMA is here to help everyone understand that we’re all coming from the same place,” he says. “We’re all physicians, we all have the same goal – patient care. Let’s not lose sight of that. “Sometimes those conversations are difficult, but there’s a way to get through it. The old doctors’ lounge played a big role 20 to 30 years ago, when people didn’t communicate like we can now. You met each other and put a face to a name, but now that’s changed.

Recent SMA presidents were instrumental in bringing physicians to the table in the discussions leading to the formation of the SHA. As a result, says Dr. Woo, physicians are in leadership positions within the core of the SHA. There is no turning back. “The change is full on and we need to just embrace it and figure out how we are going to keep moving it forward,” Dr. Woo says. “What the system was when I first started medical school and when I did my residency and in the early part of my career maybe wasn’t as fully effective as it is today. We need to recognize that what we did was fine at the time, but now we need to do better.”

“

THE SMA IS HERE TO HELP EVERYONE UNDERSTAND THAT WE’RE ALL COMING FROM THE SAME PLACE. WE’RE ALL PHYSICIANS, WE ALL HAVE THE SAME GOAL – PATIENT CARE. LET’S NOT LOSE SIGHT OF THAT.

“We need to go back to that. We need to see who the people are and make that connection on a personal level so that we’re more collegial with each other.”

he personable and approachable Dr. Woo is well positioned to lead Saskatchewan’s physicians as they adapt to a changing health landscape. The Saskatchewan Health Authority (SHA) is still new and finding its feet. Dr. Woo is an SMA representative on the committee that is attempting to hammer out new practitioner staff bylaws with the SHA. “The biggest change right now is the transformation of health care,” notes Dr. Woo. “As a membership organization, the SMA has to make sure doctors understand what we can provide for them. A lot of physicians are still in solo practice and they look to the SMA for support and guidance. We’re also here to provide oversight on the interaction between physicians and the new health authority as well as with the Ministry of Health.”

In some respects, Dr. Woo is an unlikely president of the SMA. Unlikely because a career in medicine was by no means a certainty. When he was in high school in Regina, where he was born in 1970, a questionnaire on career options suggested he become an actuary. Medicine wasn’t an option. “Looking back, I don’t ever recall in my high school years that medicine was where I wanted to be,” Dr. Woo says. “I was treasurer of my high school SRC (student representative council), and I thought I liked business and commerce and the financial aspect of that. I really did think I was going to be an accountant.” After he took the questionnaire, he had the thought that he wasn’t “a math geek … I had to look up what an actuary actually did. That was the financial influence. To go in

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a medical direction was quite different. Medicine wasn’t on my radar. So why I did it, I don’t know. I still scratch my head and wonder why.” His father is a pharmacist and owned his own drug store in inner-city Regina. His older sister graduated from the University of Saskatchewan College of Medicine in 1989, the same year Allan completed his first year of pre-med. “I thought pharmacy was an option, some sort of health science and maybe combining it with a business, like my dad,” he says. “I never really strayed too far from some sort of health focus and that’s where things led me.” After his second year in pre-med, he was accepted into the College of Medicine in 1990. He graduated in 1994 and completed an orthopedic residency at the U of S in 1999. He soon took a broader interest in the profession, becoming involved with the orthopedics section of the SMA, attending Representative Assemblies, and joining the SMA Board of Directors in 2014. Dr. Woo served on the executive of the Board of Directors and was elected president of the SMA at the 2019 Spring Representative Assembly in Saskatoon. It’s quite a jump from a teen looking for direction and guidance to a leadership position in Saskatchewan’s medical profession. Dr Woo attributes some of it to luck – being in the right place at the right time – and some of it to a need to get involved.

“When I look back, I don’t know why I take certain paths in my career. The biggest thing is you can’t complain if you don’t get involved, and if you don’t get involved you won’t know why things are happening and you will continue to question. The only way to get answers is to participate.”

he wider world beckoned the young Dr. Woo after he completed his orthopedics residency at the U of S. He was accepted for a six-month Hip Fellowship in Bern, Switzerland, studying under Dr. Reinhold Ganz, who has pioneered hip surgery procedures. “This is 1999,” notes Dr. Woo. “The Internet was still new, everything was still in print. We studied from textbooks and paper. I didn’t have a good idea of what I was getting into. You could not Google who this person was or what to expect going overseas. A lot of it was new coming from Saskatchewan. I had to get a visa, I had to get a passport, I had to get Swiss money and find a place to live. “That was definitely an eye-opener and I would recommend anyone to go overseas and live for six months. It’s very different from visiting, for sure. That was my first real travelling experience, being in a foreign country, living on my own, trying to manage day to day.” Dr. Woo returned to Canada for a Hip and Knee Arthroplasty Fellowship at the University of Toronto in 2000, and a Spine Fellowship at the University of Alberta in 2001. He met his future wife, Maya – a pharmacist – between fellowships.

“

WHEN I LOOK BACK, I DON’T KNOW WHY I TAKE CERTAIN PATHS IN MY CAREER. THE BIGGEST THING IS YOU CAN’T COMPLAIN IF YOU DON’T GET INVOLVED, AND IF YOU DON’T GET INVOLVED YOU WON’T KNOW WHY THINGS ARE HAPPENING AND YOU WILL CONTINUE TO QUESTION. THE ONLY WAY TO GET ANSWERS IS TO PARTICIPATE.

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in Saskatoon. He returned in 2004 to start a practice with one of his mentors, Dr. Ken Yong-Hing. He remains in practice in Saskatoon with the three colleagues he started with – Dr. Mario Taillon, Dr. Mark Ernst and Dr. David Kim. Maya is now manager of the Saskatoon Cancer Centre pharmacy. The couple have two children, Ethan and Tien. “I was thankful for the opportunity and thankful for the job,” Dr. Woo says. “The options at that time were not plentiful. It’s more luck than anything else that an opportunity presented itself when it did. The stars were aligned for me to return to Saskatoon. I understand the stresses residents feel when they have completed their program and are looking for a place to work.” The journey home has led to the presidency of the SMA, but Dr. Woo dismisses the notion that he has reached the pinnacle of the profession. “I was engaged to my wife, and we weren’t sure where we were going to go. She had ties in Saskatoon that made coming back ideal.” As luck would have it, after working for a year and a half in Edmonton, Dr. Woo noticed an opening for a spine surgeon

“There are other physicians who have many more accolades and awards, and are deserving of more recognition than I. I’m just here to represent the group, try to make sure the messaging is consistent and carry on for the next set of presidents who are going to follow me.” ◆

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PHYSICIAN

TEACHERLEARNER Dr. Sean Groves builds life, practice and community in the north

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A thick stack of nomination letters points to the instrumental role Dr. Sean Groves, the SMAâ&#x20AC;&#x2122;s 2019 Physician of the Year, has played in building such a unique environment for medical learners, physicians, their families and patients in this town perched on the rocky banks of Lac la Ronge.

SMA DIGEST | FALL 2019

By Maria Ryhorski In northern Saskatchewan, where many remote communities struggle to retain physicians, the town of La Ronge is home to a thriving physician group. The Rural and Remote Family Medicine Resident (FMR) Training Program is ever-growing, with 80 per cent of trainees retained and practising in the area. These residents and doctors provide outreach clinics, in-home visits and comprehensive care to the people of La Ronge and the surrounding area. Most are deeply involved in the local community and each provides support to the other, fostering a healthy and sustainable environment in which to live and work.

Dr. Nicholas Martel, a former resident with the program, credits his mentor with shaping him as a physician and instilling a deep understanding of how a rural physician can be an agent for positive change in a community. “For me, loving where I work has become so much more than a simple affection for my job and my lifestyle,” he says. “Loving where I work is the commitment to making my community a healthier, happier place to live for everyone who calls the north home. I learned that love from Sean Groves.” Upon learning of his colleagues’ effusive praise and his resultant selection as SMA Physician of the Year, Dr. Groves’ response is humble.

A thick stack of nomination letters points to the instrumental role Dr. Sean Groves, the SMA’s 2019 Physician of the Year, has played in building such a unique environment for medical learners, physicians, their families and patients in this town perched on the rocky banks of Lac la Ronge.

“I don’t really see it as an individual thing,” he says. “I work in an excellent group practice. I have huge support professionally and personally, and I think of the award more as recognition of work in a rural community and rural medicine and the opportunities that that type of setting provides for me.”

“As a colleague, Sean is inspirational,” says Dr. Michael Bayda. “He brings an energetic, positive and enthusiastic approach to every day that is contagious.”

La Ronge isn’t a place that the Alberta-born, Saskatoonraised Sean Groves ever planned to make his home, but when he arrived with his family in 2005, he quickly fell in love with the type of work there and the opportunities to make real change. He, his wife Becky and their four children quickly immersed themselves into the fabric of the community, coaching and playing for local teams, building friendships and developing a deep connection with the land and the water that surrounds them. The family frequently escapes the hustle and bustle by visiting their cabin on a nearby island, paddling on the lake, and letting nature recharge them after a busy week.

Another colleague, Dr. Christo Delport, notes, “In my 32 years of family medicine practice … I have never encountered a colleague so intricately involved in the well-being of the community in general, more specifically enhancing medical, mental health, social and addictions care for the vulnerable, marginalized and aboriginal communities. He engages and embraces people’s needs with empathy and vigor.”

“

FOR ME, LOVING WHERE I WORK HAS BECOME SO MUCH MORE THAN A SIMPLE AFFECTION FOR MY JOB AND MY LIFESTYLE. LOVING WHERE I WORK IS THE COMMITMENT TO MAKING MY COMMUNITY A HEALTHIER, HAPPIER PLACE TO LIVE FOR EVERYONE WHO CALLS THE NORTH HOME. I LEARNED THAT LOVE FROM SEAN GROVES.

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Dr. Sean Groves and his wife Becky fell in love with life in La Ronge when they arrived in 2005. They and their four children made a home there and wove themselves deeply into the fabric of their community: coaching and playing for local teams, building friendships and developing a deep connection with the land and the water that surrounds them. Daughter Pikaea (right) is pictured with Sean and Becky.

Since arriving, Dr. Groves found northern Saskatchewan to be ripe with opportunity to be creative and put his love of teaching and continuous improvement to work. Leading the FMR training program is one such opportunity that fell into his lap and has since flourished into something that Dr. Groves is most proud of. “When I took over I basically made a commitment that I would try never to say no to anyone who wanted to come,” he recalls. “It’s such a positive aspect of a practice to have people with fresh ideas. These students and residents are often up on the latest and greatest. They know the latest guidelines and a lot of times aren’t afraid to question what you’re doing. And that makes you grow as a physician. You have to explain yourself.” The tendency to question everything is one of the most important traits that he hopes to pass on. “I tell them not to believe anything I say, or what anyone else says. I try to have them think for themselves and understand that medicine is a very dynamic and changing science.” In the same way, he encourages learners to question themselves and not become complacent. “Sean has this beautiful way with his students and residents of telling them exactly how it is – including where their weaknesses may lie,” says Dr. Martel. “In the same moment that he points out a mistake or a knowledge gap, he’s likely to crack a joke and let out a burst of laughter that reminds you that learning and personal growth are an integral and life-long part of our profession. This approach has inspired

in me a happy enthusiasm to improve my knowledge and skills but has also given me the humility to recognize and understand my limitations.” A unique aspect of the program is that it does not rely on residents to do the work. This allows them the freedom to shape their learning and be flexible in terms of how they gain experience. “So they’ve been able to do things like get involved with our high-risk outreach program for populations affected by homelessness, alcohol and opioid addiction, and poverty,” Dr. Groves explains. “They support our Elders Haven here in town, which is a sort of long-term care facility for level two care population. There’s also a group home for developmentally disabled adults that they attend as well … it’s a really good way of being able to see people in their homes rather than always having them come into the clinic.” All this experience helps residents understand the importance of getting a full picture of their patient – their history and environment – and how that informs care. “I try to give them at least some sense of how Indigenous and settler populations have evolved over the years. I’m amazed at how little most medical students and residents know about the history and how treaty has affected the land and the people – both colonial and Indigenous populations – and how it’s really impacted people’s lives.” Dr. Groves understands the impact all too well since taking over the La Ronge Opioid Agonist Therapy Program in 2014.

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With the support of the local pharmacy, he removed the cap on participants and the program doubled to support roughly 85 individuals battling opioid addiction. “Before I got involved, I thought I was doing family medicine right,” he recalls. “I thought I had a good handle on things. But I realize now, after working with people who have significant mental health and addictions issues, that I was missing a lot of really important information by not exploring people’s lives in enough depth. I didn’t understand the real connection between past trauma and current health, family dynamics, and how it really impacts people’s decision-making and their approach to health. It helped me gain a much deeper sense of how important that stuff is and how important it is to explore these things with all the patients I see – not just the ones with addictions issues but all of them.”

“

I THINK PROBABLY THE MOST IMPRESSIVE THING ABOUT A COMMUNITY LIKE LA RONGE IS THE INCREDIBLE STRENGTH OF ITS PEOPLE ... TO SEE THEM RISE ABOVE CHALLENGES IN THEIR LIVES – STARTING A THOUSAND STEPS FURTHER BACK THAN WHEREVER I STARTED IN MY LIFE – IS REALLY INCREDIBLE.

This work has left Dr. Groves with a sense of awe at his patients’ resilience. “I think probably the most impressive thing about a community like La Ronge is the incredible strength of its people, who haven’t always come from the best upbringing or social circumstances. To see them rise above challenges in their lives – starting a thousand steps further back than wherever I started in my life and being able rise above – is really incredible.”

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It’s this observation that keeps Dr. Groves going and inspires him to continuously try to improve the health of his community. The support of his colleagues, whom he feels privileged to work with, also plays a role. “They’ve been incredibly helpful in getting through tough times,” he recalls, “especially in a small town where you feel like, if you make a mistake, all eyes are on you. “But then you realize that everybody makes mistakes and you try to learn as much as you can from them and support each other when it happens … and most mistakes aren’t really mistakes. They’re just something you didn’t know before, that you know now.” ◆

Family Physician LOCUM OPPORTUNITY

The Saskatchewan Health Authority (SHA), Rosetown area, invites family physician applications for the SHA Rural/Regional Locum Program. The physician will provide short-term itinerant services which may include: clinic, hospital, on call, long-term care facilities, satellite clinics and other duties as assigned.

Benefits: • • • • •

Competitive daily rate Signing bonus and contract renewal bonus Travel stipend and mileage cost reimbursement No office overhead Free accommodations

Job Qualifications • • • • •

Team player with effective communication skills Ability to function well in a high volume environment with a commitment to high quality patient and family centered care. College of Family Physicians of Canada (CFPC) certified or eligible. Eligible for a provisional or regular license to practice in Saskatchewan. ACLS certified

Contact:

Christa Garrett, Practitioner Staff Affairs, SHA 306-882-4111 ext. 2314 | christa.garrett@saskhealthauthority.ca

TOP 5 ED HOBDAY

Retirement Readiness Tips for Canadian Physicians

recieves national honour for lifetime of dedication to Sask. doctors

Understand where retirement ranks among your financial priorities. By GIrard Hengen After almost 50 years, Ed Hobday is still stickhandling his way through contracts and negotiations, and battling in the corners for Saskatchewan’s physicians. Hobday’s career with the Saskatchewan Medical Association (SMA) reached a milestone in August when he received the CMA Owen Adams Award of Honour, the highest award the Canadian Medical Association bestows on an individual who is not a member of the medical profession. A hockey player in his youth, Hobday has applied the same energy that keeps him on the ice today for oldtimers’ games to his 49-year career at the SMA. Eager and enthusiastic, Hobday never seemsato have a bad day at the office. Make

“The realityconcrete is I really enjoy what I do, I couldn’t want for a plan better job,” Hobday said. “I keep telling people that I have for retirement. the best job in the world.” He was “surprised and humbled” upon hearing he was to receive the Owen Adams Award of Honour. “I had no idea that my name had even been put forward as a candidate. That people I work with would think of me in that way is quite overwhelming and unexpected.” When he was hired in 1970, the SMA office consisted of executive director Dr. Ernie Baergen and three support staff.

Know who will support you emotionally or practically in retirement.

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Know how you will spend your time The board decidedin to retirement. create a new position, someone to work in statistics and economics, assist in negotiating fee schedules, and help out in accounting and bookkeeping.

“My first meeting was a tariff committee meeting, and I remember it clearly,” Hobday said. ”The thing to keep in mind is we had a small organization and small staff, so I got involved in most everything the SMA was doing. Right off the get-go I went to board meetings and all of the committee meetings. We didn’t have nearly as many committees as we do now, though. We had the finance committee and insurance, tariff and economics and the board and RA.

“I got to go to all of those meetings, and I very quickly had the opportunity to meet a lot of physicians. I just appreciLook beyond ated what fine folks they were and how they accepted me. I always like to say Iinvestments work with and for docs, andhave to this day and it is still the case. In some instances, I simply execute the a plan for emergencies. decisions they make, and at other times I might be able to give them advice or suggestions as to what they might do, because I can put a different lens on some of these issues.” Through his work with the SMA, nights playing hockey and his commitment to the community – he served as reeve of the RM of Corman Park - Hobday and his wife, Colleen, raised a family of four children. He acknowledges that without the support, and in some instances, the sacrifices, his family has endured, he would not have been able to throw himself into his job the way he has done. Hobday isn’t thinking about full retirement at the moment, although in theory he is now working four days a week. “I have no interest in any other job in the health-care sector other than the one I have. My health is still good, but I’ve been here a long time and we’ve got a good complement of people here in the SMA office. I tell people you won’t even miss me when I am gone because the organization is in good shape, and if it’s in good shape, it will be able to keep * MD Advisor refersin togood an MD Management Limited the docs of Saskatchewan shape. ”◆

Financial Consultant or Investment Advisor (in Quebec). MD Financial Management provides financial products and services, the MD Family of Funds and investment counselling services through the MD Group of Companies. For a detailed list of these companies, visit md.ca. SMA DIGEST | FALL 2019 13

A LIFETIME OF

CHANGE

Dr. Don Stefiuk reflects on the evolution of health care during his 40 years in practice

By Girard Hengen

Despite all of the advances Dr. Don Stefiuk witnessed during his 40 years practising medicine – new drug therapies, practice models, surgical procedures, training, equipment, and technological change – he believes physicians have lost something along the way. “To a degree, because of technology and different ways of communicating, collegiality among physicians has, I think, gradually lessened,” Dr. Stefiuk said. “It’s still there, but not in the same way that it used to be. That is something that’s sort of sad.” Dr. Stefiuk retired on June 28, 2019, after 40 years with City Centre Family Physicians of Saskatoon. He joined the original practice – Drs. Doig, Golumbia, and Associates – in 1979, when it was located in the Canada Building in downtown Saskatoon. He had just graduated from the University of Saskatchewan’s College of Medicine in 1977 and completed a two-year family medicine residency at the U of S.

hen Dr. Stefiuk started his career in the late 1970s, a typical day would see the practice’s four physicians doing hospital rounds first thing in the morning. They usually finished early, but didn’t have to start at the office until 10 a.m. “We’d go to the physicians’ lounge and talk with the other physicians there. It was a great opportunity to ask questions and get information, discuss your patients, and just socialize.” On Mondays, Dr. Stefiuk would work as the roster physician in the emergency department from noon to midnight. There were no emergency room physicians at the time. Family physicians in his group – and others in Saskatoon – often assisted in their own patients’ surgeries in hospital. Gradually, emergency room physicians took over ER shifts from family physicians and specialists performed the surgeries.

Dr. Stefiuk sat down with the SMA recently to reflect on a lifetime in health care.

“Family physicians have lost their position in the hospital,” said Dr. Stefiuk. “We used to visit our patients in emergency, we used to assist with surgery on our own patients. Physicians used to make rounds on their own patients, we used to care for patients in the hospital in all areas. I’m speaking mainly from our group perspective, but there were a lot of other groups that did the same thing.”

“I’ve had a chance to think about it and, my God, everything has changed,” he said. “Everything from technology to treatments have evolved and changed. It’s been quite amazing when you think about it.”

Physician groups have grown, and with the emergence of internists and specialists in hospitals, the burdens on family physicians might have lessened, but this has come at a cost in terms of continuity and collegiality, Dr. Stefiuk believes.

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“One of the things is you don’t get to know your colleagues like you used to,” he said. “You knew the surgeons, you knew the orthopedic people, the pediatricians. You knew them almost on a personal basis. Now you don’t.

“That’s amazing when you think about it,” Dr. Stefiuk said. The first heart transplant was done in 1967. Dr. Stefiuk notes a patient of his has had a new heart for 20 years. “He’s done amazingly well.”

“The old physicians’ lounges were filled with smoke and specialists and family physicians and administrators … Elmer Schwartz, for example, used to talk to physicians all the time, and that helped in relationships between physicians and administration. And so over the years sometimes I felt there was a lack of communication between administration and physicians. Sometimes you felt like administration didn’t really understand what was actually happening.”

Dr. Stefiuk also cites a host of other “quite amazing” advancements in medical care that changed the way he practised. These include stroke treatment, investigative procedures in radiology, organ transplants, and medications – especially in the area of cancer care.

r. Stefiuk uses an analogy to illustrate the rapid march of progress. The Wright brothers’ first flight was in 1903, and by 1939, a pilot in Germany had tested the first jet airplane. The difference is 36 years. “I was in practice longer than that period of time, so there’s been time for a lot of changes to go on in medicine. It’s been amazing, from technology to the way we communicate between physicians,” he said. Computers, of course, changed everything. His practice switched from paper to electronic records in 2000, one of the first in Saskatoon to do so. “I don’t know how people can practice without the computer,” Dr. Stefiuk said. “When we decided to computerize in 2000, we were being eaten up by files. We had two rooms full of files, and we had a file clerk. When a report came in, she had to pull the file, look at the report, refile it. If you needed to send a referral or to look at something, she had to pull the chart and give it to you and then she filed it.” The practice partners decided that the computer system – at a cost of $200,000 – would pay for itself within five years by eliminating the file rooms and adding a physician. At that time, the practice had about 10,000 patients. “Can you imagine today, with 21 physicians, how much space those files would take up?” Dr. Stefiuk said. “Computerization has really made life much easier.” First came computers, then pagers, and now cellphones for communications. All have “improved life immensely” for physicians, he said. Patients have benefited from improved treatment techniques since he started practice four decades ago. For example, people who had heart attacks were put into coronary care. “This might be an oversimplification, but you were given nitroglycerin and maybe a couple of other drugs and sent home and, you’re like California – waiting for the big one,” Dr. Stefiuk said. Now, an angiogram will show blocked arteries, and a patient can have artery bypass surgery.

The emergence of primary health care in many practices, with its multidisciplinary approach, is a positive step, he added. Working alongside nurses, social services staff, pharmacists and home-care workers has greatly aided patient care. Along with all of the advances, patients’ expectations have evolved too, he said. “People see things on the Internet. They see things on television. There’s dozens of doctor shows and they see all kinds of stuff. I think people expect more, they think more can be done than sometimes really can be.”

“

I’VE HAD A CHANCE TO THINK ABOUT IT AND, MY GOD, EVERYTHING HAS CHANGED, EVERYTHING FROM TECHNOLOGY TO TREATMENTS HAVE EVOLVED AND CHANGED. IT’S BEEN QUITE AMAZING WHEN YOU THINK ABOUT IT.

r. Stefiuk was a member of the Saskatchewan Medical Association Board of Directors from 2011 to 2015, and received an Honorary Lifetime Membership from the Canadian Medical Association in 2014. When he announced his retirement, many patients booked appointments just to talk or say goodbye. One thing that didn’t change over Dr. Stefiuk’s 40 years in medicine is his belief that physicians need to take the time to talk to their patients.

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MED 1 - Class of ‘77, 1972-73 Back row: M.Trew, Elizabeth Ueberschar, V. Von Kampen, C. Walker, D. Warden, B. Wiebe, W. Wells, L. Worobetz, R. Yeske Second row: Toby Rose, Nan Schuurmans, D. Sheridan, Linda Smith, A. Stadnyk, D. Stefiuk, J. Sunstrum, D. Surkan, G. Taylor, Katie Tihanyi Front row: Doris Nelson, Mary Ann Parker, L. Poulin, A. Raff, D. Read, J. Reggin, J. Rice, J. Road, N. Rooke “Patients today, they want to talk, they want to tell you about what’s going on, and that’s important, because you can pick up a lot of things in medicine from just talking to your patient, getting to know them. “People want to build a trust between themselves and their physician,” he continued. “Before I retired I was sitting at my

desk and a patient came in, he didn’t have an appointment, and he stood in the doorway and he said, ‘I just wanted to come by and thank you.’ Tears were rolling down his face and he said, ‘You saved my life.’ I couldn’t remember what I did, but when I retired there was a lot of emotion between me and my patients. I didn’t realize how much they trusted me or depended on me.” ◆

FAMILY PHYSICIAN OPPORTUNITY | YORKTON The opportunity

Downtown Clinic, Yorkton, is seeking a full- or part-time family physician to join the practice. The clinic is modern and well established. The successful candidate will have an established client base with ample opportunity to expand the clinic. Collaborative engagement with multidisciplinary services are available. Clinic support staff are organized and familiar with operational standards and patient care requirements. After hours rural emergency room coverage is optional. The successful candidate must hold full or provisional licensure with the College of Physicians and Surgeons of Saskatchewan and maintain membership with the Canadian Medical Protective Association. Candidates must be legally entitled to work in Canada.

Remuneration and incentives:

Remuneration is fee for service. Earning potential is about $300,000 – $350,000 annually. This clinic offers very competitive practice split to cover office overhead fees or option to purchase clinic facility.

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The community

Yorkton is a vibrant community, close to parks and lakes and numerous recreational activities. It is an outdoor enthusiast’s haven. It has a Regional Health Centre which provides: Obstetrics/Gynecology, Ophthalmology, General Surgery, Pediatrics, Radiology, Anesthesiology, Psychiatry, and Internal Medicine

To learn more contact:

Dr. Nadine Swan n.t.s@sasktel.net

AIDS CRISIS looking back By the 1980s, infectious diseases were no longer considered a threat to physicians and health workers. But a mysterious new disease started spreading to Canada. AIDS had arrived, killing everyone who contracted it and sparking stigmas borne by the fear of the unknown. It was a time of uncertainty, and even panic, in health care, recalls Saskatoon physician Dr. Deirdre Andres. Here is her story.

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By Dr. Deirdre Andres As word drifted north from the United States in the 1980s about a strange new disease, the level of fear in patients and physicians increased. The threats from infectious disease had been lessening decade by decade, with the elimination of smallpox altogether, and other effective immunization programs removing threats like polio – which had made parents fearful each summer. Infectious disease was something we as physicians no longer had to worry about. But those diseases hadn’t been universally fatal. AIDS, at that point, was. The young man lay alone in a private room. He was unconscious as a result of an AIDS-related meningitis. Whenever you walked past the room, it was empty except for him, lying alone, with doctors and nurses afraid to go in. There were no family visitors. He died alone. The fear of becoming infected with an incurable disease that might then be transmitted to those near and dear to us affected career choices, made us wonder what we would do if required to care for an infected patient. That fear affected people in the community, who worried about exposure and sought reassurance. A healthy young man makes an appointment. His job requires him to empty the bins containing menstrual care products. “Will I catch AIDS by cleaning them out?” he asks. We learned that the disease was transmitted through blood and body fluids, which elevated the risk from a specific population to a much broader one. Each patient became a potential source of infection and threat to those providing care. Physicians considered these factors when deciding specialties, when choosing what types of patients they would see. Was it OK to say, “I won’t see gay men”? We began to fear and distrust patients. Were they infected? Did they know if they were? Would they tell us if they did know? Universal precautions became the norm: double gloving, no more catching babies bare-handed. Every potential contact with a patient’s blood or bodily fluid was seen as a threat. We wouldn’t recap needles, or leave them lying on the tray or countertop. We had to dispose of them carefully. Counts became as much for the safety of the doctors, nurses and housekeeping staff, as for patient safely. Although disposable needles and syringes were already available, everything that could be made disposable became so. The amount of plastic thrown away increased.

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When testing for HIV became possible on a large scale, we learned about windows of seroconversion, pretest probability, and the risks of false positives when testing low-risk populations. Doctors couldn’t just add HIV serology to the list of CBC, ‘lytes, BUN, creatinine. Signed consent was required. We learned about informed consent for testing for HIV, because a positive test could affect employment, accommodation, family relationships. Employers, landlords, and friends and family would discriminate on the basis of a positive test, even though by then we knew there was no threat from those kinds of casual associations. As recently as 2017 some men were choosing anonymous testing because of fear of the results getting out. We learned about informed consent for the use of blood products, and learned tolerance for using far fewer blood products. Techniques and technologies for reducing blood loss were developed.

“

HIV-AIDS HAD A PROFOUND EFFECT ON HEALTH CARE, AND DECIMATED ARTS, MUSIC AND CULTURAL COMMUNITIES ... FOR THE FIRST TIME, POPULATIONS OF PATIENTS AND POTENTIAL PATIENTS MOBILIZED AND INFLUENCED RESEARCH, DIAGNOSTIC AND TREATMENT REGIMENS. As I started to plan and write this piece, I could feel the same knot in my stomach that I felt when my then-husband decided to enter a specialty with a higher risk of contact with blood and bodily fluids. I again felt the fear when I went in to see that young man in his solitary room. I remembered the fear that pervaded the small city where we lived, where debates were held on whether sexual orientation was a choice or not, when a boy with hemophilia was diagnosed with AIDS.

“

WE BEGAN TO FEAR AND DISTRUST PATIENTS. WERE THEY INFECTED? DID THEY KNOW IF THEY WERE?

WOULD THEY TELL US IF THEY DID KNOW?

Now, of course, HIV is a chronic disease, with the possibility of cure being announced from time to time. It’s treatable with complex regimens of medications. The stigma has shifted more to the IV drug users who now have their own acronym, IVDU. HIV-AIDS had a profound effect on health care, and decimated arts, music and cultural communities, as I was reminded when watching “Bohemian Rhapsody” this spring. For the first time, populations of patients and potential patients mobilized and influenced research, diagnostic and treatment regimens. These lessons have been applied by other disease advocacy groups. An exponential growth of knowledge occurred when AIDS came to the western world. HIV had existed in Africa for a couple of decades prior, where it was known as the slim disease. The continent lost a generation of parents, leaving children to be raised by grandparents.

some of the harm from hepatitis C, which followed. HIVAIDS changed ideas about informed consent, about how we interact with and treat patients. It ignited, or reignited, ethical discussions about refusing care based on factors that had little to do with illness, such as sexual orientation. It changed patients’ involvement in health-care policy. It certainly highlighted that infectious disease is not something of the past. Some of the legacies around advances in knowledge are positive; some, like those around stigma, are not. In 1997, 10 years after the first man lay dying, another man lies dying, of HIV-related malignancy. He’s had several years of anti-retroviral treatment. Even so, it took the development of a life-threatening illness for him to disclose to his family and friends. But now he, too, is in a private room. Nurses offer foot rubs, residents pop in frequently to assess management, family and friends are in and out. He dies knowing he is loved. ◆

HIV brought home the lessons we started to learn from hepatitis B the decade or so before, and likely mitigated

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WE NEED ALL HANDS ON DECK Physicians have the ability, knowledge and tools to address the opioid crisis, says Dr. Peter Butt. Now they need enough resources to support their work.

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By Girard Hengen For physicians to play a greater role in tackling the opioid crisis, one of the first things that has to change is to end the stigma around accepting people struggling with opioid use disorder as patients, says addictions consultant Dr. Peter Butt. “It’s a multi-pronged situation that requires a multi-pronged approach to addressing it,” said Dr. Butt, who works in Saskatoon. That includes more family physicians trained in opioid substitution therapy and willing to do the work. “From a medical point of view, we need all hands on deck with regards to our treatment of opioid use disorder,” said Dr. Butt, who is also an associate professor with the College of Medicine. “I would like to envision a time when we don’t have the level of stigma that we do – in the medical profession and in the health-care system – with regards to people that are struggling with addiction, because there are many that might be interested when they come out of training in doing this work, but are told when they join a group practice in family medicine, for instance, that they can’t do this work in that clinic, that they don’t want those individuals. In fact they have people that are struggling with addiction already in their practice.” Dr. Butt recently spoke to the SMA about the emergence of the opioid crisis, including how it has evolved, and the incremental steps that have been taken by physicians and the health-care system to address it.

Emergence of a crisis A “perfect storm” of factors created the crisis, including marketing of drugs by pharmaceutical companies at a time when aggressive approaches were undertaken to treat conditions such as chronic pain, acute pain in emergency, and pain associated with palliative care, which are each very different pain entities, said Dr. Butt. People who develop a dependence on opioids are at risk of contracting diseases such as HIV and hepatitis C through the sharing of needles and drug paraphernalia. Criminal activity is also associated with opioid dependency, as is the risk of overdose, especially with illicit fentanyl. Dr. Butt argues there are essentially two crises. One is the use of illicit fentanyl and the high numbers of deaths associated with it, especially in B.C. and Alberta, but less so in Saskatchewan. The other – which accounts for the majority of overdose deaths in Saskatchewan – is the misuse of prescription opioids.

“That aggressive use of opioids in chronic pain syndromes had little to no evidence for it,” Dr. Butt said. “People were going to live with that chronic pain for years, if not decades, and prescribing higher and higher doses of opioids leading to tolerance, leading to side-effects, leading perhaps to substance use disorder and opioid use disorder, created significant problems. And I think that some of the deaths that we’re seeing are iatrogenic. They’re caused by our prescribing, and we need to address this.”

Developing a response Recognizing there was a problem, the Canadian Medical Association in 2017 developed national opioid prescription guidelines for people with chronic, non-cancer pain. The number of physicians who have been approved by the College of Physicians and Surgeons of Saskatchewan to prescribe methadone, buprenorphine/naloxone, or both under the college’s Opioid Agonist Therapy (OAT) program (formerly the Methadone program) is growing, but very slowly. As of late July, the total was 85 physicians.

“

WE’RE MAKING A DIFFERENCE, BUT WE STILL HAVE WAITING LISTS, WE STILL HAVE PEOPLE OVERDOSING, AND THERE ARE STILL PEOPLE NOT GETTING THE HELP THEY NEED.

More and more emergency response teams, first responders and family members of addicts are being outfitted with take-home naloxone kits to prevent overdose deaths or acquired brain injuries. Harm reduction sites have been established in some centres. However, Dr. Butt says health systems are a long way from developing comprehensive care that envelopes an individual from initial outreach and detoxification to the final stage of recovery, which could take a year or more. A person diagnosed with opioid use disorder may receive seven to 14 days of detox, followed by 28 days in rehabil-

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“

WE’RE NOT EVEN MEETING CRITERIA TO SUPPORT PEOPLE INTO EARLY REMISSION. WE WOULDN’T DO THAT FOR CANCER, WE WOULDN’T DO THAT FOR ANY OTHER CONDITION. WE WOULD GET PEOPLE INTO SUSTAINED REMISSION.

itation – a total of five to six weeks. But according to the Diagnostic and Statistical Manual of Mental Disorders (or DSM-5), three months free of symptoms and non-use is considered early remission, while 12 months symptom-free and with non-use is considered sustained remission. “We’re not even meeting criteria to support people into early remission. We wouldn’t do that for cancer, we wouldn’t do that for any other condition. We would get people into sustained remission. We have the ability to do it. We have the knowledge to do it. We have the tools to do it. But we don’t have the system to support it,” Dr. Butt said. Dr. Morris Markentin, a family physician at the West Side Community Clinic in Saskatoon and clinical manager of the OAT program, agrees more resources are needed to respond to the opioid crisis. More physicians need to be educated in OAT, more multidisciplinary medical teams should be developed and more mental health resources applied to the response. “Many of our patients are self-medicating,” said Dr. Markentin. “The opiates aren’t just for pain care. They give you a euphoria. They’ll make you feel better. So when your life is full of angst and distress, opioids make you feel better. And if we’re not improving their mental health or improving their lives, they self-medicate with opioids because they do work.” However, many patients don’t have access to the supports they need, such as mental health, and many come from a culture that has suffered generations of trauma, he said. “We’re dealing with multi-generational trauma here and we just don’t have the resources to deal with that,” Dr. Markentin said.

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Making a difference Having seen the opioid crisis spring from a “perfect storm” of factors, physicians are making a difference. Going forward, Dr. Butt hopes to see a continuum of care that leaves no gaps in the transitions from outreach and engagement, to harm reduction strategy, through to detox, therapy and treatment, all the way to rehab, support and recovery. Gaps are being filled “incrementally,” he said, adding “we’re not quite there yet and we need to recruit and have the active support of more physicians working with this population.” Patients with higher needs are probably better off in a specialty clinic, but family medicine is an ideal place for people who are doing well in their recovery. “Care needs to be targeted so we close the gaps and develop an evidence-based continuum of care so people are able to be supported all the way into sustained remission, just like we do for cancer,” said Dr. Butt. “I don’t think that is an unreasonable thing to advocate for, nor to expect from our health-care system, but we’ve got a ways to go to get there.” Dr. Markentin calls any progress “at a snail’s pace.” Physicians are being educated on OAT, but the uptake is slow, he says. “We’re making a difference, but we still have waiting lists, we still have people overdosing, and there are still people not getting the help they need.” He agrees family physicians require training and support from the system. “They need access to addictions counsellors, they need access to psychologists, they need access to treatment. It’s not just a quick prescription fix. We are a piece of the puzzle that’s going to fix it, but if we don’t have a concerted effort, it’s not going to be successful.” ◆

WORKING TO MEET THE NEEDS OF OUR INCREASINGLY

DIVERSE

POPULATION Dr. Megan Clark | Photo by Kristen McEwen

By Greg Basky

egina family physician Dr. Megan Clark still remembers a patient she first met when she was a resident. “She was a young trans woman. She was smart and sweet, and she just needed someone to follow her through her hormone treatment. We bonded over a shared love of Harry Potter,” recalls Dr. Clark, who now provides care to about 50 transgender and gender diverse patients as part of her practice in the Family Medicine Unit at Regina Centre Crossing. Dr. Clark remembers her young patient being confused; she’d started hormone therapy and needed to get an appointment to see an out-of-province psychiatrist. “I was waiting with her, to see her through all the steps involved in getting gender reassignment surgery. It was just so rewarding.” Transgender and gender diverse people are part of Saskatchewan’s growing and increasingly diverse population. With that diversity comes unique health-care needs that doctors like Clark are stepping up to meet. She and other physicians in the province are working to make their practices safe and welcoming places for patients who can often feel vulnerable or marginalized at work or school. While reliable figures on the number of transgender people in Saskatchewan aren’t available, Dr. Clark said U.S. data would suggest that between 0.6 per cent and 0.7 per cent

of the total population likely self-identify as trans or gender diverse – which would translate to somewhere between 7,000 and 8,200 people (based on a population of 1,169,131 as of April 1, 2019). Other physicians see trans and gender diverse patients, but there are only about 10 in this province who specialize in or get referrals for this population, according to Dr. Clark; she is one of four doctors that the Ministry of Health relies on to make recommendations about which patients should be approved for out-of-province gender reassignment surgery. At Regina Centre Crossing, Dr. Clark and her colleagues use appropriate names and pronouns starting when patients first contact the clinic. “This helps patients feel safe, as does my familiarity with the local organizations and health-care systems supporting trans people and transition-related health care,” said Dr. Clark. She applies the same principles of patient-centred care and shared decision-making she does with any of her patients. “My mindset is that trans and gender diverse patients have some unique health-care needs, but the most important practice is to treat them with the same respect that everyone deserves.” Attitudes in the medical community are improving, according to Dr. Clark, but some doctors continue to pathologize this patient group.

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It’s the close patient-physician relationship she develops with her transgender clients that Dr. Clark finds most rewarding. “You are often working together long and hard through the process (of hormone therapy and gender reassignment surgery).” She gets tremendous satisfaction from seeing how much happier her patients are, and how much more positive their outlook, after the first few months of hormone therapy.

ednesday mornings, Saskatoon’s Refugee Engagement and Community Health (REACH) Clinic is buzzing with activity. Most weeks, the majority of people sitting and standing in the waiting room are from Eritrea, Ethiopia and Sudan, but there are also adults and children from the Democratic Republic of Congo, Burundi and neighbouring countries as well. Kids are running around; about half of all refugees who come to Saskatchewan are children. Staff from the local settlement agencies – Saskatoon Open Door Society and Global Gathering Place – are there as well, coordinating appointments and transportation for families. While she’s worked at REACH since it opened in February 2017, Saskatoon pediatrician Dr. Mahli Brindamour still regularly picks out new languages she hasn’t heard before. “And every week, there are families waiting who aren’t even on our list ... but we just roll with it,” said Dr. Brindamour, whose home base is Saskatoon Paediatric Consultants. The REACH Clinic, which is housed within Saskatoon Community Clinic’s downtown location, is a collaborative part-

nership involving the Saskatchewan Health Authority’s primary and public health teams, the settlement agencies, TB Prevention and Control, and the University of Saskatchewan’s College of Medicine and Community Health and Epidemiology. REACH provides a one-stop shop for refugees who can, during their first year in Saskatoon, access an interdisciplinary team of primary and specialized care physicians, and nurse practitioners (for urgent care needs), as well as prenatal care, pharmacy, and lab and diagnostic testing. During its first year, REACH provided care to 218 patients. In 2018, the clinic served 322 clients. In many cases, refugees may have previous negative experiences with health care or with authority. Dr. Brindamour and her colleagues move slowly with refugee families, to build trust. “I make sure that I book enough time. Usually visits will be two to three times longer than in my other offices, and often it will take much more than one or two visits before people will feel comfortable enough to share difficult elements of their stories,” said Dr. Brindamour, who also does clinics in La Loche, Ile à la Crosse and Stony Rapids, and looks after newborns at Sanctum 1.5, a transitional home for at-risk women and their babies. The team at REACH strives to communicate in the language of the family’s choice; they have interpretation available at all times, preferably from in-person, trained interpreters. As well, Dr. Brindamour and colleagues are attentive to the subtle signals they pick up during care encounters.

“

THEY HAVE LIVED THROUGH SUCH DIFFICULT THINGS – THE TRAUMA AND THE REASONS THEY HAD TO LEAVE THEIR HOME. DESPITE THAT, THESE KIDS ARE SO RESILIENT AND ADAPT SO WELL. IT JUST GIVES ME SO MUCH JOY TO SEE THIS HAPPEN.

Dr. Mahli Brindamour | Photo by Emma Love

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“We work to understand family dynamics and power differentials between family members, but also between the health-care team and the family members.” Dr. Brindamour said it’s the hope she sees in her young patients that she finds most gratifying. “They have lived through such difficult things – the trauma and the reasons they had to leave their home. And the difficulties they face with learning a new culture, a new language, in a new country, going to a new school,” she said. “Despite that, these kids are so resilient and adapt so well. It just gives me so much joy to see this happen.”

populations who need it the most, said Dr. Brindamour. “We (physicians) need to be committed to providing care to marginalized and underserved people, first and foremost in our own communities.” ◆

rs. Clark and Brindamour both say demand for the services they provide currently outstrips supply and that more resources need to be invested to meet the unique care needs of these patient groups. On a more positive note, they are buoyed by the interest shown by medical students who are reaching out to them to learn more about working with refugees and transgender people. Dr. Clark continues to care for the transgender patient she first met as a resident physician. And she continues to hold out hope that, over time, Saskatchewan can do better for trans and gender diverse patients. “As we as a society and a health-care system become more accepting, we can get closer to providing truly patient-centred care for this population.” Physicians have a social accountability to care for the

Resources REACH Refugee Health Clinic www.saskatooncommunityclinic.ca/reach-refugee-healthclinic Gender Identity, Gender Diversity, and Transgender Support (Saskatchewan Ministry of Health) www.saskatchewan.ca/residents/health/accessing-healthcare-services/gender-identity-gender-diversity-andtransgender-support Saskatchewan Medical Transition Guide (Saskatchewan Trans Health Coalition) www.transsask.ca/resources/guide Canadian Professional Association for Transgender Health http://cpath.ca/en Trans PULSE Canada (community-based survey on the health, well-being of trans and non-binary people in Canada) https://transpulsecanada.ca

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SMA DIGEST | FALL 2019

Samuel Simonson

Dr. Anne Davis

Dr. Jasmine Hasselback

SASKATCHEWAN DOCTORS WALKING THE TALK IN FIGHT AGAINST CLIMATE CHANGE By Greg Basky Evidence of the health impacts of climate change is everywhere: Eco-anxiety is giving rise to new mental health support groups. Smoke from wildfires is causing more problems for people with asthma and allergies. Incidence of bug-borne illnesses such as Lyme disease is on the rise. Dehydration and deaths from summer heatwaves are becoming the new norm. Canada’s health-care community is united in recognizing the threat global warming poses to the health of citizens. In February 2019, the Canadian Medical Association (CMA) joined a host of other professional groups – including the Canadian Nurses Association (CNA) and the Canadian Public Health Association (CPHA) – in calling on all federal parties to recognize that “climate change is the greatest public health challenge of the 21st century.” For individuals, it’s hard to know where to start when the real power for change rests with governments around the world. But Saskatchewan doctors – and medical students too – are finding ways to be part of the fight. Dr. Anne Davis, a family physician in Eastend, traces her passion for the environment back to her university days:

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The spark was fueled by what she was learning in ecology classes, and reading in environmental classics such as Silent Spring (by Rachel Carson, first published in 1962) and Diet for a Small Planet (by Frances Moore Lappé, published in 1971). “That interest and concern has stayed with me.” Dr. Davis recently decided that talking to individuals, writing letters and signing petitions isn’t “anywhere near enough.” So she’s upping her game: Dr. Davis is making more conscious decisions about the medical supplies she uses in her practice. She’s talking to her patients about healthy lifestyle choices that benefit the individual but also the planet – such as eating plant-based foods more often and walking instead of driving. And she’s becoming more active in the work of the Canadian Association of Physicians for the Environment (CAPE), an advocacy group whose mission is to better human health by protecting the planet. “I think there is real power in a collective voice of individuals,” said Davis. “And I would hope that a collective voice of physicians could add to the pressure for policy and change at a government level.” Doctors in training are also taking up the cause. Samuel Simonson, a third-year medical student raised on a farm near Outlook, was moved to act after hearing Dr. Courtney How-

ard speak at a Planetary Health Conference in Saskatoon this past spring; Howard is an emergency room doctor in Yellowknife and president of CAPE. “What resonated most with me was how she talked about doctors being the most trusted professionals in society,” said Simonson. “We specialize in people’s health, and climate change is affecting people’s health. She said that, because of our role, we need to do what we can, in our own way.” Last month, Simonson and other members of a Planetary Health student group made a presentation then led breakout discussion groups at the 8th Annual Global Health Conference, hosted by the University of Saskatchewan. And he’s pushing for the environment to be the focus of this year’s provincial Day of Action by medical students. Many observers feel the medical community has been slow to take up the fight against climate change. Dr. Jasmine Hasselback, a Public Health and Preventive Medicine specialist, thinks this is likely because the problem and its causes seem beyond doctors’ control. Physicians’ inaction to date may also stem from a lack of awareness and education: Many doctors do not yet realize just how serious the problem is and the close link to people’s health. While it’s true the biggest interventions are out of their hands, doctors can and should embrace individual change, according to Dr. Hasselback. In her role, she has the opportunity to be part of the growing dialogue and discourse about the health impacts of climate change. “I’m seeing both anxiety and excitement,” said Dr. Hasselback, who is a medical health officer with the Saskatchewan Health Authority. “More organizations – CBOs, private businesses, and government agencies – are asking me to come out and speak about this. So there’s a growing recognition of the strong link (between climate change and human health). In the last few years, there’s been a shift from ‘let’s talk about this’ to ‘let’s dig into how we can act.’ ” Undergraduate medical education could be doing a better job preparing new doctors to be advocates for their patients and the planet, according to Simonson. “We get the bare-bones information about what the health effects will be, but it’s not delivered in a way that connects the effects well into individual and community patient care. It also doesn’t inspire students to think critically and engage with the material in a meaningful way.” To fill that gap, Simonson and some classmates are creating a series of informational podcasts, with financial support from the College of Medicine’s Social Accountability Lab for Learning and Teaching (SALLT). All three agree that small steps can add up to big change. Individual physicians can take a more active role by sending

letters to politicians, displaying information in their office and setting a good example for their patients to follow, said Dr. Davis. She notes that Alberta already has its own CAPE chapter, but Saskatchewan does not. “Are there others who want to join me (in forming a Sask. chapter)? Together we can make a strong voice.” Physicians should look around their communities to identify activities and initiatives that are already rolling, suggests Simonson. “Don’t think you have to come up with a big new idea. Find spots where good work is already started. See where you can help out. Add your name to the work.”

“

WE CAN GET THE PEOPLE WHO ARE TALKING ABOUT CLIMATE CHANGE TO UNDERSTAND THAT THIS MATTERS. WE REALLY CAN HELP TELL THE STORY. IT’S NOT JUST ABOUT SAVING POLAR BEARS. THE IMPACT (OF UNCHECKED CLIMATE CHANGE) IS POOR HEALTH AND LESS VIBRANT COMMUNITIES.

There’s no one better than doctors to speak out on the health impacts of climate change, according to Dr. Hasselback, who switched specialties when she tired of seeing preventable conditions and major health inequities on the diagnostic images she was reading every day. “We know health and health conditions at the individual level – for example how debilitating asthma can be for children,” said Hasselback. “We can get the people who are talking about climate change to understand that this matters. We really can help tell the story. It’s not just about saving polar bears. The impact (of unchecked climate change) is poor health and less vibrant communities.” ◆

SMA DIGEST | FALL 2019

THE INDIVIDUALITY OF

BEING WELL New-to-practice rural family physician Dr. Chelsea Wilgenbusch discusses the demands of medicine, staying well and how the path to wellness is different for everyone

You’re now a year into a rural family practice. Medical school and residency are behind you. The demands of a medical career can The importance of fostering wellness in the medical com- make it difficult to look after your own well-being. Can you tell me munity is gaining recognition across the country. The Ca- a bit about that? By Maria Ryhorski

nadian Medical Association (CMA) and the Saskatchewan I think there are a lot of barriers to staying well as a physician Medical Association (SMA) have named physician health that are both intrinsic to the health-care system and extrinand wellness as priorities, and the SMA is in the process of sic to it. The system itself requires 24/7, 365 day service, in a stressful environment where errors can be unforgiving and expanding its Physician Health Program to better support life altering. physicians in all parts of the province. Honest conversaOur personality also plays a distinct role. Physicians by nations about mental health are growing more prevalent, as ture are highly motivated, compassionate individuals who individuals and organizations work to reduce the stigma put high expectations on themselves to achieve and to do for their patients. The very nature of what makes us of mental illness and normalize the importance of seek- good excellent doctors also makes us highly vulnerable to burning help. Physicians know themselves best when it comes out or compassion fatigue. to wellness – their struggles and what they find helpful. What do you see as some of the barriers to physicians staying well? The SMA approached Dr. Chelsea Wilgenbusch, a new-tois a big one. It’s just a race against the clock to log your practice family physician in Melfort and physician mentor Time hours at work, finish your paperwork, be physically active, for the SMA’s Roadmap Program for Students and Resi- have hobbies, be a supportive spouse, talk to your parents, dents, to share her perspective on staying well and how see your kids, walk your dogs, etc. It’s difficult to balance all of that when you’re spending 60-80 hours of the week at we prepare our learners to face the demands of a career work. in medicine. 28

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Lack of coverage is another issue, especially in rural areas where you just can’t seem to get the time off you would like, as these areas are often under serviced. And culture plays in as well. Everyone else is also working hard so you feel like you don’t want to burden your colleagues by working less.

You’re fairly recently out of medical school and residency. Looking back on your experience, do you think we are doing a good job preparing students to take care of themselves? I think we are trying, but we need to broaden our perspective. I don’t think that mandatory wellness hours or exposure to mindfulness are the only avenues for promoting wellness. I think the bigger issue is that we are working in a system that supports physicians working more hours and having more demands on them constantly. I think systemic change would be more impactful than teaching people how to combat burnout, therefore I think focusing on creating strong physician leaders who will advocate for this change should be one priority in our wellness initiatives. And when it comes to supporting wellness – particularly for medical learners – I think we should be supporting a wide array of activities that students/residents say enrich their lives as human beings first and doctors second. For some people that may be gardening, walking their dog, seeing an afternoon movie with their spouse or having coffee with an old friend. I think we need to broaden our scope of what constitutes “wellness” and recognize that being well looks and feels different for everyone.

Do things you are passionate about … but recognize when you’ve taken on too much and learn how to graciously say “I appreciate you thinking of me, but I am happy with my current work and don’t need another role.” Take time to reflect on your life before medicine and the things that brought you joy, and consider how you can incorporate those things into your life now, and going forward throughout your career. And accept that what makes you feel “whole” isn’t the same as what makes someone else feel well, and that is perfectly OK!

You raised an important point – that activities that foster wellness often don’t fit into a mould and are different for everyone. What do you do to stay well? I like to go to the gym and I like to run outside. I truly feel exercise is the most underutilized anti-depressant and anxiolytic in existence. Expending energy really helps to reset my mood and energy levels. Practising gratitude is also important. I try to maintain an attitude of gratefulness in everything I do, remembering that we are fortunate to live and practice medicine in a First World country. Hiking and walking with my dogs is also big for me – related to exercise which I already mentioned – but with the addition of enjoying nature with my dogs, who are always happy regardless of where I take them. Taking time to spend intentional time with my spouse – go-

What would you say to medical students who are beginning to feel ing to movies, golfing, running, eating meals together. worn out? What advice do you have for them? It’s OK to not be OK. No one is always happy all the time. No one is inherently good at setting limits for their personal and professional life either, but it is so important to learn how to do this.

Ultimately, anything that reminds me that life is bigger than work and medicine, and recognizing that maintaining my humanity is ultimately what makes me a better doctor. ◆

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TAKE TIME TO REFLECT ON YOUR LIFE BEFORE MEDICINE AND THE THINGS THAT BROUGHT YOU JOY, AND CONSIDER HOW YOU CAN INCORPORATE THOSE THINGS INTO YOUR LIFE NOW ... AND ACCEPT THAT WHAT MAKES YOU FEEL ‘WHOLE’ ISN’T THE SAME AS WHAT MAKES SOMEONE ELSE FEEL WELL, AND THAT IS PERFECTLY OK!

SMA DIGEST | FALL 2019

HOW DO YOU

STAY WHOLE Wellness isn’t a class you take. It is a holistic approach to life – incorporated into everything we do. It is built by making the time to do the things that bring your life joy and meaning.

Here – we celebrate our members doing the things that help them stay whole.

Dr. Andrea Fong | pediatric allergist and clinical immunologist, Regina On staying whole I used to be active in sports and martial arts as a kid, but like many, these activities stopped once I was in university. Shortly after starting my practice about five years ago, I decided to take advantage of the CMA discounted gym membership. I really enjoyed the group fitness classes and a year later was asked if I would be interested in teaching group fitness. If you were to ask me if being a group fitness instructor was something I ever thought I would do in my life, I would have said no! I'm the opposite of the super fit, outgoing, loud, extrovert that you expect to teach group fitness classes. It seemed like a crazy idea, especially with a busy practice, but I decided to do it as it gave me an opportunity to step outside my comfort zone and learn new skills. As the class I teach is martial arts-inspired, it has also sparked a renewed interest in studying different types of martial arts such as Muay Thai and boxing. The medical profession is not your typical 9-5 job for most. It can consume your whole life if you let it. I think it is important to pursue outside interests to help us stay physically and mentally healthy, which can then help us have a long and rewarding career! Photo by Aaron Fong

SMA DIGEST | FALL 2019

Dr. Ettiene Crouse Family physician, Moosomin On staying whole Both me and my wife enjoy farm life and I always used to help farmers around our area in my spare time. We bought some farmland of our own 10 years ago and raise cattle in our leisure time. This is possible with the support of my wife (who grew up on a farm), my colleagues and friends. They help me with various projects and my colleagues are very understanding with on-call scheduling during busy times on the farm. Farm life has helped me both physically and mentally to cope with a very busy practice. I feel all physicians need something outside their clinic for stress relief and the farm has been excellent for me.

Dr. Joanne Sivertson Obstetrician-gynecologist, Prince Albert On staying whole My outlets are running, cooking and socializing with family and friends. There is a catharsis in an early morning jog through the trees. I run without music, which allows me to work through issues on my mind or simply clear my mind and focus on the moment. It gives me a fresh and energizing start to the day. But truth be told, I first started running in order to counterbalance my enjoyment of food and wine. Food is often a central component to my social gatherings, and socializing with loved ones is my greatest joy in life. I am blessed to be surrounded by wonderful people who are encouraging and supportive, pragmatic and constructive, accepting and loving. They give me perspective and keep me grounded, which in turn increases my capacity for compassion and empathy. Recharging my batteries gives me the stamina to face the hard days. Taking time for myself and leaning on those around me makes me a better physician. 32

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Dr. Tara Lee | family physician, Swift Current On staying whole To keep my mind clear and to maintain a positive perspective on life, it is important for me to stay grounded with family and get physical activity. I strive to be a role model to my children by living a healthy lifestyle. Although I review the dangers of these activities while I approach them, I remind myself that it’s important to be physically active, enjoy nature and not impart my fear onto my children just because their mother is a doctor. We ski, bike, hike, surf, waterski, tube, quad ride and golf. On the flip side, I also like to take vacations that are relaxing, with no agenda. The best vacation I ever had was this summer when I had no idea where I was going, what we were going to do or even where we were staying. Giving up control and going with the flow is good medicine. I learn from my patients on a daily basis. I’ve learned that life is precious, you need to enjoy every moment. But mostly I’ve learned to be grateful. SMA DIGEST | FALL 2019

Dr. Don Gelhorn Family physician, Hudson Bay

That enabled me to commute back and forth to work and still be at the lake, where I could enjoy water skiing, windsurfing, kayaking and swimming when I was there. In the winters I was able to get on my snowmobile in my backyard and within minutes was able to access groomed trails that travel for hundreds of miles through the forest. Or, I could drive to some amazing crosscountry ski trails in the pine forest just a few minutes south of town.

On staying whole All of us strive for work-life balance. Success or failure to achieve this balance is not unique to rural doctors. Good nutrition and rest, positive efforts, and time to enhance your emotional commitment to your spouse and family, adequate holiday time, ongoing learning to maintain professional competence, and the pursuit of hobbies are all important steps in a self-preservation strategy. Fortunately the simplified lifestyle of a smaller community may offset some of the stressors. During the summer months we moved out to our cabin at the lake just a few miles from town.

Dr. Lettie Kgobisa Family physician, La Loche Health Center On staying whole I’m like most people. If it were up to me, I’d probably be home just sitting after work, watching TV or it watching me. However, I have recently started joining my colleagues for walks and going to the gym. It has made a huge difference in my life. I find I have more energy, my mood has improved and I’m more resilient. Before reaching out to my colleagues and accepting invitations to go hiking or walking, there was that isolation and feeling disconnected. I’ve also joined a neighbour when I’m in the city to go golfing a few times. I liked it and I think you may have Serena in the making – in about 10 years of course. Just connecting with people has opened a world of possibilities outside of work. Dr. Nomhle Chawane had been urging me to join them for some time. I finally did, and what a difference it has made.

Dr. Lettie Kgobisa (middle) 34

SMA DIGEST | FALL 2019

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SMA DIGEST | FALL 2019

TAPPING THE POWER OF

SPECTRUM Dr. Shaqil Peermohamed is using a cellphone app to disseminate information on the antimicrobial stewardship program to the province’s physicians

By Girard Hengen

Innovative physicians like Saskatoon’s Dr. Shaqil Peermohamed are tapping into the potential of the ubiquitous cellphone to improve patient care in ways that were unimaginable just a few years ago. Dr. Peermohamed is the physician lead of the antimicrobial stewardship program in Saskatoon. When he started in his position in 2016, he and the program’s pharmacy lead, Justin Kosar, were a small operation with big plans. One of the biggest challenges they faced was how to get the latest information on managing infections – tailored with local antibiotic resistance patterns – to physicians across Saskatchewan to prevent unnecessary or inappropriate usage. “With our program’s limited resources, we needed an innovative medium to effectively generate and disseminate current, evidence-based information for health-care professionals,” Dr. Peermohamed told the SMA. Traditionally, physicians have used pre-printed order sets or paper pocket guides that specified – in print – which tests to order or which antibiotics to use for various infections. “The concern with using pre-printed order sets in health care is this concept of muda, which is a Japanese word for

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waste in terms of quality of care,” said Dr. Peermohamed. “If we see a change in local antibiotic resistance patterns in our hospital or community, we need to be able to quickly adapt and adjust our antibiotic recommendations to our physicians and pharmacists. With pre-printed order sets, how do you quickly make a new order set, how do you get rid of the old one, and how do you ensure that no one is referring to that old one anymore? “That’s where the power of technology lies – because if we use an app and can ensure that the information is updated automatically, we can eliminate muda and we can ensure that clinicians have evidence-based information that’s up to date based upon local resistance patterns. This could essentially change prescribing patterns in Saskatchewan to help physicians and pharmacists make the best decision for their patients.” Spectrum is an app developed by two medical residents in Calgary who worked with software developers and teams from the University of Calgary and Alberta Health Services. Spectrum can be customized to provide local antimicrobial stewardship resources in any hospital. It can be used at the point of contact with patients, giving physicians evidencebased guidelines, antimicrobial information that incorporates local resistance patterns and updated antimicrobial formulary content.

“We had already seen several success stories following the implementation of their app, so we wanted to bring this to Saskatchewan,” said Dr. Peermohamed.

Peermohamed said a current push is to encourage more family physicians to use Spectrum and optimize prescribing patterns in community settings.

Spectrum was launched in Saskatoon on April 12, 2018, and made available for free to all health-care professionals through a University of Saskatchewan College of Medicine research award. More than 500 people downloaded Spectrum in the first week, and it currently has more than 800 active users. In November 2018, Spectrum content was accessed more than 2,400 times.

Dr. Peermohamed emphasizes the success of Saskatoon’s antimicrobial stewardship program has been a collaborative effort involving many stakeholders, including clinicians and specialists, microbiology staff, administrators and senior leaders in pharmacy administration. All saw the need to prioritize principles of antimicrobial stewardship.

Physicians, pharmacists, residents, nurses and medical students are the most common users, and the most popular clinical pathways reflect common community-acquired infections. The average user spends two minutes, 42 seconds accessing content, which Dr. Peermohamed says indicates clinicians are rapidly accessing relevant information. While the highest usage is in Saskatoon, Spectrum hits have been tracked to Regina, North Battleford, Prince Albert, Moose Jaw and Swift Current. After nine months of use on Royal University Hospital medical units, total antimicrobial use and anti-pseudomonal antimicrobial use were down 25 per cent and 35 per cent respectively. Dr. Peermohamed says this likely reflects “improved guideline adherence and appropriateness of antimicrobial prescribing.” Some of Spectrum’s success is attributed to the developers engaging specialists when they created content for the app. They asked physicians what information would be most helpful and which infections they are most commonly seeing. This input helped the developers tailor the app so it is most beneficial for front-line prescribers of antibiotics. Dr.

“We wanted to engage clinicians with an easy and simple platform to navigate and access information,” he said. “The impetus certainly was the fact that we see high rates of inappropriate prescribing, and that’s not just in Saskatchewan, that’s an international problem.” Dr. Peermohamed concludes that, although some of the major issues treatment and care persisted L-R: Dr. Neville VaninDer Merwe, Dr. Melissa Fillis,have Dr. Bronwyn Carroll for years, technological developments harnessing the power of a cellphone through an app provide never-imagined opportunities for physicians to address these issues and provide better care for their patients. “I think back to when I was in medical school and if I had a question regarding what antibiotics to give to a patient, I would have to spend a decent amount of time – and interrupt my work flow – to access guidelines and other resources, and then reflect upon local resistance patterns,” said Dr. Peermohamed “However, by centralizing evidence-based guidelines and integrating local resistance patterns into one central platform that’s easy to access and navigate at the patient’s bedside, I believe this improves clinician workflow and efficiency so they can then spend more time at the bedside with their patients.” ◆

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WE WANTED TO ENGAGE CLINICIANS WITH AN EASY AND SIMPLE PLATFORM ... THE IMPETUS CERTAINLY WAS THE FACT THAT WE SEE HIGH RATES OF INAPPROPRIATE PRESCRIBING, AND THAT’S NOT JUST IN SASKATCHEWAN, THAT’S AN INTERNATIONAL PROBLEM.

SMA DIGEST | FALL 2019

DOC BOX in a

Dr. James Purnell is addressing the physician shortage in Wollaston Lake head on through remote presence technology

By Maria Ryhorski

dequate physician coverage is an ongoing struggle in many remote communities in northern Saskatchewan. Through a partnership with Northern Medical Services, Dr. James Purnell is helping change that for the residents of Wollaston Lake using remote presence technology, less formally known as “doc in a box.” Wollaston Lake is located 550 kilometres northeast of Prince Albert and is only accessible by air or winter roads. Previously, physician coverage was sporadic, with as many as twothirds of planned physician clinics cancelled due to weather and other factors that rendered landing a plane impossible.

“What made me try this is that, when Northern Medical Services approached me, Wollaston had been without physician services for two months prior,” says Dr. Purnell. “There is an acute physician shortage.” While he admits that a remote presence is not ideal, it is a great deal better than nothing. Using “doc in a box”, a solution similar to telehealth, Dr. Purnell is able to hold a weekly clinic in Wollaston Lake. Dr. Purnell can access the system from anywhere with a cellphone connection, and patients see him and interact with him on a screen. On the ground in Wollaston, clinic staff act as his hands as he examines the patient using a variety of peripheral attachments.

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“I have access to a Bluetooth stethoscope, so whatever the nurse hears in the exam, I can hear,” he says. “I have the audoscope, the ophthalmoscope and a dermatocope that plug in digitally so I can do your nose, throat, eye and dermatological exams. So I run it as a full clinic, providing a full day of clinic time to one dedicated community.”

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THE PRIMARY REASON I’VE SEEN PROGRAMS LIKE THIS FAIL IS LACK OF RELATIONSHIPS. IT’S ALL ABOUT THOSE RELATIONSHIPS WITH THE COMMUNITY AND INTER-PROFESSIONAL RELATIONSHIPS.

To date, this technology has primarily been used in acute care. Dr. Purnell’s application of it – to provide a regularly scheduled primary care clinic to a community that would not otherwise have physician coverage – appears to be the first of its kind in Canada and possibly even the world. He also flies to Wollaston Lake once a month to provide care in person and to build relationships with the clinic staff – something he considers critical to the success of this program. “The primary reason I’ve seen programs like this fail is lack of relationships,” says Dr. Purnell. “It’s all about those relationships with the community and inter-professional relationships. You especially have to have a good collegial working relationship with the nursing staff because they’re your hands and your eyes.” In his experience, if an interaction between local staff and the physician is negative, the staff will be reluctant to use the technology again. In addition, the lack of face-to-face contact has the tendency to amplify the potential for a negative interaction. “So you have got to be able to answer the phone at two in the morning with a smile on your face,” advises Dr. Purnell. If this program is expanded to provide care in other remote corners of the province, he suggests that the personalities of the physicians who will be involved should be a primary

consideration. “You have to be really selective about who those early adopters are and what their personalities are like, because they have to come across as both collegial and helpful when working with nursing staff and the rest of the team.” Payment is one of the barriers to using this technology to alleviate physician shortages in northern communities. “There is still no billing code for the work that I do,” says Dr. Purnell who, as a salaried physician, is able to continue virtually “seeing” his patients in Wollaston Lake. However, feefor-service colleagues have limited billing codes for reimbursement of this type of service. Currently, in order to be reimbursed for providing virtual care, doctors and patients must both be located in a government-approved telemedicine facility. Using “doc in a box” to provide care from more convenient spaces such as a physician’s office, home or hotel room, as Dr. Purnell does, is not covered. This is a gap that the SMA is working with the Ministry of Health to address. In the meantime, Dr. Purnell, Wollaston Lake’s resident docin-a-box, continues to nourish relationships with his colleagues in the north with a monthly Costco run for fresh fruit and vegetables to bring with him when he visits. “A little bit of food never hurts, you know? You can win hearts and minds with food. I really appreciate the work they do for me.” ◆

Family Physicians Evergreen Medical Clinic in Saskatoon is seeking family physicians to join our team in our new purpose-built medical clinic. Located at beautiful Evergreen Square in the Evergreen community in Saskatoon, the clinic has in-house laboratory, X-ray, and ultrasound units, as well as a pharmacy. It is a paper-light clinic with offices and examination rooms equipped with networked computers for EMR use. We will provide the staff and equipment for you to work as much or as little as you would like. We have booked appointments and walk-in appointments as well as a minor injury clinic. We have well-equipped treatment rooms and consulting rooms. Our extended hours will make it possible for our doctors to have more opportunities to work if they so desire. We have a competitive expense split ratio of 75/25 for locum doctors and 80/20 for full-time doctors.

To set up time to discuss the opportunities available, please call Dr. George Tuwor at 306-331-0245 or email your CV to inquiriesmedicalclinic@gmail.com. SMA DIGEST | FALL 2019

WEALTH OF INFORMATION ABOUT PATIENTS, PRACTICE AVAILABLE TO FAMILY PHYSICIANS By Girard Hengen Detailed practice reports covering everything from prescribing patterns to patient demographics are now available to Saskatchewan family physicians. Primary Care Panel Reports are voluntary reports that provide physicians who request them with a wealth of information about the patients they see regularly. The reports were developed by the Health Quality Council (HQC) with support from the Saskatchewan Medical Association (SMA), the Saskatchewan College of Family Physicians and the Department of Academic Family Medicine at the University of Saskatchewan. They are generated using administrative health databases at the Ministry of Health and eHealth Saskatchewan under a data-sharing agreement. eHealth Saskatchewan also contributed technology and infrastructure support. “The Saskatchewan Medical Association is pleased to have assisted the Health Quality Council in developing panel reports for family physicians,” said Dr. Allan Woo, president of the SMA. “In fact, physicians are already making use of their reports and are using the information to learn more about their practices. The SMA encourages family physicians to use their panel reports and apply the insights they learn to their clinics, and in that way better serve their patients.” The initial version of these reports includes information about a doctor’s patient population such as age, sex distribution, frequency of visits, common reasons for visits and use of other health services (i.e., visits to other physicians,

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to emergency departments, admissions to hospital). The 16-page reports also provide physicians with information about their prescribing patterns for certain medications (antipsychotics, benzodiazepines and opioids) relative to meaningful targets or benchmarks. An advisory group of eight family physicians provided direction on what information to include in the reports. The reports were piloted with family physicians practising in the Prince Albert area starting in October 2018. Dr. Christo Lotz of Prince Albert says his report has caused him to reflect on his own practice. He was surprised to see that his level of connection with patients was considerably lower than he expected. However, the discrepancy made more sense once he realized his results combined the patients he sees in his by-appointment-only practice (who receive most of their care from him) and patients he sees at a separate walk-in clinic (who receive most of their care from other providers). “The common denominator for all family physicians would be whether it reflects how you wish to practise and where potential areas for improvement would be,” said Dr. Lotz. For him, the panel report has prompted him to ask questions about his practice he hadn’t previously considered. He says he’s looking at ways to use it to “interrogate” his electronic medical record system on a regular basis, to learn more about the way he delivers care. Visit the HQC website for more information: https://bit.ly/2OzqfOS. ◆

FLUENCY DIRECT ROLLING OUT

in the offices of fee-for-service physicians By Maria Ryhorski A new program being rolled out by the SMA’s EMR program in partnership with 3sHealth and the Ministry of Health has doctors raving about the increased efficiency it has brought to their practice. “I spend more time on direct patient care and less time charting” says Dr. Mark Brown, a busy family physician in Moose Jaw. He began using Fluency Direct, self-edit dictation software, as part of a pilot program. “This makes me way more efficient and I am regularly home on time, whereas in the past I would stay late, fighting with my computer as I tried to type my clinical notes.” Fluency Direct works with the EMR so that, as a physician speaks, their notes appear directly in the patient’s record. The software transcribes with great accuracy by learning the physician’s voice, accent and language nuances. Until now the software has been available only to non-fee-for-service physicians through 3sHealth, leaving fee-for-service docs like Dr. Brown without funding to access this time-saver. At the 2018 Fall Representative Assembly, Aftab Ahmad, director of the Saskatchewan EMR Program, heard from a concerned physician about the need for this type of solution among family doctors. He worked with that physician to shape a resolution directing the EMR program to take the lead in bringing access to fee-for-service physicians. “The biggest barrier was initial cost,” says Ahmad. “Now our program is providing that initial cost, the implementation and ongoing support. This work is directly connected to our Enhanced Use Strategy, whereby we assist physicians with using a variety of tools to enhance the functionality that they have within their EMR. It creates a better platform for analytics, better reporting, and with more digitization comes greater ease of use.” In a partnership that Ahmad describes as “phenomenal,” the Saskatchewan EMR Program worked with 3sHealth and the Ministry of Health to bring this efficiency into the offices of fee-for-service physicians. “3sHealth is excited to collaborate with the SMA to bring self-edit dictation to physicians working in numerous patient care settings across the system,” says Julie Johnson, director of Provincial Dictation and Transcription Services at 3sHealth. “With approximately 600 Saskatchewan physicians already using self-edit software to dictate, edit and

upload care reports all in one step, we are seeing significant benefits for patients and their care teams. These benefits include rapid availability of patient-care information, standardized documentation, reduced delays for patients and well-informed care teams.” Erin Kulcsar, team lead of the EMR program, is spearheading the roll out of the Fluency Direct program to SMA members. “Some of what excites me is that I know this is not just something that is wanted by physicians,” says Kulcsar. “I know it’s something that’s truly going to help them, and for me that makes all the difference.” The program is now prepared for wider distribution, with funding available to provide the initial start-up cost of $2,350 (implementation, hardware, training and first-year subscription cost) for Fluency Direct to each fee-for-service doctor. These doctors would then be responsible for the ongoing licencing costs of $425 per year, beginning in year two. The EMR program has dedicated practice advisors to provide one-on-one support and training to physicians, as users learn the program and how to optimize its use in their practice.

“

SOME OF WHAT EXCITES ME IS THAT I KNOW THIS IS NOT JUST SOMETHING THAT IS WANTED BY PHYSICIANS. I KNOW IT’S SOMETHING THAT’S TRULY GOING TO HELP THEM, AND FOR ME THAT MAKES ALL THE DIFFERENCE.”

For Dr. Brown, the decision to get Fluency Direct was an easy one. “I firmly believe that any physician who cannot type faster than they can talk needs a voice-recognition system to complement their electronic medical record,” he says. “From a cost point of view, I believe it is extremely good value for money. Further, I find that I am less fatigued than I was prior to using Fluency Direct, due to the improved efficiency. This improved work-life balance has been a massive boost for me.” If you are a fee-for-service physician interested in accessing Fluency Direct, please contact Erin Kulcsar at erin.kulcsar@ sma.sk.ca or emr@sma.sk.ca. ◆ Halima Mela

SMA DIGEST | FALL 2019

HEALTH NETWORKS BRING TEAM-BASED CARE CLOSER TO HOME

By Maria Ryhorski and Emmanuelle Morin

The call for a redesigned health system has grown loud over the last several years. Patients voice concerns with a system that is often fragmented, difficult to navigate and ultimately not meeting their needs. The demands of practising in this environment feel unsustainable to many physicians, and the number of physicians who report being at risk of burnout is high. Efforts are underway to address some of these system issues through a focus on team-based care. Health Networks are collaborative teams of health professionals, including physicians and community partners, who work in concert to provide fully integrated care to the individuals in a particular geographic area. They are envisioned to play a key role in improving access and quality of community based care, and strengthening health-care teams. The services offered within each network will be informed by data to ensure that they are reflective of local needs. For example, a Health Network that serves an inner-city neighbourhood with high mental health and addictions issues would have more social workers and addictions counsellors within it compared to a suburban network where the primary need might be public health and well-baby checks.

SMA DIGEST | FALL 2019

“Our goal with Health Networks is to ensure our patients receive coordinated and appropriate care as close to home as possible through team-based interdisciplinary care,” says Dr. Kevin Wasko, physician executive for integrated rural health with the Saskatchewan Health Authority and executive sponsor for Health Network development. “When patients receive care that is more integrated and less fragmented, physicians will also benefit. “Currently we see emergency departments overwhelmed with patients, many of whom would be more appropriately cared for elsewhere but they often don’t know where else to go,” said Wasko. “I know that navigating the system is just as overwhelming for us as family physicians. A team-based approach with strong interdisciplinary relationships will make care more accessible, coordinated, timely and centred around patient needs. Everyone will benefit.”

ealth Networks have been operating in parts of Regina for a number of years. Alison Hamilton, who lives with cystic fibrosis, recently experienced receiving care through a Health Network. She noticed a marked change for the better and was happy to share her story with SMA members. Alison Hamilton is from Regina and lives with cystic fibrosis. Niki Afseth is an adult cystic fibrosis nurse clinician who provides care to Hamilton and others living with cystic fibrosis. Karen Zemlak is a network access services assessor coordinator with the Saskatchewan Health Authority.

ALISON: A complication of living with cystic fibrosis (CF) impacts my gastrointestinal system and requires me to undergo a procedure typically performed in an acute-care setting. It wasn’t a good experience the first time I had this completed in hospital: I had to have this sensitive procedure in the emergency room with no privacy. Since the adult CF program is in Saskatoon, I was required to travel from Regina for the procedure, which was difficult with my young family. When it was time to undergo the procedure a second time, I shared my frustration of having the procedure done in hospital with Niki, not thinking there was any alternative. But she made some magic happen. NIKI: I knew this was a nursing procedure and although I didn’t know anything about networks in Regina at the time, I knew there had to be an alternative. I contacted the Regina home-care team and was forwarded to Karen. I don’t know what magic she created behind the scenes; I just know we were able to complete the procedure in Alison’s home. KAREN: My role is to determine and coordinate what professions are needed to provide care for patients within my network. I share an office with our network’s nurse practitioners, so communication surrounding Alison’s procedure was seamless. One of our nurse practitioners, Arnold, was equipped and willing to perform the procedure in Alison’s home and the specialist overseeing Alison’s care in Saskatoon approved of Alison receiving the treatment in this home setting.

ALISON: It was all so patient focused. Arnold contacted me and worked to schedule the procedure at my home at a time that worked for us both. The procedure lasts 24 hours, and a network-based paramedicine team came to my home midway through to check on me. Afterwards, Arnold and I were both amazed at how well it worked for both of us. From my perspective, I don’t have to worry about how network geographies or resources are structured, I just know my care includes everyone involved. I can see now how Health Networks will work to connect all aspects of my care, including my specialist physician in Saskatoon and my family physician in Regina who are both critical to my care. Health Networks, like the one serving Alison, are planned for all of Saskatchewan. Each network’s team will be tailored to meet the needs of patients in that geographic area based on healthcare use data from that area. The aim is for patient needs to be met more quickly and by the appropriate health-care professional, as close to home as possible. Expect more on Health Networks in coming issues of SMA Digest, when we’ll share physicians’ experiences with and perspectives on Health Networks. To learn more about Health Networks, visit our website: www.sma.sk.ca/news/291/sha-health-networks-geography. html. We welcome new ideas on how to improve health-care delivery. To share yours, please email sma@sma.sk.ca. ◆

“

OUR GOAL WITH HEALTH NETWORKS IS TO ENSURE OUR PATIENTS RECEIVE COORDINATED AND APPROPRIATE CARE AS CLOSE TO HOME AS POSSIBLE ... WHEN PATIENTS RECEIVE CARE THAT IS MORE INTEGRATED AND LESS FRAGMENTED, PHYSICIANS WILL ALSO BENEFIT.

SMA DIGEST | FALL 2019

eHEALTH LAUNCHES

MYSASKHEALTHRECORD

A few weeks ago eHealth launched a new initiative called MySaskHealthRecord, a secure website that provides Saskatchewan citizens with access to their personal health information. People who sign up will be able to see their lab test results, medical imaging reports and all clinical visits (displayed as inpatient, outpatient or emergency visits to a health-care facility). Physician notes, however, will not be accessible to patients. According to eHealth, there is no intent to create additional responsibilities for physicians. Instead, MySaskHealthRecord is intended to be used as a tool for patients to view, monitor and track their personal health information. It may help patients better understand their health conditions and allow them to prepare in advance for their doctors appointments. Physicians were consulted about MySaskHealthRecord and were part of the team that developed the patient portal. In addition, on behalf of eHealth, the Saskatchewan Medical Association surveyed its members twice this summer on MySaskHealthRecord. Physicians are not required to learn about or use MySaskHealthRecord. However, they should be aware that patients may now have direct access to personal health information. Physicians will not be able to access a patient’s MySaskHealthRecord account. Patients, however, can use their tablet or smartphone to share this information with their physician, if they choose to do so.

SMA DIGEST | FALL 2019

Patients will not be able to message physicians through MySaskHealthRecord. They will have access to their results and personal information prior to an appointment with a physician, so they may have questions. Patients will also be able to view potentially sensitive information without having to receive it from a physician. As soon as a patient’s results are available, that information will be accessible for health-care providers in the Electronic Health Record Viewer (eHR Viewer) and, when applicable, will also be displayed in the patient’s MySaskHealthRecord. MySaskHealthRecord will include a disclaimer to indicate that a patient’s results may not be final and will require interpretation by their health-care provider. ◆

Resources Backgrounder and Q&A for physicians: https://secure.campaigner.com/CSB/public/ archive.aspx?args=MzgxNjEzOTY%3d&acc=NTc5 ODgw eHealth Saskatchewan Service desk: 1-844-767-8259 www.ehealthsask.ca/NewsPage?StoryID=21

KNOW YOUR

PATIENTS

As advances in technology accelerate, Dr.Brenda Dalibor Slavik Senger, Director, Physician Support Programs brings home the importance of the doctor-patient relationship and knowing your patients

By Maria Ryhorski Dr. Dalibor Slavik immediately grasped the severity of his long-time patient’s pain, noting his strained movements as he struggled to get out of his chair, and the tight, pale expression drawn across his face. “I just knew that there was something going on.” This particular visit took place at Dr. Slavik’s clinic, where he was able to observe the patient’s symptoms, not just hear about them. These in-person visits are still the norm but a recent survey by the Canadian Medical Association shows that the public is pushing for a different type of care. A significant majority of those surveyed indicated a desire for virtual care, with 75 per cent believing it would improve access, and two-thirds believing that it would be more convenient and result in better care overall.

While Dr. Slavik emphasizes the importance of leveraging technology to improve patient care, he also believes that truly getting to know your patients and building a trusting relationship with them is at the core of good family medicine – and that’s difficult to do from the other side of a screen. “Face-to-face contact is extremely important,” notes Dr. Slavik. “Long story short, this patient had cancer of the spine and I might not have picked it up if I hadn’t seen him.” The patient went into surgery that night, just a few hours after coming into his office with back pain. That face-to-face interaction provides the opportunity to observe a patient’s body language and expressions. It also builds trust and allows the doctor to truly get to know the patient. Once that relationship is established, the physician can decide when a virtual visit would be appropriate.

SMA DIGEST | FALL 2019

Subtle things like eye contact and active listening are things that Dr. Slavik focuses on to build that relationship. He recalls an elderly female patient who came in one day and talked at length. “Some of the time, I didn’t even know what she was really talking about,” he says with a laugh. “She told me about all these problems that she had and they were problems that you really couldn’t do anything about. And then afterwards she stood up and said, ‘Well, doctor, thank you very much. You’ve really helped.’ My first reaction was, ‘But I haven’t done anything.’ And then I thought about it and realized, but I did. “Medicine goes more and more in the direction of big machines and MRIs, but still there is nothing that can take the place of sitting down with a patient and talking with them, explaining to them what’s going on, and giving them some sort of reassurance.” Dr. Slavik notes that this in-person interaction is often particularly important among patients with cancer, who are often propelled from one specialist to another, “and nobody, at any stage, explains to them what they can expect and why this is being done. And I think that’s where the family physician comes in. That’s why trust needs to be there, so that when you explain the whole situation to them, they can understand it.”

Building a relationship with patients where there is mutual trust allows patients to feel safe and cared for, both physically and mentally. “I would say that, often, more than half the problem is what goes on inside your head. So that mental and even social component of care is very important.” For this reason, Dr. Slavik makes a point of following up with patients who have recently been in the hospital and out of his care. “I think that visit, though it could be perceived as unnecessary from a strictly medical point of view, is very important from a psychological and social point of view … Taking the time to say, ‘So you’ve had a hard time of it? What about your wife? How is she coping with it?’ That immediately opens up the conversation and that builds trust. “When I go back to that patient who came in looking pale and couldn’t get out of his seat,” Dr. Slavik says, shaking his head, “I mean it wasn’t anything else but a sixth sense that something serious was wrong. Every now and again you have that, and you can only get it if you know your patient and you’ve developed that trust with them.” ◆

“

STILL, THERE IS NOTHING THAT CAN TAKE THE PLACE OF SITTING DOWN WITH A PATIENT AND TALKING WITH THEM, EXPLAINING TO THEM WHAT’S GOING ON, AND GIVING THEM SOME SORT OF REASSURANCE.

SMA DIGEST | FALL 2019

Celebrat ing

our staff

From programs, funds and events that support your health, education and professional life, to the EMR system in your office, to the communications that keep you abreast of health-care developments and celebrate your medical community dedicated SMA staff are at the heart of it all, working to support you. In this special feature, we recognize the achievements and milestones that our staff have reached in 2019, and give you the opportunity to get to know them a little better.

SMA DIGEST | FALL 2019

ED HOBDAY

receives national honour for lifetime of dedication to Sask. doctors

By GIrard Hengen After almost 50 years, Ed Hobday is still stickhandling his way through contracts and negotiations, and battling in the corners for Saskatchewan’s physicians. Hobday’s career with the Saskatchewan Medical Association (SMA) reached a milestone in August when he received the CMA Owen Adams Award of Honour, the highest award the Canadian Medical Association bestows on an individual who is not a member of the medical profession. A hockey player in his youth, Hobday has applied the same energy that keeps him on the ice today for oldtimers’ games to his 49-year career at the SMA. Eager and enthusiastic, Hobday never seems to have a bad day at the office. “The reality is I really enjoy what I do, I couldn’t want for a better job,” Hobday said. “I keep telling people that I have the best job in the world.” He was “surprised and humbled” upon hearing he was to receive the Owen Adams Award of Honour. “I had no idea that my name had even been put forward as a candidate. That people I work with would think of me in that way is quite overwhelming and unexpected.” When he was hired in 1970, the SMA office consisted of executive director Dr. Ernie Baergen and three support staff.

The board decided to create a new position, someone to work in statistics and economics, assist in negotiating fee schedules and help out in accounting and bookkeeping. “My first meeting was a tariff committee meeting, and I remember it clearly,” Hobday said. ”The thing to keep in mind is we had a small organization and small staff, so I got involved in most everything the SMA was doing. Right off the get-go I went to board meetings and all of the committee meetings. We didn’t have nearly as many committees as we do now, though. We had the finance committee and insurance, tariff and economics, and the board and RA. “I got to go to all of those meetings, and I very quickly had the opportunity to meet a lot of physicians. I just appreciated what fine folks they were and how they accepted me. I always like to say I work with and for docs, and to this day it is still the case. In some instances, I simply execute the decisions they make, and at other times I might be able to give them advice or suggestions as to what they might do because I can put a different lens on some of these issues.” Through his work with the SMA, nights playing hockey and his commitment to the community – he served as reeve of the RM of Corman Park – Hobday and his wife, Colleen, raised a family of four children. He acknowledges that without the support, and in some instances the sacrifices his family has endured, he would not have been able to throw himself into his job the way he has done. Hobday isn’t thinking about full retirement at the moment, although in theory he is now working four days a week. “I have no interest in any other job in the health-care sector other than the one I have. My health is still good, but I’ve been here a long time and we’ve got a good complement of people here in the SMA office. I tell people you won’t even miss me when I am gone because the organization is in good shape, and if it’s in good shape, it will be able to keep the docs of Saskatchewan in good shape.” ◆

SMA DIGEST | FALL 2019

Celebrat ing

years of service

Joelle Kostiuk

Coordinator, Membership & Benefits Joelle Kostiuk was working as a hairstylist when a client mentioned an opening as a receptionist with the Saskatchewan Medical Association (SMA). She cut ties with her old job and joined the SMA in May 1994. Twenty-five years later she’s still with the medical association, now as coordinator of Membership and Benefits. She says she has enjoyed her time at the SMA because of who she works for – the physicians of the province. “My job in the Membership and Benefits department allows me to interact on a daily basis with physicians,” she said. “Although my portfolio has not changed much over the last 25 years, the programs themselves have grown and become very important to physicians – and thus I am their go-to for information and assistance.” Hired by executive director Dr. Brian Scharfstein, Joelle has worked with three other CEOs and has seen staff numbers grow from eight to about 40. Her department has grown and she now has a co-worker to help handle the workload. It’s fair to say technology has changed her job, too.

“When I started, we did not have Internet – so no email. All mail was processed and posted for delivery. The fax machine was new at that time and we were excited when we started sending timely correspondence that way. Now email has taken over for postal services as well as faxing. Having Internet and Google was the best invention ever: No big phone books delivered each year, no encyclopedia references needed.” Colleagues and physicians alike have learned never to ask the spunky and outspoken Joelle a question they don’t want an honest answer to. She is always up for fun and mischief. Lunch hours spent with her are rarely dull. She is dedicated to members and her engaging, bubbly personality has allowed her to build many positive relationships. “Twenty-five years have gone by quickly and I am now looking forward in the next few years to retire,” she said. Retirement might find her at Candle Lake, where she spends the summer boating, fishing and socializing with friends. In the winter Joelle and her husband, Greg, take a two-week vacation somewhere hot, and ride their snowmobiles until the snow melts. Joelle and Greg have two grown children, Tianna, 26, and Tanner, 24, and enjoy time with them when they are home.

SMA DIGEST | FALL 2019

Cindy Anderson

Brenda Senger

Celebrating 16 years of service

“Well, that’s me,” said Cindy Anderson upon reading a four-line classified ad while she was in Saskatoon visiting her parents in 2002. The new position at the Saskatchewan Medical Association was an exact match for her unique experience in both individual and group insurance, and a background in health care.

You could say that Brenda Senger is something of an institution at the SMA. As director of Physician Support Programs, she is likely one of the most well-known employees among SMA members. Physicians in need regularly reach out to her, and many have heartfelt stories about her assistance and support. In addition to providing personalized help, Brenda is also a teacher and guide; her presentations on wellness at Representative Assemblies and in smaller sessions always receive high praise from physicians, who appreciate her knowledge, empathy and strength.

Director, Membership, Benefits & Insurance

Over the years she excelled and 16 years later she has expanded from administering one insurance product into director of Membership, Benefits, and Insurance for the association. She is accountable for the collection and administration of SMA membership dues, as well as SMA benefit programs including the Continuing Medical Education Reimbursement Fund, CMPA Reimbursement Fund, Retention Fund, Parental Leave Fund, and all of the SMA’s insurance products and services. During her tenure she has become familiar with all departments in the SMA. “As the SMA had a small staff initially, we supported each other when workloads were heavy or staff were on leave,” she recalls. “As a result, at some point I have assisted in every department of the SMA. This has given me an understanding and deep appreciation for the many facets of the association and how it truly serves the members.” Over her years at the SMA she has seen the organization – and the benefits and services it provides physicians – grow and evolve, providing a value for membership that she describes as truly extraordinary. She comes to the office every day, motivated to provide Saskatchewan’s physicians with the best support possible and finds this work deeply rewarding. “I get to witness the difference the SMA makes in the life of a physician,” she says, “such as support during a crisis, an insurance claim during illness or the retention fund payout at retirement.” When Cindy is not working to improve the lives of Saskatchewan physicians, she enjoys spending time with her husband of 31 years and their three children. She has a passion for learning, reads voraciously and listens to podcasts on her commute to and from work. “Everyone has something to learn,” says Cindy, “and everyone has something to teach.” 50

SMA DIGEST | FALL 2019

Director, Physician Support Programs

Brenda’s position, which she has held since 2003, encompasses the Physician Health Program and the Member Advisory Component, which supports doctors who are experiencing professional challenges. She also manages the Medical Benevolent Society, a fund that helps physicians who may be facing financial pressures as a result of unexpected life circumstances. She holds down a complex job that requires the skills of a labour relations officer mixed with equal parts counsellor and best friend. “I often summarize what I do as: ‘I comfort the distressed and I distress the comfortable.’ ” Brenda says her role has evolved over the years, but remains – at its core – about supporting physicians, medical learners and their families. She’s encouraged to see less stigma around physicians reaching out for assistance. “The opportunity to engage in the activities that bring me joy has kept me inspired and committed,” says Brenda. “To see the growth in people, to support people through tough times, to be invited into people’s lives at their most vulnerable and to marvel at their resiliency has been my privilege.” For Brenda, relaxation away from work is critical. How can she advocate for balance and wellness without setting a good example? “My husband Brad and I love spending time at our cabin, and he keeps me busy with projects there,” she says with a smile. “We love to travel, especially our hot holidays during Saskatchewan winters. I am a regular at the dog park.” Brenda is also passionate about hospice care. “Maybe in my encore career there will be time.”

Nicole Filteau

Maria Ryhorski

Celebrating 7 years of service

Celebrating 6 years of service

Nicole Filteau’s ready smile and energetic approach to improving physicians’ practices has been a constant in the clinics of south Saskatchewan since 2012. As a practice advisor she helps physicians navigate information technology and provides support and tools to enhance their practice workflows.

Maria Ryhorski hadn’t zeroed in on communications as a career path when her executive director at Canadian Virtual Hospice, an end-of-life care non-profit, suggested she would excel in the field. “She felt I was a strong writer and knew how much I loved it,” recalls Maria. “When she said that, it was like a lightbulb went on for me.”

Practice advisor, Saskatchewan EMR Program

During her seven years with the Saskatchewan EMR Program she has seen continuous change, both in her own role and in the work of the program itself. She started as a change management advisor, supporting physicians in the transition from paper records to electronic. Once the program achieved its goal of 80 percent EMR adoption in 2015, her role evolved to enhancing physicians’ use of electronic medical records. “We are building tools and services to assist physicians in reaching full potential in their EMR use.” This shift has been exciting for Nicole. “I have seen significant changes in access to information that supports the physicians in their practices,” she says. “I have also seen the desire for that technology increase and resistance decrease. There is an ongoing demand for more electronic access to information and tools.” Her years with the SMA have been rewarding and her drive to assist physicians continues to grow. “If I can help a physician with even one small change in their practice, I know that the impact of that change can result in a bigger, positive impact over time,” she says. “Knowing that the work I do is contributing to patient care in Saskatchewan keeps me motivated and driven. We are all patients in this province, so knowing that what I do can have a positive impact on my family and friends brings personal satisfaction.” It is those family and friends that bring Nicole joy and fulfillment outside of work. “I have a wonderful, fun, active family, including seven grandchildren that I love spending time with,” she says with a smile. “My husband and I are enthusiastic about travel and take every opportunity to plan trips and explore. When not working or travelling, I am an avid runner and a bit of a fitness and nutrition buff.”

Communications advisor

Since joining the SMA Communications department in April 2013, Maria has been helping the organization share its messages with stakeholders through words and images. She developed the current visual identity – including the logo and other promotional materials – and is editor of the association’s flagship publication, SMA Digest. “I do a little bit of everything in the Communications department,” says Maria, “but the thing I probably love most is getting to know the amazing doctors we have here in Saskatchewan and telling their stories.” Her role with the SMA has evolved and grown over the years, from mostly coordinating and assisting to more planning and advising. When she’s not writing or designing communications materials for the SMA, you can often find her exploring the far reaches of the world. “There’s nothing I love more than being in a new country, no map, and no idea where I’ll be sleeping that night, backpack on my back, breathing in all the beauty around me,” she says. “I was lucky enough to go on an expedition to Hang Son Doong in Vietnam this year – the largest cave in the world – and I saw the kind of beauty I never would have dreamed existed.” Closer to home, Maria enjoys heading to Lake Winnipeg to soak up some love and family time, or exploring northern Saskatchewan with her husband and their dog. “There’s nothing like boating into a remote lake, finding an island to set up camp and watching the day fade away to the sound of loons and a crackling fire.”

SMA DIGEST | FALL 2019

Tanessa Bauer

Mark Ceaser

Celebrating 6 years of service

Celebrating 5 years of service

The SMA Board of Directors is a busy group. Its 12 leaders meet at least a dozen times each year and steer the organization representing the 2,500 plus physicians who make up the medical profession in this province. As executive assistant to the Board of Directors, Tanessa Bauer helps board members stay organized and focused. She organizes their meetings, helps with correspondence and arranges other meetings and teleconferences with an array of health system and political leaders. Tanessa is also instrumental in organizing the SMA’s biannual Representative Assemblies (RAs).

Mark Ceaser has been with the SMA since December 2014. As the director of Economics, he’s the person in charge of crunching the physician compensation numbers for the association. “My educational background is in economics,” Mark says, “but I’ve done a wide variety of things, including being a professional recording/touring musician, a home support worker for adults with intellectual disabilities and an epidemiologist with Health Canada’s First Nations and Inuit Health Branch. At the SMA, a large portion of my time and energy is spent on feefor-service compensation files, such as tariff requests, billing issues, allocation and Payment Schedule modernization. It’s laborious work, but I like it a lot. I have a great team and we get a lot done.”

Executive assistant, Board of Directors

Tanessa began in her position in June 2013. “It looked like a place where there would be room to grow, so I took it,” says Tanessa. “My job is very busy and changes every day. There are always new board members coming on, and so I never feel like I am in the same job.” The RAs are particularly challenging because there are so many moving parts. Besides the main agenda, there are section meetings happening the day before, and awards, and banquets and receptions to organize. “I was an event planner in a previous life, so I draw on those skills a lot,” says Tanessa. “The most challenging part of putting together an RA is gathering all the moving parts, including people. I am always chasing down people to ensure they have information or have completed some small piece of the puzzle. But it all counts in the larger picture. And I am usually doing all that while I am keeping the board organized.” Currently on maternity leave, Tanessa is just as busy at home these days, raising her two children who are both under age two. In their free time, she and her husband Lee like to travel. Tanessa looks forward to returning to work: “It’s exciting and it’s going to keep growing, and I have formed friendships there that will last a lifetime.”

SMA DIGEST | FALL 2019

Director, Economics

Mark likes working with physicians. “Probably like most people at the SMA, I like working with physicians. We are here to provide advice, advocate on their behalf and facilitate conversations with other health-system stakeholders,” he says. “I think the work also holds a really good challenge. It’s complex, it’s like a large puzzle that’s missing a few pieces. There is just as much art as there is science in this work. I am very satisfied when we finally find solutions to these incredibly intricate problems.” When he’s not working at the SMA, Mark unwinds with family, music and meditation. “When I’m not around here, you can usually find me with Farideh, my lovely wife, and Paulina, my four-year-old daughter. Lately I have been practising meditation as a way to relax. I also like to play my guitar and occasionally still write songs – something I did professionally for many years,” he explains. “I have released a number of albums over the years, and I am very keen to stay in touch with the music world. Supporting Farideh’s career in music helps me do that. Her band, Rosie and the Riveters, have had great success and I enjoy being around her creative work. It’s fun and it’s something that brings the entire family even closer together.“

Erin Kulcsar

Team lead, Saskatchewan EMR Program

Celebrating 5 years of service Change has been a constant during Erin Kulcsar’s five years with the Saskatchewan Medical Association.

The health system is changing rapidly and strong physician leadership has never been more important. Gain the tools to lead in a CMA-SMA in-house PLI course.

In fact, even her title has changed, from, ironically, change management advisor to team lead, EMR program in Regina. “Over the last five years, the number of changes I have seen are exponential,” she said. “Our entire program has evolved to include new programs, new initiatives, roles, etc.” When Erin started in July 2014, the SMA was an unknown commodity to her. She had seen a job posting with the SMA in change management, a field she knew and liked. “When I researched the organization and the EMR program itself, I was drawn to the purpose and values of the organization and the exciting work that the EMR program does,” she said. “I was born and raised in Saskatchewan and as a proud resident of the province, I was looking for meaningful work to better our province. Health care is a critical issue for all citizens, myself included, and I was inspired to take on a role that would assist physicians in our province enhance patient care.” As change management adviser, she supported clinics in adopting an EMR. When the adoption rate reached 85 per cent, it became clear that the needs of physicians were changing. EMR program staff wondered how they could best serve physicians, and the strategy shifted from adoption to enhanced use. A new structure was developed and Erin was hired in January 2019 as team lead in Regina, where Erin and her husband – and three spoiled dogs – call home. As team lead she is responsible for two recently launched SMA programs: the Peer Support Program and Fluency Direct (see story on page 41). She is also responsible for five practice advisors (formerly change management advisors) who are being trained in the new programs. “I am extremely fortunate to work with such an exceptionally talented group of practice advisors,” Erin said. “This team is engaged and complements each other so well. We have been very successful in rolling out new initiatives while maintaining existing EMR programs.”

PHYSICIAN LEADERSHIP

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Watch sma.sk.ca/pli for more information or contact Samantha Lee at samantha.lee@sma.sk.ca.

SMA DIGEST | FALL 2019

COURSES CONFERENCES NOVEMBER

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FEBRUARY

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SMA DIGEST | FALL 2019

MARCH

PLI: LEADERSHIP FOR MEDICAL WOMEN March 6-7, 2020 | Regina, Sask. www.sma.sk.ca/PLI

APRIL

PLI: MANAGING DISRUPTIVE BEHAVIOR April 24-25, 2020 | Saskatoon, Sask. www.sma.sk.ca/PLI PEDIATRICS CONFERENCE April 25-26, 2020 | Saskatoon, Sask. www.usask.ca/cmelearning

CLASSIFIEDS ANNOUNCEMENTS SEEKING FAMILY PHYSICIAN ASSOCIATE

Saskatoon, Sask.

& gynecology in Regina at the University of Saskatchewan, where he became a Fellow of the Royal College of Surgeons of Canada. During the last two years, Dr. Zhao completed his fellowship in female pelvic floor reconstructive surgery at the University of Alberta in Edmonton, Alta. As the winner of multiple international fellowship grants, he went on to pursue additional training in Europe and the United States. Dr. Zhao is skilled in minimally invasive surgeries, including laparoscopic, robotic, and vaginal approaches. His clinical interests include:

Seeking an associate in family practice for a busy Saskatoon clinic. 21st Street Medical Group is located beside St. Paul’s Hospital in a fairly new building. Clinic hours are Monday Friday, from 9 a.m. to 4 p.m. On-call is minimal. A part-time associate has retired so we are seeking to fill this space. The opportunity is for a physician looking for either full- or part-time work at this busy practice. There is X-ray, U/S, PFTs, spirometry, and ECG access in building. Several consultants also work in the building making a total of 35 physicians on site. Practice available on mutual arrangements. If interested, please contact Dr. Yellepeddy Nataraj at 306-281-6221.

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Urogynecology: pelvic organ prolapse, stress urinary incontinence, urgency urinary incontinence, fecal incontinence

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Functional urology: urodynamic testing, recurrent UTI, voiding dysfunction, urethral diverticulum, lower urinary tract fistula

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General gynecology: abnormal uterine bleeding, contraception, infertility, abnormal pap, pelvic pain, and other benign pathology

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Obstetrics: low risk and high risk obstetrical care

NEW NEUROLOGIST IN REGINA: DR. LESLIE FERGUSON

Now accepting patients with a wait list of less than one month.

Regina, Sask.

Dr. Leslie Ferguson has started a practice in Regina for general neurology. He is fellowship trained in movement disorders. He will gladly see any of your patients with general neurology and movement disorder concerns. He is also able to provide botox injections for cervical dystonia, hemifacial spasm, blepharospasm and migraine headache. He is currently taking new patients from any of the southern health areas. Referrals can be forwarded as follows: Dr. Les Ferguson Ph: 306-566-4145 | Fax: 306-566-4150 Address: Regina Medical Centre 100 – 2250 12th Avenue Regina, Sask. S4P 3X1

NEW OBGYN AND UROGYNECOLOGY PRACTICE NOW ACCEPTING PATIENTS: DR. CHARLES ZHAO

Regina, Sask.

Dr. Charles Zhao, BSc, MD, FRCSC, grew up in Toronto, Ont. where he received his Bachelor of Science from the University of Toronto and subsequent medical degree from the University of Western Ontario in London, Ont. He continued his postgraduate residency training in obstetrics

Ph: 306-586-3120 | Fax: 306-586-3128 | E: drzhaoobgyn@gmail.com Address: 405-2631 28th Avenue Regina, Sask. S4S 6X3

DR. C. DEMKIW-BARTEL JOINING WILLOWGROVE MEDICAL GROUP

Saskatoon, Sask.

Willowgrove Medical Group wishes to announce that Dr. C. Demkiw-Bartel, CCFP, MD, BSP, BA, RT, has joined the practice. Dr. Demkiw-Bartel will be focusing her practice on skincare. Specifically: acne, acne scarring, melasma, eczema, rosacea, post inflammatory hyper-pigmentation, photo-damaged skin, aging skin/fine lines/wrinkles, general scars Warts: genital, plantar, general body, hand, skin tags, seborrheic keratosis, actinic keratosis, molluscum contagiosum, dermatofibroma Please feel free to direct your consultations here should your patients have concerns in these areas. Ph: 306-653-1543 | Fax 306-653-0422 Address: WIllowgrove Medical Group Unit #2 - 527 Nelson Road Saskatoon, Sask. S7S 1P4

SMA DIGEST | FALL 2019

IN MEMORIAM Dr. Marc Omar Shokeir 1969 - 2019

Dr. Marc Omar Shokeir died unexpectedly on March 28, 2019 in Battleford at the age of 49. He is survived by his mother Donna; sister Zivy (Lucien); his children Peter, Joy, Philip, Emma, Julia, Katherine, Eliza (mother Cheryl Shokeir); Ezra, Vincent (mother Candice Lankhaar); Madeline (mother Lisa Shaw); and numerous nieces and nephews. He was predeceased by his father Dr. Mohamed H. K. Shokeir. Omar was born, raised and attended medical school in Saskatoon. He was a brilliant pathologist and laboratory administrator who was privileged to practice in Vancouver, Bellingham, Red Deer, Calgary, Prince Albert, and North Battleford. During his 27 years as a physician he helped innumerable people, mentored many, served in medical associations in the U.S. and Canada, published many scientific papers, and helped establish several pathology laboratories. Ever the dynamo, Omar was an avid athlete who completed five Ironman Triathlons, numerous alpine climbs and rode his bike religiously. His vast knowledge and keen intellect earmarked him as a great conversationalist and led him to compete on â&#x20AC;&#x153;Jeopardy.â&#x20AC;? His friends and family will miss his compassionate listening, his sage advice, his kind soul, his prolific talking, his big bear hugs and his fabulous sense of humour. A memorial service was held on May 4, 2019. In his memory, contributions can be made to the Saskatoon Health Region Pathologists Fund in Medicine.

SMA DIGEST | FALL 2019

Traditionally, physicians in need of care feel guilty about accepting care and shame for needing it.

Letâ&#x20AC;&#x2122;s start

the conversation

Many physicians struggle with undiagnosed, untreated or self-treated mental health issues. Many others struggle with relationship and family issues, and substance abuse. If you or a colleague is struggling, please contact the Physician Health Program for confidential support.

Brenda Senger

Director, Physician Support Programs 306. 244. 2196 or brenda.senger@sma.sk.ca SMA DIGEST | FALL 2019 57

Photo by Dr. Lisa Smith, family physician

Return undeliverable Canadian addresses to:

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

Mail to:

40007031

SMA Digest - Fall 2019 | vol. 59: i. 2

Articles inside

Know your patients

Health Networks bring team-based care closer to home

Doc in a box

The individuality of being well

Working to meet the needs of our increasingly diverse population

Saskatchewan doctors walking the talk in the fight against climate change

Fluency Direct rolling out in the offices of fee-for-service physicians

Tapping the power of SPECTRUM

We need all hands on deck

Aids crisis: Looking back

A lifetime of change

Physician Teacher Learner

On a mission to bring physicians together