May/June 2015 - Alberta Medical Association

Transcription

Alberta Doctors'
DIGEST
May-June 2015 | Volume 40 | Number 3
Mum’s the word
Confidentiality and the Physician
and Family Support Program
Emerging Leaders in Health
Promotion Grant program
Four inspirational stories. Wow, Alberta's
medical students, residents and
physician-mentors have been busy!
Emerging Leaders in Health
Promotion Grant program:
Canadian Medical Association steps up
Red, blue and yellow:
The colorful use of color
in anatomical illustration
Patients First®
CHBA - Calgary Region
-2014-
CONTENTS
DEPARTMENTS
Patients First® is a registered trademark
of the Alberta Medical Association.
Alberta Doctors’ Digest is published
six times annually by the Alberta
Medical Association for its members.
Editor:
Dennis W. Jirsch, MD, PhD
4
9
11 22 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
July-August issue deadline: June 12
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.
From the Editor
Health Law Update
Mind Your Own Business
Dr. Gadget
26 Residents' Page
28 In a Different Vein
32 Classified Advertisements
FEATURES
6 Mum’s the word
Confidentiality and the Physician and Family Support Program
14 Emerging Leaders in Health Promotion Grant program:
Connecting Aboriginal youth to their community
Starting early with healthy eating smarts
Kids and infectious diseases: (not) all fun and games
Advocating healthy family choices; family first, individual second
Canadian Medical Association steps up
24 Red, blue and yellow
The colorful use of color in anatomical illustration
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
AMA MISSION STATEMENT
The AMA stands as an advocate for its physician
members, providing leadership and support for
their role in the provision of quality health care.
COVER PHOTO: Dr. William S. Hnydyk is the Alberta Medical Association Senior Management
Team lead with responsibility for the Physician and Family Support Program.
( provided by Curtis Comeau)
MAY - JUNE 2015
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FROM THE EDITOR
Pen and paper
Dennis W. Jirsch, MD, PhD | EDITOR
T
he prescription I
picked up from my
family doctor the
other day was beautiful.
Computer-generated, it
was a model of clarity:
a certain antibiotic, four
times a day for 10 days.
Pharmacists and nurses must be astounded at their luck.
We’ve long heard about bad handwriting and some
years ago, headlines announced that medication errors
attributable to illegible scrawl were responsible for
7,000 deaths a year in the United States of America.1
Now docs’ handwriting may be particularly execrable
but we’re certainly not alone. Napoleon’s scribble was
indecipherable at times and may have cost him the
Battle of Waterloo. Other examples: Beethoven’s opus
“Für Elise” may have originally been titled “Für Therese,”
and Eric Clapton’s instrumental “Badge,” was evidently
first titled “Bridge.”
Typescript fixes all this and perhaps the day will come
when there is no writing. Not yet. I was trying to read a
“progress note” the other day. One of the entries was
worse than bad, in a bad field – a series of close zig-zag
slashes of a pen, with another, more horizontal slash
beneath. I asked for help from a couple of the medical
records people around and even a couple of docs, but we
could make nothing of it. I remembered that Leonardo
da Vinci disguised his stuff by writing in mirror images,
so I looked with a mirror from someone’s purse. No
difference. It was impenetrable.
Otzi, the prehistoric man found in an Alpine glacier in
1991, came to mind. CT scans, genomic analysis, etc.,
have told us lots about Otzi. We know the frozen fellow
suffered from whipworm, had 57 tattoos, an omnivore’s
stomach content and that he died of a chest wound.
What if, I wondered, a bit of a progress note found its
way into a residual Rocky Mountain glacier? Or got
imbedded in amber? Would this little bit of arcana yield
to super-duper analysis in future? Nope, I concluded.
Researchers would have too little to work with, would
infer that the peculiar marks were made by Phoenicians,
somehow out-of-place and out-of-time.
AMA - ALBERTA DOCTORS’ DIGEST
Though it predates the Norman Conquest, cursive
handwriting is on its way out, and is taught in fewer and
fewer schools. I suppose cursive script was once faster
than print, with less need to lift pen from paper. Early
pens were made from reeds, or goose quills – hence the
derivation of “pen” from the French “penne” for feather.
Along came the fountain pen. I never found a fountain
pen I couldn’t get to bleed on paper, hands, whatever, and
in younger days, it was inviting dip for the pigtails of the
girl in the desk ahead of me. A few diehards persist with
fountain pens but I suspect their owners are generally
looking for ink or a sink to clean up in.
Medication errors attributable
to illegible scrawl were responsible for
7,000 deaths a year… typescript fixes all
this and perhaps the day will come when
there is no writing.
Hungarian Laszlo Biro went the next step, inventing the
now-ubiquitous ballpoint pen in 1938. Ballpoints are here
to stay, I expect. There’s still a need for terse memos on
paper when electronics just won’t do: “Get milk,” say, or,
when things go really awry, pushing paper toward the
bank teller: “Give me all your money.”
My total dependence on pen and paper was brought home
to me indelibly some years ago. I fell for a high-end men’s
shop ad that urged me, seemed to promise me in fact, that
I would prosper in Egyptian cotton shirts, ones made by
the haberdasher that had outfitted Sir Winston Churchill.
I fell for it and came home with three crisp shirts of
inestimable quality and their promise of a golden future.
For weeks my shirts seemed too beautiful to touch, but
one day I took the little pins out of the various nips and
tucks and put one on. >
> There was stuff I hadn’t counted on! To start with, there
were five – count’em, five – mother-of-pearl buttons at
each cuff, another seven of these little devils to close the
shirt and all so small as to require picky-picky fiddling.
Understand my hell – a doc who at the time doffed
and donned clothes many times each day, what with
appendectomies, endoscopies, trips to ER and OR. Most
painful, though – the game changer, as they say – there
were no pockets. The hand that broached my left pectoral
chest found what? Nothing.
My misery was profound. Lord Churchill’s haberdasher
and I parted ways at once. My multi-threaded, pocketlessshirts found their way, by degrees, to the trunk of my car.
They never quite made it to the reuse depot – such was
my rancor – but were used over a period of years to check
the oil level on a dipstick or to buff my windows. I have not
owned a pocketless-shirt since.
Now I might still sport a plastic
pocket protector, but people will put up with
just so much. I’m partial to the generic ballpoint
pens that will write on anything, and were
readily available until a recent budget squeeze
went looking for some hundreds of millions.
Let me try another war poet on you, albeit a later war.
Sidney Keyes3 wrote some lines that are mysteriously
beautiful and will haunt me forever. Of course my bias
is that these were written with pen and ink, and that
they would have a more difficult birth – perhaps
impossible today.
He said, "Dance for me," and he said,
"You are too beautiful for the wind
To pick at, or the sun to burn." He said,
"I'm a poor tattered thing, but not unkind
To the sad dancer and the dancing dead.”
I’m fond of a world that is
disappearing. Am I one of those musty types
that can’t write without a pen, who finds a word
processor only useful when dealing with text
that is pretty well complete…
Now if I were ever to think I could imagine a quatrain
as beautiful as this, I’d start with a sheaf of fine vellum,
a pen with a gold nib and liquid blue-black ink. I’d start
on a day unusually filled with enthusiasm. I’d have to be
pretty rambunctious, but I wouldn’t try it any other way.
Nonsense, you say.
Now I might still sport a plastic pocket protector, but
people will put up with just so much. I’m partial to the
generic ballpoint pens that will write on anything and
were readily available until a recent budget squeeze went
looking for some hundreds of millions. The bits of paper
I find on rummaging through pockets comprise a bit
of cultural history for me that is more compelling than
anything I find in a cell phone, organizer or laptop.
I’m fond of a world that is disappearing. Am I one of
those musty types that can’t write without a pen, who
finds a word processor only useful when dealing with
text that is pretty well complete, when errant commas
or the odd word are added or elided. To me it’s a matter
of history and habit – all the thrumming gray matter, all
the neural pathways, all the complex play of bones and
sinews and muscle involved – yield the scraggly output
that I can sometimes muster.
But I think it is best to know my biases.
References
1. http://mindblowingfacts.org/2013/05/sloppy-handwritingskills-of-doctors-are-responsible-for-over-7000-deathseach-year/.
2. http://en.wikipedia.org/wiki/In_Flanders_Fields.
3. http://philippopelon.livejournal.com/14945.html; From
Death and the Maiden, Four Postures of Death, by Sidney
Keyes.
I like handwritten stuff. I’m much taken with the
handwritten copy of Flanders Fields, on Wiki, written by
Lieutenant Colonel and physician John McCrae.2 This
piece has become the anthem for Remembrance Day and
the horrors and casualties of war. I like to think it had to
be written this way, penned in cursive script on paper.
MAY - JUNE 2015
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COVER FEATURE
Mum’s the word
Confidentiality and the Physician and Family Support Program
Terrie E. Brandon, MD, CCFP | CLINICAL
DIRECTOR, PHYSICIAN AND FAMILY SUPPORT PROGRAM
T
he Physician and Family Support Program (PFSP)
gathers feedback from Alberta Medical Association
(AMA) members on an ongoing basis through our
tracker survey and satisfaction surveys. Not surprisingly,
one concern that is sometimes raised is that of program
confidentiality.
At PFSP we have always believed that physicians need
a safe place to seek support for health concerns and
that we all have a right to privacy regarding our health
information. The program takes confidentiality very
seriously and has implemented measures to safeguard
the privacy of those who use our service.
When you call the PFSP assistance line, you might
wonder who knows that you’ve called. The short answer
is that only the people you speak to know your name
(unless you’ve given explicit consent for someone else to
be involved). Your call is answered by a service provider
who is external to the AMA, who will collect some
limited contact and demographic information. Your call
will be returned by an assessment physician who will
discuss your concerns with you and help you access
appropriate resources. The assessment physician will not
retain any of your information. If you are referred to a
therapist, your name will be known only to the therapist
and to the service provider – both are independent
contractors who are at arm’s length from PFSP and AMA.
A small number of physicians who call our line have
more complex health issues and may agree to enter our
case coordination program. This is a voluntary program in
which the physician caller will meet with members of our
team. With the physician’s consent, limited information
may be shared with others involved in the care and
support of the physician.
It’s important to know that in Alberta, there are
two programs dealing with physician health. One is
the AMA’s PFSP. The other is the Physician Health
Monitoring Program (PHMP) of the College of Physicians
& Surgeons of Alberta (CPSA). The two programs are
entirely separate, both with their own mandates. They do
not share any information except in the instance where
a physician is involved with both programs and consents
to the sharing of information in order to support the
maintenance of, or return to, safe practice.
At PFSP we have always believed that
physicians need a safe place to seek support for
health concerns and that we all have a right to
privacy regarding our health information.
While we make every effort to maintain confidentiality,
there are limits to it. One example would be in a case
where there is concern about the personal safety of
a caller and urgent intervention is required. Another
potential example is where a physician reveals a
health condition that would be reasonably likely to
cause serious harm to patients. In the event that the
ill physician is unable or unwilling to self-report to the
CPSA, the CPSA Standards of Practice require that a
physician working within a physician health program,
such as PFSP, is obligated to report. I say that this is
a “potential” example because in my experience, this
has never happened. Physicians care deeply about the
safety of their patients and when they understand that
their health condition might impact patient care, they
generally voluntarily withdraw from practice until they
are well enough to return. Physicians also understand
their own obligation to report this type of health
condition to the CPSA.
At PFSP, we share your concern about protecting the
privacy of your health information. With the exception
of the extremely rare circumstance in which we may
be obligated to divulge information to a third party,
no personal health information will ever be disclosed
without a caller’s consent. It is an honor to be of service
to our colleagues and we endeavor to provide every
caller with excellent service and access to support in a
confidential manner.
Please read the following Q and A series for more
information on this subject. As always, I welcome your
questions, comments and feedback on this issue. You
can reach me at [email protected]. >
>
Confidentially speaking …
7
Answering your questions about confidentiality within the Alberta Medical Association’s Physician and
Family Support Program
These questions and answers address confidentiality within the Alberta Medical Association’s (AMA’s) Physician
and Family Support Program (PFSP) and the relationship between PFSP and the College of Physicians & Surgeons of
Alberta’s (CPSA’s) Physician Health Monitoring Program (PHMP).
When I contact the PFSP 24-hour assistance line,
who will know my name and other personal information
I provide at that time?
All services on the PFSP assistance line are provided by
contractors who are external to the program and the
AMA. When you contact the PFSP assistance line, your
identity and any other personal information you provide
is known only to:
• The contracted assistance line operator
• The assessment physician on-call.
What does PFSP know about my call to the
assistance line?
Other than the assistance line operator and the
assessment physician on-call, no one at PFSP is provided
with any identifiable information about you. Only
non-identifiable data, such as your gender and location
is provided to PFSP. PFSP uses this data in aggregate
form to compile statistics for program planning and
accountability.
What are the roles of the assistance line operator and
the assessment physician?
Are there any circumstances when the assistance line
operator or the assessment physician would provide my
identity and/or personal information to anyone else?
The following diagram depicts the process that occurs
when you contact the PFSP assistance line:
The limited circumstances under which your identity and
personal information may be shared are when:
Assistance line operator answers PFSP telephone line
24 hours a day, seven days a week, 365 days a year
(1.877.767.4637).
The operator will collect your contact information and ask
for a brief explanation of why you’re calling to determine
eligibility for PFSP services and provide basic triage for
your situation.
If you agree, the operator will arrange for a PFSP
assessment physician to contact you in a timely manner.
PFSP has contracts with assessment physicians who rotate
call on a weekly basis.
PFSP assessment physicians are committed to the
health and safety of their colleagues and understand
the challenges and issues that can arise for physicians,
residents and medical students.
The assessment physician does not act as a treating
clinician, but provides support and advice in the
management of your health issue and helps identify
resources that may be useful to you.
• The information provided to the assistance line raises
concerns about your personal safety and urgent
intervention is required.
• You provide consent to the assistance line operator or
assessment physician to discuss your situation with a
treating clinician that you have agreed to see.
• You provide consent to the assistance line operator
or assessment physician to discuss your situation
with the PFSP clinical director. For physicians,
residents
and medical students whose health issues may benefit
from on-going support from the PFSP, the PFSP
clinical director may suggest meeting with the case
coordination team.
What is PFSP case coordination?
PFSP case coordination provides support to the
participant and assists with access to the clinical
resources necessary to meet his/her needs. The PFSP’s
case coordination team does not act in a treatment
capacity. With the participant’s consent, the team may
liaise with the participant’s treatment providers as well
as non-clinical stakeholders who may be involved in more
complex situations.
Participation in PFSP case coordination is voluntary.
If you and the assessment physician agree that counselling
is a suitable resource for you, the assistance line operator
will contact you to arrange this. The assistance line
operator manages all counselling referrals for PFSP.
About 3% of the callers to the PFSP assistance line each
year participate in PFSP case coordination. In 2014, 34 of
the 1,250 individuals who called the PFSP assistance line
accessed case coordination services. >
PFSP is not informed of your counselling sessions.
MAY - JUNE 2015
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> Why are there two physician health programs in Alberta
and do they work together?
The AMA and the CPSA are both invested in the health
of physicians. The CPSA’s PHMP and the AMA’s PFSP
operate independently, each with their own specific
purpose. Interaction between the two programs can
occur with regard to the small group of physicians who
participate in PFSP case coordination. For purposes of
helping a physician maintain or return to his/her practice,
and only with the physician’s consent, the PFSP case
coordination team may share health information with the
PHMP. Otherwise, all information provided by physicians
to the PFSP case coordination team remains confidential.
The following diagram illustrates the unique purposes of
PFSP case coordination services and the PHMP, and the
circumstances under which they may share information:
Physician and Family Support
Program Case Coordination
Services
Physician Health Monitoring
Program
• Not a treatment program
• The CPSA’s Standards of
Practice define the reporting
requirements regarding
physicians’ medical conditions.
• Voluntary participation for
physicians, residents and
medical students with complex
health issues
• PFSP case coordination:
- Supports physicians’
management of their health.
-
Provides confidential
assistance with accessing treatment and other
non-clinical resources.
• Not a treatment program
In order to support the
maintenance of or return to
safe practice, the PFSP case
coordination team may ask
the physician for permission
to share his/her health
information with PHMP.
No information is shared
without the physician’s
consent.
Are there any circumstances where the PFSP is required
to report a physician’s medical condition to the CPSA’s
PHMP without the physician’s consent?
All physicians in Alberta are bound by the CPSA’s
Standards of Practice, which stipulate the reporting
requirements regarding physicians’ medical conditions.
When appropriate, PFSP will encourage the physician
to self-report to the CPSA’s PHMP. In the rare instance
where the physician does not self-report to CPSA’s
PHMP and there may be serious harm to patients or
others, the PFSP is obligated to do so. However, prior to
taking that action the matter would be fully discussed
with the physician.
• PHMP:
-
Monitors the health of a
physician whose medical
condition is either currently
having an impact on his/her
practice or may do so in
the future.
-
May place conditions on a
physician’s practice to ensure
that the physician’s own
health is maintained and the
physician remains fit to care
for patients.
HEALTH LAW UPDATE
9
BC constitutional challenge will
have its day in court
Jonathan P. Rossall, QC, LLM | PARTNER,
I
n November 2015, a
constitutional challenge
to the exclusivity of our
publicly funded health
care system is scheduled
to commence before the
British Columbia (BC)
Supreme Court. The case,
which names the BC Medical Services Commission,
the minister of health and the BC Attorney General as
defendants, is scheduled to take 18 weeks to complete,
and involves not only the testimony of patients, but
numerous experts. This momentous case may well set
the path for the acceptance of privately funded health
care in BC and arguably across the country.
In January 2009, Dr. Day commenced
his constitutional challenge to the provisions
in the BC legislation restricting the ability of
BC residents to purchase health insurance to
fund privately secured medical services.
By way of background, the challenge was commenced
by Dr. Brian Day, a BC orthopedic surgeon (and former
president of the Canadian Medical Association), partially
in response to periodic audits and challenges to the
operation of his surgical facility in Vancouver. The Camby
Surgery Centre (opened in 1996) has historically offered
privately funded surgical services to both the residents
of BC and non-residents, outside of the four corners of
the BC health insurance plan. Dr. Day has long been an
advocate of privately funded health services being made
available to Canadian citizens (and others) where waiting
lists make accessing the public health system impractical
or intolerable.
MCLENNAN ROSS LLP
In January 2009, Dr. Day commenced his constitutional
challenge to the provisions in the BC legislation
restricting the ability of BC residents to purchase health
insurance to fund privately secured medical services.
The challenge is similar to that brought in the province of
Quebec in 2000 resulting in the 2005 Supreme Court of
Canada decision in Chaoulli vs. Quebec.1 In that case, the
Supreme Court of Canada ruled that the rights of Quebec
residents were violated by laws that forced citizens to
wait, while denying them the right to access care outside
of the government system. The Supreme Court ruled that
laws restricting the ability of Quebec citizen residents to
secure health insurance in order to privately fund medical
services were unconstitutional.
Dr. Day likens the current BC health
system to North Korea’s national airline,
Air Koryo (which at the time was rated as
the world’s worst).
For reasons that are not completely clear, the principles
from that decision have not found application in other
provinces across the country in the intervening time
frame. It should be noted that of the seven judges sitting
on the case, one found for Chaoulli based solely on the
application of domestic Quebec human rights legislation;
three found for Chaoulli based on the application of
the Canadian Charter of Rights and Freedoms; and three
dissented. Therefore, technically there is no majority
decision applying charter principles. Notably, in Alberta
a challenge was brought recently in Calgary by a dentist
seeking to secure private funding for health services
which, although available under the public health care
insurance program, would only have been available at
a substantial delay.1 That challenge was unsuccessful
(albeit because of a lack of proper evidence, not because
the principles in Chaoulli were not applicable). It should >
MAY - JUNE 2015
10
> also be noted that in August 2005, delegates to the
Canadian Medical Association’s annual meeting adopted
a motion supporting access to private-sector health
services and private medical insurance in circumstances
where patients cannot obtain timely access to care
through the single-payer health care system.
(He) points out that the Canada
Health Act requires that care must be
comprehensive, universal, portable and
accessible, as well as being publicly funded
and administered. He claims that governments
ignore the first four principles, but ardently
enforce the last.
Dr. Day’s challenge, brought on his own behalf and on
behalf of a number of suffering patients, seeks to secure
the right of patients to obtain private health care services
and, in his words, grant Canadians “… the same rights
as those in jail, and the same constitutional protection
under the Charter of Rights and Freedoms that was
granted to citizens of Quebec.” According to Dr. Day, the
outcome of this case will “significantly impact the health
system.” In an article published by the British Columbia
Medical Journal on August 7, 2014, Dr. Day likens the
current BC health system to North Korea’s national
airline, Air Koryo (which at the time was rated as the
world’s worst). Dr. Day suggested that, like Air Koryo,
the health care system “… extracts funds; sets prices
and dictates spending; owns and controls the facilities;
decides where services will be located; trains, employs,
regulates and funds the workers; governs how, when and
where clients are served; determines the level and quality
of services; self-regulates, self-evaluates and outlaws
competition.” In the result, he calls Canada’s “Koryo”
health care model unique on the planet.
Dr. Day also points out that the Canada Health Act
requires that care must be comprehensive, universal,
portable and accessible, as well as being publicly funded
and administered. He claims that governments ignore
the first four principles, but ardently enforce the last.
He claims that the term “medically necessary” in the
Canada Health Act is deliberately not defined. He goes on
to say that “reasonable access” translates to care given
when government, not the patient or doctor, deems it
appropriate. In the result, it is his view that the act has
limited the ability of provinces to adapt to the modern
era of medicine.
Members of the medical community and patients alike
should be watching with great interest as this case
unfolds. Because of the nature of the legal process, it
may be years before the final determination is made
by the Supreme Court of Canada. However, given the
Supreme Court’s express findings in Chaoulli, it seems
likely that if Dr. Day prevails before the lower court in
BC, ultimately he will succeed in his quest to secure the
rights of Canadians to obtain privately provided health
services in this country.
Reference
1. Allen vs. Her Majesty the Queen, 2014 ABQB 184.
Ph. 403.949.3344 www.ecofriendlyservices.ca
MIND YOUR OWN BUSINESS
11
Succession – if you fail to plan, you plan to fail
Practice Management Program Staff
T
he unexpected
departure of a leader
can quickly derail
the smooth running of
your business. In the primary care world, there are many
leaders, such as executive directors, clinic managers or
other key positions in clinics. Planning in advance for
leadership change is a valuable insurance policy, as it can
reduce the risks associated with a skills shortage, aging
workforce and growing competition for high performers.
Investing more time and resources in planning for the
future is known as succession planning, and if done
right, it can also improve the continuity of your current
programs and service delivery.
A succession plan is a component of good human
resource planning and management. Succession planning
acknowledges that staff will not be with a business
indefinitely (this is a good thing) and it provides a plan
and process for addressing the changes that will occur
when they leave. Most succession plans focus on the
most senior position; however, all key positions should
be considered in the plan. Key positions can be defined
as those positions that are crucial for the operations of
your business.
Why is succession planning important?
The benefits of good succession planning include:
• Ensuring the business can continue to run when the
leader has left unexpectedly.
• Providing an ongoing supply of qualified, motivated
people who are prepared to take over when key
employees leave.
• An alignment between your vision and having the
appropriate staff achieve strategic priorities.
• A commitment to developing career paths for
employees which can allow you to better recruit and
retain top-performing employees.
Who is responsible for succession planning?
Regardless of the business structure, the physician
owners or the Board of Directors are responsible for
succession planning. The physician owners need to work
in conjunction with their current leader to create a plan
for leadership that will succeed when that individual
leaves. There are numerous examples of the business
falling into disarray when the leader leaves if there is
no succession plan in place. To protect your business,
and the service and care you deliver to patients, it
is important for the physician owners to spend time
reflecting on what they would do if, or when, the leader
leaves and creating a plan of action.
What are the challenges?
Succession planning has its challenges:
• Long-time employees or senior leaders are staying
in their positions longer, despite the fact that the
skills needed for the job may have changed, and
they may be unaware that other skill sets would be
advantageous for the business.
• Some non-profits are so small that there are limited
opportunities for advancement and thus leaders depart
more frequently.
• Lack of financial resources: employees may leave
for better salaries and benefits offered in other
workplaces.
• Poor communication around the succession plan can
result in confusion and turmoil within the business as
staff speculates about its purpose and intent.
• A plan often does not promote people in a timely
fashion, leading potential successors to leave the
business to seek new opportunities.
• There are no guarantees potential candidates for
promotion will be promoted, as that all depends on
timing and needs of the business rather than the
aspirations of employees. >
• Creating an external reputation as an employer that
invests in its people and provides opportunities and
support for advancement.
• Regular communication that lets your employees know
that they are valued.
MAY - JUNE 2015
12
> How does this all tie in together?
In order to drive a successful succession plan, you need to understand who works in your business and what the
business needs are. Listed below are some of the key questions to ask your group. Remember, this can take some time
to create, so it is best to set aside time over a few meetings/weeks to discuss and develop.
Practice example:
Current business
structure
Current leadership
team
Identified successors/ Additional talent
replacement plans
pipeline
Documentation
Is the current
structure working?
Who are your
key players?
Success plan,
restructuring, etc.
Who are high
potentials?
Are knowledge/job
duties and key contacts
documented for each
of the key roles?
The right direct reports?
Too many? Too few?
How are they doing?
Who is a potential
successor?
What are their
performance,
capabilities, potential?
Organization structure,
job profiles and strategic
chart
Any job that doesn’t
but should report to
the executive director/
manager.
What are their
performance, career
potential and interests/
aspirations?
Who are external
successors?
What should we do to
develop them?
Are performance
assessments
completed regularly?
Any missing capabilities
that we need to
recruit for?
Strengths, weaknesses,
development needs?
Are they ready to step
up? If not, what are we
doing to help develop
them?
What internal/external
resources are available
for development?
What tools are available
to help recruit either
internally or externally?
Critical jobs?
What are we doing to
help develop them?
Retention risks
(if no bigger job opens
up or passed over)?
What projects/
initiatives are
available to develop
them/continue to
engage them?
Business facts: small,
medium, large – what
is the potential for
development?
Any other structural
concerns/issues?
Any retention risks?
Any missing talent?
Development
thoughts/plans?
Other considerations?
Other risks? Challenges?
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>
> Key elements of successful succession planning
• Talent assessment – gauge the bench strengths
of your leader – do you have who you need (now
and in future) and if not, how do you get there?
• Recruiting – develop a talent pipeline for key
roles/jobs.
• Performance assessment – let people know they are
valued contributors and provide them opportunities for
development, exposure to projects, board members,
networking across departments/programs, etc. (to
increase their exposure).
• Strategic planning – do you have a strategic plan or
business plan? Determine what capabilities, roles
and talent are needed to execute the business plan/
strategy today and in the future.
• Development – create development plans for
individuals (e.g., leadership workshops, classes, on the
job learning, mentoring, assignments, special projects,
360 degree assessments, external classes, etc.).
• Retention and engagement – rewards and recognition,
work environment, opportunities for development,
job autonomy and scope of responsibilities, etc.
Tips for a successful succession plan
• Review and update your succession plan regularly.
Ideally, review the plan once a year – set the date
in your agenda. It’s a good way to keep it front and
center. Reviewing the plan ensures you reassess your
hiring needs and determine where the employees
identified in the succession plan are in their
professional and personal development.
• Develop procedure manuals for essential tasks carried
out by key positions.
• If your business has the means, provide adequate time
to prepare successors. The earlier they are identified,
the easier it is on the successor and on other
employees within your business.
• Although succession planning is common, your
business’s succession plan is unique and should reflect
your business needs.
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.
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MAY - JUNE 2015
13
14
FEATURE
Emerging Leaders in Health Promotion Grant program:
Connecting Aboriginal youth to their community
Vanda Killeen | SENIOR
COMMUNICATIONS CONSULTANT, ALBERTA MEDICAL ASSOCIATION PUBLIC AFFAIRS
“If a program could work to increase community
connectedness by engaging youth in Aboriginal
community gatherings – which would also serve
as an opportunity to promote health and wellness –
there could be a corresponding decrease in
substance abuse.”
With their two Edmonton-based Aboriginal
Community Gatherings for Health, also known as
Family Night(s), Dr. McKennitt and his leadership
team of four medical students and a coordinator from
the Aboriginal community organization worked to
reach approximately 80 Aboriginal youth with two
evenings of activities, including a free soup/bannock
supper, free health information sessions and fun
activities (sports, games) for children and youth.
Aboriginal family night was a resource of strength for the Aboriginal community.
( provided by Dr. Daniel W. McKennitt)
W
ith his Emerging Leaders in Health
Promotion Grant program – mâmawihitowin:
Aboriginal Community Gatherings for Health
– Dr. Daniel W. McKennitt turned the focus inward
for his project leadership team, as he asked them to
reflect upon how they view ethnic groups and consider
what stereotypes they may have.
As suggested by project mentor, endocrinologist
Dr. Ellen L. Toth, “This was an important exercise
to help identify our own prejudices.” Dr. McKennitt
elaborated, “To help bring about a type of paradigm
shift, we learned about the experiences of the
Aboriginal community and developed true empathy,
particularly for Aboriginal youth.”
As he researched the statistics and situations
of Aboriginal youth (aged six to 13) and their
disproportionate health outcomes relating to
substance abuse compared to non-Aboriginal youth,
Dr. McKennitt identified the need for an effective
health promotion program dedicated to increasing
community connectedness for Aboriginal youth.
“One factor linked to substance abuse is low
community connectedness,” says Dr. McKennitt.
The project team helped ensure positive perceptions
and attendance at the events by involving Aboriginal
leaders and an Aboriginal community organization
in the planning and implementation of the events.
This helped eliminate the “top-down approach”
taken by many external organizations with Aboriginal
community programs, explains Dr. McKennitt.
One factor to substance abuse is low
community connectedness.
“We respected their culture and recognized that
Aboriginal family night is a resource of strength for the
Aboriginal community. Aboriginal self-determination
led every step of the way with these two gatherings,”
Dr. McKennitt adds.
Having recognized that many Aboriginal children lack
exposure to health promotion, Dr. McKennitt and his
project team focused on making health promotion a
key component of the community gatherings/family
nights. At the meetings leading up to the community
gatherings, they also learned about the medicine >
> wheel and its four components, including the physical,
mental, social and spiritual and they looked for ways
to align their health promotion with the quadrants of
the medicine wheel.
15
“I learned that health promotion is a difficult task
and that consistent encouragement and exposure
is necessary to produce a beneficial outcome,”
Dr. McKennitt observed.
About the Emerging Leaders in Health
Promotion Grant program
Established in 2011, the Emerging Leaders in Health
Promotion Grant program sponsors successful medical
student and resident physician applicants in the
conception and implementation 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.
Health promotion is a difficult task. Consistent encouragement and exposure is
necessary to produce a beneficial outcome. ( provided by Dr. Daniel W. McKennitt)
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MAY - JUNE 2015
16
FEATURE
Starting early with healthy eating smarts
volunteer ranks of An Apple A Day were bolstered
for the 2013-14 edition of the project, with 30 medical
students on board to help deliver the project sessions.
“This project’s been of great value to the medical
students involved in it,” comments Simone Kortbeek,
An Apple A Day project leader. “For those involved
in organizing and facilitating sessions, this has been
an opportunity to support a health advocacy project,
something we’ll continue to pursue throughout our
careers as physicians regardless of specialty.”
An Apple A Day helped interpret food advertising and labeling.
( provided by University of Calgary)
O
ne of two Emerging Leaders in Health
Promotion Grant projects that has been carried
over from the previous year by University
of Calgary medical students, An Apple A Day‘s
mission from day/year one (2012-13) was to increase
school-aged children’s awareness of the need to
consistently eat healthy and make positive lifestyle
decisions, and to educate them accordingly.
In its second year, still guided by the mentorship of
Dr. Clare V. Henderson (pediatric endocrinology fellow
at the Alberta Children’s Hospital), the Calgary-based
An Apple A Day expanded its objectives, adding a
session on interpreting food advertising and helping
the young students understand how marketing
influences their food choices. (You never know … that
Silly Rabbit just might come party with you in your
kitchen while you eat your cereal! And how about that
prize you can mail away for?!)
The 2013-14 version of An Apple A Day was delivered
to an additional 125 students (on top of the more
than 200 student participants in the previous year)
and it’s anticipated that six schools will be on board
to receive the program in spring, 2015. While initially
directed towards students in grades three and four, the
project’s objectives have been modified and developed
to apply to other primary grades. And finally, the
We hope that by encouraging
and educating children about healthy eating
early on, we can combat behaviors they may
be seeing at home and misleading marketing
they’re seeing in media and in the stores.
“Through this project, we’ve acquired the solid
experience of identifying a population-specific need
and implementing an advocacy initiative to address
this need,” Simone continues.
The need to educate children about what healthy
eating looks like and what’s involved in that – learning
to read nutrition labels and understanding the roles
of protein, fats, carbohydrates, minerals, water and
vitamins in our diets – is becoming more urgent,
as growing numbers of children show indications
of childhood obesity and diabetes. Other societal
challenges are the poor examples sometimes set by
parents and the advertisements directed at children.
“With An Apple A Day, we hope that by encouraging
and educating children about healthy eating early on,
we can combat behaviors they may be seeing at home
and misleading marketing they’re seeing in media and
in the stores,” explains Simone.
FEATURE
17
Kids and infectious diseases: (not) all fun and games
With their colorful and activity-filled tent, featuring
an infection prevention “lottery wheel,” a “build-yourown” bacterium/virus craft and an adjacent GloGerm/
hand sanitizer station, Stephanie and her team
energetically educated and engaged their tent’s young
visitors (target group was children aged five to 14).
“We engaged the children through interactive lessons
in which team/group-based learning and creativity
were encouraged,” explains Stephanie. “We wanted to
take a fun approach to infection prevention awareness,
as opposed to the majority of youth resources in this
area, which tend to focus heavily on details of disease
and less on practical awareness. Plus, they’re often
just plain boring.”
Where else could you create your own bacterium or virus and toss it into a
giant mouth without actually infecting anyone? Sounds like great fun!
( provided by Stephanie Nguyen)
I
nfectious diseases in children are a serious matter,
as they represent a major cause of morbidity in
Canadian children and have been reported as one of
the top five causes of hospitalization of children under
nine years. But educating young children about how
something they can’t see can make them very sick,
and helping them understand actions they can take to
help prevent common infections, requires a light touch
and a sense of fun.
Project lead Stephanie Nguyen demonstrated that
she and her team of fellow medical students and
volunteers possess both, as they guided Stephanie’s
project – Infection Prevention Awareness at the
Calgary International Children’s Festival (CICF) –
through its second year as an Emerging Leaders
in Health Promotion Grant project.
This project was a great reminder of
the power of promotion and prevention on
people’s future health and well-being.
In order to operate the “lottery wheel” the children
were given a pump of hand sanitizer and taught how
to properly apply it and how it works. Then, the child
spun the wheel, which was labelled with examples
of situations children regularly encounter (e.g.,
sharing food with a friend who has sneezed into his/
her hands) that can lead to an infection or illness.
Together, the kids identified what was wrong with the
situation and what they could do to prevent infection/
illness. They also designed their own bacterium/virus,
a cotton-stuffed “bug toy” which they tossed around/
over a line of children and into a giant “mouth,”
illustrating how covering your mouth (represented by
the barrier of children) can decrease the transmission
of pathogens.
As they worked with between 1,200 and 1,500 young
visitors to their tent each day during the festival,
Stephanie and her crew achieved the project’s
three objectives:
1. Provide children with an understanding of infectious
disease transmission and the concept of “invisible”
microbes that cause harm.
2.Teach children behaviors that can reduce their risk of
developing and/or spreading infections to others.
3.Introduce children to the medical field and showcase
student physicians as positive role models. >
MAY - JUNE 2015
18
> With the skilled and experienced guidance of
physician mentor Dr. Joseph Vayalumkal, a clinical
assistant professor in the Department of Pediatrics,
Section of Infectious Disease and the Medical
Officer of Infection Prevention and Control at the
Alberta Children’s Hospital, Stephanie and her team
appreciated the opportunity the project gave them to
practice health promotion advocacy.
“First, as we developed learning objectives for our
target audience, we expanded on knowledge acquired
in medical school,” says Stephanie. “Second, we
learned to collaborate with other health professionals
“MCI takes care of
everything so I can take
care of my patients.”
to ensure our objectives and teaching agenda were
relevant. And third, this project provided us with the
perfect patient/population environment to facilitate
health promotion conversations, many times over!”
“Mostly,” says Stephanie, “this project was a great
reminder of the power of promotion and prevention
on people’s future health and well-being,” adding,
“Opportunities like this Emerging Leaders in Health
Promotion Grant are core components of developing
into a well-rounded physician and are seldom available
through the regular medical school curriculum.”
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FEATURE
19
Advocating healthy family choices; family first, individual second
Focusing on the first of three requirements of the
Emerging Leaders in Health Promotion Grant –
to promote development of the physician’s role
as advocate for healthy populations – Dr. Hicks
acknowledged how challenging it is for health care
professionals to identify children at risk and find
opportunities and time to intervene.
“Providing smoking cessation advice and support is
effective but it can be time-consuming,” says
Dr. Hicks. “The workshop and supporting materials
that I developed with the Alberta Medical Association
(AMA) grant provide residents with a rapid tool to
build patient-oriented, goal-directed behavior change.”
Perched outside the Lake Agnes Tea House in Lake Louise AB, 10-year-old
asthma-sufferer Bronwen Hicks breathes in the fresh mountain air she loves.
No tobacco smoke in sight! ( provided by Dr. E. Anne Hicks)
W
ith her medical resident training workshop
and supporting materials, Dr. E. Anne
Hicks used her Emerging Leaders in Health
Promotion Grant to help pediatrician residents
(and their peers) apply a brief, motivational,
interview-based method to address tobacco use by
their patients and/or their patient’s caregivers, for
purposes of influencing attempts at quitting and
providing cessation advice.
“Overall,” explains Dr. Hicks, “this project was
designed to produce a simple, flexible tool for trainees
in pediatrics to help patients and parents develop
and pursue behavior change goals for overall health
improvement, specifically around tobacco use.”
Begun in November 2014, Dr. Hicks’ project
had two goals:
1. Increase patient and caregiver understanding
of the health effects of tobacco and engagement in
cessation attempts.
Having developed the training module as an organic
program that could be run in a more formal workshop
environment or a more casual group setting, Dr. Hicks
met the second requirement of the grant program –
to provide experience in health promotion as integral
to medical practice – by making it convenient for
residents to perpetuate their learnings by presenting
to others, providing the trainees with leadership skills
they could use with patients as well as with peers and
allied health members.
Introduced at the Pediatric Respiratory Medicine
Clinic at the Alberta Children’s Hospital, Dr. Hicks’
poster campaign provided visual clues for patients
and caregivers to help them anticipate subsequent
discussions with their resident physician. While the
posters helped ready patients and caregivers for
tobacco cessation discussions, the workshops helped
residents comfortably approach patients and families,
encourage them to identify positive health-related
behavior changes and set goals for achieving those
changes. Trainees learned how to talk about the issue
and how to align a patient’s stage of counselling with
his/her stage of readiness (to take the next step in the
cessation process). >
2.Increase medical trainee skills and comfort
in addressing tobacco-related issues and in
engaging patients and caregivers in goal-oriented
behavior change.
MAY - JUNE 2015
20
> “Being able to successfully advocate for behavior
change is particularly key in pediatrics, where
family changes are as, or more, important than
individual changes,” says Dr. Hicks. “This sometimes
requires parents to make lifestyle choices for the
benefit of their children, with minimal perceived
benefit to themselves.”
With respect to the third requirement of the Emerging
Leaders in Health Promotion grant – to facilitate
growth of leadership and advocacy skills in a mentored
environment – Dr. Hicks notes, “I improved my skills in
peer teaching and I learned how to earn the support
of busy allied health teams (mainly nursing and
respiratory therapy workers) in this clinic initiative.”
Dr. Marielena L. DiBartolo (L) helped Dr. E. Anne Hicks (R) with this smoking cessation
project. ( provided by Dr. E. Anne Hicks)
Being able to successfully advocate
for behavior change is particularly key in
pediatrics, where family changes are as, or
more, important than individual changes.
Dr. Hicks was fortunate to work on this project under
the mentorship of Dr. Marielena L. DiBartolo, a
pediatric respiratory medicine physician, who brought
her own strong commitment to (and abundant
experience in) tobacco cessation to the project.
“Dr. DiBartolo supported the program development,
identified specific educational goals for the teaching
sessions and provided materials and information
regarding the effects of tobacco use on children,”
explains Dr. Hicks.
Grateful to the AMA’s Health Issues Council and the
Canadian Medical Association for the opportunity
to work on this project, Dr. Hicks intends to make
tobacco cessation an area of lifelong learning and
patient care. “In discussing this project with families,
allied health teams and trainees, I’ve learned a lot
about what drives people to make choices and how to
help them self-motivate to make healthy choices.”
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FEATURE
21
CMA steps up to support Emerging Leaders in
Health Promotion Grant program
I
n early 2015, the Alberta Medical Association’s
(AMA’s) Emerging Leaders in Health Promotion
Grant program welcomed the addition of the
Canadian Medical Association (CMA) as a grant
co-sponsor, along with the AMA’s Health Issues
Council (HIC).
“We’re very happy to have the CMA join HIC in
the sponsorship of the Emerging Leaders in Health
Promotion grant program,” comments Dr. Lyle
B. Mittelsteadt, Senior Medical Advisor, AMA
Professional Affairs. “We appreciate the CMA’s
involvement in and support of a range of leadership
development activities for AMA members. They’re
a good fit as a co-sponsor of our Health Promotion
Grant program, with its focus on promoting the
physician’s role as advocate for healthy populations,
providing experience in health promotion as integral to
medical practice and facilitating growth of leadership/
advocacy skills in a mentored environment.”
Health promotion advocacy and leadership skills
Entering its fifth year in the fall, the Emerging
Leaders in Health Promotion Grant program continues
to provide the AMA’s resident and medical student
members with a valuable opportunity to acquire vital
health promotion advocacy and leadership skills.
Recipients of the award have commented on the
value of health promotion advocacy skills, particularly
when exercised in support of children, seniors or
disadvantaged populations (i.e., patient populations
that often are unequipped or unable to advocate
for themselves).
As 2013-14 grant recipient Dr. E. Anne Hicks
comments, “Being able to successfully advocate
for behavior change is particularly key in pediatrics,
where family changes are as important or more
important than changes for individual patients …” and
as 2013-14 recipient Dr. Daniel W. KcKennitt observes,
“My Emerging Leaders in Health Promotion Grant
project provided great value, as we identified that
many Aboriginal children lack health promotion …”
With respect to leadership, grant recipients
acknowledge the opportunities that the Health
Promotion Grant program affords them to experience
situations that require leadership that they otherwise
– if not for their involvement in the Health Promotion
Grant program – may not have.
“We learned to delegate tasks and employ
communication skills in order to have everyone work
as a team,” says grant recipient Darby Ewashina.
With her Good Food Box program, grant recipient
Charley Boyd comments, “I’m now quicker thinking on
my feet and more comfortable adapting to unexpected
situations.” She adds, “My confidence as a leader grew
with each food box delivery, as I had to multi-task by
organizing participants, delivering the workshop and
overseeing the box packing; all while addressing all
sorts of questions about healthy eating.”
The co-sponsorship of the Emerging Leaders in
Health Promotion Grant program by the AMA
and the CMA is a reflection of both organizations'
commitment to leadership development for our
residents and medical students.
MAY - JUNE 2015
22
DR. GADGET
Medical apps eh? Made in Canada
Wesley D. Jackson, MD, CCFP, FCFP
T
here are now well
over 100,000
medical health
(mHealth) apps
available, ranging from
fitness apps and acne
treatment to blood
pressure tracking and
advanced medical guidelines and reference books.
With the proliferation of mobile and wearable
devices, the number of mHealth apps will increase
dramatically, possibly exponentially, over the next
few years. The end user must decide, with minimal
direction from regulatory bodies, which apps are not
only evidence-based, but also relevant to their needs.
Physicians will be increasingly expected to recommend
apps to their patients and co-workers.
In an attempt to improve relevance to a broad range
of readers, I will focus on a few made-in-Canada
apps that I have found useful. All of these apps are
available at no cost, have significant input from
Canadian medical professionals and seem to be
generally evidence-based – although I have not put
any of them under intense scrutiny. As always, when
recommending or using an app, one must always
approach with an attitude of “user beware.”
Medical journals
Tired of dodging around stacks of “to-read” journals?
Want to do some journal reading at night without
turning the lights on? Got a minute between ORs?
The Canadian Medical Association Journal is available
as a free app (value $330 per year) (http://www.cmaj.
ca/site/mobile/) for all Canadian Medical Association
(CMA) members in Canada.
For Canadian medical news, the free Medical Post
app (http://www.canadianhealthcarenetwork.ca/
physicians/news/medical-post-free-tablet-editionavailable-now-38465) is also available to CMA
members for leisurely reading on your mobile device.
Patient resources
Looking for a great resource for your young patients
with anxiety disorder? Consider MindShift (http://
www.anxietybc.com/mobile-app), an excellent app
designed by the Anxiety Disorders Association of
British Columbia to help teens and young adults
cope with anxiety.
Want to teach your patients more about
immunization? Consider recommending Immunize
Canada (http://www.immunize.ca/en/app.aspx), an
app that allows parents to easily record and store
vaccine information, access vaccination schedules,
manage vaccination appointments for the entire
family, access evidence-based and expert-reviewed
information about recommended and routine
vaccinations for children, adults and travellers
and even receive alerts about disease outbreaks
in their area.
Medical references
Having problems keeping up with the most recent
Canadian guidelines and recommendations?
CHEP (http://hypertension.ca/en/) is a direct link
to Hypertension Canada. The Choosing Wisely
Canada app (http://www.choosingwiselycanada.
org/news/2015/01/27/cwc-goes-mobile/) has an
efficient search engine for all recommendations of this
initiative. STI Canada (http://www.phac-aspc.gc.ca/
std-mts/sti-its/index-eng.php), provided by Health
Canada, offers up-to-date recommendations for the
screening, diagnosis, management and treatment
of sexually transmitted infections.
The Canadian Cardiovascular Society produces a suite
of useful apps (http://ccs.ca/index.php/en/resources/
mobile-apps) which contain updated guidelines for
heart failure, antiplatelet, atrial fibrillation, lipids,
drive+fly and pediatric cardiac risk assessment. The
app iCCS combines A-fib, drive+Fly, heart failure and
cardiac resynchronization guidelines into a single
app. Several of these apps contain useful calculators.
I particularly like the cardiovascular risk calculators
contained in Lipids. >
> Learner resources
23
LOOKING TO SET UP
YOUR PRACTICE?
WE’RE JUST WHAT THE
DOCTOR ORDERED.
SnapDx (http://www.snapdx.co) is an app developed
at the University of Calgary for use by medical
trainees and clinicians at the bedside. This
award-winning app provides evidence-based
questions, tests and illustrations to help sort through
a differential diagnosis.
Physicians will be increasingly
expected to recommend apps to their patients
and co-workers.
Continuing professional development
Don’t have time to attend lectures, but want to
learn more about a specific condition? Amedea MD
(http://www.amedeamd.com/) delivers engaging
presentations by “highly regarded thought-leaders
in the health care and medical education worlds.”
These lectures, which are Canadian content and
restricted to healthcare professionals, can be
downloaded for offline viewing.
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MAY - JUNE 2015
24
FEATURE
Red, blue and yellow:
The colorful use of color in anatomical illustration
Scott Assen | MEDICAL
STUDENT, UNIVERSITY OF CALGARY
(PRECEPTORS: PROFESSOR DR. FRANK W. STAHNISCH, FACULTY OF MEDICINE, UNIVERSITY OF CALGARY)
Early anatomy pre-color
Dutch physician, Dr. Jan Swammerdam, published this work on the anatomy of the uterus.
The image used a red wax injection process which improved the visibility of arteries.
( public domain)
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 Scott Assen of the University of Calgary.
Color is both symbolic and practical
Modern anatomical illustration uses color both
symbolically and literally, often with the aim of overlaying
function on an accurate structural representation, as
represented for example in the central atlases of The
Classic Collector’s Edition – Gray’s Anatomy. The established
convention of red for arteries, blue for veins, and yellow
for nerves aids students of anatomy to orient themselves
quickly and effectively. In vivo, however, these structures
are not so clearly defined. Arteries and nerves appear
white, and veins appear whitish-blue. So how did this
convention come about? To answer this question, we
must examine the historical circumstances of anatomical
illustration, from the middle ages to the modern period.
Prior to the first uses of color in anatomical illustration,
value gradations were approximated with techniques
such as stippling and cross-hatching. In the era before
the Italian anatomist Andreas Vesalius (1514-64), most
anatomical illustration was schematic in nature and was
primarily concerned with confirming previously known
facts. A notable exception is Marcantonio della Torre
(1481-1511), who established a school of anatomy in Pavia,
in what is now Italy. Della Torre employed the famous
artist Leonardo da Vinci (1452-1519) as an illustrator,
and while none of della Torre’s texts have survived, da
Vinci’s anatomical sketches are notable both for their
accuracy and their beauty. Da Vinci worked from cadavers
he personally dissected, marking a tightening in the gap
between subject and depiction. The goal of da Vinci’s
anatomic work was, however, to further the graphic arts,
rather than to benefit anatomic science.
The turning point in early anatomic illustration is marked
by Vesalius, and his marvellous De humani corporis fabrica,
published in 1543. This influential work was written and
illustrated directly from human dissection, ushering
in a revolution in anatomy and toppling the teachings
of Galen, who worked from animal models. Vesalius’
anatomical illustrations were woodcut monochrome
engravings, notwithstanding a special copy given to the
Holy Roman Emperor, Charles V (1500-58), which was
hand-colored. This edition features arteries and veins
colored with red and blue, with frequent reversals of color
in the same vessel. This is perhaps unsurprising given
that the physiology of circulation was discovered in 1651
by the British surgeon William Harvey (1578-1657), some
hundred years later.
The first color prints
The first color-printed medical illustrations were
published in 1627 by Gaspare Aselli (1581-1626), a
physician and professor in Pavia. Aselli discovered the
lacteals accidentally while vivisecting dogs. He noticed
that recently fed dogs had an engorged network of
whitish vessels throughout the intestinal mesentery.
His publication of this discovery included color-printed
illustrations of the canine intestine, mesentery and liver. >
> The woodcut plates used four colors: black, red and two
shades of brown, with the white of the paper representing
the lacteals. It is worth noting that the red used for the
mesenteric vessels corresponds with their appearance
in vivo, due to their relatively small calibre. Thus, Aselli’s
color scheme is a literal use of color, rather than the
symbolic use we see primarily today.
Wax injection and symbolism
Aselli’s color printing technique was lacking in detail
and laborious in its use, and so fell by the wayside in
favor of the established monochrome woodcut printing
method. Dissecting techniques, however, continued to
improve, and in 1672, Jan Swammerdam (1637-80), a
Dutch physician, published a work on the anatomy of the
uterus. The text contains a description of Swammerdam’s
red wax injection process, which was used to improve
the visibility of arteries. The accompanying images are
hand-colored and showcase the first truly symbolic use
of color in anatomic illustration.
Swammerdam showed Frederik Ruysch (1638-1731),
a Dutch anatomist, the wax injection process. Ruysch
used the technique to dramatic effect, creating macabre
dioramas involving fetal skeletons, wax-injected organs
and even preserved insects. He came to amass a great
collection, not unlike the plastinated body exhibits
of today.
Mezzotinting: a new method
High-quality color printing advanced again in 1704 with an
innovation from Frankfurt-born Jacob Christoph Le Blon
(1667-1741). Le Blon developed a three-color mezzotinting
printing method using three different impressions of one
image, printing in blue, yellow and red. By combining these
colors, Le Blon was able to print any other color, including
black. He published one known anatomic plate of male
genitalia. It is, however, exceedingly rare, because Le Blon
was a poor businessman and his printing venture quickly
went under. Luckily, Jan Ladmiral (1698-1773), a pupil of
Le Blon’s, picked up the technique (and claimed sole credit
for it). He was employed by Bernhard Siegfried Albinus
(1697-1770), a famous anatomist in Leiden, to make a print
of a section of intestinal mucosa, published in 1736. The
arteries of this specimen had been injected with red wax,
and the veins with blue wax. Correspondingly, the red and
blue mezzotint plates contained the entirety of the arteries
and the veins, respectively. In this way, blue veins were
used symbolically for the first time.
Over the next several decades, another student of Le
Blon’s, a Frenchman named Jacques Fabian Gautier
d’Agoty (1716-85), published anatomical plates using the
color mezzotint method. D’Agoty also claimed erroneously
to have invented the process himself. His anatomical
renderings were of inferior quality, useful to neither the
physician nor the artist. He did however depict the nerves
and chose the more literal white to represent them.
The rise of color symbolism
In a similar time period, Christoph Jacob Trew (1695-1769),
a physician and naturalist from Nuremberg, published a
painted depiction of a knee with red arteries and yellow
nerves. Trew used color to great symbolic effect in his
work. He was the first to color the unique bones of the
skull to aid students in orienting themselves, a technique
that can be found in almost every anatomy atlas since.
Lithography
Trew’s yellow nerves did not catch on, however, and
abundant examples can be found of the symbolic use
of white for nerves upon the adoption of lithography as
a printing technique. Lithography was invented in the
1820s in Germany and enabled the mass production of
high-quality color prints. Its adherents include the Italian
anatomist Paolo Mascagni (1755-1818), French anatomists
Jules Germain Cloquet (1790-1883) and Jean-Baptiste
Sarlandière (1787-1838), and the English anatomist George
Viner Ellis (1812-1900), all of whom depicted arteries in
red, veins in blue and nerves in white.
Henry Gray and yellow nerves
It was not until the late 19th century that depictions
of yellow nerves began to gain traction. The seminal
textbook Anatomy of the London anatomist Henry Gray
(1827-61) was first published in 1858, but early editions
had monochrome illustrations, depicted in a dry, clean,
institutionalized style. It was not until the confusinglynamed 1887 New American from the Eleventh English Edition
was published that color was used. In fact, the illustrations
remained mostly monochrome, with only arteries, veins
and nerves colored in red, blue and yellow respectively.
From this point forth, anatomy texts and atlases continued
with this convention – for example, the popular and
beautiful anatomical illustrations of the New York surgeon
Dr. Frank H. Netter (1906-91) that are frequently used
today are no exception.
Conclusion
The symbolic use of color in anatomical illustration is, of
course, intimately interwoven with the general history of
anatomy and the history of color printing and publication.
Crucial factors influencing the adoption of the modern
convention for coloring vessels and nerves include the
wax injection process used to highlight the vessels during
dissection, primary color use in three-plate color printing,
and the increased awareness of the utility of color use in
orientation and education.
References available upon request.
MAY - JUNE 2015
25
26
RESIDENTS’ PAGE
Do leaders need to change the world?
Nice idea. Not necessary.
Dr. Kimberly G. Williams | UNIVERSITY
R
ecently, the
Royal College of
Physicians and
Surgeons of Canada
rolled out CanMEDS
2015, the framework
describing the skills
physicians need in the
21st century. One of the
core competencies has
changed from manager
to leader to reflect the
need for physicians to
contribute to the shaping
of health care into the future. So what is a leader?
Leadership is not a new concept. Traditionally it has often
been described as “someone who leads the process of
social influence by enlisting the support of others in the
accomplishment of a common task”.4 So, what makes a
great leader today?
Roselinde Torres, a business person and researcher,
believes leaders are: “people who see around corners
therefore shaping their future, not just reacting to it.”3 She
states that many successful leaders have the capacity to
develop relationships with people who are really different
than them whether these differences are biological,
physical, functional, political and/or socioeconomic.3 She
notes that great leaders understand that having a diverse
network is a key resource in developing creative solutions.3
On the other hand, author Simon Sinek focuses on creating
the right environment to support leaders. The environment
needs to be one of trust and cooperation because when
people feel safe they will naturally combine their strengths
and talents with others, he notes.2 He explains the difficulty
is that trust and safety cannot be imposed by rules and
regulations. Thus, leadership is a choice because sacrifice is
a two-way street.2
OF CALGARY, PGY1 PSYCHIATRY
Finally, Drew Dudley, a leadership consultant, believes that
by making leadership about changing the world we have
disqualified most people.1 He notes “it can be frightening
to think that we can matter that much because as long as
we make leadership something bigger than us, as long as
we keep leadership as something beyond us, as long as we
make it about changing the world, we give ourselves an
excuse not to expect it every day from ourselves and from
each other.”1
So if leadership is about creating a safe environment,
realizing that it is not about changing the world, but
about the small actions we take everyday, and about
having a diverse network that helps us to shape the
future, then it is essential for resident physicians
to be leaders.
So what then does resident physician leadership look
like? It comes in a variety of forms. I have a colleague
who spends many sleepless nights each year helping
to organize the Kimmet Cup, a charity event that raises
money for local charities to honor a medical student
who passed away. I have seen a colleague stay late to
write a letter to request compassionate coverage of
a medication for one of the patients she was working
with. There are many ways that resident physicians
participate in leadership, often not even knowing it.
The Royal College of Physicians and Surgeons of Canada
notes that leaders require neither a formal title nor
necessarily need to be in charge. It notes that a main
function of leaders is to make it possible for the most
capable and appropriate person to take charge within a
given team and context.5 As resident physicians, we work
daily on interdisciplinary health teams. Each team member
plays a critical role in ensuring the best outcomes for
patients. When given the opportunity to coordinate care,
resident physicians are leaders when we understand that
it is the team providing care. Everyone working together
provides the best outcome for patients. Sometimes >
> leadership is stepping up, sometimes it is stepping back
– leadership is all about the team in health care. Resident
physicians are an important part of the team.
27
References
1. Dudley D. [Drew Dudley]. (2010, September). Everyday
Leadership [video file]. Retrieved from http://www.ted.com/
talks/drew_dudley_everyday_leadership?language=en.
2. Sinek S. [Simon Sinek]. (2014, March). Why Good Leaders
Make You Feel Safe [video file]. Retrieved from https://www.
ted.com/talks/simon_sinek_why_good_leaders_make_you_
feel_safe.
3. Torres R. [Roselinde Torres]. (2013, October). What it Takes
to be a Great Leader [video file]. Retrieved from http://www.
ted.com/talks/roselinde_torres_what_it_takes_to_be_a_
great_leader?language=en.
4. Chemers M. (1997). An Integrative Theory of Leadership.
Mahwah, NJ: Lawrence Erlbaum Associates Inc. Publishers.
5. Dath D, Chan M K and Abbott C. (2015). CanMEDS 2015:
From Manger to Leader. Ottawa ON: Royal College of
Physicians and Surgeons of Canada.
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MAY - JUNE 2015
28
IN A DIFFERENT VEIN
Beat glossophobia – take the 12 steps
Alexander H.G. Paterson, MB ChB, MD, FRCP, FACP | CO-EDITOR
Stewart McLean of The
Vinyl Café, who pockets
big dough for invited
speeches, devoted a CBC
radio episode in January
to a story called “Words,”1
where his alter ego, Dave,
is invited to give a speech
to a bunch of serious
music students about the pop scene in the 60s.1
So after a career of giving talks and speeches, from
fairly good to shudderingly bad, I now have the temerity
to offer advice on how to avoid mind blank-outs,
embarrassing silences, pity and low self-esteem. And
I’ve sat through enough really tedious talks that I’m
motivated to do something about it – despite recognizing
the truth of Daumier’s comment to Guido in Fellini’s
movie 8½: “What a monstrous presumption to believe
that others might profit from the squalid catalogue of
your mistakes.”
Dave – gullible, yet grounded when things matter
(the Canadian version of Czech literature’s Good Soldier
Svejk) – mounts the university podium and succumbs
to autonomic adrenergic discharge from glossophobia
(the fear of public speaking). Saliva paralysis sets in, with
the inside of the mouth becoming a dry paste. Hands and
neck quivering, stammering, mind blanking out. It’s all
part of the act. He is dying a public death to the shiver
of audience schadenfreude (that embarrassment and
fascination we feel watching someone screw up).
Rhetoric is rarely taught in those Canadian College of
Self-Appointed Health Leaders courses, and yet, it is
critical for the self-appointed leader to master. I have
seen some fairly good administrators from deans to docs
let themselves down to the sniggers of their underlings
by delivering balls-up.
And of course, I’ve broken every tip that follows.
1. Know your target audience
This was my most recent mistake.
After a career of giving talks and
speeches, from fairly good to shudderingly
bad, I now have the temerity to offer advice on
how to avoid mind blank-outs, embarrassing
silences, pity and low self-esteem.
McLean’s audience loves it.
He knows his audience. But there’s more to it than
that. Politicians know their audience, but oratory in the
provincial legislature and the current election campaign
is mediocre to dismal in the Not Your Grandfather’s/
Wilted Rose Party and not a lot better in The Extremists.
And while we can’t do much about the fragile state of
democracy in Alberta, you might at least suggest to your
MLA that he/she take the 12 steps.
I gave a speech at the Palliser Hotel in January. It went
poorly. Not as poorly as some when I have had to get
out of town fast, but poorly in that I should have known
better, failing to follow the fundamental rule, “Know Your
Audience.” I was damned well going to give them what I
thought they should know, not what they wanted.
It was to a bunch of mid-level managers, their wives/
girlfriends and assorted employees of an oil and gas
recruitment company. They just wanted to hear jokes.
I told a few fairly good stories but then beat their
heads with the poetry of Robert Burns – I could see it
wasn’t going well when one of the women at a front
table yawned …
So, what do they really want? What’s the education
level? You may have to avoid nuances and dumb down
what you say. What’s the age range? Telling stories of old
men with bad memories rarely raises a laugh in the under
40s (or over 80s). >
> 2. Make sure you’re heard clearly
29
You don’t need to go as far as Demosthenes who
(according to my Grade five English teacher,
Mr. “Excalibur” Doyle, a bottom-whacking Irishman) got
rid of his stutter by going to the beach, filling his mouth
with pebbles and yelling at the Aegean Sea. He had to
shout at a crowd of angry Greeks without a microphone.
According to Demosthenes, the three most important
elements of oratory were “Delivery, delivery and
delivery.” The ancient Greeks, much as today, responded
to style over substance.
Checking that you can be heard is critical. I’ve witnessed
some speakers with good material ignored because they
can’t be heard easily and the audience starts chatting. I
like to check that people at the back of the room can hear
me. Try the microphone before the talk and keep it about
nine inches from your mouth, unless you want a heavybreathing, telephone-molester sound effect followed by
the howl of a microphone in pain.
3. Deliver what you were asked to talk about
You will disappoint the Red Deer Business Women’s Club
if you talk about the latest re-jigging of Alberta Health
Services if they’ve asked you to talk on advances in
breast cancer. Keep it straightforward with a dash of the
sensational. Few in the public want to hear the real truth.
4. Don’t try to say too much
Voltaire was right when he said: “The secret of being a
bore is trying to tell everything.”
Make the content a few minutes short of the time
allotted and never go over time. Take an easy, relaxed
pace. Audiences are delighted when you finish early.
It’s pathetic to see a speaker chided by the chairman
of a session for going over time: “One minute please.”
And then the speaker has to flash through the
remaining slides instead of devoting the time to
a relaxed conclusion.
“I was going to talk about the theory behind this and the
clinical trial but it seems I don’t have time…” A pathetic
attempt to cast blame on the chairman for prematurely
ending what the speaker believes is the most important
talk of the day. The only person I’ve seen get away
with ignoring the chairman was Robert Gallo, the
co-discoverer of HIV, who went over by half an hour.
He just kept going. I was talking after him and on the
way up to the podium I said to him:
“I’ve had to cut my talk back because of you.”
“They needed to hear what I had to say,” he said. Sure.
5. Avoid the seduction of enjoyment of the podium
Some speakers – especially the inexperienced – love
the feeling of having the audience in the palm of
Dr. Alexander H.G. Paterson speaks at a Canadian Breast Cancer Foundation meeting
in Montreal QC, about six years ago. Apparently, he wasn't heckled or run out of town.
Let's hear it for "the 12 steps." ( provided by Dr. Alexander H.G. Paterson)
their hand: the unexpected laughter, the spontaneous
applause, the rustle of interest. It’s a strange sense of
power, people hanging on your feeble words. But they
quickly sense you’re enjoying yourself too much and
begin to resent you.
“Yes, he started off OK but went on too long.” You might
get away with this if you’re Fidel Castro, Hugo Chavez or
Kim Jong-un, but not when you’re Joe McBlow.
6. Use a minimal number of data slides with
little detail on them
In a formal medical/scientific talk, people want the
data delivered clearly and concisely without too much
methodology and statistical analysis (even though this
may be critical to eventual interpretation of the data).
If your talk is more theoretical and you have only a
couple of data points, try using a black or white board.
Some of the most impressive speakers I’ve heard do
that. In three months you’ll be lucky if the audience
can recall one point you made, so give them a clear
take-home message. >
MAY - JUNE 2015
30
> 7. Use humor …
… for a good opener, perhaps something topical about
the place you’re speaking in, or this one: “… As Henry
VIII said to one of his wives, I won’t keep you long …”
I’ve used that so often that you can have it.
But don’t use this: “Hello, how’re y’all tonight? Where’re
y’all from?”
And make your anecdote or joke relevant to the topic.
It’s tedious listening to a succession of unconnected
jokes that have nothing to do with the topic but are being
trotted out because the speaker has found them funny.
No blonde jokes. In fact, keep off any material that can
be construed as offensive to women (or men if you are a
female speaker) unless you’re appearing in Yuk Yuk’s or
the Gotham Comedy Club in New York.
8. Don’t worry if you feel nervous
An audience usually feels sympathy for the nervous
speaker, and they’ll be on your side as long as you don’t
make any other mistakes, like going over time. Sympathy
evaporates fast there.
I’ve heard some people say that if you’re nervous, just
think of the audience as being nunga-punga (naked).
If that works for you, think it. It doesn’t work for me.
It frightens me.
Do you sometimes wonder how celebrities are always
cool and amusing when interviewed on talk shows?
Perhaps it’s because concert pianists, virtuoso violinists
and opening night actors with a tendency to tremor use
the beta-blocker, propranolol, five to 10 milligrams, to
avoid big occasion nerves without an effect on cerebral
function. Rarely do you see a nervous celeb (perhaps Rob
Ford was an exception) on a late night show. Hollywood
physicians know all about propranolol and prescribe it for
their egocentric stars (many also use cocaine to bolster
the banter).
10. Be prepared
It’s obvious, but many flout this fundamental exercise
and find themselves gasping like a fish on a slab while
their audience wishes they were somewhere else. Take
time the night before to review what you want to say
and how you want to say it.
11. Speaking notes and punch lines
Here’s an old story I told at a recent dinner:
A man goes into a bar and asks for a Johnny Walker
Black Label. He’s a whisky connoisseur. The barman
brings him a drink. He sips it, shakes his head and says:
“Barman, this is not a Black Label. It’s a Whyte & Mackay,
about five-years-old, I’d say.”
“You’re right, sir! I didn’t realize you were an expert. I’ll
tell you what, I’ll pour you some malts and if you get
them right, you don’t pay, but if you’re wrong, you pay
double.”
“Agreed.”
The barman pours him a drink. The connoisseur rolls it
around his mouth: “Balvenie, 10-years-old.”
“Right on, sir.”
The barman pours another. “Glenmorangie, it’s
14-years-old, no 13-years-old.”
“Amazing” sighs the barman.
A wee fella has been watching from the end of the bar
and he moves up and slides a glass to the expert:
“Try this,” he says.
The connoisseur sips it, “Yeuggh!” and spits it out.
“This is urine!”
“Yes, but… How old am I?”
And if everyone’s boozing, do have a drink yourself
but make sure you stay at least one drink behind
everyone else.
Here are my speaker notes for this story:
9. Connect: Choose a couple of people in the
audience and talk to them
Whatever happens, get the punch line right!
This is an old trick. I try to choose a couple in different
parts of the audience. It usually works and allows you
to connect with the audience and ambience. However,
if the individual you’re connecting with falls asleep, you
could have a problem. There was a physician at the
Edmonton’s Cross Cancer Institute who used to come
into a lecture, sit at the front and promptly fall asleep.
There is no easy way to combat this. Singing a lullaby
amuses those still awake.
“Yes but how old am I?”
12. Remember Aristotle’s dictum
A good speech, like a good drama, has a beginning,
a middle and an end.
Simple, isn’t it?
Reference
1. ”Words” Vinyl Café broadcast January 10, 2015,
12:00 AM [email protected].
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schedules, so the physician can adopt
his/her work schedule. We also will
pay up to $5,000 to the physician for
moving and relocation costs.
Contact: Dr. Gaas
T 780.756.3300
C 780.893.5181
F 780.756.3301
[email protected]
EDMONTON AB
Family medical clinic in west
Edmonton is seeking part- and/or
full-time family physicians. We offer
flexible hours, low overhead
(negotiable), fully computerized
clinic using Mediplan electronic
medical records. The clinic is
associated with Edmonton West
Primary Care Network.
Contact: Dr. Patocka
T 780.487.7532
[email protected]
Two positions are immediately
available at the West End Medical
Clinic/M. Gaas Professional
Corporation at unit M7, 9509 156
Street, Edmonton AB T5P 4J5.
We are also looking for specialists;
internist, pediatrician, gynecologist
and orthopedic surgeon to join our
busy clinic. Full-time family physician/
general practitioner positions are
available. The physician who will
join us at this busy clinic will provide
family practice care to a large
population of patients in the west
end and provide care to patients
of different age groups including
pediatric, geriatric, antenatal and
prenatal care.
EDMONTON AB
Physician income will be based on
fee-for-service payment and the
overhead fees are negotiable. The
physician must be licensed and
eligible to apply for the licensure with
the College of Physicians & Surgeons
of Alberta (CPSA), their qualifications
and experience must comply with the
Flexible work hours: Clinic is open
9 a.m. to 9 p.m. weekdays and
weekends allowing physicians to have
flexible work hours and flexible work
arrangements.
Family physicians needed in
Edmonton. Beverly Medical Clinic
Inc. is a new state-of-the-art medical
clinic that is expanding rapidly. The
clinic is growing and needs more
dedicated family physicians as one
of the physicians is planning to slow
down. We are currently seeking two
family physicians.
Terms of employment and wages:
The family physician positions are
permanent, full-time, fee-for-service
with anticipated annual income
of $300,000. The physician and
the clinic will share fee-for-service
billings, 70% (physician) and 30%
(clinic) for overhead expenses.
Job duties: The physician will be
providing primary care to patients of >
MAY - JUNE 2015
32
>
the Beverly Medical Clinic, including
diagnosing and treating medical
disorders, interpreting medical tests,
prescribing medications and making
referrals to specialist physicians as
appropriate.
Education and experience: Medical
degree with specialist training in
family medicine. Preference will
be given to candidates with family
practice experience and candidates
must be eligible for registration with
of Alberta. Preference will be given to
candidates that are College of Family
Physicians of Canada certified and
preference will be given to Canadian
citizens and permanent residents.
Skills required: Specialist training
in family medicine, ability to work
effectively, independently and
in a multi-disciplinary team,
effective written and verbal
communication skills.
Contact: Dr. A. Elfourtia or
Dr. Z. Ramadan
Beverly Medical Clinic
4243 118 Ave
Edmonton AB T5W 1A5
T 780.756.7700 or
C 780.224.7972
EDMONTON AB
EDMONTON AB
Dx Medical Centres is a new,
spacious and modern clinic in Mill
Woods with high-visibility exposure
in a busy residential area. We are
looking for general practitioners for
the growing practice to join our team
working collaboratively with multiple
disciplines of the health care field.
Urban Medical Clinic in vibrant
southeast Edmonton is a new state
of-the-art medical clinic that is rapidly
expanding. The clinic uses TELUS
PS Suite electronic medical records.
Our team currently includes two
family physicians and we are part of
Edmonton Southside Primary Care
Network with full-time nurse and
dietician. We have 8,000 patients
registered. The clinic is growing and
we are recruiting part- and full-time
physicians. Competitive overhead
for long term commitments. We
have eight examination rooms, one
procedure room and one specially
designed wheelchair room.
Our clinic offers a pleasant working
environment in a contemporary
facility. The clinic is paperless with
excellent support staff. We would like
to offer you the opportunity to work
in an enhanced practice environment
that fits your lifestyle, needs and
availability without investment or
administrative time commitments.
We provide competitive split to
our valued physicians on a
fee-for-service schedule.
Candidates must be licensed or
eligible to apply for licensure with
of Alberta.
Contact: Dr. Oshean Naidoo
[email protected] or
Dr. Dhanakodi Rengan
[email protected]
T 780.757.9545 >
Contact: Christina
T 780.705.8400
[email protected]
EDMONTON AB
Millbourne Mall Medical Centre
(MMMC) and Parsons Medical
Centre (PMC) are looking for a
full-time physician. MMMC and PMC
are a work-of-art busy family practice
and walk-in. MMMC and PMC serve
a large community and wide spectrum
age group (birth to geriatric). No
hospital on-call coverage required.
Full electronic medical records,
dedicated staff for billing, referrals
and taking vitals, as well as on-site
clinic manager. MMMC and PMC are
members of the Edmonton Southside
Primary Care Network which allow
patients to have access to an on-site
dietician and mental/psychology/
psychiatry health services.
Both clinics offer a large array
of specialist services including
pediatric, internist, endocrinologist,
ENT, respirologist, lung function
testing, general surgeon and on-site
pharmacies. Overhead is negotiable,
flexible working hours and clinics are
open seven-days-a-week.
Contact: Tatiana Marcu
T 587.521.2022
[email protected]
PHYSICIAN(S) REQUIRED FT/PT
Also locums required
ALL-WELL
PRIMARY CARE CENTRES
MILLWOODS EDMONTON
Phone: Clinic Manager (780) 953-6733
Dr. Paul Arnold (780) 970-2070
> EDMONTON AB
Family physicians needed in
Edmonton. The Beverly Towne
Medical Clinic is a new medical clinic
in Edmonton at 11730 34 Street.
(The clinic is operated by the Beverly
Medical Clinic Inc.)
We are currently seeking three family
physicians to join this new practice.
Terms of employment and wages:
These family physician positions are
permanent, full-time, fee-for-service
with anticipated annual income of
$300,000. The physician and the
clinic will share fee-for-service billings,
70% (physician)/30% (clinic) for
overhead expenses.
Flexible work hours: The clinic is open
9 a.m. to 9 p.m. during the week, and
also on weekends, allowing physicians
to have flexible work hours and
flexible work arrangements.
Job duties: The physician will be
providing primary care to patients
of the Beverly Towne Medical Clinic,
including diagnosing and treating
medical disorders, interpreting
medical tests, prescribing
medications, and making referrals to
specialist physicians as appropriate.
Education and experience: Medical
degree with specialist training in
family medicine. Preference will
be given to candidates with family
practice experience and candidates
must be eligible for registration with
of Alberta. Preference will be given
to candidates that are Canadian
College of Family Physicians (CCFP)
certified and preference will be
given to Canadian citizens and
permanent residents.
Skills required: Specialist training
in family medicine; ability to work
effectively, independently and
in a multi-disciplinary team;
effective written and verbal
communication skills.
Contact: Dr. A. Elfourtia or
Dr. Z. Ramadan
Beverly Towne Medical Clinic
11730 34 St
Edmonton AB
T 780.756.7700 or
C 780.224.7972
EDMONTON AND FORT
MCMURRAY AB
MD Group, Lessard Medical Clinic,
West Oliver Medical Centre and
Manning Clinic each have 10
examination rooms and Alafia
Clinic with four examination rooms
are looking for six full-time family
physicians. A neurologist, psychiatrist,
internist and pediatrician are required
at all four clinics.
Two positions are available at the
West Oliver Medical Centre in a
great downtown area, 101-10538 124
Street and one position at the Lessard
Medical Clinic in the west end, 6633
177 Street, Edmonton. Two positions
at Manning Clinic in northwest
Edmonton, 220 Manning Crossing and
one position at Alafia Clinic, 613-8600
Franklin Avenue in Fort McMurray.
The physician must be licensed or
eligible to apply for licensure by the
College of Physicians & Surgeons
of Alberta (CPSA). For the eligible
physicians, their qualifications and
experience must comply with the
CPSA licensure requirements and
guidelines.
The physician income will be based
on fee-for-service with an average
annual income of $300,000 to
$450,000 with competitive overhead
for long term commitments; 70/30%
split. Essential medical support and
specialists are employed within
the company and are managed by
an excellent team of professional
physicians and supportive staff. We
use Healthquest electronic medical
records (paper free) and we are a
member of a primary care network.
Full-time chronic disease management
nurse to care for chronic disease
patients at Lessard, billing support and
attached pharmacy are available at the
Lessard and West Oliver locations.
Work with a nice and dedicated staff,
nurse available for doctor’s assistance
and referrals. Also provide on-site
dietician and mental health/psychology
services. Clinic hours are Monday to
Friday 8:30 a.m. to 8:30 p.m., Saturday
and Sunday 10:30 a.m. to 5 p.m.
Contact: Management Office
T 780.757.7999 or
T 780.756.3090
F 780.757.7991
[email protected]
SHERWOOD PARK AB
The Nottingham Medical Clinic in
Sherwood Park is expanding and
we are looking to add part- and
full-time family physicians. Currently
the clinic has four physicians and is
appointment- based. We use Med
Access electronic medical records and
offer flexible hours. Laboratory, X-ray
and on-site pharmacy.
Clinic is associated with the Sherwood
Park Primary Care Network providing
additional benefits.
Contact:
T 780.416.3220
[email protected]
PHYSICIAN AND/OR
LOCUM WANTED
CALGARY AND EDMONTON AB
You require balance … you demand
the best. Join the fastest growing
medical group in Alberta to practice
medicine the way it was meant to be.
Imagine Health Centres (IHC) is
currently looking for family physicians
and specialists to join our dynamic
team in either Calgary or Edmonton.
Physicians will enjoy extremely
efficient workflows allowing for very
attractive remuneration, no hospital
on-call, paperless electronic medical
records, friendly staff and industryleading fee splits.
Imagine Health Centres are
multidisciplinary family medicine
clinics with a focus on health
prevention and wellness. Come and
be a part of our team which includes
physicians, physiotherapists, massage
therapists, psychologists, nutritionists
and pharmacists.
Imagine Health Centres prides itself
in providing the very best support for
family physicians and their families in
and out of the clinic. Health benefit
plans and full financial/tax/accounting
advisory services are available to
all IHC physicians. There is also an
optional and limited time opportunity
to participate in ownership of our
innovative clinics.
Compensation is fee-for-service.
Current positions available are locum,
part- or full-time. >
MAY - JUNE 2015
33
34
>
We currently have three Edmonton
clinics with a fourth opening this fall in
Windermere (southwest Edmonton).
The current clinics are near South
Edmonton Common, Old Strathcona
and west Edmonton.
We currently have one clinic in
southeast Calgary with a second clinic
that opened downtown in April.
All inquiries will be kept strictly
confidential and only qualified
candidates will be contacted.
Submit your CV to: Dr. Jon Chan
[email protected]
PRACTICE WANTED
CALGARY AB
I am a family doctor looking to take
over any medical clinic from which
the owner is relocating or retiring. I
would also consider buying a medical
building.
If you are a family physician or
specialist looking for part- or full-time
work please contact me.
Contact: Dr. D. Das
T 403.585.6840
[email protected]
EDMONTON AB
SPACE AVAILABLE
Summerside Medical Clinic and Edge
Centre Walk-in Clinic require part- and
full-time family physicians, specialists
and locums are welcome. The clinics
are in the vibrant, rapidly growing
communities of Summerside and Mill
Woods. Examination rooms are fully
equipped with electronic medical
records, printers in all examination
rooms and affiliated with the Edmonton
Southside Primary Care Network.
CALGARY AB
The Edge Centre has 5,000 sq. ft.
and can accommodate other medical
professionals such as dentist,
massage therapist, physiotherapist,
chiropractor, etc.
Fully finished medical office space
for lease; available July 1. New
construction, 1,630 sq. ft., bright corner
unit, functional and efficient plan
including five examination rooms, one
corner office, staff room, clean room,
nurse’s station and reception/waiting
area. Located within a busy medical
office building and conveniently
situated near Rockyview General
Hospital.
Contact: Lindsay Hills
Leasing Manager
NorthWest Healthcare Properties
T 403.282.9838, ext. 3301
[email protected]
PRACTICE AVAILABLE
PENTICTON BC
Practice in BC’s Okanagan Valley,
a 12-month playground of lakes,
golf, skiing and wine tours. A
well-established, full-service family
practice available in mid-2016. Modern,
well-equipped office with Med Access
electronic medical records and Dragon
medical dictation. Above-average
billings, experienced medical office
assistants, one-in-six weekend group
hospital rounds and one-in-40 “doctorof-the-day” hospital on-call.
Options for this practice include
purchase of a two-doctor office
building, membership in a family
practice maternity clinic and one-in-12
ownership of a community walk-in
clinic with no buy-in.
Contact: Dr. Glen D. Burgoyne
T 250.492.4066
[email protected] >
Tired of
the grind?
Contact: Dr. Nirmala Brar
T 780.249.2727
[email protected]
SHERWOOD PARK AB
Dr. Patti Farrell & Associates is a new
busy modern family practice clinic with
electronic medical records and require
locum coverage periods throughout
2015. Fee split is negotiable. Current
clinic hours are Monday to Friday
8 a.m. to 4 p.m. are negotiable.
Dr. Farrell is a lone practitioner
(efficient clinic design built for two
doctors) looking for a permanent
clinic associate.
It’s time for a change.
Join our medical services team for
the opportunity to do meaningful
work. You'll set your own hours and
enjoy a healthy work-life balance
without the overhead that comes
with private practice.
If you have experience treating
musculoskeletal injuries from
general practice, sports medicine,
occupational medicine or
emergency medicine, please
contact:
Contact:
C 780.499.8388
[email protected]
[email protected]
See our posting at www.wcb.ab.ca
for more information
>
COURSES
CME CRUISES WITH
SEA COURSES CRUISES
• Accredited for family physicians
and specialists
• Unbiased and pharma-free
• Canada’s first choice in CMEatSEA®
since 1995
• Companion cruises FREE
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
ALASKA GLACIERS
July 12-19
Focus: Crossroads in clinical care
Ship: Celebrity Infinity
AUSTRALIA AND NEW ZEALAND
January 5-19, 2016
Focus: Caring for an aging patient
Ship: Celebrity Solstice
August 2-9
Focus: Cardiology and respirology
TAHITI AND COOK ISLANDS
February 20-March 2, 2016
Focus: Tahitian CME Pearls 2016
Ship: Paul Gauguin
BRITISH ISLES
July 15-27
Focus: Endocrinology,
gastroenterology and infectious
diseases
Ship: Celebrity Silhouette
SOUTH AMERICA
February 28-March 9, 2016
Focus: Hot topics in medicine
MEDITERRANEAN
September 19-October 2
Focus: Challenges in medicine
Ship: Celebrity Equinox
ST. LAWRENCE
September 19-27
Focus: Third annual McGill CME
cruise
Ship: Crystal Symphony
FIJI TO TAHITI
November 10-21
Focus: Endocrinology and diabetes
Ship: Paul Gauguin
PANAMA CANAL
November 20-30
Focus: Best evidence in clinical
medicine
Ship: Zuiderdam
CARIBBEAN
March 13-20, 2016
Focus: Primary Care Review
Ship: Liberty of the Seas
TASTE OF THE EAST
April 12–May 2, 2016
Singapore, Asia, India, United Arab
Emirates
Focus: Adventures in Medicine
Ship: Regent Seven Seas Voyager
For current promotions and pricing,
contact: Sea Courses Cruises
TF 1.888.647.7327
[email protected]
www.seacourses.com
SERVICES
35
DOCUDAVIT MEDICAL SOLUTIONS
Retiring, moving or closing your
practice? Physician’s estate?
DOCUdavit Medical Solutions
provides free, paper or electronic
patient record storage with no hidden
costs. We also provide great rates for
closing specialists.
DOCUdavit Solutions has achieved
ISO 9001:2008 and ISO 27001:2013
certification validating our
commitment to quality management,
customer service and information
security management.
Contact: Sid Soil
DOCUdavit Solutions
TF 1.888.781.9083, ext. 105
[email protected]
DISPLAY OR
CLASSIFIED ADS
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
MAY - JUNE 2015
“WHERE MD HAS
HELPED THE
MOST IS WITH
GETTING OUR
RETIREMENT AND
POST-RETIREMENT
ORGANIZED.”
“From the start, we found MD very
trustworthy, supportive and informative.
They created a financial plan that helped
make sure we could meet our financial
goals—and things have gone exactly as
planned. Now that we’re in the latter
stages of our careers, it’s nice to know
we can retire whenever we’re ready.”
– Dr. Jean-Denis Yelle, Trauma Surgeon
– Mrs. Susan Nevitt-Yelle, BN, Administrative Assistant
EVERY PHYSICIAN HAS A STORY.
HEAR MORE: MD.CMA.CA/MYSTORY
FOUR TIMES MORE PHYSICIANS TRUST MD.1
Fifty-three per cent of Canadian Medical Association members trusted MD Financial Management as their
primary financial services firm, four times more than the next closest individual competitor at twelve per cent.
Survey respondents (MD clients and non-MD clients) were also asked to identify their primary financial
institution (MD or Other), then rate their level of trust associated with that institution. MD received the highest
trust rating compared with all other firms rated. Source: MD Financial Management Loyalty Survey, June 2014.
1
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.

May/June 2015 - Alberta Medical Association

Transcription

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