march/april 2015 - number 2

March-April 2015 | Volume 40 | Number 2

DIGESTAlberta Doctors'

Patients First®

What’s our medical profession really like?

Students find out at Alberta Medical Students’ Conference and Retreat in Banff

The centennial of Dr. Harry G. MackidAlberta’s first Canadian Medical Association president

And the message is … “Don’t give up!”

Alberta Medical Association Youth Run Club ambassador Paula Findlay walks the talk

Mayhap you have met these menschen!

Join the Alberta Medical Association in thanking these outstanding physician mentors

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COVER PHOTOS: Alberta Medical Students' Conference and Retreat. ( provided by Grace Xu)

6 What’s our medical profession really like? Students find out at Alberta Medical Students’ Conference and Retreat in Banff

1 1 The 2015 Tarrant Scholarship opportunity is here! Medical students can apply, practicing physicians can give back through donations

14 The centennial of Dr. Harry G. Mackid Alberta’s first Canadian Medical Association president

16 And the message is … “Don’t give up!” Alberta Medical Association Youth Run Club ambassador Paula Findlay walks the talk of her personal beliefs at Beaumont’s École Bellevue School

22 The beginnings of plastic surgery in Canada War time challenges drove new techniques

24 Arming adolescents with knowledge about mental health Emerging Leaders in Health Promotion Grant Program funds community psychiatry project

26 Mayhap you have met these menschen! Join the Alberta Medical Association in thanking these outstanding physician mentors

CONTENTS

FEATURES

DEPARTMENTS 4 From the Editor

8 Health Law Update

10 Mind Your Own Business

12 Insurance Insights

17 Dr. Gadget

19 PFSP Perspectives

28 In a Different Vein

31 Classified Advertisements

MARCH - APRIL 2015

3

AMA MISSION STATEMENT

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

Patients First® is a registered trademark of the Alberta Medical Association.

Alberta Doctors’ Digest is published six times annually by the Alberta Medical Association for its members.

Editor: Dennis W. Jirsch, MD, PhD

Co-Editor: Alexander H.G. Paterson, MB ChB, MD, FRCP, FACP

Editor-in-Chief: Marvin Polis

President: Richard G.R. Johnston, MD, MBA, FRCPC

President-Elect: Carl W. Nohr, MDCM, PhD, FRCSC, FACS

Immediate Past President: Allan S. Garbutt, PhD, MD, CCFP

Alberta Medical Association 12230 106 Ave NW Edmonton AB T5N 3Z1 T 780.482.2626 TF 1.800.272.9680 F 780.482.5445 [email protected] www.albertadoctors.org

May-June issue deadline: April 13

The opinions expressed in Alberta Doctors’ Digest are those of the authors and do not necessarily reflect the opinions or positions of the Alberta Medical Association or its Board of Directors. The association reserves the right to edit all letters to the editor.

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

© 2015 by the Alberta Medical Association

Design by Backstreet Communications

TOWERsymphony

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AMA - ALBERTA DOCTORS’ DIGEST

A short while ago my existence was disturbed.

Disturbed by stillness. By quiet solitude.

Recovering from back surgery – successful,

thank you – I spent big chunks of my day supine, flat as the proverbial pancake, interrupted only by brief walks, half-turns to one or other side, thrice daily exercises and washroom breaks.

I tried to watch television, but my interest shrivelled at horrific and seemingly endless deaths at the hands of fanatics, or hell-bent economic news only acknowledged by politicos once every last man had seen that the emperor had no clothes. And I began to believe post-operative Gravol was a remedy for the banal entertainment that pried itself between commercials.

happy and even glad at the chance to poke and prod the near and far recesses of my memory.

If there was a pattern to my mental wandering, it was to revisit nodes of memory and their connections that were unique to me, the things I prized. I became impatient at interruptions in the day and was anxious to get back to my “aloneness,” to turn to this or that recollection and wonder: Was it still true? Partly true? Did it ever happen? What did it mean?

FROM THE EDITOR4

Dennis W. Jirsch, MD, PhD | EDITOR

Varieties of solitude

Recovering from back surgery, I spent big chunks of my day supine, flat as the proverbial pancake.

It was an opportunity to “stand down” from an external world which for a time seemed extraneous and impertinent.

In a cerebral sense, I like to think I was, like uber-rapper Eminem, “Cleaning out my Closet.” From time-to-time in this indulgent adventure some small courage was required: I had to “put on my big boy pants,” even if only in an intra-cranial sense, and see the world as it had become, given time and the river. Perhaps this immersion of a week or two changed little in me, perhaps lots, but at times I was near jubilant and I revelled in austere pleasures in a world devoid of expectation and without urgency.

Pico Iyer has written a lovely essay that I can relate to. In The Art of Stillness,1 he describes the tonic to be had in “the age old practice of slowing down, taking stock and discovering the simple cathartic thrill of stillness.”

My own genial time was unexpected. It has caused me to wonder, after the fact, about the relationship between solitude and its aggrieved cousin, loneliness. Ours is a lonely planet, I know, and solitude may be our biggest fear. Much alarm derives from the spirit of the time. Our electronic gadgets bombard us with mail, text, phone calls, FaceTime and so on, but they also keep new distances between us. I think of the vigil of having to keep up with hundreds of “friends.” “Keep in touch,” >

I tried books, magazines and fiddling with all the electronic gadgets at hand, but in my convalescent state it became clear to me that the world and I, for a time, had little to say to each other beyond that which was necessary or civil. I chalked it up to the “metabolic response to trauma/surgery,” since my appetite was huge, but my outer world had contracted to a sea of irrelevance.

As my Brit acquaintances might say, it was an opportunity to “stand down” from an external world which for a time seemed extraneous and impertinent. And stand down I did. I was surprised to find that at this odd remove from my usual life, and given the near slow-mo tempo and quiet of my room, I became self-absorbed and more – quite

MARCH - APRIL 2015

5has become the parting slogan of all our encounters, a substitute for touching noses.

Years ago, psychiatrist Dr. Anthony Storr wrote a book reminding us of the special relationship between solitude and creativity.2 We recognize the “big C” creativity evident in the lives of famous loners such as Einstein, Newton, Nietzsche, Spinoza, Wittgenstein and so on. I’d like to think that “small c” creativity must also be found in those people who spend more mundane lives, alone but happy with their circumstances.

We are comfortable with our geniuses and heroes as loners, can recount the reclusiveness of those in our religious pantheons, and we may even remember the stories of the hermits of the 4th century, wandering in the deserts of North Africa.

> Consider the fuss and worry that goes into dinner parties and social occasions that view unattached men or women as anomalies in want of repair, if only for the sake of symmetry.

Admiral Richard Byrd, one of our more recent heroes, spent the winter alone in the Antarctic in 1934. In his book, “Alone,” he explained:

“I wanted to go for experience’s sake; one man’s desire to know that kind of experience to the full … to be able to live exactly as I chose, obedient to no necessities but those imposed by wind and night and cold; and to no man’s laws but my own.”3

Byrd’s words serve him well, but disclose our negative attitudes to those who prefer solitude in their perhaps smaller lives. Of these, we may use the term “unnatural” and are quick to point out our genetic and evolutionary history as pack animals. Some might go so far as to say that living alone is a form of pathology, that interpersonal relationships are necessary for health and happiness. Solo is dangerous, we’ll argue, on several counts. One might fall by this or that wayside, unnoticed. No one might witness an incremental slip into madness.

We may even call a preference for solitude “self-indulgent,” reasoning, peculiarly, that life may be happier or easier without serious social engagement. It’s escapist, some say, urging: Be a man/woman. Stop running. Get a grip. Others will cry “anti-social” – exhibiting little thought, or none at all, since that’s what choosing solitude is all about. Evading “social responsibility,” is another disparagement, again of indefinite meaning, as if the need to have x-spouses or y-progeny has particular ethos in a world as fouled as ours.

My own genial time was unexpected. It has caused me to wonder, after the fact, about the relationship between solitude and its aggrieved cousin, loneliness.

Penal isolation was once thought to be beneficial, prompting remorse and reform by making a prisoner confront his/her conscience. Today, we know that imposed solitude of any prolonged time is torture, pure and simple…

It is quite another matter to be subjected to solitude, rather than opting for it. Penal isolation was once thought to be beneficial, prompting remorse and reform by making a prisoner confront his/her conscience. Today, we know that imposed solitude of any prolonged time is torture, pure and simple, and that predictable anxiety and agitation will follow, with deep depression, disrupted thinking and hallucinations. Upon release, the damage will have been done with nightmares, unremitting anxiety, depression and suicidal ideas to follow. After a war we call it Post-Traumatic Stress Disorder.

My post-op ruminating was more than pleasant, while it lasted, but introduced me to something vast. There’s the solitude necessary for a life’s work, an oeuvre if you will. There is also loneliness so deep one will sit in a café at midnight just to hear a stranger speak. Forced isolation is hell, not so the propensity to live closer to one’s core.

With time I became more mobile and looked further afield. My mini-reverie ended well and I didn’t experience the “tyranny of the empty room.” I’m prepared to think that it may all have been part of the egotism of convalescence. Perhaps unknown hormones ebbed and were in turn replaced by others.

We know though that solitude is something we can’t evade, that it will come, sooner or later. Whether 18 or 89, we know that we are all old. Gabriel Garcia Marquez put it well: “The secret of a good old age is simply an honorable pact with solitude.”4

He was right, at any age.

References

1. The Art of Stillness: Adventures in Going Nowhere, Iyer P. TED books, Simon & Schuster, New York, 2014.

2. Solitude: A Return to the Self. Storr A. Ballantine Books, New York, 1988.

3. Alone, Byrd RE. Putnam, New York, 1938.

4. http://en.wikiquote.org/wiki/Gabriel_Garc%C3%ADa_M%C3%A1rque.


On the weekend of January 23-25, over 320 medical students from the University of Alberta (U of A) and University of Calgary (U of C)

convened at the Banff Convention Centre for the 11th annual Alberta Medical Students’ Conference and Retreat (AMSCAR). AMSCAR 2015 welcomed future physicians from Alberta’s two medical schools to gather, network and connect amongst not only each other, but also with practicing physicians and health care organizations. This event served as a great opportunity for students to learn about physician wellness and develop strategies to live healthy lifestyles as future professionals through a collection of keynote speakers, activities and group sessions.

AMSCAR is an event where medical students across the province come together and mingle as future colleagues. With a diverse assortment of sessions ranging from clinical skills and artistic endeavors, physical activities, relaxation techniques, physical wellness and coping with stress workshops, students were able to participate in activities catered to their interests. On Sunday, students had the opportunity to engage in a relaxation activity of their choice. Many spent the day on the ski slopes, while others explored the town of Banff. One of the goals

of AMSCAR was bridging gaps between the schools while also learning about strategies for personal and professional wellness.

Alberta Medical Association (AMA) President-Elect Dr. Carl W. Nohr was heavily involved throughout the weekend, greeting medical students from both schools upon arrival and actively encouraging them to get involved in the profession. Dr. Nohr gave one of the keynote addresses during the event, sharing memorable experiences from his career as a general surgeon to highlight the importance of work-life harmony.

6 COVER FEATURE

What’s our medical profession really like? Students find out at Alberta Medical Students’ Conference and Retreat in Banff

AMSCAR 2015 successfully brought together community stakeholders and medical students to promote mental well-being and student resilience, and impart tangible health and wellness strategies.

Students appreciated the depth and diversity of topics presented by the keynote speakers. Dr. Owen Heisler Assistant Registrar College of Physicians & Surgeons of Alberta, raised awareness on the importance of life balance and practical ethics. Mark Anielski, president and CEO of Anielski Management Inc., professor of the School of Business at the U of A and author of “The Economics of Happiness,” shared his perspective on pursuing happiness with a witty economics twist. Rahim Sajan, curator of TEDxCalgary and public school teacher in Calgary, addressed the importance of community leadership and inter-professionalism. >

Vishal Puri | AMA REPRESENTATIVE, UNIVERSITY OF ALBERTA, CLASS OF 2018

A L B E R TA M E D I C A L S T U D E N T S ’ CO N F E R E N C E A N D R E T R E AT

S I N C E 2 0 0 4

UNIVERSITY OFCALGARY

UNIVERSITY OFALBERTA

MARCH - APRIL 2015

> “AMSCAR 2015 successfully brought together community stakeholders and medical students to promote mental well-being and student resilience, and impart tangible health and wellness strategies," said Samantha Lam President AMSCAR Committee. “The AMSCAR Committee had members from both schools who spent countless hours planning and hosting a unique and worthwhile event that united students from both schools for a common purpose. Students had a safe environment to try new activities and learn about topics as they explored what health and wellness meant to them. This year, we expanded offerings to include more artistic outlets. We are incredibly thankful to our speakers, who inspired and challenged us with their wit, stories and questions, and our passionate session presenters, who shared their talent and time with our students so that we had the opportunity to learn. The committee and students are indebted to all our supporters and will do our utmost to be healthy and well physicians of the future.”

AMSCAR was a great opportunity for students to learn about physician wellness and develop strategies to live healthy lifestyles as future professionals through a collection of keynote speakers, activities and group sessions. AMSCAR was made possible with the generous support of sponsors, including the Alberta Medical Association. ( provided by Grace Xu)

The AMSCAR Committee has worked hard over the last year in planning and making this event possible for Alberta’s medical students. As well, such a grand and memorable event would not have been possible without the generous contributions of sponsors, including the AMA, who believe in the cause. The support we received, making this event financially accessible for all students, makes us feel supported and united as members of the profession.

With the weekend of relaxation and wellness coming to a close, students returned home with a newfound perspective on a healthier lifestyle and work-life balance. We have an increased awareness of the challenges tomorrow’s physicians will face, as well as strategies to cope with them. AMSCAR 2015 was an unforgettable experience for Alberta’s medical students and instilled a renewed sense of resilience, health and well-being.

To learn more about AMSCAR, please visit the website at https://amscar2015.wordpress.com.

7


By the time this column is published, a couple of months

will have passed since the Supreme Court of Canada’s unanimous decision in Carter vs. Canada (Attorney General)

was handed down. Hopefully the vitriol and the euphoria will have passed, and some reasoned discussion will have started on what to make of this momentous ruling.

Because of the one-year suspension of the declaration of invalidity granted by the court (to allow the Federal and Provincial Governments time to craft the necessary policies and processes), the current laws remain in place. While the decision is fresh in my mind, let me reflect on one aspect of it which has not, as of this date, received a whole lot of press.

It is noteworthy that, notwithstanding the headlines to the contrary, the court did not actually strike down the Criminal Code’s prohibitions on assisted suicide. The court stated that they no longer apply “… to the extent that they prohibit physician-assisted death for a competent adult person who (1) clearly consents to the termination of life and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.” The prohibitions in question are sections 14 and 241 of the Criminal Code, which read as follows:

14. No person is entitled to consent to have death inflicted on him, and such consent does not affect the criminal responsibility of any person by whom death may be inflicted on the person by whom consent is given. 241. Everyone who… (b) aids or abets a person to commit suicide, whether suicide ensues or not, is guilty of an indictable offence and liable to imprisonment for a term not exceeding fourteen years.

The sections in question make no mention of physicians, but rather refer to a “person” or to “everyone.” However, the decision, both in the Supreme Court and in the lower courts, is physician-specific – sections 14 and 241 will not apply “to the extent that they prohibit physician-assisted death.” This appears to be an intentional step on the part of the courts notwithstanding the specific recognition that others, such as relatives of the suffering person, face the same jeopardy in providing assistance. This recognition is underlined by a comment made by the court regarding the risk of criminal charges facing the relatives of Kay Carter (one of the original applicants, who travelled to Switzerland with the help of the relatives to seek her peaceful death in that jurisdiction).

8 HEALTH LAW UPDATE

Physician (only) assisted suicide – a different perspective on Carter vs. Canada (Attorney General)

>

Jonathan P. Rossall, QC, LLM | PARTNER, MCLENNAN ROSS LLP

Notwithstanding the headlines to the contrary, the court did not actually strike down the Criminal Code’s prohibitions on assisted suicide.

The court stated:

“We note, as the trial judge did, that Lee Carter and Hollis Johnson’s interest in liberty may be engaged by the threat of criminal sanction for their role in Kay Carter’s death in Switzerland. However, this potential deprivation was not the focus of the arguments raised at trial, and neither Ms Carter nor Mr. Hollis sought a personal remedy before this court. Accordingly, we have confined ourselves to the rights of those who seek assistance in dying, rather than of those who might provide such assistance.”

Firstly, this last statement is incorrect. Admittedly, the court made the necessary finding that it was the suffering parties (Kay Carter and Gloria Taylor) whose section 7 Charter rights to life, liberty and security of the person were breached. However, in crafting the remedy,

MARCH - APRIL 2015

9the court specifically focused on the rights of some of those who might provide assistance – i.e., physicians. It chose not to expand the scope of its protections to others (such as relatives).

Why? The obvious answer is that the case was not specifically about physicians, but rather was about competent patients who seek assistance in ending their lives when faced with a “grievous and irremediable medical condition that causes enduring and intolerable suffering.” In providing a remedy for those persons, it was necessary to provide immunity or an exemption for those that provide assistance.

> (such as the Carter’s in the present case) cooperate in transporting the patient to a location where the pharmaceuticals can be administered (thus assisting in the process), why should they be exposed to criminal sanction?

This prospect is made all that much more likely because the court’s ruling does not compel a physician to provide assistance to suffering individuals. In fact, the court expressly recognized that a physician’s decision to participate or not in assisted dying is a matter of conscience and in some cases of religious belief. The court went on to state that “… the Charter rights of patients and physicians need to be reconciled.” In the absence of an available physician, then, who is the person to turn to?

And why is it assumed that the means chosen to end a life will always require medical assistance or intervention? What of an individual who, again, has received the requisite medical certification so as to meet the threshold for psychological or physical suffering established by the court, and chooses to utilize prescription medications already in his/her possession but simply requires the assistance of a loved one to create the concoction? And beyond the use of pharmaceuticals, there are doubtless many ways for an individual to commit suicide which do not require a physician’s assistance.

In my view, it is unfortunate that the court’s rulings fell short of addressing these types of issues.

That said, I laude the Supreme Court for its courage and resolve in dealing with what it describes as “a question that asks (them) to balance competing values of great importance.” There is much work to be done to set in place the framework necessary to implement its decision. That work is complicated by the constitutional overlap in this case commented upon by the court. In Canada, criminal matters fall within the jurisdiction of the federal government, while health matters, (including regulation of physicians) fall to the provinces. Therefore, implementing the guidelines and policies necessary to put into practice the edicts of the court will be complicated. Given the amount of effort and political capital that will be involved in this process, it is too bad that the various courts involved in this decision did not pay a little more attention to the rights of all of those who might be called upon to provide assistance to those who continue to suffer.

Given the amount of effort and political capital that will be involved in this process, it is too bad that the various courts involved in this decision did not pay a little more attention to the rights of all of those who might be called upon to provide assistance to those who continue to suffer.

But what was stopping the court from extending that exemption to all persons who “aid and abet a person to commit suicide?” Is there an assumption that those persons will always be physicians? Ahh, some might argue, but it is the physician who will ultimately assess the competency of the suffering individual as well as the extent of the medical condition suffered. A lay person cannot perform that assessment.

That may be true, but it is not the act of assessment which gives rise to the risk to the physician under the current legislation. Today, in the face of this still-in-force legislation, a physician is entitled (with immunity) to assess a patient and determine that they are competent to make a decision to end his/her life because he/she is faced with a grievous and irremediable medical condition. It is the act of procuring the tools, such as medication, which gives rise to the aiding and abetting of suicide. If this is so, then why, for example, would pharmacists or nurse practitioners not be entitled to the same protections? And if the relatives of the patient


Privacy Impact Assessment (PIA)

Have you adopted any new administrative practices or information systems that collect, use or disclose health information about identifiable individuals in your clinic? This could include adopting a patient portal, using your smartphone to access your electronic medical record (EMR) system, or even hiring a new billing, transcription or shredding service provider.

First and foremost, you must keep your PIAs current. “Keeping current” means PIAs document your diligence as a custodian when you make changes to office systems that will impact the collection, use and disclosure of health information. This includes regularly reviewing and updating your clinic’s Privacy and Security Policy and Procedures Manual. As you adopt new practices and/or technology, you need to be able to reference past PIAs when developing or updating your PIA. Alberta Health requires updated PIAs in order to access Netcare. Even if you do not have an EMR, you must have a PIA that outlines how you collect, use and disclose health information within your office.

The Office of Information and Privacy Commissioner (OIPC) has guidelines on their website on how to write a PIA and there are independent contractors that can assist clinics with completing these documents (http://oipc.ab.ca/Content_Files/Files/PIAs/PIA_Requirements_2010.pdf).

The Information Management Agreement (IMA)

These must be entered into when a custodian is considering a third party to:

• Process, store, retrieve or dispose of health information, e.g., storage company, shredding company.

• Strip, encode or otherwise transform individually identifying health information to create non-identifying health information, e.g., billing or transcription services.

• Provide information management or information technology services, e.g., EMR vendor.

Practice Management Program Staff

The Alberta Medical Association (AMA) has developed IMA templates that are located on our website at www.albertadoctors.org.

Indemnification clauses in IMAs

Many vendors will have their own IMAs so physicians should ensure that they are protected in these IMAs. Often vendors will ask the physician to indemnify the vendor from any losses it may sustain due to physician negligence. The Canadian Medical Protective Association (CMPA) recommends avoiding unilateral clauses in favor of the other party for mutual clauses. This way the physician will be held harmless for any negligence caused by the vendor.

Information Sharing Agreement (ISA)

Although not a requirement under the Health Information Act, an ISA is a component of the College of Physicians & Surgeons of Alberta (CPSA) guidelines. Many physicians enter practice and share patient charts without considering what happens to the records when one of their colleagues leaves or when there is a change in management/ownership of the clinic. When forming/joining a clinic, physicians need to ensure they have an ISA that:

• Outlines the terms and conditions of the exchange (sharing) of custodian duties in a common manner within a shared patient record environment.

• Helps guide issues pertaining to the management, security requirements and professional responsibilities relating to the sharing of patient records.

• Outlines what will happen to the patient records as custodians enter and leave the clinic.

The AMA worked with CPSA, OIPC and CMPA to develop an ISA template that can be accessed on the AMA website (https://www.albertadoctors.org/EMRs/Lead_ISA_Nov_5_2013.pdf).

The Practice Management Program is available to assist in a number of areas related to the effective management of your practice. For assistance, please contact Linda Ertman at [email protected] or phone 780.733.3632.

Are you still compliant with the Health Information Act? Many physicians are unaware when and why they need to update their agreements to stay compliant

MIND YOUR OWN BUSINESS10

MARCH - APRIL 2015

The 2015 Tarrant Scholarship opportunity is here!Medical students can apply, practicing physicians can give back through donations

The Section of Rural Medicine (SRM) is accepting applications for the 2015 Tarrant Scholarship, named in honor of the late Dr. Michael Tarrant, a

dedicated family physician and champion of rural medical undergraduate education.

The Tarrant Scholarship serves as a well-received and highly valued incentive for qualified third-year medical students to focus their undergraduate studies (and ultimately their careers) on rural medicine.

As one of Alberta’s largest unrestricted medical school undergraduate awards, the Tarrant Scholarship is presented every fall to third-year medical students from the University of Alberta (U of A) and the University of Calgary (U of C) who demonstrate a strong interest in and dedication to rural medicine during their undergraduate years.

Since its inception in 2004, the Tarrant Scholarship has been awarded to 29 medical students and has provided close to $300,000 in awards, as it funds a full year’s tuition and related fees for its fortunate recipients.

Medical students can apply

Medical students are eligible to apply for the scholarship if they:

FEATURE 11

Twitter is a great way to stay up to date on news like:

• News, events and announcements.

• President’s Letter and other publications.

• Important information from other medical associations.

• Don’t have a Twitter account? Signing up for Twitter is fast, easy and free. Just go to twitter.com. You can open an account in under a minute.

We tweet new items almost every day. Join us!

SHORT AND TWEET! Get the latest AMA news in 140 letters or less

Find us at: twitter.com/albertadoctors

• Are a U of A or U of C medical student who will enter third-year medical school this fall.

• Are keenly interested in building a career in rural medicine in Alberta.

• Demonstrate a dedication to rural medicine in their undergraduate studies and work.

Physicians can donate to support the scholarship and rural medicine

This year, SRM has partnered with the Canadian Medical Foundation and the Alberta Medical Association (AMA) to enable members to contribute on a charitable basis to the Tarrant Scholarship program. All funds donated go directly to support the Tarrant Scholarship. We hope you will consider making a tax-deductible donation to help secure the future of the Tarrant Scholarship, as it works to sustain the educational development of future rural physicians.

Application form

Visit the AMA’s website at www.albertadoctors.org/tarrant to download the 2015 Tarrant Scholarship application form.

The application deadline is May 22.

Vanda Killeen | ALBERTA MEDICAL ASSOCIATION PUBLIC AFFAIRS


As recent news stories of privacy breaches have

shown, data security and privacy protection are a critical public relations and business issue for Canadian health care organizations.

Examples of recent privacy breach class actions include the Durham Health Region in 2009 where a nurse lost an unencrypted USB key with the personal health information of 83,500 individuals. Regional health authorities in Nova Scotia and Newfoundland suffered when employees were found guilty of unlawfully accessing patient records.

On an individual level, a medical clinic sustained a network security breach when a hacker stole patient records, including financial information and health benefits account data. The data was resold to individuals who used the benefits information to fraudulently obtain medical services. Health care carriers sued the medical clinic to recover reimbursements made for fraudulently obtained health services.

In addition to Canada’s two federal privacy laws, the Privacy Act and the Personal Information Protection and Electronic Documents Act (PIPEDA), Alberta, Saskatchewan, Manitoba, Ontario, Newfoundland and Labrador, New Brunswick and Nova Scotia have also each passed legislation to deal specifically with the collection, use and disclosure of personal health information by organizations or individuals who have possession of personal health information, or receive personal health information from such organizations. Each statute contains provisions entitling individuals to access their personal health information, limits access to and use of health information within the organization and prohibits disclosure for purposes other than those to which an individual has given consent.

For a business, privacy risks or cyber risks (as they are increasingly becoming known as), are the specific risks that relate to the use of computers, information technology and virtual reality. While the benefits of using Internet-based and other technologies are numerous, so are the inherent risks, creating exposures that were virtually unheard of two decades ago.

A privacy breach is an incident involving unauthorized disclosure of personal information. A breach may be intentional or inadvertent or as a result of criminal activity. A privacy breach may be the result of inadvertent errors or malicious actions. A breach may also be a one-time occurrence (such as the loss of a data stick) or due to systemic breakdowns (such as faulty procedures). Some of the most common privacy breaches occur when personal information is stolen, lost or even faxed to the wrong party in-error. Computers can be forgotten on buses. USB sticks can fall out of pockets!

Privacy or cyber risks for your business can be split into the following areas:

1. Losses due to cyber crime

2. Accidental loss of your own or someone else’s data

3. Physical loss of systems

4. Liability for your online activities or comments made in emails

Losses come from:

Intentional action

• Intentional deletion of a file or program

Unintentional action

• Accidental deletion of a file or program

• Misplacement of CDs or memory sticks

• Administration errors

• Inability to read unknown file format >

Batten-down your computer! Should cyber liability insurance be in your future?

INSURANCE INSIGHTS12

Phil Cunningham, BA (Hons), CIP, PgDip | SENIOR VICE PRESIDENT, MARDON GROUP INSURANCE

MARCH - APRIL 2015

13Disaster

• Earthquake, flood, fire, etc.

Failure

• Power failure resulting in data in volatile memory not being saved to permanent memory

• Hardware failure

• Software crash or freeze resulting in data not being saved

• Software bugs or poor usability

• Business failure (vendor bankruptcy) where data is stored with a software vendor

• Data or database corruption

Insurance coverages are now available to protect against liability arising from cyber risks. A typical policy covers:

• Unauthorized access to, use of or tampering with all forms of private and public data.

• Liability arising from denial of service attacks or the inability to access websites or computer systems.

• Crisis management and public relations expenses incurred to respond to adverse or unfavorable media attention surrounding the privacy breach, including subsequent credit monitoring costs associated with an individual whose private information may have been disclosed.

• Regulatory action defence expenses.

For more information and prices on cyber liability insurance or on the Alberta Medical Association’s Commercial Office Insurance Program, please contact Mardon Group Insurance toll-free at 1.866.846.4467.

>

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many of the senior surgeons of his day and once declined an offer to join the Mayo Clinic.

“H.G.” as he was affectionately known, came to Calgary (population 3,400) from Ontario in 1889. He was its fifth physician, joining Dr. James D. Lafferty in practice. Together they secured the medical care contract for the workers constructing the Canadian Pacific Railway (CPR) from Fort Macleod to Edmonton.

Next year will be the 100th anniversary of the death of Alberta’s first Canadian Medical Association (CMA) president (1911-12), Dr. Harry G. Mackid

(1858-1916). It also coincides with the 50th anniversary of the Mackid Symposium (1966-2016). What better time to acknowledge Dr. Mackid’s – albeit shortened from diabetes – life. It ended six years before another Albertan, Professor Dr. James B. Collip, isolated and concentrated the first therapeutic dose of insulin.

Dr. Mackid was Alberta’s most illustrious early medical pioneer. He was big, handsome and like many colleagues, wore a mustache to give him a more mature appearance. He had a warm smile and a handshake you remembered for a lifetime. Friendship and hospitality were his religion. Always well groomed, he filled any room with his buoyant, dignified presence and aura of confidence. His many stories were always peppered with good humor. And he was generous to a fault.

Dr. Mackid was a self-taught surgeon who supplemented his experience with trips to Europe. He personally knew

Dr. Mackid was Alberta’s most illustrious early medical pioneer.

14 FEATURE

The centennial of Dr. Harry G. Mackid Alberta’s first Canadian Medical Association president

>

To prepare for the anticipated typhoid cases, Drs. Neville Lindsay and Mackid opened the first Calgary Cottage Hospital in 1890 with eight to 12 cots. After Lafferty successfully ran for mayor in 1890, Mackid continued as the CPR’s chief medical officer for the rest of his life, initially covering Alberta and Saskatchewan.

As soon as the railway was opened, Dr. Robert G. Brett, Dr. George A. Kennedy and others began referring their patients to him from as far as 100 miles away, for major and then abdominal surgery. Not infrequently they came with the patient and assisted at surgery.

In 1891 Dr. Mackid admitted the first patient – a nosebleed – to the newly opened Holy Cross Hospital.

By 1894 the cottage hospital was too small. Dr. Mackid fostered public interest in a new 35-bed hospital and it opened in 1895. Mrs. Mackid fundraised to help equip it. H.G. admitted the first patient – with typhoid fever.

Two years after his arrival, Dr. Henry George sought his advice to confirm the presence of smallpox in a Chinese laundryman, who had just arrived from Vancouver. All 45 contacts were quarantined. Trains were stopped and

J. Robert Lampard, MD

Dr. Harry G. Mackid was Alberta's first Canadian Medical Association president. ( provided by Courtenay Mackid)

HARRY GOODSIR MACKID, MD, FACS1858-1916

11-1

11 mackid:Layout 1 4/29/08 1:53 PM Page 132

MARCH - APRIL 2015

15searched before they reached Calgary. Four of the eight diagnosed cases died. When the quarantined patients were discharged, Calgary’s only race riot occurred.

As soon as the new Calgary General Hospital (CGH) opened, Dr. Mackid and his medical and nursing colleagues started the second nursing training program in Alberta, following the lead two years earlier at the Medicine Hat Hospital in 1894. Mary Moone, registered nurse graduated in 1898 as the first CGH nurse.

In 1904, H.G. was joined in practice by his son Dr. Ludwig Stuart (L.S.) Mackid. The Mackid clinic would operate for decades.

> the first Fellow of the American College of Surgeons in Alberta. One of the major medical challenges he faced in the pre-antibiotic era was to minimize infections. In 1914 H.G. and L.S. aborted a typhoid epidemic of 300 cases by vaccinating large numbers of Calgarians.

Around town, Dr. Mackid had a reputation as a well-known (humorous) prankster, according to Bob Edwards of the Calgary Eye Opener. When H.G. met Mother Fulham in a downtown drugstore she complained of a sore foot. She took off her stocking to be examined. He exclaimed, “This has to be dirtiest leg in town.” She said, “I’ll bet you a dollar it isn’t.” The bet was on. So she pulled down her other stocking and won the bet. In return, he is reputed to have hitched her horses through her back fence.

For the last six years of his life, Dr. Mackid had diabetes. Despite his diagnosis, he was elected president of the CMA in 1911-12, the first from Alberta. He oversaw the integration of the one-year-old Canadian Medical Association Journal with CMA staff. During his elected year, local medical societies were encouraged to join the CMA and the membership increased by 33% to 1,400 members.

In his 1912 CMA retirement speech in Edmonton, Dr. Mackid accepted a motion to appoint Dr. Thomas G. Roddick as the honorary president of the CMA for the rest of his life. Roddick had led the fight to form the Medical Council of Canada. The motion was drowned out in a chorus of cheers and a standing ovation.

After 1913, H.G. cut back his operating time. That created an opportunity for Lethbridge surgeon Dr. Frank H. Mewburn to move to Calgary and work full time at it. Dr. Mewburn would become the first professor of surgery at the University of Alberta in 1922.

When Dr. Mewburn and his son Ludwig went overseas in World War 1, H.G. went back to full-time practice. On his 58th birthday in 1916, his wife went to waken him for his 10 a.m. surgical slate. He was unresponsive and never recovered.

Although now we don’t have to go to Europe for our continuing medical education, we can bask in the long shadow and 1913 prediction of one of Alberta’s most charismatic physicians:

“The West is young and lusty and full of life. It is unhampered by traditions. Give the West a little more time and she will yield a rich harvest of energetic and trained men who have in them that valuable dash of western originality.”

“What is the value of the West to Medicine? Does it not lie in the words, energy, and newness and opportunity.”

Sir Ernest Waterloo retorted that “no colonial will operate on me.” Mackid pulled out his tape measure and began to measure Waterloo’s length, width and depth. Asked why, Mackid said it would be for the size of the coffin he would need for his body to be returned to England.

In 1906, H.G. was the center of controversy over untendered medical contracts, one of which he held for the CPR. The Calgary Medical Society argued that these contracts should be open to competition. All were, except for the CPR contract. When the CPR vice president refused to open it, however, the argument ended.

A year later a CPR train brought Sir Ernest Waterloo to Calgary. Waterloo was the CPR’s London legal advisor. He had an acute abdomen, so the emergent call went out to H.G. He arrived at Waterloo’s railway car, made his diagnosis and recommended immediate surgery.

Sir Ernest retorted that “no colonial will operate on me.” Mackid pulled out his tape measure and began to measure Waterloo’s length, width and depth. Asked why, Mackid said it would be for the size of the coffin he would need for his body to be returned to England. The lawyer relented and underwent immediate surgery. The appendix burst in Mackid’s hands. Convalescence was in the Mackid home under Mrs. Mackid.

That same year Dr. Mackid saved the CGH from financial disaster. He introduced a 50 cent per month charge to all CPR employees for prepaid hospital care. The next year H.G. brought the first X-ray unit to Calgary.

With the formation of the American College of Surgeons, in 1913 Dr. Mackid submitted his credentials and became


Standing in front of her rapt, young audience, describing what could have been a time of failure but instead was a time of great fortitude, Paula showed the students, many of whom belong to the school’s Youth Run Club, that the strength and values she had acquired from years of athletic pursuits helped her keep putting one foot in front of the other that day, as she forced and willed herself to finish the race.

“I couldn’t control a lot of things, but I could control my attitude,” she explained. “I chose to learn from this and be positive … it was hard to do, but it’s definitely helped me. I think I learned a lot, through my failures.”

Paula’s messages of ‘keep trying,’ ‘don’t give up,’ ‘push yourself through’ and ‘stare possible failure and fear in the face’ are at the heart of the AMA’s Youth Run Club and its mission to get Alberta’s young students up and moving; out from behind their phones, computers and televisions, into their running shoes and into the fresh, outdoor air (or the indoor air of a gymnasium), to run, walk, jog or jump … basically to get active in any and every way.

It’s not a hard sell to schools, as École Bellevue Principal Patrick Gamache-Hutchison attests to. “We encourage healthy lifestyles at our school, and the biggest thing is participation for our students.”

Grateful that his school was the lucky winner of a draw held by YRC partner Ever Active Schools for a visit from five-time world triathlon series winner Paula, Patrick commented, “To bring in a world-class athlete like this, to pass on that message (of activity and healthy lifestyles), is important.”

Aside from the definite benefits of activity and healthy lifestyles, one of the biggest benefits of the YRC – one that will extend for years beyond the days of lapping around school fields and winning ribbons in races – was captured by perceptive grade-five student Zachary Perrin.

Noting that it was inspiring to hear from a ‘number one athlete in her sport,’ it was Paula’s perseverance and bravery that stood out for Zachary.

“Her actually keeping on going with her injury … that takes a lot of courage, and for her to actually finish it with that amount of pain … it was pretty exciting to hear.”

Alberta Medical Association (AMA) Youth Run Club (YRC) School École Bellevue Elementary in Beaumont got an early Christmas present

in December 2014. Youth Run Club Ambassador and Olympic triathlete Paula Findlay visited and shared her messages with honesty and humility that resonated with the school’s 300 students.

The 25-year-old athlete described her personally disappointing performance at the 2012 Olympics, in which her injury-ridden body maddeningly betrayed her years of dedication and training. Paula confessed to feeling “embarrassed” and that she “had let (her) parents down, and (her) sponsors and coaches and everyone who got me there.”

You can’t help but wince as Paula eloquently describes the wrenching moments from that sunny, humid day in London when, suffering from an un-healed hip injury, she hit the proverbial wall and believed she could not continue a moment more.

“My legs felt so tired, I just had no energy. But I was at the Olympics and I couldn’t believe that my body wasn’t responding to what I had trained it to do,” she said. “I knew something wasn’t right, and this was all happening at the greatest sporting show on earth.”

16 FEATURE

And the message is … “Don’t give up!”Youth Run Club ambassador Paula Findlay walks the talk of her personal beliefs at Beaumont’s École Bellevue School


The mission of the AMA’s Youth Run Club is to get Albertans to run, walk, jog or jump ... basically to get active in any and every way. ( provided by lnternational Triathlon Union)

MARCH - APRIL 2015

When I was going through my training,

more than one of my supervisors stated: “I have forgotten more than you’ll ever know!” I was somewhat insulted

at the time, but as I progress in my career (longer than I would like to admit at this time), I begin to understand the truth in that statement. My memory gaps, along with advances in medical knowledge and treatment, often leave me uncertain at the time, as to the current evidence-based treatment of the patient in front of me.

Thankfully, enter, point-of-care clinical decision support tools defined as: “syntheses of evidence whose goal is to make physicians' decision-making easier.”1

In my residency days, I carried around in my white coat a frayed, ringed copy of the Washington Manual, which, along with my pocket protector filled with writing instruments and portable flashlight, uncombed over-the-ears hair and a stethoscope gave me a somewhat lop-sided, but strangely intellectual look

Peace at the point of care – clinical decision support tools

DR. GADGET

Wesley D. Jackson, MD, CCFP, FCFP

>

(or at least so I thought). Despite the fact that the manual was updated once a year and that the time from original penning of the material to publication could be delayed for more than a year, I felt peace knowing that I had the ‘latest’ information on most medical conditions that I might encounter in my left jacket pocket. That peace faded as I better understood that the rapid change in medical knowledge often outstripped the ability to disseminate it.

Today, my choices for bedside tools are much wider, are updated far more often, encompass a much larger scope of journals reviewed and medical conditions addressed – and fit in my left-front pants pocket (no white jacket these days). One of the major problems today lies in choosing “the best” point-of-care decision support tool. Prorok et al.,3 in their article published in 2012, used an 11-point quality assessment scale to review 10 online medical texts including First Consult, Medscape and Pepid – among others. They ranked DynamedTM and UpToDate® as first and second respectively, with Pepid occupying the 10th position.

The following table is my attempt to compare the front-runners, DynamedTM and UpToDate®.

DynamedTM UpToDate®

Description “Point-of-care tool created for physicians (especially in hospital settings) in their clinical decision-making activities.”1,2

“Popular point-of-care clinical text ... designed to provide concise, practical answers when clinicians need them.”1,2 Preferred by many physicians.

Updates Daily. New evidence is integrated into the existing content upon rigorous syntheses of the evidence. Timeliness ranked #1 of 10 point-of-care tools by Prorok et al.3

Daily. Content is updated by the authors whenever important new information is published.

Timeliness ranked #5 of 10 point-of-care tools by Prorok et al.3

Content 3,200 topics

Ranked #3 by Prorok et al.310,000 topics

Ranked #1 by Prorok et al.3

Audience Family practice physicians and primary care providers.

Internal medicine physicians and selected subspecialties.

17


18

Your membership in the CMA automatically gives you a powerful, peer-reviewed, point-of-care clinical decision support tool in DynamedTM. UpToDate® is also an excellent authoritative text, which provides broader content and expert recommendations on treatment at a significantly greater financial cost to the individual physician.

DynamedTM UpToDate®

Style Bulleted list. Narrative, written by content experts with treatment recommendations.

Unique features

ICD 9 codes.

Direct links to primary literature.

Includes Lexicomp drug database.

Model Critically-appraised evidence based medicine. Peer reviewed, expert author.

Journals monitored

>500 440

App Free with institutional license. Available across all platforms. Stand-alone app recently available (previously accessible through Skyscape).

Available at extra cost across all platforms.

Cost Included with Canadian Medical Association (CMA) membership ($395 value).

Stand-alone app included with institutional license – free to CMA members https://www.cma.ca/En/Pages/point-of-care-summaries.aspx

$439 USD per year – practicing physicians (including CMA discount).

$159 USD per year – residents.

$99 USD per year – students.

Stand-alone app $30 per year extra – not included with most institutional licenses.

University libraries and some primary care networks include subscriptions for their members.

Both products

• Editors are subject experts• Point-of-care clinical decision support• Fast, accurate, valid and unbiased• Peer reviewed• Patient handouts• Direct links to references

>

Both tools are very easy to use and are very helpful at the bedside and either one would be an excellent choice as your ‘go-to’ app. Your membership in the CMA automatically gives you a powerful, peer-reviewed, point-of-care clinical decision support tool in DynamedTM. UpToDate® is also an excellent authoritative text, which provides broader content and expert recommendations on treatment at a significantly greater financial cost to the individual physician.

So my old, frayed Washington manual, my white coat and my hair are now distant memories. I can no longer make the fashion statement of the past, but I can now take solace that I am better able to give timely, up-to-date advice at the bedside – and have found peace once again – until the next major advance in medical knowledge translation. Sigh!

References

1. Point-of-Care Tools in Medicine, http://hlwiki.slais.ubc.ca/index.php/Point-of-care_tools_in_medicine#DynaMed_.E2.80.93_EBSCO.

2. Clinical Information Resources and Evidence-Based Practice, http://harrell.library.psu.edu/content.php?pid=203158&sid=1713938.

3. Prorok JC, Iserman EC, Wilczynski NL and Haynes RB. (2012). The Quality, Breadth, and Timeliness of Content Updating Vary Substantially for 10 Online Medical Texts: An Analytic Survey. Journal of Clinical Epidemiology, 65(12), 1289–1295. doi:10.1016/j.jclinepi.2012.05.003.

MARCH - APRIL 2015

It’s satisfying when the catchy title of a book, play or article delivers

a thoughtful, entertaining or well-written piece of work. I think of the musical revue, Jacques Brel is Alive and Well and

Living in Paris, which I enjoyed many years ago at Theatre Calgary. Emergency physician Dr. Ian M. Wishart’s recent workshop at Cabin Fever 2015 on how to teach procedures to medical students and residents is another example of a title that doesn’t disappoint. His session is called How to Gut a Moose – Teaching Procedural Skills.

Blairmore family doctor, Dr. Kristy J. Penner and Edmonton emergency physician, Dr. Jared D. Bly, co-presented Choose Your Own Life – Developing Resilience in Rural Emergency Medicine at the Emergency Medicine for Rural Hospitals conference in Banff this past January. From them I learned about Zwack and Schweitzer’s article with the intriguing title, If Every Fifth Physician Is Affected by Burnout, What About the Other Four? 1

Burnout defined

Interest and investigation into physician resilience has followed in the wake of the widespread attention to physician burnout over the past 20 years (Christina Maslach published the Maslach Burnout Inventory in 1981). The questions on the inventory identify degrees of exhaustion, depersonalization and inefficacy regarding one’s work – at its worst, I’m exhausted, I don’t care and I’m useless.

Questions to ponder

Zwack and Schweitzer’s qualitative study of resilience used semi-structured interviews of 200 German physicians – mostly surgeons, psychiatrists and family doctors. Among the questions they asked were:

Vincent M. Hanlon, MD | ASSESSMENT PHYSICIAN, PHYSICIAN AND FAMILY SUPPORT PROGRAM (PFSP)

1. If you had a second chance, would you still want to be a doctor? If so, why?

2. How can a physician remain healthy and satisfied? Which strategies do you apply? Which strategies do you find with your colleagues?

3. If a medical student asked you what he/she could do to prevent burnout: Which advice would you give? Which mistakes you made yourself would you warn against?1

Participants were recruited into the study based on their “motivation to share personal insights and experiences.” The use of structured interviews of doctors to gain insight into the nature of resilience is similar to an earlier Canadian study, Building Physician Resilience, by Jensen, Trollope-Kumar et al.2 This study included 17 family physicians from the Hamilton area, “with a reputation for resilience in their practice communities.”

Burning out? It just might happen unless you learn to become more resilient

PFSP PERSPECTIVES

It’s not easy for some of us to recognize our imperfections, to acknowledge our need to be a part of a supportive community and to seek care for ourselves.

What is resilience?

In the accompanying commentary on the article by Zwack and Schwietzer, Epstein and Krasner define resilience as:

… the ability of an individual to respond to stress in a healthy, adaptive way such that personal goals are achieved at minimal psychological and physical cost; resilient individuals not only “bounce back” rapidly after challenges but also grow stronger in the process.3 >

19


20 > Three important sources of resilience

Three themes emerged from Zwack and Schweitzer’s analysis of the interviews. Physicians spoke about “job-related sources of gratification,” specifically strength, meaning and energy flowing from the doctor-patient relationship, and from feelings of efficacy derived from their work.

They described useful attitudes toward their work that fostered resilience, notably: “acceptance and realism,” “recognizing when change is necessary,” “accepting personal boundaries” and “creating inner distance by taking an observer perspective.”

Among practices and routines leading to greater resilience, many of the physicians interviewed cited most frequently: “leisure-time activities,” “quest for and cultivation of contact with colleagues” and “cultivation of relations with family and friends.”

To engage or withdraw

Certain insights provided by physicians regarding their practices seem at first counterintuitive. Forty percent of the participants noted a source of resilience in “proactive engagement with the limits of one’s own skills, complications that crop up and treatment errors when communicating with colleagues and disciplinarians.” Ditto with patients. More open communication and ownership regarding errors, lingering regret about past interactions with patients and difficult treatment decisions can be fostered through a variety of activities – phone calls between colleagues, conversations over lunch, Balint groups or more formal “error management meetings.”

A resilience-promoting attitude described by nearly half of the physicians was “active engagement with the downside(s) of the medical profession.” We may recognize the downside of a life in medicine in the demoralizing realities of workplace conflict, bureaucratic demands, unremitting time pressures, rapid technological change or mountains of paperwork. According to Epstein and Krasner: “Paradoxically, loss of resilience can result from the seemingly energy-saving measures of withdrawal.”

The process of engagement can be a healthy alternative to the tendency to avoid or begrudge the unpleasant aspects of our work. Engagement as a preventative response to the threat of burnout is also described in the work of Maslach and Leiter.4

Epstein and Krasner make two additional points in their commentary, which arise out of their own research into mindful communication within medical practice and training environments. Physicians who participated in their intervention study of mindful communication at the University of Rochester School of Medicine and Dentistry expressed a desire for community to combat the increasing physical isolation they experience in their workplaces, and the emotional isolation of not

having enough time to develop personal connections with colleagues. The replacement of much face-to-face communication by means of digital connectivity may be an exacerbating factor. This latter observation reminds me of Sherry Turkle’s cautionary book, Alone Together – Why We Expect More From Technology and Less From Each Other.5

Obstacles on the road to self-care

The second noteworthy point about the mindful communication intervention described in Epstein and Krasner’s commentary is that

Physicians needed – but found it difficult – to give themselves permission to engage in activities that would improve their self-awareness and self-care, despite recognizing that these qualities enhanced their own resilience and their capacity to provide the kind of patient care they and their patients value.3

It’s not easy for some of us to recognize our imperfections, to acknowledge our need to be a part of a supportive community and to seek care for ourselves. >

Burned out or baked to perfection? Daily bread in a London, England market. ( provided by Dr. Vincent M. Hanlon)

Resilient individuals not only bounce back rapidly after challenges but also grow stronger in the process. Ocotillo and saguaro in the Sonoran desert near Tucson, Arizona. ( provided by Dr. Vincent M. Hanlon)

MARCH - APRIL 2015

21Both the German and Canadian studies of physician resilience are based on experienced physicians examining and speaking about their lives. They describe strategies they use to address the threat of burnout, the erosion of communities of practice, increasing professional isolation and physician reluctance to draw on the wisdom and support of others.

Can we find time to continue those conversations? How about starting with some café therapy? Invite a colleague for coffee (or tea) and chat about the best ways you’ve discovered to promote your own and your colleague’s resilience.

References available upon request.

>

The new life on this Christmas cactus co-exists in a supportive community. ( provided by Dr. Vincent M. Hanlon)

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FEATURE

The beginnings of plastic surgery in Canada War time challenges drove new techniques

Each fall the Alberta Medical Association Representative Forum/annual general meeting features the Dr. Margaret Hutton Lecture Series. Medical students present on various interesting aspects of medical history. To share their excellent research and conclusions, we are carrying the highlights of the lectures in Alberta Doctors’ Digest.

This issue features Ms Malika Ladha of the University of Calgary.

Reparative operations were occurring in Canada even before the establishment of plastic surgery as a distinct medical specialty toward the beginning of

the 20th century. For example, while German surgeon Dr. Karl Thiersch (1822-95) had developed a reconstructive technique at the University of Erlangen and Leipzig in 1874,1 Dr. James Bell (1852-1911) soon applied this method successfully in Montreal. As a general surgeon, he treated six cases of chronic ulcers which otherwise could not be induced to heal, often leading to amputations.2 Over 100 years later, this procedure – known as split thickness skin grafting – is still in widespread use in burn and reconstructive surgery.3

Malika Ladha | STUDENT, UNIVERSITY OF CALGARY (PRECEPTORS: DR. A. ROBERTSON HARROP, MSC, FRCSC AND DR. FRANK W. STAHNISCH, MSC, PHD)

Bell’s application of Thiersch’s technique represents an instance of how non-specialized physicians contributed to some of the modern repertoire of plastic surgery.4 Plastic surgery emerged rather late as a surgical specialty toward the beginning of the 20th century. This was an inevitable process that witnessed young surgeons undertake the surgical challenges of their time.

As the clouds of World War I (WWI) loomed over the world, only a small number of surgeons had experience with reconstructive surgical techniques, often stemming from treating industrial disasters, burns, and in certain cases, previous wartime experiences such as the American Civil War (1861-65) and the African Boer Wars (1880-81 and 1899-1902).5 The sheer number of WWI casualties and the previously unseen injuries prompted for new techniques and procedures beyond the scope of general surgery in the 1910s and 1920s.

WWI: Early days of plastic surgery

The battle style of WWI, specifically trench warfare, exposed soldiers’ faces to injury from large and small artillery, which in turn resulted in horrific facial fractures and soft tissue injuries.6,7 At the outset of the war, there was a limited understanding of specialized treatment forms for these injuries and a lack of appropriate treatment facilities. The role of Sir Dr. Harold Gillies (1882-1920), an otolaryngologist from New Zealand serving in the Royal Army Medical Corps,8,9 in addressing these WWI issues is well known.

Gillies set up a specialized jaw and face unit at the Cambridge Military Hospital in Aldershot, England. Due to the overwhelming number of casualties, this unit was then later transferred to Queen Mary’s Hospital in Sidcup, Kent in 1917.9 It was here that Gillies was introduced to Major Carl Waldron (1887-1977), a Johns Hopkins-trained otolaryngologist from the University of Toronto. Waldron’s patient load had increased substantially such that he sent for Dr. Fulton Risdon (1880-1968) of Toronto, who was serving with the Royal Canadian Medical Army Corps (RCMAC) in Britain.10 This facilitated a decisive meeting and exchange between Gillies and Risdon, which can be viewed as “planting the seeds” for plastic and reconstructive surgery to emerge in Canada. >

22

The trench warfare of WWI resulted in horrific facial fractures and soft tissue injuries. ( provided by Thinkstock)

MARCH - APRIL 2015

23Born in St. Thomas, Ontario in 1880, Risdon had pursued his scientific and medical education at the University of Toronto. Rather unusual at the time, he had a dual education in both dentistry (1907) and medicine (1914).11 He joined the RCMAC when the war broke out in 1914 and soon emerged as a commissioned captain. He became the first Canadian to train under Gillies at his specialized reconstructive surgery unit and surely learned many new techniques and practices during this time.12

Translating war experiences to civilian surgical practice

Having been released from the army in 1919, Risdon transferred his clinical experience from the battlefield to his private practice in Toronto. This marked his personal and scientific commitment to the newly emerging field, becoming “the first in Canada to devote himself to practice of plastic surgery, at a time when general surgery opposed sub-specialization of any kind.”12

During the interwar period between WWI and World War II (WWII), Risdon – like many scientific-minded physicians and surgeons – went to the United States of America to pursue post-graduate training. He then returned to Toronto in 1921 with appointments as a professor of oral surgery with the University of Toronto and staff member at the Christie Street and Toronto Western Hospitals, the latter at which he remained on staff for 45 years.

He became well-known among surgeons for the “Risdown Wire,” a technique of using wires to provide fixation of the mandibular fractures, which previously had been difficult to fixate in order to achieve reliable bone healing.13

Risdon was a founding member of two of the world’s earliest plastic surgery organizations: the American Association of Plastic Surgeons in 1921 and The American Board of Plastic Surgery in 1932.11 Yet despite his commitment to the field, Risdon was unable to attain a position related to plastic surgery with the University of Toronto. This was likely due to the relations between Dr. William Gallie (1882-1959) and Risdon.14 In his historical account of the development of the Canadian Society of Plastic Surgeons, Toronto-based plastic surgeon Dr. Leith Douglas (1930-2011) highlighted the climate within the surgical community at the time:

“The most influential surgeon in Toronto during that time was Dr. W.E. Gallie, head of the department of surgery at the University of Toronto. Several surgeons who knew Risdon and Gallie have said there was little love lost between the two men.”14

This perhaps affected how Gallie addressed the growing need for reconstructive surgeons in Canada. Instead of consulting Risdon to train young medical trainees, Gallie

> selected two promising surgeons from Toronto, Dr. Stuart Gordon (1903-86) and Dr. Alfred Farmer (1904-2002), to train under Sir Harold Gillies in 1930. And while Risdon did not have a direct successor, he certainly had laid the foundation for Gordon and Farmer to secure the future of the specialty in Canada.

Meanwhile, Risdon made many contributions in the clinical arena. His legacy includes the aforementioned Risdown Wire, the use of bone grafting in the treatment of difficult mandibular injuries and the “Risdon approach” for mandibular fractures and arthroplasties of the tempo-mandibular joint.15,16,17,18

Canadian Society of Plastic Surgeons

Gordon, Farmer and other surgeons interested in the new field met on November 7, 1947 at the Queen Mary Veterans’ Hospital in Montreal to form the Canadian Society of Plastic Surgeons (CSPS).14 The establishment of the society was a landmark for the discipline’s cohesion, proliferation and acceptance in Canada.

Despite not being present at this meeting, Risdon was elected to serve as the inaugural CSPS president. Under Risdon’s leadership, the society decided to host annual meetings with scientific sessions. This continues to this day – the 69th annual meeting will be held in Victoria, British Columbia this June.

Outside of his hospital research career, Risdon is remembered for his personality and social amiability. Risdon, who held memberships at various social clubs, also spent time on the best golf courses of the cities in which he attended scientific meetings, sometimes even missing academic sessions on this account.11

In conclusion, Risdon made pioneering contributions to the emerging field of plastic surgery both in Canada and abroad. He furthered the knowledge of various treatment options and actively contributed to the establishment of this new surgical field in Canada. By tackling the challenges of his era with innovation and relentless motivation, he inevitably became part of the process which advanced sub-specialization in medicine and surgery.

Acknowledgment

The author would like to thank Dr. A. Robertson Harrop,2 MSc, FRCSC and Dr. Frank W. Stahnisch,2 ,3 MSc, PhD for their contributions and mentorship.

Section of Plastic Surgery, Department of Surgery, Cumming School of Medicine;1 Department of Community Health Sciences, Cumming School of Medicine;2 Department of History, Faculty of Arts;3 University of Calgary.

References available upon request.


24 FEATURE

Arming adolescents with knowledge about mental health Emerging Leaders in Health Promotion Grant Program funds community psychiatry project

Mental health is integral to our overall health. It is a state of well-being in which the individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her own community. Mental health is different from the absence of mental health problems and illnesses.1

With her Mind Your Brain Emerging Leaders in Health Promotion Grant Program, project lead Dr. Prajjita S. Bardoloi, a resident in psychiatry

at the University of Alberta, had clear objectives. She wished to “educate young people (ages 13 to 18) about mental and brain health in order to raise the understanding of mental health in the community and expand upon the preventative aspect of mental health, by teaching participants about the importance of a healthy mind and body.”

Working with the Michener Park (University of Alberta student/family residence) youth group and youth from the Red Deer South Asian Society, Dr. Bardoloi and her project partner (non-medical student), Trisha Mondal, with the oversight of project mentor Dr. B. Soniya Jegadesh (practicing psychiatrist, Alberta Hospital), delivered educational sessions at both venues, focusing on four aspects of mental and brain health: stress, physiological brain damage and how to prevent it, the effects of drugs and alcohol on adolescent brains, and the effect of diet on the brain.

“There aren’t many early intervention or education programs available for the youth community,” explains Dr. Bardoloi, adding that her project was in accordance with the Children’s Mental Health Plan for Alberta: Three-Year Action Plan 2008-11 (Alberta Health and Wellness, 2008). “We feel that arming adolescents and young adults with proper knowledge and coping skills will help them deal with adult life more capably. The early intervention could also help decrease mental health risks later in life.”

Over the course of the sessions, Dr. Bardoloi and Ms Mondal administered a number of questionnaires that assessed the participants’ pre-existing knowledge base >


Dr. Prajjita S. Bardoloi describes the composition of the human brain to youth in a Mind Your Brain education session. ( provided by Gautom Bardoloi)

L to R: Dr. Prajjita S. Bardoloi, a resident in psychiatry at the University of Alberta and project assistant Trisha Mondal, studying cognitive science at York University, lead a Mind Your Brain education session. ( provided by Gautom Bardoloi)

24

MARCH - APRIL 2015

25and biases regarding mental health, diet, exercise, sleep and health-related behaviors, (for example, wearing helmets and avoiding smoking, excessive alcohol and other illicit substances). The final session’s questionnaire assessed the participants’ growth in understanding. In order to encourage attendance by the young subjects, sessions included snack breaks and question-and-answer periods.

Through a series of mini-lectures, discussions and activities for skills development (such as stress management, relaxation techniques and coping skills) led by Dr. Bardoloi, she and Ms Mondal worked to provide their youth participants with knowledge of mental and brain health preventative techniques that could improve their ability to handle stressors and make healthy decisions, both as youth and in the future, as adults.

“I think it’s vital that we begin mental and brain health education at a young age,” states Dr. Bardoloi. “Applying the bio-psychosocial model of mental illness, we know that many of the factors influencing mental illness can occur in the early stages of life.”

Goals of the Emerging Leaders in Health Promotion Grant Program

As she selected the sessions’ four areas of concentration, based on her clinical experience, and then led the

community-based sessions with her adolescent participants, Dr. Bardoloi met the requirement of the Emerging Leaders in Health Promotion Grant Program to “promote development of the physician’s role as an advocate for healthy populations.”

With the application of her leadership skills to the planning and facilitation of the Mind Your Brain youth education sessions, Dr. Bardoloi acquired “experience in health promotion as integral to medical practice.” As she worked with her mentor, Dr. Jegadesh, on the conception, development, planning and implementation of the Mind Your Brain program, Dr. Bardoloi “developed her leadership and advocacy skills in a mentored environment.”

Established in 2011, the Emerging Leaders in Health Promotion Grant Program sponsors successful medical student and resident physician applicants in the conception and application of a health promotion project targeting the general Alberta population. The Alberta Medical Association's Health Issues Council and the Canadian Medical Association have committed funds to support this grant program.

Reference

1. World Health Organization (2001). Strengthening Mental Health Promotion. (Fact sheet, No. 220).

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FEATURE

Mayhap you have met these menschen!Join the AMA in thanking these outstanding physician mentors

While serving in the traditional sense as experienced and trusted advisors, within the context of the Emerging Leaders in Health

Promotion (ELiHP) Grant Program, project mentors (senior members of the medical profession) do that and a whole lot more.

In addition to sharing a strong interest in an ELiHP project’s health promotion issue, they play a key role by supporting a medical student or resident physician to build stronger personal skills as an advocate for healthy populations and as a leader. They guide, inspire, oversee and come to the rescue, when required!

The 2013-14 ELiHP grant projects have wrapped up and the next few issues of Alberta Doctors’ Digest will continue to profile these remaining grant projects and their medical student and resident physician project leads. So the time is right to thank the program’s 2013-14 mentors for their time, dedication, tireless assistance and guidance.

An Apple a Day Mentor: Dr. Clare V. Henderson

Cooking with Ravi’oli Mentor: Dr. Harvey P. Woytiuk (Read the project profile under 2013-14 recipients on the AMA website at www.albertadoctors.org/about/awards/health-promo-grant)

Infection Prevention Awareness at the Calgary International Children’s Festival Mentor: Dr. Joseph Vayalumkal

Initiation of Smoking Cessation in Pediatric Patients and their Caregivers Mentor: Dr. Marielena L. DiBartolo

Mâmawihitowin: Aboriginal Community Gatherings for Health Mentor: Dr. Ellen L. Toth

Mind Your Brain Mentor: Dr. B. Soniya Jegadesh (Read the project profile under 2013-14 recipients on the AMA website at www.albertadoctors.org/about/awards/health-promo-grant)

Obesity and Children: A School Health Promotion Project Mentor: Dr. Sandip S. Gandham (Read the project profile under 2013-14 recipients on the AMA website at www.albertadoctors.org/about/awards/health-promo-grant)

Charley’s Peace Regional Good Food Box Program Mentor: Dr. Dave L. Willox (Read the project profile under 2013-14 recipients on the AMA website at www.albertadoctors.org/about/awards/health-promo-grant)

Rewards of Reading: A Literacy Campaign Mentor: Dr. Janette A. Hurley (Read the project profile under 2013-14 recipients on the AMA website at www.albertadoctors.org/about/awards/health-promo-grant) >


26

MARCH - APRIL 2015

27Background Established in 2011, the Emerging Leaders in Health Promotion Grant Program sponsors successful medical student and resident physician applicants in the conception and application of a health promotion project targeting the general Alberta population. The Alberta Medical Association’s (AMA’s) Health Issues Council (HIC) and the Canadian Medical Association (CMA) have committed funds to support this grant program.

The ELiHP Grant Program is a partnership of:

• AMA, through HIC

• CMA

• Medical student associations at both Alberta universities

• Professional Association of Resident Physicians of Alberta

The grant is intended to:

• Promote development of the physician’s role as advocate for healthy populations.

• Provide experience in health promotion as integral to medical practice.

• Facilitate growth of leadership and advocacy skills in a mentored environment.

Note: In its allocation of funds to support the delivery of health advocacy initiatives, the ELiHP Grant Program is different than the Committee on Student Affairs Sponsorship program, which supports initiatives that focus on the medical student population (leadership, professionalism, collegiality, wellness and diversity).

For more information on the ELiHP Grant Program, visit the AMA’s website at www.albertadoctors.org/about/awards/health-promo-grant.

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Fiscal “austerity” is a buzzword with connotations of

war-time rationing, disciplinary punishment for previous sprees and inexcusable excesses, accompanied by a glare and a finger-wagging

lecture from a Scottish grannie. It usually describes government policies during economic-adverse times in order to reduce budget deficits. It’s an opportunity to balance budgets and cozy up to the credit rating agencies, but it’s also an opportunity for renewal, a re-birth by restructuring.

Alexander H.G. Paterson, MB ChB, MD, FRCP, FACP | CO-EDITOR

muddying people’s understanding of what is really going on and creates a demand for more economists.

And the only economist worth reading is the New York Times columnist, Paul Krugman (mainly because he writes well) who won a Nobel Prize for his thesis on “economies of scale,” possibly using Alberta Health Services (AHS) as a shining example. Here he is writing about fiscal austerity:

“When applied to macroeconomics, this urge to find moral meaning creates in all of us a predisposition toward believing stories that attribute the pain of a slump to the excesses of the boom that precedes it – and, perhaps, also makes it natural to see the pain as necessary, part of an inevitable cleansing process.…”1

So there. Enough. I rest my case.

Here’s my thesis: “austerity” or “cut backs” are fine when you’re short of cash – but they probably mean you’ve been a foolish virgin during the good times – something every householder knows. But cut-backs, when practiced by governments, are generally effective in balancing budgets but ineffective in achieving any beneficial re-structuring.

Inevitably the wrong programs, the wrong people and the wrong trousers are cut back, although the budget does get balanced. In a household, after a bracing time of eating porridge, dry bread and water, there is generally a recovery of buying activity appropriate for that household, but in the medical economy, as in the general economy, misdirected austerity takes longer to recover from.

But first a brief review of economic life in Alberta after 43 years of the less-than-stellar provincial Progressive Conservative (PC) Party (now the “Not Your Grandfather’s Party/Wilted Rose Party”).

The Lougheed years were indeed elysium. The topic at many cocktail parties was whether concorde should land in Calgary or Edmonton. I met Peter Lougheed a couple of times and he was a fine gentleman who seemed more interested in talking to my wife than to me. He was a well-educated master of the fine balance – the need to modernize, to stand up to eastern bullies, with awareness that good times don’t last forever. He established the >

Medical austerity – Alberta style

IN A DIFFERENT VEIN

We’ve hardly had a spending spree these last seven years but I have detected a certain smugness from colleagues in non-oil producing provinces asking how we’re now coping.

As has happened in Greece, Japan and other countries undergoing fiscal austerity, there is a trend toward balancing budgets, but usually a failure to restructure, of “purging the rottenness from the system” (as Andrew Mellon said when advising Herbert Hoover not to interfere in the Great Depression).

“Economics” is, of course, a non-science consisting of simple concepts dressed up as complex processes, e.g., “deleveraging” simply means paying down debt. Other equally simple buzzes are: “economies of scale;” “quantitative easing;” “fiscal cliff;” “Keynesian” and so on.

Economics allows economists to voice their prejudices from a cloud of dodgy tables, graphs and assorted gimcrackery – the tabulation of amazingly inaccurate data tarted up with lipstick and eyeshadow to look eye-catching and credible. This has the effect of

28

MARCH - APRIL 2015

29Heritage Fund and for a time it accumulated cash on par with Norway’s “Oljefondet” (all Norwegians now are, in theory, krone millionaires).

Then came Mr. Getty and the fun continued – but the jig got faster. Mr. Getty, a big proponent of “the family,” initiated the Family Day holiday. But there was a feeling that perhaps things were going too far. You could get a grant for a family re-union – so the McTavishs or the Boychuks could get together round a barbecue in July or August. Our dear old lymphoma expert at the Cross even got a grant ($800) for his collection of Islamic Poetry on display in his house.

> important committees – you know, ones that actually make decisions and act on them. That would take a few years longer.

I can’t say much about the Stelmach spending years, other than recruitment funds eased up, there was some expansion and the Heritage Fund became depleted.

And the Red Queen’s years? There was that strange decision to spend large sums of money opening family care centres in places with perfectly adequate family practices so that patients could discuss at length their illness, treatment and side-effects at eight o’clock at night with professionals paid a handsome hourly rate in order to give the illusion of health care access. The Red Queen and her Alberta Health Services creator-in-chief, Rocking Ron Liepert (currently about to take Ottawa by storm as a Federal MP – stand by for the creation of “Canada Health Services”) did not like you or me – we were “entrenched interests,” annoying obstacles to reforming health care by people with much experience in law and the insurance business.

Well, we’ve hardly had a spending spree these last seven years but I have detected a certain smugness from colleagues in non-oil producing provinces asking how we’re now coping.

There’s agreement among economists that austerity leads to short-term, higher unemployment and lower private sector spending. If you’re right leaning, you believe that austerity sends a message of thrift, that government could do with trimming and that the private sector will benefit from decreased government competition, and if you’re left-leaning you believe that austerity leads to unnecessary unemployment, a fall in living standards – all to satisfy the demands of wealthy creditors.

Economics allows economists to voice their prejudices from a cloud of dodgy tables, graphs and assorted gimcrackery – the tabulation of amazingly inaccurate data tarted up with lipstick and eyeshadow to look eye-catching and credible.

Then the Klein years – and consideration was given to the possibility that good times may not roll forever. Medical austerity ensued. These were what might be called “paperclip and explosions austerity.” There was a fierce cutting of everything superfluous: buns at rounds, committee lunches … and especially paperclips. These were not to be thrown out. It was the heyday of the cost-cutter – a sombre, black-gowned Scottish Presbyterian minister pointing the finger of scorn at the excesses of golf on a Sunday. Costs had to be cut. Recruiting ceased. I had the opportunity to recruit to Calgary a world-leader in palliative care. He wanted a dedicated nurse, no start-up funds, no special treatment. I was told by a nameless administrator that we couldn’t do this – “it’s like selling the family farm.” This palliative care doctor (who went to the MD Anderson) would have brought in millions of dollars to the Alberta economy but – belly up for a dedicated nurse? Oh dear no … austerity.

The Klein years of paperclip austerity ended with a bang – the demolition of the Calgary General Hospital (CGH). At the time I was puzzled by the CGH blow-up – although I loved the noise, smoke and excitement. Perhaps it was the PC’s need to reward its friends in the development and building community. Fair enough. Oh, and the Colleen and Ralph Klein Cancer Centre was first announced for Calgary.

And we struggled on, unable to recruit, but gradually the provincial debt was paid off and the buns started to creep back to the morning rounds and lunches for really important committees, though not for the less

Inevitably the wrong programs, the wrong people and the wrong trousers are cut back, although the budget does get balanced.

But provincial austerity is not the same as federal austerity. Most people living in Alberta (apart from a few Maffia households) do not have the ability to print money. The federal government does and could, theoretically, print money to buy Government of Canada bonds and use the proceeds to transfer cash to the provinces in need. This is unlikely to happen. We can however increase unemployment and transfer some of the required safety net spending to the federal government. >


30 > So, how to do the coming austerity properly? It will not be done properly of course but let’s imagine.…

In the health care arena, cutting back on staffing means the young, the noisy and the impertinent will be the first to go. The old, the living dead and those with intimate access to fiscal decision makers will stay on.

Can we not create a double-diad troika? The first troika being of three experienced clinicians who actually see patients, support them, teach well and do research, who advise on what areas can be cut back or abolished with no adverse effect (and likely an improvement) on patient care. It would be like the troika demanding restructuring in Greece, with the exception that this team would know where the dead wood is. The second troika would look after the administrative and political aspects of the medical austerity program.

Here are some other sensible measures:

Appoint people to the Born-Again Superboard with real health care knowledge and reduce the honoraria they trouser for just sitting there. I don’t get Diamond Jim’s decision to re-instate the “superboard,” although it does give an easy way to reward loyal followers. Few of these people have any idea of what is going on in health care – even less than the central AHS administration. They’re only going to be rubber stamping any administrative decision. Perhaps that’s the point – the appearance of democracy.

Cut the endless creation of AHS policies that only the creators read.

Reduce blood tests, MRI and CT scanning in line with the Canadian Medical Association’s “Choose Wisely” project. This would be a restructuring beneficial to patient care. There may even be an increase in direct patient history-taking and physical examination.

Put a five cent per litre tax on gasoline and get the kids with back-to-front baseball hats driving Dodge trucks at 150 kilometers per hour on the Deerfoot and Calgary Trail. What on earth is wrong with a small increase in the gasoline tax?

Raise the provincial income tax level for those earning more than $400,000 per annum to give more employment to tax lawyers.

And finally, cut electricity bills in half by turning the lights out at night.

“Last one out turn off the lights please…”

Reference

1. Krugman P. “How the Case for Austerity Has Crumbled.” New York Times, June 6, 2013.

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

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For eligibility criteria please visit this link: http://www.cpsa.ab.ca/Services/Registration_Department/Alberta_Medical_License.aspx >

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Beverly Medical Clinic is a new state-of-the-art medical clinic that is rapidly expanding. Our team currently includes three family physicians, two internists and a pediatrician.

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SOUTH AFRICA November 24-December 9 Focus: Adventures in medicine Ship: Regent Seven Seas Mariner

CARIBBEAN NEW YEAR’S December 27–January 3, 2016 Focus: Dermatology and women’s health Ship: Freedom of the Seas

AUSTRALIA AND NEW ZEALAND January 5-19, 2016 Focus: Caring for an aging patient Ship: Celebrity Solstice

TAHITI AND COOK ISLANDS February 20-March 2, 2016 Focus: Tahitian CME Pearls 2016 Ship: Paul Gauguin

SOUTH AMERICA February 28-March 9, 2016 Focus: CME with McGill University Ship: Celebrity Infinity

For current promotions and pricing, contact: Sea Courses Cruises TF 1.888.647.7327 [email protected] www.seacourses.com >

MARCH - APRIL 2015

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TO PLACE OR RENEW, CONTACT:

Daphne C. Andrychuk

Communications Assistant, Public Affairs

Alberta Medical Association

T 780.482.2626, ext. 3116 TF 1.800.272.9680, ext. 3116

F 780.482.5445

daphne.andrychuk@ albertadoctors.org

DISPLAY OR CLASSIFIED ADS

WellPoint Phys Ad - 12-02-15 - outlines.indd 1 12/02/2015 12:40:01 PM

PHYSICIAN(S) REQUIRED FT/PT

MILLWOODS EDMONTON

Also locums required

Phone: Clinic Manager (780) 953-6733 Dr. Paul Arnold (780) 970-2070

ALL-WELLPRIMARY CARE CENTRES

SERVICES

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Contact: Sid Soil DOCUdavit Solutions TF 1.888.781.9083, ext. 105 [email protected]

FOR SALE

CALGARY AB

Acreage for sale in North Springbank, 20 minutes from hospitals and university. Sunny two-storey with fantastic views from every room. Located on two acres with massive four-car garage, two bedrooms and den, loft/study area and gorgeous sunroom attached a large kitchen. No basement, upstairs laundry and solar panels. Asking $915,000.

Contact: T 403.648.1933 www.comfree.ca and enter access code 537355

>

MOST CANADIAN PHYSICIANS CHOOSE MD AS THEIR PRIMARY INVESTMENT FIRM.1

MD is the only financial services firm created to meet the specific needs of physicians. We offer personalized, objective advice on everything from investments and incorporation, to insurance, banking, borrowing and estate and trust.

WHY WILL YOU INVEST WITH MD?CONTACT AN MD ADVISOR TODAY TO DISCUSS YOUR INVESTMENT NEEDS.

1 877 877-3706 | md.cma.ca/invest

1Fifty-three per cent of Canadian Medical Association members chose MD as their primary financial services firm, with the closest competitor at 12%. Source: MD Financial Management Loyalty Survey, June 2014.

MD Financial Management provides financial products and services, the MD Family of Funds and investment counselling services through the MD Group of Companies. For a detailed list of these companies, visit md.cma.ca. Incorporation guidance limited to asset allocation and integrating corporate entities into financial plans and wealth strategies. Professional legal, tax and accounting advice regarding incorporation should be obtained in respect to an individual’s specific circumstances. Banking products and services are offered by National Bank of Canada through a relationship with MD Management Limited. Credit and lending products are subject to credit approval by National Bank of Canada.

− Dr. David Burt, Family Physician

“I INVEST WITH MD BECAUSE I FEEL CONFIDENT THAT OUR FUTURE IS BRIGHT.”

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