SMA Digest (Winter 2016) v.56 | i.1 by SMA Communications

A publication of the Saskatchewan Medical Association Volume 56 | Issue 1

DIGEST

WINTER 2016

PHYSICIANS RESPOND DURING FIRE CRISIS OF 2015

2013-17 AGREEMENT WHAT TO EXPECT

TRANSFORMING M&M ROUNDS a new model affects improvements in patient care

RETHINKING SENIORS CARE physicians agree change is needed

Transforming M&M rounds Winter 2016 | VOLUME 56 ISSUE 1 SMA Digest is the official member magazine of the Saskatchewan Medical Association. It is published twice per year and is distributed to nearly 90 per cent of practicing physicians in Saskatchewan.

Dr. Lisa Calder, lead researcher in the development of the Ottawa Model for M&M rounds, discusses how the model functions to identify cognitive and system issues at the root of adverse events, and how it translates these learnings into improvements in patient care.

Upcoming issues The next issue of SMA Digest will be distributed in Summer 2016. Advertising The deadline for booking and submitting advertising for the summer issue is Monday, June 13, 2016. Rates for display advertising are available upon request. Classified ad placement is free for members promoting physician, locum and practice opportunities; ads should be submitted via email and must not exceed 150 words. Feedback Member feedback is valuable and encouraged. Please direct comments, letters, ideas and advertising inquiries to: Maria Ryhorski Communications Advisor Saskatchewan Medical Association 201-2174 Airport Drive Saskatoon, SK S7L 6M6 (306) 244-2196 maria@sma.sk.ca SMA mission The SMA is a member based organization that promotes the honour and integrity of the profession. We: • Provide a common voice for physicians • Support the educational, professional, economic and personal wellbeing of physicians • Advocate for a high-quality, patientcentred health-care system

COVER PHOTO: Dr. Johanna Kaiser, in front of a Canadian Armed Forces light armoured vehicle, on the side of Highway 2, north of La Ronge last summer, while on “rounds” that took her to Wadin Bay and English Bay to provide care to fire crews and workers supporting them. Tanks and soldiers were a common sight in La Ronge and area after almost 1,000 military personnel were deployed to assist with the battle against the fires.

Residents help medical students prepare for CaRMS interviews An impending interview for the Canadian Resident Matching Service (CaRMS) can be a stressful prospect for medical students. For the first time the SMA and CMA cohosted mock CaRMS interviews, with residents helping year four students learn from their experience.

CONTENTS

2 4 6 10 12 14 15 16 18 19 21 22 24 26 30

YOUR SMA Presidentâ&#x20AC;&#x2122;s message Fall 2015 Representative Assembly highlights Representative Assembly resolutions Transforming M&M rounds Funding agreement addresses disparities and funds new programs Physician mentorship expands: docs4docs SMA insurance premium cheques mailed Making the most of medicine: reflections on a 59 Â˝ year career Retired docs continue to serve

HEALTH CARE Rethinking seniors care Collaborating to create a culture of safety Northern docs advocate for adequate physician supply Saskatchewan Change Day inspires health-care improvements Northern physicians respond during the fire crisis of 2015 Saskatchewan needs better tobacco control

STUDENTS & RESIDENTS 34 36 38 40

Residents help medical students prep for CaRMS interviews

42 44 46 48

UPCOMING COURSES & CONFERENCES ANNOUNCEMENTS CLASSIFIEDS IN MEMORIAM

Mindfulness benefits students Feeling empowered and engaged Roadmap Photo Contest winners

Physicians respond to fire crisis of 2015

While fires blazed across much of northern Saskatchewan during the summer of 2015, forcing the evacuation of many communities, a cohort of physicians remained behind to serve the brave men and women who fought the fires. Some of these physicians shared their stories.

PRESIDENT’S NOTE

PRESIDENT’S MES Greetings to my physician colleagues throughout Saskatchewan. It has been a privilege and honour to serve you since becoming your president. As I reflect on the past eight months, I am humbled by the great work you do each and every day. Some days, the work is routine and predictable, and at other times, it is quite the opposite. In this edition of the SMA Digest, you’ll read stories that reflect the four strategic priorities of the Saskatchewan Medical Association. As we continue to build a strong member-based organization, we are committed to providing support and services at the beginning through to the end of physicians’ careers. For the first time, the SMA in conjunction with the Canadian Medical Association hosted mock CaRMS interviews. It was a busy office on a cold January morning when residents put medical students through the paces in preparation for their CaRMS interviews (p. 34). And at the other end of the career continuum, a group of retired

SMA DIGEST | WINTER 2016

physicians is laying the groundwork for the new section of retired physicians that will have its inaugural annual general meeting during the spring Representative Assembly (p. 18). Enhancing physician well-being is a common thread in the work at the SMA. You’ll see this in several articles from details about the 2013-2017 Medical Compensation Review Committee (MCRC) Agreement (p. 12) to research that shows the benefits of practising mindfulness (p. 36). In a profile of retired locum Dr. Richard McIntyre, you’ll hear about how delightful it was for him to come home to Saskatchewan and fly to rural communities providing locum relief services (p. 16). I am grateful for your participation and leadership as the health-care system evolves and I encourage you to continue those efforts. For many of us, we demonstrated leadership by participating in the Health Quality Council’s Change Day (p. 24). We have also advocated for expanded controls on tobacco in the province

YOUR SMA

SSAGE (p. 30). At the 2015 fall Representative Assembly, we learned about improving mortality and morbidity rounds from our keynote speaker Dr. Lisa Calder (p. 10). Dr. Calder’s research has resulted in a more effective model for M&M rounds that identifies the cognitive and system issues at the root of an adverse event and translates that into action items for improving patient care. We believe in the importance of enhancing the role of physicians in the health-care team. When Dr. Intheran Pillay visited La Ronge as part of the President/Vice-President’s Tour, he heard how physicians in northern Saskatchewan responded when wild fires threatened their communities last summer. Their dedication and creativity ensured people from the North received timely and appropriate care whether they remained to fight fires or were evacuated to several locations in the province and beyond (p. 26).

you. I am proud of what you, my colleagues, do as we work to serve the people of Saskatchewan with appropriate access to high-quality and physician-coordinated health-care services. Sincerely,

DR. MARK BROWN SMA President president@sma.sk.ca

These and the other articles in the SMA Digest’s 2016 winter edition are intended to encourage and inspire

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PATIENT SAFETY & COLLEGIALITY at the fall 2015 representative assembly by Lana Haight Saskatchewan physicians continued their dialogue on ways to increase patient safety and improve collegiality at the 2015 fall Representative Assembly of the Saskatchewan Medical Association. “Increasing collegiality leads to better teams,” wrote one physician in the RA evaluation after the biannual meeting of the assembly held in Saskatoon on Nov. 13 and 14, 2015. “It was an opportunity to meet with colleagues, discuss issues, build relationships and learn about best practices,” the delegate continued. Sixty-eight delegates attended the assembly where the business of the medical profession and its association was discussed. Thirty resolutions were brought forward to the assembly. All were carried but one. A list of the resolutions is found on page 6. Other business included reports from the Board of Directors, the Finance Committee, and the Canadian Medical Association Board of Directors as well as a review of the 2015 spring RA resolutions. A report on the implementation of the 2013-2017 Agreement was also presented. SMA President Dr. Mark Brown affirmed the benefits of meeting twice a year. “The Representative Assembly is an excellent opportunity for physicians to come together to discuss issues that are affecting them as they strive to provide the best health-care services to their patients,” he said.

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In his address to the assembly, Dr. Brown covered three issues: • the urgency of establishing a comprehensive seniors strategy, • the importance of further developing primary care services, and • the necessity of improving collegiality. He shared with the delegates the concerns he and VicePresident Dr. Intheran Pillay heard during their fall tour of regional medical associations. Physicians explained the challenges seniors are facing in accessing appropriate care. Those who work in the North talked about some seniors having no local services at all and having to leave their communities for health care. Dr. Brown echoed the physicians’ calls to strengthen primary care in Saskatchewan in order for patients to have access to their physicians as often as needed, perhaps it is a phone call or even an answer to an email. These are the kinds of novel approaches to providing health-care services that are being explored through the “Whites of the Eyes” program. Collegiality – physicians working with physicians as well as physicians working with other health-care providers – is essential to moving Saskatchewan toward improved health care. Dr. Brown told the assembly that too often decisions are made that affect physicians but physicians are not involved in the process. He called on physicians to be stronger together to facilitate change.

YOUR SMA

RA delegates provided the SMA staff with valuable feedback that will help with the planning of future representative assemblies. Almost all of the delegates who filled out the RA evaluation gave the resolution process a high rating. Suggestions for improving the process included: circulating the resolutions in advance of the meeting and providing information on how to craft a good resolution. “Please provide information to delegates/new members on who and how resolutions can be made and brought to the table,” wrote one delegate. The Representative Assembly meets in May and November. When asked if the assembly should continue meeting twice a year, 30 respondents said yes while five said no. “There is not enough time in one RA to cover all the issues. Two RAs ensures follow-up of discussions, promotes collegiality. More frequent contact is better,” wrote one delegate. “This is a vital opportunity to connect with colleagues across the province. It allows for more timely discussion of important topics/issues affecting the profession,” wrote another.

“

THE REPRESENTATIVE ASSEMBLY IS AN EXCELLENT OPPORTUNITY FOR PHYSICIANS TO COME TOGETHER TO DISCUSS ISSUES THAT ARE AFFECTING THEM AS THEY STRIVE TO PROVIDE THE BEST HEALTH-CARE SERVICES TO THEIR PATIENTS.

Those who said they preferred one RA each year cited costs and time as reasons for making a change.

The 2016 spring Representative Assembly will be May 6 and 7 in Regina. SMA DIGEST | WINTER 2016

FALL 2015 RA RESOLUTIONS The fall meeting of the SMA Representative Assembly was held Nov. 13-14, 2015, in Saskatoon. These resolutions were carried or referred to the board during the meeting.

RESOLUTION 1

RESOLUTION 6

That the following members have been nominated as a delegate to the Representative Assembly: Dr. John Gjevre - Saskatoon Health Region Dr. Amith Mulla - Cypress Health Region Kassett/Brunet - Carried

That the 2016 ordinary membership dues be set at $2000

RESOLUTION 2 That the RA appoint Dr. Stan Oleksinski, Dr. Shayne Burwell and Dr. Vijay Trivedi to the Resolutions Committee. Sridhar/Kozroski - Carried

resulting in the following dues structure: CMA

SMA

CONJOINT

ORDINARY

$495

$2000

$2495

PART-TIME

$248

$1180

$1428

RESIDENT

$50

$57

STUDENT

$12

$17

RETIRED

$173

$30

$203

OUT-OFPROVINCE

$30

Sridhar/Hanekom - Carried

RESOLUTION 3 That the narrative portion of the reports be received for information. Malhotra/Litwin - Carried

RESOLUTION 7 That the attached 2016 SMA budget (Appendix A) be approved. Slavik/Brown - Carried

RESOLUTION 4 That the minutes of the May 2015 meeting of the Representative Assembly be approved. Abdullah/Dahl - Carried

RESOLUTION 8 That the SMA request eHealth Saskatchewan implement Single Sign On.

RESOLUTION 5 That the Representative Assembly approves the actions of the Board of Directors as reported. Kozroski/Sridhar - Motion 6

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Thorpe/Sivertson - Carried

YOUR SMA RESOLUTION 9

RESOLUTION 13

That the SMA request RHAs work with eHealth to imple-

That the Section of Family Practice of the SMA request

ment Single Sign On.Â

that the pooled referral process must have representaThorpe/Sivertson - Carried

tion from the Section of Family Practice of the SMA. Oleksinski/Konstantynowicz - Carried

RESOLUTION 10 That the SMA urge government to adopt regulations

RESOLUTION 14

around electronic cigarettes to prevent young people

That the Section of Family Practice of the SMA request

from using them and to prevent the undermining of to-

that all regional health authorities comply with their

bacco control.

practitioner staff bylaws, specifically with having practiBrown/Pillay - Carried

tioner liaison committee meetings. Oleksinski/Yelland - Carried

RESOLUTION 11 That the SMA urge government to protect residents from

RESOLUTION 15

second-hand smoke by banning smoking of all tobacco

That the Section of Family Practice of the SMA request

products, including shisha and hookah, in all indoor and

a review of the processes and parameters of the FPCCP

outdoor public places such as patios of restaurants and

(Family Practice Comprehensive Care Program) by the

bars, hospital grounds, sports fields, playgrounds and

SMA and the Saskatchewan Ministry of Health. Oleksinski/Konstantynowicz - Carried

outdoor stadiums. Brown/Pillay - Carried

RESOLUTION 16 RESOLUTION 12

When an inpatient is treated with any medication with

That the SMA urge government to ban the sale of all fla-

EDS coverage, that medication should continue to be

voured tobacco products, including menthol, to prevent

covered after discharge. Konstantynowicz/Achyuthan - Carried

youth from starting to smoke. Brown/Pillay - Carried

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RESOLUTION 17

RESOLUTION 21

That the SMA advocate for adequate physician supply

The SMAâ&#x20AC;&#x2122;s expectation is that both parties (MCRC and the

in northern Saskatchewan communities given the cur-

Ministry of Health) ensure a timely start and expeditious

rent shortage of physician positions, higher health-care

conclusion of the fee negotiations in the future. Timely

needs, and poorer health outcomes. Flegel/Bayda - Carried

conclusion and signing of contracts should be the new norm. Kassett/Cuthbert - Carried

RESOLUTION 18 That the SMA demand improvements in the CPSS time-

RESOLUTION 22

line for processing the predictable annual work of licens-

That the SMA works with the CMA and provincial and fed-

ing and registration of residents wishing to continue clin-

eral ministries of health and Indigenous agencies in the

ical work in Saskatchewan at the successful completion

development of both provincial and national strategies

of their final residency year (i.e.: FMR2, PGY5). Kozroski/Cuthbert - Carried

that address the gross health-care inequities that exist within our First Nations, Metis and Inuit communities. Pillay/Brown - Carried

RESOLUTION 19 That any medically necessary ambulance transportation

RESOLUTION 23

to and from a referral centre be an insured service. Cuthbert/Kassett - Carried

That the SMA is strongly opposed to the tendering of the physicianâ&#x20AC;&#x2122;s professional services given concerns regarding the commoditization of complex services, adverse effects on recruitment/retention and potential to decrease

RESOLUTION 20 That obesity be recognized as a chronic disease in Saskatchewan and be given appropriate attention and corresponding funding. Cuthbert/Kassett - Carried

SMA DIGEST | WINTER 2016

quality of care. Kraushaar/Goyal - Carried

YOUR SMA

RESOLUTION 24

RESOLUTION 29

That the SMA enter discussions with government to de-

That the SMA reach out to the Ministry of Health to ask

velop a provincial plan promoting GP surgery/GP anes-

them to resolve the current problems with pooled refer-

thesia services and identify rural communities whose

rals within a six-month time frame. Thorpe/Konstantynowicz - Carried

continued ability to provide maternity and acute care may depend on training, recruiting and retaining a critical capacity of family physicians with enhanced skills. Loden/Strydom â&#x20AC;&#x201C; Carried

RESOLUTION 30 That the RA membership thanks the committees and staff of the SMA for their hard work over the past year. Pfeifer/Ibrahim - Carried

RESOLUTION 25 That the Section of Pathology and the Section of General Surgery ask the SMA to advocate for a similar level of resourcing for lab medicine as was made available during the Surgical Initiative to enable surgery and laboratory medicine to meet quality outcome guidelines. Pfeifer/Brunet - Carried

RESOLUTION 26 That the SMA recommends the Ministry of Health support fully functioning and resourced trauma programs in Saskatoon and Regina to better serve the people of Saskatchewan. Pfeifer/Chandran - Carried

RESOLUTION 27 That the SMA request that the CPSS and the Ministry of Health/MCIB reconsider their previous recommendations against routine neonatal/infant circumcision if requested by parents, and thereby restore funding for such procedures by the MCIB. Moolla/Kassett - Defeated

RESOLUTION 28 That the SMA pursue reimbursement of insured services provided to Canadians whose insurance has lapsed (Good Samaritan rule). Woo/Burwell - Carried

SMA DIGEST | WINTER 2016

TRANSFORMING M&M ROUNDS

Dr. Lisa Calder on improving patient care by Maria Ryhorski A new model for mortality and morbidity (M&M) rounds is gaining traction across the country for its effectiveness in identifying cognitive and system issues at the root of adverse events, and for translating these learnings into actionable recommendations that improve patient care.

•

Dr. Lisa Calder, scientist with the Ottawa Hospital Research Institute, emergency department physician and lead investigator in the development of the Ottawa M&M Model, was prompted to develop a more effective model for M&M rounds after a colleague expressed frustration with the fact that current rounds didn’t result in any meaningful change.

•

“It’s more than just getting together and meeting,” says Dr. Calder. “It’s selecting the right cases, it’s analyzing them with the right sort of analytical tools, and then it’s putting together messaging so that it can actually be acted on.” In partnership with her team, she developed a structure for rounds which included: • Appropriate case selection – identified as cases with adverse outcomes where there was potential preventability and identifiable cognitive and/or system issues; • Structured case analysis;

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•

Interprofessional participation (nursing, pharmacy and social work colleagues invited to participate); Development of an M&M bottom line – a succinct point summary of cognitive and system issues identified and lessons learned, accompanied by concrete recommendations; and Creation of an administrative pathway for system issues to be brought forward for action.

Dr. Calder previously observed that M&M rounds often lapsed into discussion of “fascinomas” or “great saves,” resulting in very little useful learning. Limiting discussion to cases where cognitive/system issues were at play and the adverse outcome might have been avoided, then performing a structured analysis and translating those learnings into an M&M bottom line transformed these rounds into a feasible and effective exercise in quality improvement. Unfortunately, one obstacle to effective rounds is the tendency for them to become a venue for placing blame and judgement. “It’s very easy for a bunch of physicians to sit around and pick apart a case,” she says. “We can all do that mindlessly.

YOUR SMA But it’s a very different proposition to say, ‘Well, let’s really look at this and see what we can do constructively to prevent it from happening again. That’s a whole different conversation.” The key to combatting blame culture in M&M rounds is good facilitation says Dr. Calder, laying the ground rules up front and reinforcing that the goal is not to place blame but to learn how to do better. “And that leads to some very profound shifts in the way people look at these exercises but also in the way that they interact with each other,” she continues. “So there’s an opportunity here to really push forward that patient safety culture by creating a safe environment for people to discuss these cases openly without pointing that blame finger.” Interprofessional involvement is also key to the Ottawa Model. “When it comes to analyzing a case, the physician perspective is only one perspective,” says Dr. Calder. Frequently she has found that when physicians discuss a case, they may not see why an event occurred, but if you open up the discussion to a member of another discipline, oftentimes that person will be able to identify why it happened because they’ve seen it happen before. Interprofessional involvement is also beneficial from the perspective of blame orientation. Dr. Calder found that when everyone who was involved in the case was present and each reviewed what happened from their unique perspective and examined what they could do better, it resulted in a complete culture shift. “It all comes back to patient safety culture,” says Dr. Calder. “You can’t pretend that you’re just going to improve culture amongst just the physician group, for example. If you’re looking to influence culture, you really have to have all the players of the health-care team around and available.” “Importantly as well, when it comes to those action pieces where you identify a whole bunch of issues in your bottom line and you want to act on them, you need all the healthcare team members around because they’re going to help you do the work.” Once the M&M bottom line has been developed (and deidentified of all personal health information), the next step is disseminating the learnings and feeding them up through hospital administration so that system issues can be addressed and acted upon.

“This is key because what happens is when you start doing these M&M rounds, you’re thinking ‘This is awesome. We’re identifying all these issues.’ Then all of a sudden you’re hitting up against all these issues that are bigger than you. Your own division or department can’t address all these issues, so then what happens to it?” In the Ottawa Model, Dr. Calder and her team set up a quality committee that would triage issues and then pass them up through the hierarchy of hospital administration for action as appropriate. Having leadership on board was critical to this piece. The success of this model has resulted in adoption by other departments and hospitals, who report similarly positive outcomes. It’s particularly impactful to Dr. Calder when the teams applying the Ottawa Model can point to specific quality improvement initiatives that were a direct result of the changes they made to how they conducted their rounds. The model is in use throughout most of The Ottawa Hospital and there is uptake from other hospitals including Sunnybrook in Toronto, a hospital in Calgary and even the Mayo Clinic. The model is customizable to different clinical settings and has been adapted for family medicine, psychiatry, intensive care, as well as surgical and medical specialties.

“

IT’S VERY EASY FOR A BUNCH OF PHYSICIANS TO SIT AROUND AND PICK APART A CASE. WE CAN ALL DO THAT MINDLESSLY. BUT IT’S A VERY DIFFERENT PROPOSITION TO SAY, ‘WELL, LET’S REALLY LOOK AT THIS AND SEE WHAT WE CAN DO CONSTRUCTIVELY TO PREVENT IT FROM HAPPENING AGAIN.’ THAT’S A WHOLE DIFFERENT CONVERSATION.

SMA DIGEST | WINTER 2016

“

EVERYONE CAN PLAY A ROLE WHEN IT COMES TO PATIENT SAFETY AND QUALITY IMPROVEMENT [...] THIS REALLY IS SOMETHING THAT ANYBODY CAN DO. THE POTENTIAL FOR IMPACT IS HUGE AND IT’S VERY GRATIFYING.

Dr. Calder encourages any physician interested in quality improvement and improving patient care to explore the Ottawa Model for M&M rounds. “Everyone can play a role when it comes to patient safety and quality improvement,” she says. “Sometimes people think that it’s a niche role – that only some people do safety and quality – this really is something that anybody can do. The potential for impact is huge and it’s very gratifying.” Dr. Lisa Calder is currently the Director of Medical Care Analytics with the Canadian Medical Protective Association as well as an emergency room physician at The Ottawa Hospital. She is also a scientist with the Clinical Epidemiology Program at the Ottawa Hospital Research Institute and an associate professor in the Faculty of Medicine at the University of Ottawa.

RESOURCES To learn more, please refer to the publication of Dr. Calder’s research, Enhancing the Quality of Morbidity and Mortality Rounds: The Ottawa M&M Model in the Academic Family Medicine journal:

http://onlinelibrary.wiley.com/doi/10.1111/acem.12330/epdf For resources to support implementing the Ottawa Model in your practice setting, please contact the communications department at the SMA at sma@sma.sk.ca. 12

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FUNDING AGREEMEN

and provides resources for new pro by Lana Haight The final adjustments and payments related to the 20132017 Medical Compensation Review Committee (MCRC) Agreement between the Saskatchewan Medical Association and the Province of Saskatchewan come into effect in the coming weeks. Highlights include: • Increase to payment schedule to address disparities; • Increase to funding for several existing programs; and • New funding for innovative programs. The agreement includes lump sum increases for fee-for-service and non-fee-for-service physicians paid retroactively for the first two fiscal years (2013-2014 and 2014-2015) and an across-the-board 1.95 per cent rate increase on Oct. 1, 2015. Effective April 1, 2016, a 2.95 per cent rate increase is scheduled and will be allocated to address disparities. Some sections will receive an increase of more than 2.95 per cent while others will receive an increase that is less than 2.95 per cent. “The first process of allocation is called macro-allocation where we take the overall allocation funds and divide them equitably among the sections,” explained Mark Ceaser, the Saskatchewan Medical Association’s economics director. “The equitable division of funds is based on three components: a net income index, a workload index and an interprovincial payment schedule comparison index.” The macro-allocation process was completed and approved by the SMA Board of Directors prior to the 2015 fall Representative Assembly. By the end of January, the sections were finished their work on micro-allocation. “The micro-allocation process is where each section assigns its allocated amount to individual fee codes,” said Ceaser. As of April 1, several existing programs including the Continuing Medical Education (CME) fund and the Family Physician Comprehensive Care Program (FPCCP) will receive

NT ADDRESSES DISPARITIES

ograms in 2016-17

increases to the current funding to recognize that more physicians are working in Saskatchewan and accessing these types of programs. New innovative programs received first-time funding and details are still being worked out. “Whites of the Eyes” refers to improving patient access and health outcomes in ways other than with face-to-face contact, including physician-to-patient, physician-to-physician or other health-care provider, and physician-to-family member. Telephone calls, email or text messaging make it easier for patients to connect with physicians, but physicians are currently not paid for the majority of those types of communication. The “Whites of the Eyes” program will receive $3.5 million in 2016-2017. “Physicians are continuously providing us with many examples of how patient access and health outcomes are improving through collaborative care and technology. We want to acknowledge those who are already providing services in these innovative ways and also make it easier for physicians to provide their services in the most effective and efficient ways they see fit. Our hope is to have a robust and flexible payment schedule that enables better patient care,” said Ceaser. “The ‘Whites of the Eyes’ funding will be used to test some innovative ideas to see what works well and to identify areas of improvement.” Appropriateness is about delivering the right care at the right time for the right patient. The goal is to ensure care is provided in an appropriate and effective manner, minimizing unnecessary waste and improving quality in the health system. In 2016-2017, $1.1 million has been allocated to the appropriateness program. More specifically, the appropriateness funding can be used by physicians to provide support in the form of human resources and/or data infrastructures.

“There are several appropriateness initiatives currently underway in Saskatchewan, both big and small, being led by the Ministry of Health or regional health authorities. We are looking at aligning and streamlining some of the SMA’s appropriateness funding with those existing initiatives, keeping in mind criteria such as impact, scalability and achievability,” said Ceaser. The “new items fund,” which receives $500,000 annually, provides payment for procedures not previously paid for by the provincial government. For example, the joint SMA-Ministry of Health Payment Schedule Review Committee approved a fee code for cochlear implants as of April 1, 2016. The process for requesting a new fee item for the Payment Schedule is found on the SMA website under New Fee Items/Tariffs (www.sma.sk.ca/104/new-fee-items-tariffs.html). While it is recommended that a physician or group of physicians start with the section, it is not necessary. Recognizing that medicine is constantly changing, Ceaser encourages physicians to get involved in their sections to provide information about innovative approaches to medicine and the challenges and opportunities for achieving those solutions. “The most engaged and informed sections are often the ones providing innovative solutions to common problems. Effective consultation within and between sections is crucial for building relationships and expanding the possibilities for improvement. I strongly encourage sections to meet regularly and to appoint an Intersectional Council representative,” said Ceaser. As the parties to the 2013-2017 agreement, the SMA and the Ministry of Health are committed to proceeding with the modernization of the fee schedule within the principles of patient-centred care, appropriateness and fairness. This work is intended to be revenue-neutral.

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PHYSICIAN MENTORSHIP EXPANDS matching new-in-practice and established physicians by Lana Haight

Dr. Jasmine Hasselback is excited about the future of mentorship within the medical community in Saskatchewan. “Once you become passionate about mentoring, it’s nearly impossible for your fire to be extinguished,” said Dr. Hasselback, a fifth-year post-graduate resident in the public health and preventive medicine program at the University of Saskatchewan. Dr. Hasselback is working with the Saskatchewan Medical Association to establish docs4docs, Saskatchewan Physician Mentorship, for new-in-practice and established physicians. “I have such a passion for mentoring and what it accomplishes. I see it as incredibly valuable.” Dr. Hasselback “caught the vision” of mentorship at the University of Ottawa where she completed her undergraduate medical education, graduating in 2011. She participated in a group mentorship program that included other medical students as well as a physician. The relationships she developed then continue to this day. The U of S also offers mentorship to medical students through a peer-to-peer program called P.E.E.R.S.i.M and in a medical student-to-physician program called Synergy. With P.E.E.R.S.i.M in its fifth year and Synergy in its fourth year, those who participated in the early years are now preparing to enter independent practice. They have benefitted from mentorship and have been trained to approach the practice of medicine in a collaborative and team-based model. “It’s a natural progression to carry mentorship forward,” said Dr. Hasselback, adding that without docs4docs, a gap exists in the province.

SMA DIGEST | WINTER 2016

“This program is helping those new-in-practice make the transition to practice in an environment that is very much in flux. A lot of people transitioning to practice have a lot of anxiety. They have a lot of questions and are experiencing uncertainty. The docs4docs program fills that gap by providing them with an anchor,” she explained. While some of those preparing to practise in Saskatchewan are from the province, have trained here and may have already connected with established physicians, physicians

“

A LOT OF PEOPLE TRANSITIONING TO PRACTICE HAVE A LOT OF ANXIETY. THEY HAVE A LOT OF QUESTIONS AND ARE EXPERIENCING UNCERTAINTY. THE DOCS4DOCS PROGRAM FILLS THAT GAP BY PROVIDING THEM WITH AN ANCHOR.

new-in-practice in the province also come from other parts of Canada and throughout the world. It’s the reality of a mobile society. “They are very unfamiliar as to what’s unique and what’s special and what’s great about Saskatchewan and practising here,” said Dr. Hasselback. Mentorship doesn’t just happen, notes Dr. Hasselback. It takes intentional relationship building and the time that’s needed to build that relationship. Results may not be immediate, but they will be long-lasting. Both mentees and mentors benefit. A mentee will “learn the ropes” from a physician who understands and has navigated the health-care system in Saskatchewan. A mentor will have the opportunity to stay connected to a younger generation and be more involved in succession planning. Both will learn from the other and will build a larger professional network. Applications are currently being accepted for the first iteration of docs4docs. Established physicians and new-inpractice physicians fill out an online application (www.sma. sk.ca/docs4docs) that asks questions about their professional experience as well as their personal interests. They will also be asked about their professional goals and objectives. This information will be used to match mentees with mentors. Dr. Hasselback will finish her residency in June 2017 and is looking forward to participating in the docs4docs program herself. The SMA is planning a social event in conjunction with the 2016 spring Representative Assembly for those participating in docs4docs. As an added incentive to join the physician mentorship program, the SMA will provide a discounted rate at a PMI course if a mentor/mentee pair attend the same course. For more information or to apply, visit our website or contact Delilah Dueck at 306-244-2196 or delilah@sma.sk.ca.

SMA INSURANCE PREMIUM RETURN CHEQUES MAILED The SMA Insurance Committee is again pleased to advise that the BCMA/AMA/ SMA “harmonized” life insurance plan implemented in 2012 not only offers solid coverage and competitive rates, but also continues to generate surpluses. Plan participants are eligible to share in the good experience of the plan and as such, 20 per cent of life insurance premiums paid during the 2014-2015 policy year were returned to eligible members by cheque in early January. Your Insurance Committee continuously monitors the insurance industry looking for opportunities to improve the association products. Enhancements to the SMA plans are on-going and automatically retrofitted into existing policies so it is not necessary to re-apply for the improved coverage. In 2015, the SMA disability insurance plan coverage maximums increased for new-to-practice family physicians and specialists, and our student plan was overhauled! Although there is not a return of premiums for the SMA disability insurance plan this year, the plan continues to be strong financially with fully-funded reserves. The SMA disability insurance plan provides comprehensive, competitive, and physician-specific coverage. The safety net that this type of insurance provides to our members is demonstrated by the volume of claims and benefits paid out this past policy year.

If you have any questions regarding SMA insurance, or would like to receive information on any of the other insurance products offered through the SMA, please contact:

THE SMA INSURANCE TEAM CINDY ANDERSON

cindy@sma.sk.ca

www.sma.sk.ca/docs4docs

GISELE DEAULT

gisele@sma.sk.ca

CAROL FRIESEN

carol.friesen@sma.sk.ca SMA DIGEST | WINTER 2016

MAKING THE MOST OF MEDICINE

refections on a 59 ½ year career by Maria Ryhorski “People have asked me from time to time how I manage to lead this sort of life at my age,” reflects 86 year old Dr. Richard McIntyre, who until recently has been flying his own plane to his Saskatchewan Medical Association locum assignments, “and I am delighted to be able to tell them that the key is fitness through daily cardiovascular and general strengthening exercise. The second tenet – which I owe entirely to my mother – is tenacity.” It becomes increasingly clear, as I listen to this down-toearth physician recount nearly 60 years of medical service, that the latter quality is decidedly appropriate. This is his third attempt at retirement, having been drawn back to active practice each time previously by his drive for knowledge and engagement, and his fascination with the practice of medicine. “It has been an extremely fulfilling career,” says Dr. McIntyre, “particularly the last few years having more time to attack each medical problem with fewer deadlines and interruptions.” Dr. McIntyre spent all but 11 of the last 59 ½ years practising in rural communities throughout Saskatchewan, British

Columbia and the United States. Following his retirement in 1998, he began practising as a locum physician, first in British Columbia and since then, reconnecting with his roots here in Saskatchewan. “It’s been quite delightful,” he says of working as a locum back in his home province. The flexibility of the schedule has allowed him time to continue to pursue hobbies old and new, including his first love of flying, as well as golfing, learning French and playing the violin. Being an SMA locum has also allowed him to integrate this love of flying into his work. Whenever possible he and his wife load up his Cherokee 180 with a fold up bicycle and everything they need for his next assignment and set off to explore another corner of the province. “There’s just something different about going to various [rural] parts of the province,” says Dr. McIntyre. “I can’t recommend it highly enough to young doctors who are trying to figure out where they want to end up.” In his experience, the connection between physician and patient is more closely established in rural communities, and there is a community spirit that he has not seen in urban centres.

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EMPLOY A HEALTHY DISREGARD FOR THE ALMIGHTY DOLLAR. IT CAN BECOME A DISTRACTION THAT CAN TAKE THE JOY OUT OF THIS WONDERFUL, WONDERFUL PROFESSION OF OURS.

SMA DIGEST | WINTER 2016

need a

family

break? vacation CME “You will encounter grass roots medicine and it will allow you to put much of your hard earned knowledge to direct usage,” he says. “Much of the traditional rural hospitality, forthrightness, and honesty is still alive and well.” There is a strong sense of gratitude as Dr. McIntyre recounts a full life and career, and remarks that, “If I started all over again, I wouldn’t change a thing.” Despite his depth of experience, he doesn’t consider himself an authority by any means but when prompted for the best of what he had learned over the years, he had this to say: “First, collegiality with your fellow practitioners – young or old, of either gender, specialist or non-specialist – will keep our profession strong and our work enjoyable and our patients the better for it. And second, employ a healthy disregard for the almighty dollar. It can become a distraction that can take the joy out of this wonderful, wonderful profession of ours.”

book a SMA

LOCUM The Rural Relief Program is now booking SMA locums for the spring and summer of 2016. If you practise in a community with fewer than four physicians, you may be eligible to take advantage of this great SMA program with subsidized locum rates. Please make your requests at least three months in advance to ensure locum placement.

Email randall@sma.sk.ca SMA DIGEST | WINTER 2016

RETIRED DOCS CONTINUE TO SERVE by Lana Haight

They may be retired, but they aren’t leaving the profession. “Just because we are not in active practice does not mean we are no longer physicians,” said Dr. Ulla Nielsen, a retired pediatrician and interim vice-chair of the new Section of Retired Physicians of the Saskatchewan Medical Association (SRPSMA). “Physicians after they have gone through their training, after they have gone through their practice, after they have gone through their own business and practice development, they don’t just quit being docs.” The new section held its inaugural meeting on Nov. 12, 2015, and will hold its first annual general meeting in conjunction with the 2016 spring Representative Assembly in Regina. Section members will approve their constitution and elect an executive. The goals of the section include collegiality, advocacy for members and the general senior population, collection and development of resources for retired physicians, as well as the enabling of retired physicians to share their skills and expertise in teaching and mentoring. “The profession is doing itself a disservice if it doesn’t continue to use the skills, expertise and wisdom of retired physicians,” said Dr. Nielsen, in an interview. “We are the elders of the profession.” Retired physicians are an untapped resource and many are eager to help the next generation of physicians. Whatever question a new physician may have, a retired physician could probably be found to provide an answer, she says. Opportunities for mentorship are being explored at the University of Saskatchewan’s College of Medicine. While the current number of retired physicians could be as high as 200 in Saskatchewan, an exact number isn’t known 18

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because not everyone who retires continues to be an SMA member. The association’s definition is based on income and hours of work. However, for the purposes of the new section, physicians can determine themselves if they are retired. Age isn’t the only reason physicians retire; some leave active practice because of a disability. “The SMA supports physicians at the beginning of their careers. We should also support them at the end of their careers,” said Dr. Nielsen. Saskatchewan is joining a growing number of provincial and territorial medical associations with retired physician sections. Associations in Nova Scotia, Newfoundland and Labrador, Quebec, Manitoba, Alberta and the Yukon, as well as the Canadian Medical Association, are in various stages of developing such a section. For more information about the retired physicians section, please contact Dr. Nielsen at ulla.nielsen@usask.ca.

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THE PROFESSION IS DOING ITSELF A DISSERVICE IF IT DOESN’T CONTINUE TO USE THE SKILLS, EXPERTISE AND WISDOM OF RETIRED PHYSICIANS.

HEALTH CARE

RETHINKING SENIORS CARE by Maria Ryhorski Saskatchewan physicians agreed that the current model for seniors care is not working and that a shift to community-based care, supported by an interdisciplinary team of health care providers, would be a promising part of the solution during a seniors care town hall meeting hosted by the Canadian Medical Association last November. The CMA is advocating for a national seniors strategy and met with physicians across the country to inform their efforts. “We need to recognize that older complex patients don’t just need the health-care system once in a while for an emergency,” said Dr. Jenny Basran, geriatrician and head of the Division of Geriatric Medicine at the University of Saskatchewan, in her address to the group. “They will need us in varying intensities throughout the rest of their lives. It’s time to move from episodic care to continuous care.” She noted that this would mean a significant shift in a health-care system currently structured around episodic care, where one health issue is dealt with at a time and elderly patients are frequently hospitalized and eventually institutionalized – a move that is often neither right for the patient nor what they want. But there are a number of changes that must occur for this shift to happen. Elderly patients typically have complex health needs and multiple co-morbidities. And according to Basran, “Complexity requires team-based care. It is unrealis-

tic for a physician to do alone.” In addition, moving care out of hospitals and into the community and patients’ homes is important; it is less expensive and usually more supportive of the patient’s needs and in line with their wishes. In discussion, the group concluded that a team, anchored by a family physician and comprised of interdisciplinary health care practitioners, the patient and their family, could effectively collaborate to support the needs and goals of the patient. But for this to be successful, they identified a number of supporting pieces that would need to be in place. Education and mentorship were seen to be foundational both in terms of acquiring baseline knowledge of geriatric care and learning how to work effectively in a team-based/ community-based setting. Continuity among team members was also seen to be important because of its role in facilitating longitudinal care and building relationships within the team, including the patient and their family. In addition, the development of a comprehensive health record that is linked to all databases and that travels with the patient, or a “Single Care Plan” as Dr. Basran refers to it, was also identified as vital to ensuring that all team members have a complete picture of the patient’s health and needs. According to Basran, “This will make it easy to do the right SMA DIGEST | WINTER 2016

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WE NEED TO RECOGNIZE THAT OLDER COMPLEX PATIENTS DON’T JUST NEED THE HEALTH-CARE SYSTEM ONCE IN A WHILE FOR AN EMERGENCY. THEY WILL NEED US IN VARYING INTENSITIES THROUGHOUT THE REST OF THEIR LIVES. IT’S TIME TO MOVE FROM EPISODIC CARE TO CONTINUOUS CARE.

thing and, more importantly, empower patients and their families to understand their whole health picture and make goals accordingly.” Finally securing funding and updating the fee schedule to support this team-based/community-based model of care would be essential, and it was highlighted as an area where the Saskatchewan Medical Association could provide direct support. “We have a real opportunity here in Saskatchewan,” said SMA President Dr. Mark Brown, “because we just signed a new agreement and we’ve made a commitment to the provincial government to modernize our fee schedule.” Overall participants felt the discussion was productive but agreed that there is much work to be done to bring these ideas into practice. “In order to shift from what we are doing right now there needs to be a lot of education,” said SMA Vice-President Dr. Intheran Pillay. “We need to have a strategy that’s universal, that every one of us is aware of if we’re providing care to seniors, and it needs to be customized to suit the needs of the patients.” The CMA continues to advocate for a national seniors strategy and encourages physician involvement. To learn how you can get involved with the CMA on seniors care and other important issues, please visit www.cma.ca/advocacy.

SMA DIGEST | WINTER 2016

FUNDAMENTAL

CRITICAL CARE SUPPORT Enhance your knowledge and skills in initial resuscitation and immediate support of your critically-ill patient on May 27-28 in Saskatoon. The Fundamental Critical Care Support course is designed for physicians and allied health-care providers to initially stabilize a critically ill patient until Critical Care can be accessed. It provides small group didactic and practical education, including hi-fidelity simulation to enhance your learning opportunities. CME credits can be claimed (course licensed by the Society of Critical Care Medicine). This is a full two-day course. Certification endorsed by SCCM.

website: course directors: cost: email:

www.sccm.org/FCCS Dr. Brian Brownbridge Dr. Mark James $750 saskfccs@gmail.com

HEALTH CARE

COLLABORATING TO CREATE

a culture of safety in Saskatchewan health care by Elizabeth Ireland, Health Quality Council communications consultant Improving safety is a top priority in Saskatchewan’s healthcare system. The Health Quality Council (HQC) is actively involved in efforts underway in health regions across the province to build a safety culture.

“In health care, a culture of safety is something that is shaped from the bottom up. The employees closest to the work – and closest to potentially harmful events – know their work best,” says Dr. Shaw.

HQC’s board chair, Dr. Susan Shaw, is co-lead of Safer Every Day – Saskatoon Health Region’s most recent 90-day improvement initiative. And, HQC is home to the provincial Safety Alert/Stop the Line initiative. Physician engagement and leadership are key to both endeavors.

“It is the role of physician and system leaders to provide the support, direction, and removal of barriers for that safety culture to emerge.”

SAFER EVERY DAY

Saskatoon’s second major improvement initiative, which began in mid-September, aims to identify and create breakthrough strategies for building a stronger safety culture. The focus is on understanding the current culture and dayin day-out approaches to safety. Safer Every Day is part of a larger strategy to eliminate preventable harm provincewide by March 31, 2020. “This initiative elevates safety from ‘off the side of the desk’ for some of our staff by aligning resources specifically to the effort across parts of the health region,” says Dr. Shaw, who practises critical care and anaesthesiology in Saskatoon. “What immediately became apparent is that we were tapping into a pre-existing interest in safety, particularly among physicians. We were purposeful from the start knowing that we wanted to build stronger and more meaningful partnerships with physicians.” Dr. Shaw and her colleagues canvassed industries outside of health care, such as construction, mining, and oil and gas, to understand the foundations of a strong safety culture and how to always keep safety top of mind. As part of Safer Every Day, the teams worked to identify and validate ways to build a comprehensive safety culture.

Safer Every Day involved seven teams, each focused on a specific area of safety. Five of the seven teams were physician-led; these leaders included radiologist Dr. Paul Babyn (focus on Building Capacity for Safety and Quality Improvement), pediatrician Dr. Vicki Cattell (Team Communication and Performance), anaesthesiologists Dr. Malone Chaya (Psychological Safety and Staff Support) and Dr. Mark James

“

IN HEALTH CARE, A CULTURE OF SAFETY IS SOMETHING THAT IS SHAPED FROM THE BOTTOM UP. THE EMPLOYEES CLOSEST TO THE WORK – AND CLOSEST TO POTENTIALLY HARMFUL EVENTS – KNOW THEIR WORK BEST.

SMA DIGEST | WINTER 2016

(Clinical Process Improvements), and nephrologist Dr. David Reid (Mortality Review). Many other physicians stepped forward to make significant and lasting contributions to the work throughout the 90 days. “Safety is such an important issue that physicians are highly engaged and we want to make a difference,” says Dr. Shaw. “This 90-day initiative gave physicians, other health care professionals, and patient and family advisors a place to start and a structure for how to have the most impact.”

SAFETY ALERT/STOP THE LINE

The region’s multifaceted Safer Every Day campaign aligns closely with the provincial safety improvement work being supported by the Health Quality Council (HQC). Implemented first in Saskatoon, but now spreading to other regions, the Safety Alert/Stop the Line initiative includes processes, policies, and behaviours intended to strengthen the culture of safety and make health-care settings safer for everyone. “The goal of Safety Alert/Stop the Line is to put processes in place so that everyone – employees, providers, patients, and patients’ families – can be safety inspectors. Employees are expected, and patients are invited, to ‘stop the line’ when they notice a potentially harmful situation,” says HQC’s Kate Fast, lead on the provincial initiative. “In this way, the situation can be addressed before it causes harm.” Before the new approach was introduced in Saskatoon, employees had to navigate through 13 different intakes to report a safety issue. Employees can now call one phone number and the coordinator on the other end of line fills out one report. The caller knows that the concern will be assigned to the appropriate person for follow up. Having one central intake also enables patients and their family members to report safety issues and concerns. In approximately 90 per cent of the calls, safety has been mitigated and restored to the patient or employee. The system also allows for a standardized response process for all safety concerns, with more serious issues being addressed more quickly. “These two exciting safety initiatives – Safer Every Day and Safety Alert/Stop the Line – are mutually supportive and demonstrate how working collaboratively can result in accelerated change in our province,” says Fast.

SMA DIGEST | WINTER 2016

NORTHERN DOCS ADV

for adequate physician supply

by Maria Ryhorski | Photo credit to Lee-Anne Gilecki, Class of 2016 “Living, working and visiting Ile-a-la-Crosse is overwhelmingly positive,” said Dr. Melanie Flegel her enthusiastic tone echoing the sentiment. In fact this young physician, three years out of residency and Ile-a-la-Crosse physician of 2 ½ years, can’t say enough good things about her second home. “It’s a beautiful location! It’s got a very rich history. It’s very family-centred and there’s a very strong sense of community,” she added in an interview on Jan. 14. “So even though we’re talking about obstacles and trying to make improvements on the health-care system, there are so many strengths about the community and the system as a whole.” I’ve approached Dr. Flegel to learn more about her concerns with the health-care environment in northern Saskatchewan that sparked recent action by her and her physician colleagues to advocate for better physician resourcing. She’s quick to point out that she’s no expert, but in her opinion and that of the clinical team she works with there is cause for concern when it comes to adequate access to care for their patients. “The communities that we serve are often not allocated the number of clinics that they need,” she points out. Dr. Flegel works as part of a nine-member physician team that equates to 6.5 full-time equivalent positions serving the communities of Ile-a-la-Crosse, Buffalo Narrows, Beauval, Dillon, Patuanak and Canoe Narrows. They serve a patient base of approximately 5,000, 93.8 per cent of which selfidentify as aboriginal. Their team, employed by Northern Medical Services, operates primarily out of Ile-a-la-Crosse, with satellite clinics in Patuanak, Dillon, Buffalo Narrows,

VOCATE and Beauval each of which is allocated a limited number of clinics per week. Some of their patients live in communities which are not allotted any. “For example Canoe Narrows, which has approximately 716 people, has no physician clinics in the community,” she continues, “and [patients] either have to travel 100 kilometers each way to Meadow Lake or Ile-a-la-Crosse to access physician services.” She adds that arranging transportation, to the often infrequent clinics in neighboring communities, can be difficult for many patients. This is an all too common problem for many northern and aboriginal communities. This limited access is compounded by the fact that patients in the North have a higher burden of disease and poorer health outcomes compared with those in other parts of Saskatchewan. Infant mortality and premature death rates are disproportionately high. Diabetes is more common and death rates from injuries, respiratory illness and suicide are higher. “These are communities that are way under-resourced already,” says Dr. Flegel, “and higher needs means that more services are required to provide adequate care.” Dr. Flegel and other physicians in these communities are doing what they can to counteract some of the disadvantages their patients face and promote good health. They feel it is important to take direction from the members of their community on how they can best be of service rather than pushing their own agenda, so they make a concentrated effort to partner with existing community initiatives. They contribute by helping distribute healthy food, assisting with mental health programming, sponsoring free swim sessions at the pool, and giving presentations at the local school on topics such as sex ed, healthy relationships, medical education and women’s health.

“We have a lot of very passionate and dedicated health-care staff and professionals who dedicate a lot of their personal time to improving the health of our community,” says Dr. Flegel. “There’s a lot of good projects going on and lots of good people behind them.” But despite their best efforts, there is only so much the existing team can do without more help. “They [patients] are under allocated physician clinic services,” reiterates Dr. Flegel. “And if we’re going to increase the number of clinics that we provide, we have to increase the number of physicians that we have, because as it is, we only have enough physicians to do what we have been doing up to this point.” Advocacy is the next step to seeing these concerns addressed at the health system level. Dr. Flegel and others are active in committee work at both the local and provincial level, in addition to their work with the Saskatchewan Medical Association. Through their efforts, the SMA President’s Tour has expanded to include a stop in the Keewatin Yatthé/ Athabaska Health Region, and the inadequacy of physician resourcing in the North has been brought to the attention of the SMA both through a letter to the SMA president and a motion brought forward at the last Representative Assembly. Dr. Flegel’s motion “That the SMA advocate for adequate physician supply in northern Saskatchewan communities given the current shortage of physician positions, higher health-care needs, and poorer health outcomes (Flegel/ Bayda)” was carried at the 2015 fall RA. Currently the SMA is actively working to ensure adequate physician supply in northern Saskatchewan communities and this will remain a key focus in the coming year. SMA DIGEST | WINTER 2016

SASKATCHEWAN CHANGE DAY

inspires health-care improvements

by Shannon Boklaschuk, Health Quality Council communications consultant | Photo credit to Shannon Boklaschuk Saskatoon emergency physician Dr. Mark Wahba has made a small change that could have a big impact on his patients. For the second annual Saskatchewan Change Day campaign, Dr. Wahba made the following pledge: “When I would like a patient to follow up with their family doctor after their ER visit, I’m going to call their doctor’s office and make the appointment for them.” By doing that, Dr. Wahba hopes to shorten the amount of time a patient has to wait for an appointment with his or her family physician. “After some emergency department visits, it is beneficial for people to follow up and be reassessed within a short timeframe,” he said. “Unfortunately, I sometimes hear patients say, ‘It takes weeks to get in to see my family doctor.’ I wondered, ‘If I call and speak to their family physician or the receptionist, could we find a way to get them seen sooner?’ “Family physicians and primary care teams are the best providers when it comes to continuity of care. We sometimes see people return to the emergency department for problems that their family physicians would want to see, and probably should see. If I can help co-ordinate better followup and continuity for the patient and their family physician, hopefully the patient will have a better outcome.” Saskatchewan Change Day, which is part of a global movement aimed at making small health-care improvements, was celebrated on Nov. 5, 2015. The Change Day concept

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originated in the National Health Service (NHS) in the United Kingdom and has since spread around the world, including to Sweden, Saudi Arabia, South Africa, India, Jordan, the Netherlands, Finland, Australia, New Zealand, Scotland, Northern Ireland, and the provinces of Saskatchewan, Alberta, and British Columbia in Canada. The Health Quality Council (HQC) organized Canada’s first Change Day in 2014, as well as the recently completed 2015 campaign. The 2015 Saskatchewan Change Day theme was “Make Health Better Together.” Participants could pledge to do something to improve their own health, the health of their workplace, or the health of the patients, residents, or clients they serve. The 2015 campaign generated more than 1,430 pledges from across the province, slightly surpassing the 2014 total of just under 1,400 pledges. The idea behind Change Day is that every individual has the power to make a change for the better – a concept that Dr. Wahba supports. “I think all health-care providers can look at what they are doing and find small ways to improve. We are all in this together, so we all need to look at what we can do differently,” said Dr. Wahba, who also works part-time at HQC as a physician consultant. Dr. Joy Dobson was another Saskatchewan physician who was inspired by Change Day. Her pledge focused on hand washing. “Nosocomial infections are one of the biggest risks in hospitals. Patients are at their most vulnerable and we are often

HEALTH CARE

“

UNFORTUNATELY, I SOMETIMES HEAR PATIENTS SAY, ‘IT TAKES WEEKS TO GET IN TO SEE MY FAMILY DOCTOR.’ I WONDERED, ‘IF I CALL AND SPEAK TO THEIR FAMILY PHYSICIAN OR THE RECEPTIONIST, COULD WE FIND A WAY TO GET THEM SEEN SOONER?’

AFTER SOME EMERGENCY DEPARTMENT VISITS, IT IS BENEFICIAL FOR PEOPLE TO FOLLOW UP AND BE REASSESSED WITHIN A SHORT TIMEFRAME.

DR. MARK WAHBA Emergency room physician in Saskatoon

the vector for harm,” said Dr. Dobson, an anaesthesiologist in Regina Qu’Appelle Health Region who is also a locum in Moose Jaw. “I have a pretty reliable – but not perfect – routine of washing my hands after every case as I leave the room. That protects me as much as others. But I realized that even if I go directly to my next patient, that person didn’t see me wash my hands and know they are clean. I think the patient would feel safer if they see me cleanse my hands with Isagel as I enter the room to care for them.” Dr. Cecil Hammond focused his Change Day pledge on improving the quality of care he provides to his patients at the Prince Albert Medical Clinic. He said that same principle guides his decision-making as senior medical officer in Prince Albert Parkland Health Region.

Dr. Susan Shaw, who practises critical care and anaesthesiology in Saskatoon Health Region and who serves as HQC’s board chair, has been a driving force behind bringing Change Day to Saskatchewan. When she first learned about the NHS Change Day in 2013, she wanted to give it a try in this province. “Our province is filled with caring, innovative, and passionate people, but at times it might feel like you have to wait for permission to try something new. You don’t,” she said. “We all have the power within ourselves to commit to making one small change. Together, many small changes will combine to create something big – a health-care system that is energized and continually improving.”

“We have so much evidence-based clinical information out there that every day new advances in care, therapy, medicines, diagnostics, and resources are becoming available. Utilizing these resources, I am hoping to improve the quality of care I provide,” he said. Dr. Hammond, who is originally from South Africa, decided to make a Change Day pledge because he felt “it was the right thing to do” and “it was the right time to do it.” He has been practising medicine in Saskatchewan for several years and doesn’t want to become complacent about the care he provides to the patients of this province.

FOR MORE INFORMATION ABOUT SASKATCHEWAN CHANGE DAY, “Every patient I see, I ask myself the question: ‘What would I VISIT WWW.SKCHANGEDAY.COM OR FOLLOW CHANGE DAY ON want done if this was my mother, father, brother, or sister?’ ” TWITTER (@SKCHANGEDAY).

SMA DIGEST | WINTER 2016

NORTHERN PHYSICIANS RESPOND

during fire crisis of 2015 by Lana Haight

The smoke in northern Saskatchewan from wildfires is long gone, but the memories of the summer of 2015 are fresh in the minds of physicians.

Then, the fire crisis grew in the central and eastern parts of the province and patients in the acute unit at the La Ronge hospital were moved to Prince Albert.

“It was horrible and chaotic yet heartwarming at the same time. I know that’s a strange thing to say,” said Dr. Stephanie Young, one of the senior medical officers in Mamawetan Churchill River Health Region and a family physician in La Ronge.

By July 4, the fires had grown larger and closer to many communities, and the voluntary evacuation became mandatory for the Town of La Ronge, the Village of Air Ronge and the Lac La Ronge Indian Band. The hospital in La Ronge was forced to close completely and the long-term care patients moved because the facility was in the “hot zone.”

Wildfires in northern Saskatchewan dominated headlines last summer with several communities evacuated. Initially, people with pre-existing medical conditions were advised to leave because of heavy smoke. The northwestern community of La Loche was the first to be evacuated in June, resulting in the closure of its health facility in the Keewatin Yatthé Health Region. Patients in the acute, long-term care and family healing units were moved.

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While the health region administrators had been planning for the likely evacuation of the hospital, the event happened with little notice. They and others at the hospital pulled together the charts of the long-term care patients and paired each patient with a family member who travelled via ambulance to Saskatoon. Time was running out because fire was threatening to block the highway south of La Ronge. “We were told, ‘They have to go now,’” said Dr. Young emphatically. “We were basically, ‘Go. Go. Go.’”

As thousands of people from the Lac La Ronge area were heading south to safety, physicians in La Ronge were making the short trek to Air Ronge. The physicians and other health-care professionals continued working in high gear and transported equipment and supplies to the ambulance garage in Air Ronge where they set up a makeshift emergency department. “Probably within an hour, we pulled together as much emergency equipment as we could. We had a crash cart and our ventilator. We gathered as much medication as possible, burn supplies and trauma kits,” said Dr. Young, in an interview. With their emergency department up and running, the physicians faced a dilemma. Air Ronge was no longer considered safe because it, too, was being threatened by fire and they were told they should leave. “Everybody’s heart sank. We asked ourselves, ‘Are we risking our lives? Is this a stupid decision? What are we doing

this for?’ It was such an emotionally charged moment. In my heart, I was terrified. The fire was coming so close,” recounted Dr. Young, her voice cracking with emotion. “We said, ‘There are people here who are fighting for our community. There are people here from all over the world. People who have dropped everything to come and help save our community.’ There were 700 of them. And we said, ‘We can’t leave them. We have to do what we can as long as we’re safe. We will stay as long as we know we can get out in an emergency.’” For two weeks, physicians worked in shifts out of the makeshift emergency department. Most lived together in a nearby home owned by another local physician, because their own houses were also in the “hot zone” and inaccessible to them. “Once we got settled and we figured out what we were doing and what our day-to-day jobs looked like and what we were capable of doing here and what we weren’t, it was

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good. We saw our first few patients and we were up and running, it was good to know we were supporting people and were part of the team fighting the fires,” said Dr. Johanna Kaiser, another family physician in La Ronge. Each day started and ended with meetings. They also pitched in wherever needed, including making sandwiches for those in the community fighting the fires and feeding pets held in a temporary shelter in town. “The dedication of our doctors, nurses, health region staff and EMS workers: it was such a beautiful thing to witness,” said Dr. Young.

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WE SAID, ‘THERE ARE PEOPLE HERE FROM ALL OVER THE WORLD. PEOPLE WHO HAVE DROPPED EVERYTHING TO COME AND HELP SAVE OUR COMMUNITY.’ THERE WERE 700 OF THEM. AND WE SAID, ‘WE CAN’T LEAVE THEM.’

They tended to minor medical emergencies, such as dog bites, lacerations and musculoskeletal injuries, as firefighters and others came to the emergency department. Each day, they travelled to English Bay, Wadin Bay and Sucker River, communities that were isolated because of the fires. There, they connected with locals who were fighting fires, caring for their minor injuries, refilling prescriptions and assessing the mental health of the fire crews and support workers. “The practice of medicine itself wasn’t too different than what we would normally do. We are all used to working in low resource settings when we go out to surrounding communities and the outposts, not having a lab or anything like that, and just having your basic point-of-care diagnostic equipment,” said Dr. Kaiser.

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The decision to stay in La Ronge was, at first, a difficult one because of the potential risk, but in the end Dr. Kaiser couldn’t imagine being anywhere else. “I have very fond memories of that time because of all the amazing teamwork, support and humour of my colleagues, allied health professionals, and other community members looking after the people in La Ronge and the evacuees in other centres.” Meanwhile, other physicians from La Ronge were in Saskatoon providing medical care to the evacuees. They, too, were working out of a makeshift medical station set up in the SaskTel Sports Centre on Nelson Road where hundreds of people from northern Saskatchewan were housed in the cramped and hot emergency shelter. The physicians had regular clinic hours and saw patients on a walk-in basis. With access to patients’ electronic medical records, they wrote prescriptions for those who didn’t bring enough of medication for a two-week stay in the city, provided prenatal care, and met with those who had chronic diseases such as diabetes. They also were monitoring for possible communicable diseases. “We were really worried about someone getting a flu-like illness and that spreading like crazy through the group. We did quite a few assessments for that. We were also looking for scabies and lice because that can be an issue and we were worried about that spreading from person to person in close quarters,” said Dr. Sean Groves, a La Ronge family physician and one of the methadone prescribers in the community. A big concern for Dr. Groves was the 80 people from the La Ronge area who were on the methadone program. Moving high-risk patients to such an unstable living situation posed its challenges. The biggest complication was some of those in the methadone program were evacuated to Cold Lake, Alta., and they weren’t able to access their treatment. The La Ronge physicians worked with the Ministry of Health to move those people to Saskatoon where they could provide regular follow-up. “Sometimes it’s just too easy to find what you need when you’re in a bigger centre and you don’t have your usual supports around you,” said Dr. Groves, in an interview. While in Saskatoon, Dr. Groves started two of his patients on the methadone program and found it helpful to be able to see them on a regular basis at the evacuation centre. The evacuation of northerners to Saskatoon coincided with the beginning of the placement for two family medicine residents in La Ronge. They, too, worked out of evacuation centre in Saskatoon.

“It was a really good opportunity to introduce them to the patients, to our electronic system and they were introduced to some of the logistical challenges of providing care in more complicated settings, which is a lot of what we do in rural and remote settings anyway. We just make it work,” said Dr. Groves, who is also the site director for the family medicine residency program in La Ronge. The co-ordination of medical services throughout Saskatchewan and beyond was remarkable, says Dr. Veronica McKinney, director of Northern Medical Services.

Smoke clouds the sun as ambulances wait at the La Ronge Health Centre to transport long-term care patients to Saskatoon.

Some northern communities, such as Wollaston Lake, weren’t directly affected by the fires but the people living in those communities were cut off from their usual health-care providers in La Ronge. “We arranged for physicians to be flown out of Prince Albert or out of Saskatoon and sometimes we had to use different planes than we normally would but we were able to manage that coordination of physician services to these outlying communities,” said Dr. McKinney, in an interview. Ensuring the continuity of care was of primary importance to the physicians from northern Saskatchewan throughout the crisis. That meant some stayed in Air Ronge to provide health-care services to fire crews while others cared for patients in the evacuation centres in the province. And others were available via cell phone to physicians throughout Saskatchewan, Manitoba and Alberta.

Registered nurse Genevieve Chartrand and Dr. Stephanie Young take a break.

“A lot of times, the patients don’t know their own histories or even the conditions that they have and the names of the prescriptions that they need,” said Dr. McKinney. “For them to be able to see their health-care provider, their physician, that they knew and trusted and that they could talk with and already had an established relationship was huge. Or to know that even if they weren’t speaking directly with that physician, but that physician was aware and that they were helping to direct what was going on was very comforting to a number of patients.” Not only are the memories well ingrained in the minds of the physicians; the relationships made among those providing health-care services in the North and in Saskatchewan were strengthened. So too were the relationships that developed between the physicians and others from their community.

Dr. Jeff Irvine visits the temporary kennel set up for animals left behind.

“You can’t go through something like that and not be changed for the better,” said Dr. Young. That’s a sentiment echoed by Dr. Kaiser. “It ties you to a place and a group of people, and I am more invested than ever in family medicine here, in all the strange shapes that it takes,” she said.

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Dr. Jeff Irvine, Dr. Johanna Kaiser, Dr. Kieran Conway, and Dr. Stephanie Young

SK NEEDS BETTER TOBACCO CONTROL by Maria Ryhorski Physicians voted unanimously in favour of three motions calling for tighter tobacco control legislation at the Saskatchewan Medical Association fall 2015 Representative Assembly. Evidence has shown that tighter tobacco control has a direct impact on smoking rates. Since the ban on smoking in indoor public places was implemented ten years ago in Saskatchewan, smoking rates in the province have fallen from around 22 per cent to around 18 per cent. However, in the years since, Saskatchewan has fallen behind many of the other provinces in terms of tobacco control and a recent report released by the Canadian Cancer Society indicates that, while some progress has been made, there is much more work to do. Dr. Mark Brown, current SMA President, Moose Jaw family physician and anti-smoking advocate who led the movement to ban smoking in indoor public places ten years ago, is once again taking a leadership role in the push for stronger smoking legislation, with the full support of the membership behind him. I spoke with Dr. Brown on Jan. 13 to hear his thoughts on the issue.

HOW WELL DO YOU THINK WE’RE DOING IN TERMS OF TOBACCO CONTROL IN SASKATCHEWAN? DR. BROWN: Well, I think we’re doing poorly, you know, we were right at the forefront ten years ago with the ban on smoking in indoor public places and that was fantastic that we were leading the charge at that point. I think now what happened is that there’s been very little in terms of anti-smoking legislation since then, and what we’re seeing is that provinces that have typically been more conservative in terms of restricting freedoms, like Alberta, are getting ahead of Saskatchewan in terms of tobacco legislation. We’ve seen Alberta introduce legislation in the past year

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banning flavoured tobaccos; we’ve seen some communities, specifically Saskatoon city council, pass a bylaw to say – OK, no more smoking in public places, indoors or outdoors - and that’s fantastic, but what we always say as leaders in health care is that, it shouldn’t take each city to decide for itself. The government should be showing leadership and doing what’s right. This is something that would potentially reduce smoking rates and improve health care province-wide.

TELL ME ABOUT THE RESOLUTIONS THAT WERE PASSED AT THE RA. DR. BROWN: So what we’re calling for is bans on smoking in all public places indoors and outdoors. We’re calling for bans on flavoured tobaccos, because we know that a lot of young people get hooked on tobacco by trying out flavoured tobaccos first. The other thing we’re calling for is some sort of legislation on vaping because right now there is no legislation. There’s no regulation whatsoever. We’re not saying that it needs to be banned; we’re just saying that it needs to be regulated the same way as other addictive substances.

WHAT DO YOU HOPE WILL BE ACCOMPLISHED? DR. BROWN: Well, what we know is that smoking rates go down when it’s made socially unacceptable to smoke in public. Fewer people smoke. So that’s fact. We know that. We also know that if we tighten up regulations around tobacco, we’re going to see fewer young people smoking, and this seems to be where people are getting hooked right now. And we also know that the tobacco industry is targeting young people because they know that if they can get you hooked at 14 or 15 or 16, then they’ve probably got a client for life. More importantly, we know that if we can get people to stop smoking, their risk of lung cancer goes down. Their risk of a whole bunch of other cancers goes down. Their risk of a heart attack goes down dramatically if they stop smok-

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THE GOVERNMENT SHOULD BE SHOWING LEADERSHIP AND DOING WHAT’S RIGHT. THIS IS SOMETHING THAT WOULD POTENTIALLY REDUCE SMOKING RATES AND IMPROVE HEALTH CARE PROVINCE-WIDE.

ing. So these are all illnesses that tobacco causes and we can have a dramatic effect on health care, the health of our patients and the health of the province by inputting regulations around tobacco. The other thing that we know for a fact is that smoking is one of the leading things that makes people sick, and that costs us in terms of health-care dollars. And we’ve got a health-care system that’s getting more and more difficult to afford. Given this, the government really should show leadership and acknowledge that downstream the savings, if we reduce overall smoking rates in the province, are going to be immense. We need to be taking those steps.

WHAT CAN PHYSICIANS IN FRONT-LINE CARE DO TO DECREASE THE USE OF TOBACCO? DR. BROWN: As physicians we need to continue to educate our public, on a public level but also on a one-on-one level with people in the office. Specifically we need to focus a lot of attention on warning our young people about the risks of smoking. You know, “Don’t start. It’s not worth it. It’s not good for you.” The other thing that we need to do is to make sure that we support people who currently smoke but are wanting to quit. We need to encourage them. And just a small bit of advice for doctors - the evidence has shown very clearly that you don’t need to go into a long counseling session with a patient to get them to quit smoking. You just need to comment on it. The research has shown that if you just bring it up, even with one or two comments, that it actually is effective in getting people to rethink and in getting people to quit.

RESOLUTIONS 10

THAT THE SMA URGE GOVERNMENT TO ADOPT REGULATIONS AROUND ELECTRONIC CIGARETTES TO PREVENT YOUNG PEOPLE FROM USING THEM AND TO PREVENT THE UNDERMINING OF TOBACCO CONTROL.

THAT THE SMA URGE GOVERNMENT TO PROTECT RESIDENTS FROM SECOND-HAND SMOKE BY BANNING SMOKING OF ALL TOBACCO PRODUCTS, INCLUDING SHISHA AND HOOKAH, IN ALL INDOOR AND OUTDOOR PUBLIC PLACES SUCH AS PATIOS OF RESTAURANTS AND BARS, HOSPITAL GROUNDS, SPORTS FIELDS, PLAYGROUNDS AND OUTDOOR STADIUMS.

THAT THE SMA URGE GOVERNMENT TO BAN THE SALE OF ALL FLAVOURED TOBACCO PRODUCTS, INCLUDING MENTHOL, TO PREVENT YOUTH FROM STARTING TO SMOKE. Brown/Pillay - Carried

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HOW SASKATC In 2009 and 2014 the Canadian Cancer Society (CCS), the Heart and recommendations. Recently these organizations retained an indepenThe full report is available at https://www.cancer.ca/en/about-us/for-

SOME PROGRESS CONTROL THE SALE OF TAX EXEMPT AND DISCOUNT TOBACCO (2009). Saskatchewan has implemented limits on the amount of tax-exempt tobacco to First Nations. It has also put in place a real-time validation system for tobacco products sold on reserves. The government also increased tobacco taxes in 2010 and 2013 and is now the province with the fifth highest price of cigarettes in Canada.

PROHIBIT SMOKING IN MOTOR VEHICLES WHEN A PERSON UNDER THE AGE OF 19 IS PRESENT (2009). Smoking while driving in a vehicle with a person under 16 was prohibited by law in 2010.

INITIATE WELL-FUNDED MASS-MEDIA CAMPAIGNS TO EDUCATE THE PUBLIC ABOUT THE DANGER OF USING TOBACCO AND TO COUNTER TOBACCO COMPANY MARKETING AND PROMOTIONAL ACTIVITIES (2009). Saskatchewan has made some attempts at campaigns related to individual and policy changes, such as the youth projects View and Vote and Smokestream.

HELP SMOKERS TO QUIT BY PROVIDING SUPPORT AND SUBSIDIZING QUIT-SMOKING PRODUCTS AND PROGRAMS (2009). SUPPORT PEOPLE TRYING TO QUIT BY SUBSIDIZING THE COST OF NICOTINE REPLACEMENT THERAPY PRODUCTS (2014). In 2011, Saskatchewan started subsidizing Champix® and Zyban® for people on low or fixed incomes, but it is not yet helping tobacco users who want to access the most popular cessation aid – Nicotine Replacement Therapy (NRT). The province provides funds to train health professionals in cessation interventions through an online course. Saskatchewan is also partially funding the Smokers’ Helpline, a free confidential phone and online support service.

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CHEWAN IS DOING

HEALTH CARE

Stroke Foundation (HSF) and The Lung Association of Saskatchewan (LAS) outlined the following ten evidenced-based tobacco control dent consultant to assess our province’s progress since the recommendations were made. This is a summary of that report. media/media-releases/saskatchewan/2015/tobacco-report-card/?region=sk

SIGNIFICANT IMPROVEMENT NEEDED SUPPORT COMMUNITIES IN THEIR PREVENTION AND CESSATION EFFORTS WHERE SMOKING RATES ARE VERY HIGH (2009). The last time funding was provided for community projects was in 2012-13. Only three projects were funded and just one of them was independently evaluated, with mixed results. There is no conclusive evidence that the projects changed behaviour. Financing is needed for both evidencebased projects and for independent evaluation.

INCREASE FUNDING IN THE PROVINCE’S TOBACCO REDUCTION STRATEGY, BUILDING A HEALTHIER SASKATCHEWAN (2014). Saskatchewan currently spends approximately $450,000 per year on tobacco control initiatives, which amounts to a mere 40 cents per capita (2014 population figures). This is the lowest per capita funding rate in Canada, with Nunavut’s the highest at $8.43. The average rate in Canada is $3.65, which is still well below the funding level recommended by the US Centers for Disease Control of $7-11 US per capita.

ADOPT REGULATIONS AROUND ELECTRONIC CIGARETTES TO PREVENT YOUNG PEOPLE FROM USING THEM AND TO PREVENT UNDERMINING OF TOBACCO CONTROL (2014). The provincial government has not taken any steps to regulate electronic cigarettes, although seven provinces have brought forward legislation. Several Saskatchewan municipalities have taken action through municipal bylaws in the absence of provincial leadership.

BAN THE SALE OF FLAVOURED TOBACCO PRODUCTS (2009). BAN THE SALE OF ALL FLAVOURED TOBACCO PRODUCTS, INCLUDING MENTHOL, TO PREVENT YOUTH FROM STARTING TO SMOKE (2014). There are no restrictions on the sale of flavoured tobacco products in Saskatchewan. A simple regulatory change could ban these products. Five provinces have adopted legislation to ban flavours in tobacco products including menthol in tobacco products.

BAN SMOKING IN PUBLIC PLACES INCLUDING SCHOOL GROUNDS, HEALTH-CARE PROPERTIES AND ON OUTDOOR BAR AND RESTAURANT PATIOS (2009). PROTECT RESIDENTS FROM SECOND-HAND SMOKE BY BANNING SMOKING OF ALL TOBACCO PRODUCTS INCLUDING SHISHA AND HOOKAH, IN OUTDOOR PLACES SUCH AS PATIOS OF RESTAURANTS AND BARS, HOSPITAL GROUNDS, SPORTS FIELDS, PLAYGROUNDS AND OUTDOOR STADIUMS (2014). Saskatchewan legislation prohibits tobacco use on elementary and secondary school grounds, but nothing has been done to regulate smoking on health-care properties, playgrounds, sports fields, stadiums or bar and restaurant patios. Saskatchewan has not yet addressed the issue of waterpipe use (shisha and hookah) either indoors or outdoors.

PROHIBIT TOBACCO SALES IN PHARMACIES, UNIVERSITIES AND COLLEGES, BARS AND RESTAURANTS, ATHLETIC AND RECREATIONAL FACILITIES, AND THROUGH VENDING MACHINES (2009). RESTRICT THE SALES OF TOBACCO IN RESTAURANTS AND BARS, POST-SECONDARY INSTITUTIONS, AND ATHLETIC AND RECREATIONAL FACILITIES (2014). LICENSE ALL TOBACCO RETAILERS (2014). Of all the locations listed in this recommendation, the only place tobacco sales are prohibited is in pharmacies. Saskatchewan is one of the few provinces that does not require a provincial licence for tobacco retailers.

TO SHOW YOUR SUPPORT FOR THE CANADIAN CANCER SOCIETY’S CAMPAIGNS FOR SMOKE AND VAPE-FREE PUBLIC SPACES AND TO END THE USE OF FLAVOURED TOBACCO PRODUCTS, VISIT THEIR WEBSITE HTTPS://TAKEACTION.CANCER.CA/#/MAIN_PAGE/SASKATCHEWAN

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RESIDENTS HELP MEDICAL STUDENTS

prepare for CaRMS interviews by Lana Haight

Dr. Brenton Janzen remembers the anxiety and stress he felt as he prepared for his interviews for the Canadian Resident Matching Service (CaRMS) and wanted to give back.

katoon, in 2016, and will be offering the mock interviews across Canada in 2017, in conjunction with the provincialterritorial medical associations.

“You think your whole career is at stake. You’ve been working seven, eight, nine years toward this and you’re not sure if you’re going to get what you want or if you’ll like the outcome,” said the second-year family medicine resident after leading sessions for mock CaRMS interviews on Jan. 9.

Fehr believes hosting the mock interviews is another way for the SMA to support students and residents, encouraging them to stay in the province

“Being able to help out the next generation of students going into residency programs, it’s a nice way to give them a leg up that we never had.” The Saskatchewan Medical Association and the Canadian Medical Association hosted the mock interviews at the SMA offices in Saskatoon. Scattered throughout the building in offices and board rooms, medical students received tips from residents on how to answer well the questions that they’ll face in their CaRMS interviews. The 53 medical students from the University of Saskatchewan were assigned to a group of three or four students to one resident. Of the nine residents who ran the groups, three were from family medicine, two from surgical specialties and four from other specialties. The students were asked questions and given feedback from the resident as well as the other medical students in the group. Each session lasted two hours. “I got such good feedback today and it’s really boosted my confidence. I’m really happy with how things went. And I have my first interview on Monday. It was good timing,” said Cassie Fehr, fourth-year medical student at the U of S. Fehr found she learned not only from the feedback she received, but she also benefitted from listening to how the other students answered questions. “It really helps you to hone your own.” The CMA began the mock interview program in Montreal leading up to the CaRMS interviews in January, 2015. It expanded the program to eight locations, including Sas34

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Prior to this year, medical students were on their own to devise a plan for preparing for the interviews. Dr. Janzen and his three roommates in medical school worked together to figure out how to answer questions, especially the tough ones. “I don’t think I would have done as well on my interviews if it hadn’t been for them,” said Dr. Janzen, who is finishing his family medicine residency in Moose Jaw. “The four of us went out for a fancy dinner because we were all stressed. We had some wine and we went over each other’s answers and borrowed phrases from each other. There’s definitely better ways of saying things that make you sound like a more mature and articulate applicant. I can be pretty blunt so it worked in my favour, getting to steal some phrasing from some of my roommates.” Being well prepared for the 30-minute CaRMS is critical, says Dr. Janzen. “You might be the best applicant but if you don’t put your best foot forward, it might not turn out the best. That can have some big ramifications on a career that you’ve already sacrificed for.” This spring, 94 students will graduate with a medical degree from the U of S. Through the CaRMS match, the university has allocated residency spots for 101 graduates from medical schools in Canada. Setting aside a Saturday morning for students and residents to gather in an organized format was especially beneficial, says Fehr.

“Obviously we know a lot of the residents but they’re busy and we’re busy and it’s hard to meet up. And you don’t want to waste other people’s time. All of my friends are preparing as well. You don’t want to be selfish because everyone’s going through the same thing.” Fehr wants to stay in Saskatchewan and applied for residency positions in neurology, physiatry (physical medicine and rehabilitation) and family medicine. She participated in two sessions at the mock interviews, one with a family medicine resident and one with a psychiatry resident. Even after doing some interview prep on her own, she was asked a couple of “zinger” questions. One question she hadn’t anticipated was identifying the biggest sacrifice she has made to be in medicine. After the mock interview, she was ready for it. “I think time. I’m giving up the prime of my life. I could be travelling. I could be doing a lot of things. I could also be making money if I had chosen a different profession. I think that’s not something to be forgotten. But this is the career that I will be the happiest in and I value that over the other things,” she said confidently and with a smile.

Dr. Brenton Janzen, resident

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I TOLD THEM, ‘RELAX. YOU’RE GOOD CANDIDATES. YOU’RE U OF S TRAINED. WE HAVE A GREAT SCHOOL HERE. YOU CAN SELL YOURSELF TO THE PROGRAM.’

In addition to helping with how to best frame an answer to questions, Dr. Janzen wanted to help the students see what they’re going through as normal. “When you see the students come in, you realize that everybody’s nervous. Everyone has one or two questions that they kind of flub and don’t give a great answer,” he said. “I told them, ‘Relax. You’re good candidates. You’re U of S trained. We have a great school here. You can sell yourself to the program. Any will be happy to have you. Just go with what works for you, what fits with your personality and lifestyle.’” The annual process of matching medical students in their final year to residency training programs is in full swing across Canada. Interviews for the first iteration ended Feb. 7. The deadline for students and programs to submit their rankings is Feb. 18. March 2 is the big day when the matches are released. Students aren’t the only ones who are eager for the results. As one of the Moose Jaw family medicine residents who helped with the CaRMS interviews in 2015 and 2016, Dr. Janzen remembers Match Day last year. “When we got our match list (for Moose Jaw), it was an exciting day. It wasn’t the same as opening your own match day with your heart in your throat, but it was still exciting,” he said.

Cassie Fehr, Class of 2016

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I GOT SUCH GOOD FEEDBACK TODAY AND IT’S REALLY BOOSTED MY CONFIDENCE. I’M REALLY HAPPY WITH HOW THINGS WENT. SMA DIGEST | WINTER 2016

MINDFULNESS BENEFITS STUDENTS by Maria Ryhorski A recent study on the effects of mindfulness by fourth-year University of Saskatchewan medical student Tatiana Rac has confirmed what mindfulness advocate and content expert in the research Dr. Anita Chakravarti has long known to be true. Practising mindfulness regularly increases resilience and self-compassion, improves focus, and reduces negative coping and perceived stress.

“Those first couple of months of medical school were extremely stressful,” she says. “Adjusting to a new routine and environment was hard at first.”

Mindfulness – “the awareness that emerges through paying attention, on purpose, in the present moment, and non-judgementally to the unfolding of experience moment by moment,” according to Jon Kabat-Zinn, founder of the Mindfulness Based Stress Reduction (MBSR) program – has been empirically shown to have many positive effects on participants’ health and well-being. Effects like increased resilience and improved focus are of particular benefit to members of the medical community, which is known for its heavy workload, high stress levels and tendency to sacrifice self-care for the sake of providing care to others.

“Every time I left the session I felt rejuvenated and ready to tackle the next challenge.”

As study participant and third-year medical student Jillian Kerry knows, these stressors can take hold early in a medical career.

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EVERY TIME I LEFT THE SESSION I FELT REJUVENATED AND READY TO TACKLE THE NEXT CHALLENGE.

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When the opportunity to participate in research on the effects of mindfulness arose, she signed up, was selected and quickly saw positive effects.

Mindfulness has acted as a grounding mechanism for her, helping her to be more attuned to herself and her surroundings. “In the past I might have brushed off the way my body responded to a stressful situation. But mindfulness encourages you to acknowledge those feelings, be with them and then let them go.” This type of feedback has become familiar to Dr. Chakravarti, who does health and wellness promotion with the department of anaesthesiology at the U of S, as well as with the Saskatoon Health Region Healthy Workplace and SMA Physician Health Program, since she started providing drop-in mindfulness sessions for medical students over five years ago. She would hear from student participants how it was helping with their sleep or with their focus but she had nothing concrete to show how this drop-in model for mindfulness was benefitting them. When Rac approached her regarding her research, it was an opportunity to empirically verify the positive effects that drop-in mindfulness sessions were having on the well-being of medical students. Within two weeks Rac gathered a team, including Dr. Chakravarti, head of psychiatry Dr. Marilyn Baetz, and faculty liaison Dr. Marcel D’Eon, and they rushed to submit an application for research grants being offered by the Canadian

STUDENTS & RESIDENTS

Dr. Anita Chakravarti and Tatiana Rac

Physician Health Institute of the Canadian Medical Association. They were one of only four groups from across Canada selected to receive grants in 2013. Their research represented a shift from the intensive eight week Mindfulness Based Stress Reduction (MBSR) Program, to studying the effects of a more feasible model involving six one-hour drop-in Mindful Medical Practice (MMP) sessions over a period of several weeks. Participants were divided into three groups: those uninterested in MMP, those interested and selected to participate in MMP sessions, and those interested but not selected to participate in MMP. It was found that students who were interested in MMP and were selected to participate in the MMP sessions experienced increased resilience and a reduction in perceived stress and negative coping behaviours compared with the group who were interested in MMP but were not selected to participate in the sessions. Another notable outcome of the research was the light it shone on the interest among medical students to practise mindfulness. “Our sample size was 200,” says Rac, “and out of those, about 60-70 per cent were interested in participating in mindfulness. It shows very high demand.” Unfortunately the intervention group was not large enough to accommodate everyone who was interested, so only about 40 were able to participate in the sessions. Disappointment was clearly expressed by those interested but not selected for the intervention. And interestingly, according to Rac, “Some of the advocates for having more sessions were the people who were not interested in it at all. They saw the big benefits to their friends who were in it. Medical students generally felt that it should be available to everybody as an option.”

Resident mindfulness workshop participatns: Kasie Kelln, Jason Trickovic, Kylie Riou, Robyn Tenaski, Melissa Andersen, Ciaran McLoughlin, Ravi Varshney, Sharon Husak, Adam Tancred, Yifan Wang, Kayla Flood, In an attempt to meet this demand, Dr. Chakravarti is working through the SMA Physician Health Program with the support of the wellness committee of the Student Medical Society of Saskatchewan, to provide medical students with the opportunity to practise mindfulness. Beginning in September 2015, two Introduction to Mindful Medical Practice workshops were held for students and followed up with weekly practice sessions. In addition, a workshop was held at the SMA offices on Dec. 5 for residents. All have been well attended but communication of the availability of these sessions to the medical learner community continues to be a challenge, as does providing an appropriate and convenient venue and time. Despite these challenges, Dr. Chakravarti remains determined to share the benefits of mindfulness practice with all those interested, particularly within the medical and health services community. “I feel, with the current statistics around burnout and mental health issues among medical students, residents, and even physicians, that we have to provide those who are interested with options that are evidence-based and effective,” she says. Self-care is critical because if physicians look after their own well-being, they will be better able to serve their patients. “If even one [health care provider] gets it, how many patients is that going to impact?” she asks. “Whether they teach it or embody it, it’s going to create a ripple effect.” Weekly mindfulness practice sessions are underway. If you are interested in attending an Introduction to Mindful Medical Practice workshop so you are eligible to attend the weekly practice sessions, please contact Dr. Anita Chakravarti at anita.chakravarti@usask.ca.

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FEELING EMPOWERED & ENGAGED

residents and students meet with SK health-care leaders by James Winkel, saskdocs communications manager Close to 70 University of Saskatchewan (U of S) medical students and residents peppered some of Saskatchewan’s health-care leaders at the first ever Minister’s Engagement Forum held in the U of S Academic Health Sciences building on Oct. 7, 2015.

Dr. Visvanathan did an outstanding job keeping the panelists on time and on track, and making sure the medical residents and students stuck to their questions. The result was both the medical learners and leaders walking away with a better understanding of some of the relevant issues.

Co-hosted by the Saskatchewan Medical Association (SMA) and saskdocs, the forum was part of the organizations’ commitment to have medical residents engage and interact with provincial health ministers and other health-care leaders in Saskatchewan.

The issues included: physician supply, particularly around the anticipated release of the provincial physician resource plan; the implementation of a province-wide electronic health record system (EHS) and uniform access to such a system; and the availability of resources and training for physicians to address seniors care in the province.

The forum had a panel format, which was led by Dr. Kishore Visvanathan of Saskatoon. Satellite locations in Regina, Swift Current and Melfort were linked, to give medical residents and students in each of these locations the opportunity to ask questions as well. Members of the panel included: • • • • • •

Honourable Dustin Duncan, Minister of Health Honourable Greg Ottenbreit, Minister Responsible for Rural and Remote Health Dr. Mark Brown, President, Saskatchewan Medical Association Dr. Dennis Kendel, CEO, saskdocs Dr. Preston Smith, Dean, University of Saskatchewan’s College of Medicine Dan Florizone, CEO, Saskatoon Health Region

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The questions raised were especially important to Dr. Brown who urged many of the medical residents and students to not only consider family medicine in their career paths, but to go further and consider family medicine in Saskatchewan’s rural or remote communities. “While physician supply dynamics are changing across the country, there are still many opportunities for physicians in this province, especially outside of the major cities. If you’re a medical student or resident that has never been exposed to practices or communities outside of Regina or Saskatoon, give rural and remote a chance and see what you think,” said Dr. Brown, at the forum.

STUDENTS & RESIDENTS

DR. WILLIAM QUAN MD, FRCPC, FAAP and

DR. MAHLI BRINDAMOUR MD, FRCPC Dr. Kendel offered students some advice as they consider career options in medicine. A U of S medical graduate and former family physician, Dr. Kendel urged many of the trainees in attendance to take many factors into account when applying for resident positions. He would like to see more of them apply for positions in Saskatchewan in order to engage with them along the way. “While the ratio of residency positions and medical graduates throughout Canada’s medical universities is always changing, I think it is important for many of our U of S medical graduates to consider applying for residencies here in Saskatchewan. From my experience your chances are always better to match in your home province,” said Dr. Kendel. Both organizations look forward to future engagement opportunities with U of S medical trainees. Events such as the Minister’s Engagement Forum ensure questions and concerns are heard and dialogue is used to build a strong and diversified provincial physician workforce.

wish to announce that they have joined the office of

DR. CARLA KROCHAK & DR. ERIN WOODS in the practice of general pediatrics at

SASKATOON PEDIATRIC CONSULTANTS PLEASE CALL OR FAX REFERRALS TO: 301A-39 23rd Street E Saskatoon, SK S7K 0H6 Phone: 306-653-7741 Fax: 306-653-7743 Downtown office with easy access to parking. Services in French and Cantonese available. All general pediatric, neurobehavioral and new immigrant health referrals are welcome. Urgent referrals will be accommodated on a priority basis.

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ROADMAP photo c 8 8

Every year, the Roadmap Program holds residents asking them to showcase rural and dozens of entries. In no particular order...

here

1. 2. 3. 4.

Navid Robertson, FMR Jackie Chou, FMR Natasha Desjardins, FMR Neil Arnstead, Year 4

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contest winners a photo contest for medical students and regional Saskatchewan. This year we received

are the winners! 5. 6. 7. 8.

Krissy Kim, IM specialist resident Tara Sander/Jon Herriot, Year 4 Matthew Butz, Year 3 Eric Brenna, Year 2

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UPCOMING COURSES & CONFERENCES MARCH

SASKATCHEWAN REFUGEE HEALTHCARE March 11-12, 2016 – Saskatoon, SK For more information, visit www.usask.ca/cme ROADMAP TOUR – SUN COUNTRY HEALTH REGION March 12, 2016 – Weyburn, SK For more information, email delilah@sma.sk.ca

APRIL

ROADMAP TOUR – KELSEY TRAIL HEALTH REGION April 9, 2016 – Tisdale, SK For more information, email delilah@sma.sk.ca SASKATCHEWAN PSYCHIATRIC ASSOCIATION April 15-16, 2016 – Regina, SK For more information, visit www.usask.ca/cme 2016 METHADONE AND SUBOXONE OPIOID SUBSTITUTION THERAPY CONFERENCE April 22-23, 2016 - Saskatoon, SK For more information, visit www.cps.sk.ca BEV LEECH ANESTHESIA EDUCATION DAY AND RESIDENTS’ RESEARCH COMPETITION April 23-24, 2016 – Regina, SK For more information, visit www.sma.sk.ca

MAY

RURAL AND REMOTE MEDICINE COURSE 2016 Society of Rural Physicians of Canada May 5-7, 2016 – Charlevoix, QC For more information, visit www.srpc.ca/rr/index.html 2016 SPRING REPRESENTATIVE ASSEMBLY May 6-7, 2016 – Regina, SK For more information, visit www.sma.sk.ca PRACTICAL ORTHOPEDICS May 13-14, 2016 – Saskatoon, SK For more information, visit www.usask.ca/cme WELCOMING STRANGERS Christian Medical and Dental Society Annual Conference May 26-29, 2016 – Saskatoon, SK For more information, visit www.cmdscanada.org FUNDAMENTAL CRITICAL CARE SUPPORT May 27-28, 2016 – Saskatoon, SK For more information, visit www.sccm.org/FCCS You can also email saskfccs@gmail.com

JUNE

DRUG THERAPY June 2-3, 2016 – Saskatoon, SK For more information, visit www.usask.ca/cme

FREE ONLINE COURSES METHADONE4PAIN.CA

TRANSFUSION MEDICINE FOR PHYSICIANS

Methadone4Pain.ca is a course for physicians wishing to improve their knowledge and develop core competencies in methadone prescribing for pain management in palliative care. Approved for 1 hour MainProM1 credits and as a Royal College Accredited Group Learning Activity (Section 1).

Transfusion Medicine for Physicians is an accredited CME e-learning course developed to promote standardized safe transfusion medicine practice among physicians and raise awareness of current best practices. Based on expert published guidelines and literature, this online course features interactive case studies that highlight important points that are common in daily clinical decision making.

This self-directed course includes three modules: •

Introduction and Indications for Methadone

•

Initiation for Analgesia

•

Safety and Support for Physicians and Patients

For more information, visit Methadone4Pain.ca 42

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•

Six ten-minute modules

•

CME accredited for 1.0 Section 1 credit

For more information, visit http://pbco.ca/index.php/physici ans/transfusion-medicine-for-physicians

Dr. Lana Cheshenchuk at suitlana@sasktel.net or call 306.545.5868.

2’ - 0”

10’- 0”

Saskatoon, SK - Fantastic Opportunity! Beautiful Clinic! Great Location! This bustling East

MANUFACTURE AND INSTALL… EXTERIOR

side family practice is looking for energetic family physicians for winter and long term locums.

TWO SETS Partnership possibilities available. Kenderdine Medical Clinic has moved into a brand FIRST SURFACE VINYL ONalso EXISTING LEXAN newFACE facility with experienced professional staff. One of the trailblazers in Saskatchewan’s EMR INSTALLED ON EXISTING LEXAN FACE OVERALL SIZE: AS SHOWN

program, there is also an X -Ray and pharmacy all on site. There is a significant, large and stable patient population and high volume walk-in traffic. Offering a competitive split including

CONSTRUCTION: VINYL GRAPHICS SUBSTRATE: EXISTING CABINET: EXISTING

70/30 for evening and weekend MEC shifts!

GRAPHICS

KENDERDINE: BLACK MEDICAL CLINIC: WHITE LOGO: WHITE/RED/BLACK BACKGROUND: WHITE

COLOUR DATA

VINYL: BLACK 3630-33 RED

Contact Business Manager Daniel McNeil @ 306 934-6606 ext. 105 or dmcneil.kmc@sasktel.net.

28 Autumn 2011 SMA News Digest

sma news digest autumn 2011.indd 28

831B-60th Street East skatoon, Saskatchewan Canada S7K 5Z7 Tel (306) 934-0868 Fax (306) 934-6862 www.pattisonsign.com A Division of Jim Pattison Industries Ltd.

DATE: FEB 04/11 SKETCH: S11-002R4 SALES: D.WASKO

Phone: 306-343-SIMS (7467)

Landlord Approval Email: info@sasksims.ca

ARTIST: B.WILLIAMS

SCALE: 3/4” = 1’ - 0” PAGE: 1

9/16/2011 2:29:32 PM

Customer Approval

REVISION HISTORY (PRIOR TO MASTER PRINT) Website: www.sasksims.ca

T h e d e s i g n d e p i c t e d h e r e i n i s t h e s o l e p r o p e r t y o f Pa t t i s o n S i g n G r o u p and may not be reproduced in whole or in part without prior written c o n s e n t f r o m t h e c o m p a n y. A c t u a l c o l o u r s , l e t t e r s i z e s a n d g r a p h i c l a y o u t m a y v a r y s l i g h t l y d u e t o t h e p r o p e r t i e s o f m a t e r i a l s .

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

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

courses throughout the province and will come to you!

SMA DIGEST | WINTER 2016

ANNOUNCEMENTS & CLASSIFIEDS WELCOME TO THE SMA

The SMA is pleased to welcome a variety of new talent to our organization! To the accounting team: • Brenda Bodman, Senior Staff Accountant To the communications team: • Lana Haight, Communications Advisor • Ivan Muzychka, Senior Communications Advisor To the EMR team: • Tracey Arnold, Change Management Advisor • Charlene Koch, Change Management Advisor • Lalania MacNevin, Change Management Advisor To the insurance team: • Carol Friesen, Insurance Administrator To Physician Support Programs team: • Ravneet Kaur, Administrative Assistant To the senior leadership team: • Sherry Chen, Director of Corporate Services

COMING SOON: A FRESH AND CONSISTENT LOOK FOR THE SMA

Over the next few months the SMA will unveil its updated visual identity. We’ve been working to create a fresh and professional look that is representative of our identity as your association, and of our commitment to living our values as an organization. This will mean new business cards, letterhead and a consistent look across all our materials from the SMA Digest, to our brochures, to our website, to the emails you receive from us.

MCC QE PART II SEEKS PHYSICIAN EXAMINERS

Physician examiners are needed for the MCC QE Part II in Saskatoon April 30 and 31, 2016. For further information please contact Nicole Kopp at nicole.kopp@usask.ca or by phone at 306-966-6769. Qualifications: • Licentiate of the Medical Council of Canada (LMCC) and should be two years post LMCC. • Two years of Canadian independent practice. • Unrestricted license, not under professional investigation and currently practising medicine.

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• •

• • •

Should have the ability and stamina for the task. Should not examine in the three years prior to anyone in their immediate family or household’s eligibility to take the Medical Council of Canada’s Qualifying Examination Part II. Should not examine for a minimum of three years before and a minimum of three years after participating in a preparatory course. Should not have a conflict of interest. SIPPA graduates must be three years on full licensure in an unsupervised practice.

PHYSICIAN NEEDED AT GAMC Gateway Alliance Medical Clinic (GAMC) requires a full-time physician. GAMC has two locations in the east and south sides of Regina, with access to an on-site pharmacy. These facilities are newly renovated, multi-disciplinary clinics, and have been in operation for three years. Both locations are also near laboratory and x-ray services. We have a busy family practice and walk-in, which includes routine obstetrical, pediatric care, geriatric care and chronic disease management. GAMC runs special clinics, which include asthma/COPD (GAMC offers in-office spirometry), minor surgical procedures, men’s health clinics, diabetes and hypertension patient education sessions. We have affiliations to multiple sporting fraternities around the city. GAMC operates almost exclusively paperless via electronic medical records. Adequate and free parking facilities for staff and patients are available.

HOW TO APPLY

Please email your resume/CV to Anastasiia Antonyuk at anastasiiagamc@gmail.com.

PHYSICIAN NEEDED AT WINDSOR EAST MEDICAL Physician required at Windsor East Medical Clinic (either general or specialist practice) on either a part- or full-time basis. The clinic was built in November 2015, and is located on Quance Street, Regina. It currently includes both a general and aesthetic medical practice. For more info, contact Dr. Naidoo at 306-206-1855.

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

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

Director, Physician Support Programs

306.244.2196 brenda@sma.sk.ca

New to Saskatchewan and craving a taste of home?

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

Store Hours:

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

Find us:

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

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

IN MEMORIAM Dr. Robert D. Forrest 1943-2016

Dr. Robert (Bob) Forrest passed away peacefully on Jan. 13, 2016, in the loving presence of his wife. He had been living at Oak Bay Kiwanis Pavilion in Victoria, BC. Born on Aug. 15, 1943, in Moose Jaw, SK, Bob is survived by his wife, Susan Speight Forrest, and their two sons. Bob excelled in academics and sports. He loved basketball (a great right hook!) and a good game of tennis. He completed his undergraduate medical degree at the University of Saskatchewan and then went on to McGill University for his neurology residency. He acquired encephalitis when working on the children’s unit at Montreal Children’s Hospital. Against all odds, he re-learned to speak and walk, and then went on to re-learn medicine and practised for many more years in Montreal, Saskatchewan and BC. Bob was a man of incredible perseverance, tenacity, and resilience. He was well -respected by his peers and was a mentor to many. A summer celebration of Bob’s life will be held for family and close friends.

Dr. Richard Lloyd Johnsrude 1928-2015

Dr. Richard (Dick) Johnsrude passed away on June 7, 2015, peacefully at his home in Saskatoon while enjoying a drink on the deck before dinner. Born on Mar. 25, 1928, in Kingsford, SK, Dick is survived by his wife, Mary, and their two sons and one daughter, as well as their families. Dick graduated from the University of Saskatchewan with a Bachelor of Science degree in pharmacy and worked as a pharmacist in Macklin, SK. and Surrey, BC. However, a lifelong desire to become a medical doctor prompted him to enter the College of Medicine at the University of British Columbia from which he graduated in 1964. The Johnsrudes then decided to relocate back to Macklin where Dick practised for nearly 25 years. His years as the primary care physician for the Macklin community brought Dick much satisfaction. Many knew him as Doctor Johnsrude, some knew him as Dick, and to others, he was simply “Doc.” He took great pleasure in getting to know his patients, often stopping in for house calls long after this was commonplace. Special occasions were often met with a flood of homemade sausage, 46

SMA DIGEST | WINTER 2016

cuts of wild game and delicious baked goods in thanks for the time Dick had spent helping families through times of crisis. In Macklin, he became an avid golfer and was one of the founding members of the Macklin Golf Club. At the request of the late Dr. Richard Johnsrude, there was no funeral service.

Dr. Alan R. Kirby 1924-2015

Dr. Alan Kirby died at Luther Special Care Home on Dec. 11, 2015. Born in Newcastle-on-Tyne, England, he is survived by his wife Margaret, their three children and 11 grandchildren. Alan attended Newcastle Grammar School and the University of Durham (M.B.B.S. 1947). He was trained in surgery in Newcastle (F.R.C.S. England 1957) and later in neurosurgery in London. He met Margaret, his wife of 60 years, while working together in Newcastle. They were married in 1955 and immigrated to Saskatoon in 1963. Alan worked in the Royal University Hospital, at first in the Department of Neurosurgery and later in the Department of Rehabilitation, until his retirement in 1989. Music was always an important part of Alan’s life. He was the organist and choirmaster in several Anglican churches throughout his years in Saskatoon. A memorial service was held at All Saints Anglican Church in Saskatoon on Jan. 2, 2016, and a private interment took place at the Columbarium at St. John’s Cathedral.

Dr. Rampurkar Manohar 1925-2015

It was with great sorrow that the family of Dr. Rampurkar (Ram) Manohar announced his peaceful passing in Burlington, ON. He was predeceased by his wife of 65 years, Asha Manohar, who died on July 13, 2014. Ram will be dearly missed by his three daughters and their children. Ram’s intelligence was matched only by the generosity of his spirit. He was a warm and caring man who guided others with his wisdom. He was highly respected by friends and colleagues at the University of Saskatchewan where he enjoyed a long and rewarding career inspiring many through his love of academia.

IN MEMORIAM Throughout his life, Ram pursued many interests including art, science, physics, computer science and music. He was passionate about life and learning, and strived to enjoy each day of his life to the fullest. Ram had many friends and relatives across the globe with whom he established and maintained close and loving relationships. Ram provided inspiration and mentorship to many within his extended family. He will be greatly missed. A memorial reception was held at the University of Saskatchewan on Nov. 28, 2015.

Dr. Roman T. Michalski 1944-2015

Dr. Roman Michalski passed away at St. Paul’s Hospital on Nov. 23, 2015, with his beloved wife of 45 years, Eva, and their daughter by his side. Born in Warsaw, Poland, on May 2, 1944, Roman moved to Saskatoon with his family in 1983. In 1989, they moved to Prince Albert where Roman spent 19 years in the Pathology Department at Victoria Union Hospital and later became the Head of Pathology. He retired in 2008 and moved back to Saskatoon where he continued to work part-time at City Hospital. Roman was a humble man, never wanting to highlight his achievements. He obtained his medical degree and a PhD in Warsaw, specializing in internal medicine and hematology. Once in Canada, he re-specialized in pathology. Roman was an exceptionally intelligent man surrounded by books and literature, and he was an author in countless medical publications. His medical opinion was highly regarded and sought after. Other than medicine, his passions were writing and photography. His sharp wit and humour were portrayed in the prose that he wrote and read for friends’ special occasions. Roman was a kind man who loved animals and nature. Roman will always be remembered for his intelligent humour, wit and pragmatically comical view on life. He will also be remembered for his kindness and composure despite what life threw at him. He was a great man who will never be forgotten and will continue to be loved by all. The Mass of Christian Burial was celebrated on Nov. 28, 2015, at Our Lady of Czestochowa Parish in Saskatoon.

Dr. Michael S. Slobodzian

ing World War II. After receiving his medical degree from the University of Manitoba, he moved to Saskatoon where he was one of the first physicians on staff at St. Paul’s Hospital and went on to practice family medicine in the Saskatoon area for 50 years. As a caring, dedicated doctor he brought thousands into this world and touched the lives of many more with his boundless compassion and good humour. To his family, he showed unwavering love. He will be missed by many and always remembered. He was predeceased by his first wife, Eunice (nee Joys), and two of their sons. He is survived by his five children, his loving wife of 21 years, Kathy (Millar) and her children, as well as 12 grandchildren. A celebration of his life was held at the Sheraton Cavalier on Sept. 24, 2015, with a private family interment at a later date.

Dr. John Luther Spencer 1933-2015

Dr. John (Jack) Spencer passed away Dec. 15, 2015. Born on Feb. 8, 1933 in Weldon, SK, Jack attended the University of Saskatchewan and was in the first graduating class from the College of Medicine, receiving his M.D. in 1957. He held honorary membership in the College of Medicine Alumnae Association and was a life member of the Canadian Medical Protective Association. He was a member of the Canadian Society of Aviation Medicine as well as the American Society of Clinical Hypnosis. In 2003, he was elected as Senior Member to the Canadian Medical Association. Jack was a designated medical examiner for Transport Canada Civil Aviation as well as for the R.C.M.P. As a member of the Saskatchewan Medical Association, he served on the Representative Assembly for many years and later on the nominating committee. He accepted an appointment as a clinical professor for the College of Medicine, a commitment to student education as a sort of “giveback.” For some ten years he served with C.A.S.A.R.A. (Civil Aviation Search and Rescue). He was a medical consultant to Parkland Terrace Special Care Home. Jack served in various positions of the local medical district association. Jack is lovingly remembered by his wife, Vi Spencer, as well as their four children and their families. The funeral service for Jack was held on Dec. 20, 2015, at Shellbrook Community Hall. He was laid to rest in the Shellbrook Cemetery.

1924-2015

Dr. Michael Slobodzian passed away peacefully on Sept. 17, 2015, at St. Paul’s Hospital in Saskatoon. His family was at his side. Born in Winnipegosis, MB, on Aug. 16, 1924, Michael served as an officer and a pilot in the Royal Canadian Air Force durSMA DIGEST | WINTER 2016

North 49 offer a diversity of rehabilitation services for: • Motor Vehicle Injuries.! • Work Injuries.! • Sports Injuries.! • Hand Injuries.!

• Concussion Management.! • Temporomandibular Disorders (TMD/TMJ). !

• Dizziness & Balance Problems.! • Fall Risk Assessment.! • Pre & Post Surgical.

Physical Therapy and Vestibular Therapy Services Provided by:! KREGG OCHITWA BScPT, CWCE, CredMDT! AMANDA PETRIE MPT, BScPHSI! PETER McLEOD BScPT! ELISE GRAY BScPT, BSPE! NATALIE McVITTIE MPT, BSc (Hons)!

Hand Therapy Services Provided by:! CATHY SAJTOS BScPT, CHT, DipManipPT, FCAMT !

Kinesiology (Exercise Therapy) Services Provided by:! TAMARA KOWAL BScKin, CPT, CEP Locally owned and operated.

OPPORTUNITIES IN SWIFT CURRENT

Opportunities available for two family physicians in Swift Current, SK. Our aim is to provide an environment where physicians can establish a balanced lifestyle and where each physician can tailor their practice to suit their personal needs and preferences. There are also opportunities available in emergency medicine, obstetrics, minor procedures and operating room assisting, if interested. If interested or for further information/site-tour contact: DR. NICOLAAS VAN DER BERG email: nicolaasvanderberg@gmail.com tel: 1-306-351-4801

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Clinic Location:!

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

Clinic Hours:!

Monday to Friday! 9am to 6pm!

Phone: 343-7776! Fax: 343-7780! Email:! contactus@north49therapy.ca

ITâ&#x20AC;&#x2122;S MORE THAN JUST RRSP TIME. We have your financial best interests at heart. No one understands how the recent government changes impact physicians better than MD. Now more than ever, you need tax planning advice that goes beyond registered retirement savings plans (RRSPs).

Itâ&#x20AC;&#x2122;s time to invest with MD. Talk to us today. 1 800 267-2322 md.cma.ca/time MD Financial Management provides financial products and services, the MD Family of Funds and investment counselling services through the MD Group of Companies. MD Financial Management Inc. is owned by the Canadian Medical Association. SMA DIGEST | WINTER 2016

Photo by Navid Robertson, FMR

Return undeliverable Canadian addresses to:

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

Mail to:

40007031