Alberta Doctors' Digest May/June 2015

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 FirstÂŽ

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

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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 amamail@albertadoctors.org 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

16 Emerging Leaders in Health Promotion Grant program:

Starting early with healthy eating smarts

17 Emerging Leaders in Health Promotion Grant program:

Kids and infectious diseases: (not) all fun and games

19 Emerging Leaders in Health Promotion Grant program:

Advocating healthy family choices; family first, individual second

21 Emerging Leaders in Health Promotion Grant program:

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.

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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.

AMA - ALBERTA DOCTORS’ DIGEST

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 terrie.brandon@albertadoctors.org. >

>

Confidentially speaking …

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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.

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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.

AMA - ALBERTA DOCTORS’ DIGEST

• 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.

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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

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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 >

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> 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

AMA - ALBERTA DOCTORS’ DIGEST

MIND YOUR OWN BUSINESS

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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.

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> 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 linda.ertman@albertadoctors.org or phone 780.733.3632.

CUMMING SCHOOL OF MEDICINE Office of Continuing Medical Education and Professional Development

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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.

AMA - ALBERTA DOCTORS’ DIGEST

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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FEATURE Emerging Leaders in Health Promotion Grant program: Starting early with healthy eating smarts Vanda Killeen | SENIOR

COMMUNICATIONS CONSULTANT, ALBERTA MEDICAL ASSOCIATION PUBLIC AFFAIRS

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

AMA - ALBERTA DOCTORS’ DIGEST

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

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Emerging Leaders in Health Promotion Grant program: Kids and infectious diseases: (not) all fun and games Vanda Killeen | SENIOR

COMMUNICATIONS CONSULTANT, ALBERTA MEDICAL ASSOCIATION PUBLIC AFFAIRS

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. >

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> 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

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Emerging Leaders in Health Promotion Grant program: Advocating healthy family choices; family first, individual second Vanda Killeen | SENIOR

COMMUNICATIONS CONSULTANT, ALBERTA MEDICAL ASSOCIATION PUBLIC AFFAIRS

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.

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> “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

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CMA steps up to support Emerging Leaders in Health Promotion Grant program Vanda Killeen | SENIOR

COMMUNICATIONS CONSULTANT, ALBERTA MEDICAL ASSOCIATION PUBLIC AFFAIRS

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.

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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?

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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.

AMA - ALBERTA DOCTORS’ DIGEST

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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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.

AMA - ALBERTA DOCTORS’ DIGEST

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

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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

AMA - ALBERTA DOCTORS’ DIGEST

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.

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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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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.

AMA - ALBERTA DOCTORS’ DIGEST

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

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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. >

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> 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.

AMA - ALBERTA DOCTORS’ DIGEST

“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 podcasting@cbc.ca.

CLASSIFIED ADVERTISEMENTS

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

Contact: Marion Barrett Med+Stop Medical Clinics Ltd. 290-5255 Richmond Rd SW Calgary AB T3E 7C4 T 403.240.1752 F 403.249.3120 msmc@telusplanet.net CALGARY AND EDMONTON AB Imagine Health Centres in Calgary and Edmonton have an immediate opening for a psychiatrist certified with the College of Physicians & Surgeons of Alberta (CPSA).

Imagine Health Centres are dynamic multidisciplinary clinics with a large array of services including family physicians, specialists and many other allied health professionals such as pharmacists, physiotherapists, psychologists and more. Imagine Health Centres are dedicated to promoting the health of patients utilizing the most up-to-date preventative and screening strategies.

The successful candidate will work closely with our multidisciplinary team to optimize management of our patients with mental health issues.

Collaborate with our large network of family physicians and their referrals to maximize outcomes for your patients.

Opportunities for group therapy and corporate health are available. There are also opportunities to help develop leading programs for mental health at all levels of primary care within our multiple sites located throughout Calgary and Edmonton.

An attractive compensation package will be offered to the successful candidate.

All candidates must be immediately eligible for licensure or already licensed with the CPSA and provide proof of malpractice insurance from the Canadian Medical Protective Association.

Compensation is fee-for-service.

All inquiries will be kept strictly confidential and only qualified candidates will be contacted.

Submit your CV to: Dr. Jon Chan physicians@imaginehealthcentres.ca EDMONTON AB

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CPSA licensure requirements and guidelines. We offer flexible work 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 westendmedicalclinic@gmail.com 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 foodprex@telus.net

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 >

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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 the College of Physicians & Surgeons 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 the College of Physicians & Surgeons of Alberta.

Contact: Dr. Oshean Naidoo onaidoo@telus.net or Dr. Dhanakodi Rengan drengan@telus.net T 780.757.9545 >

Contact: Christina T 780.705.8400 info@dxmedical.ca

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 manager@millbournemedicalcentre.ca AMA - ALBERTA DOCTORS’ DIGEST

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 the College of Physicians & Surgeons 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 lessardclinic@gmail.com

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 sdenson@shaw.ca

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. >

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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 physicians@imaginehealthcentres.ca

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 drddebasish@gmail.com

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 lindsay.hills@nwhp.ca

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 glenburgoyne@hotmail.com >

Tired of the grind?

Contact: Dr. Nirmala Brar T 780.249.2727 nimmi@theplaza.ca 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 terrypurich@me.com

physician.opportunities@wcb.ab.ca

See our posting at www.wcb.ab.ca for more information

AMA - ALBERTA DOCTORS’ DIGEST

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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 Ship: Celebrity Infinity

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 Ship: Celebrity Infinity

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 cruises@seacourses.com www.seacourses.com

SERVICES

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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 ssoil@docudavit.com

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.

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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.