Just For Canadian Doctors Spring 2019

Page 1

spring 2019

life + leisure


set sail out of


go back in time in ireland

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inside: Continuing medical Education Calendar where will you meet? d u b li n




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DOCTORS life + leisure

spring 2019


spring 2019 Publisher Linh T. Huynh

Editor Barb Sligl Art Direction BSS Creative

Contributing Editor Janet Gyenes

Editorial Assistant Adam Flint

Contributors Janet Gyenes Lisa Kadane Sharon Matthews Stevens Dr. Chris Pengilly Manfred Purtzki Dr. Kellen Silverthorn Mark Stevens Barb Sligl Roberta Staley Catherine Tse Cover photo iStock

14 24

Senior Account Executive Monique Nguyen

Account Executive Wing-Yee Kwong

Production Manager Ninh Hoang

CE Development Adam Flint

Sales, Classifieds and Advertising In Print Circulation Office 200 – 896 Cambie Street Vancouver, BC V6B 2P6 Canada Phone: 604-681-1811 Fax: 604-681-0456 Email: info@AdvertisingInPrint.com

PHOTOS: barb sligl; sharon matthews stevens; istock

Just For Canadian Doctors is published four times a year by Jamieson-Quinn Holdings Ltd. dba In Print Publications and distributed to Canadian doctors. Publication of advertisements and any opinions expressed do not constitute endorsement or assumption of liability for any claims made. The contents of this magazine are protected by copyright. None of the contents of the magazine may be reproduced without the written permission of In Print Publications. In Print Publications 200 – 896 Cambie Street Vancouver, BC V6B 2P6 Canada


14 The ancient coast of eastern Ireland 24 On the waterfront in historic Kingston, ON COLUMNS


9 motoring

5 spring mix 17 CME calendar 27 sudoku 30 small talk

Autonomous cars

10 the thirsty doctor Foraged tipples

12 pay it forward The story behind the Canadian Centre for Refugee and Immigrant Health Care

23 the wealthy doctor

www.justforcanadiandoctors.com Printed in Canada.

4 ways to save on personal income tax in the wake of TOSI

28 doctor on a soapbox

award winS! Stories and photographs that appeared in this magazine (and sister publication, Just for Canadian Dentists) recently won multiple awards in the 2018 North American Travel Journalists Association Awards, including silver.

Dr. Lorne Porayko

Embrace the EMR

cover photo Legendary Boldt Castle (on Heart Island in the US) is a sail away from Kingston, ON (page 24). Its Power House and Clock Tower, jutting into the St. Lawrence River, may be the most photographed structure in the Thousand Islands (page 27).

Spring 2019 Just For Canadian doctors


from the editor

Rocky ruins and walls on the ancient east coast of Ireland (page 14).

Storied lands

and fantastical (page 24). But it still involves pirates, dungeons and cannon fire… And in Utah’s arid desert, there’s some very literal storytelling going on—upon a stage set against the backdrop of surreal red-rock formations travel (page 5). Nature does provide the wildest props and decoration. back Back in Ireland, Dublin has in time been home to many storytellers, from Jonathan Swift (whose Gulliver’s Travels may be the ultimate travel tale) to James Joyce (author of the most epic of tomes, Ulysses). Trace their steps, and then have a pint of fortifying Guinness (page 17). If nothing else, travel inspires and spurs stories, to tell and retell. Share yours!

barb sligl


art of the joy of travel is the storytelling. The tall tales (sometimes), myths and legends, history and anecdotes. Go back a thousand years or more and it’s hard to tell truth from fiction, reality from fantasy. Standing amidst ancient ruins along Ireland’s wind-whipped coast, upon which Vikings (and perhaps leprechauns) once strode, it feels like the setting of a fairy tale… or Game of Thrones, which is partly filmed in the country (see its wild landscapes in the TV show’s final season this April). It’s easy to imagine a fire-breathing dragon descending over the misty hillsides and rocky ruins as you follow battles, step into castles and stumble across fairy trees (they do exist) on Ireland’s ancient east coast (page 14). Going back a mere century or so, the history of Kingston, Ontario, isn’t as removed

Any ideas, comments or questions? Reach us at feedback@InPrintPublications.com.

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Just For Canadian doctors Spring 2019

Just for Canadian Doctors 1/6 Vertical : 2.25”w x 4.875” h FEB 2018

what/when/where > spring

style | food | drink | festivals | places | getaways | gear‌


rock it

tune in


to the

desert where Nature + music blend in Southwest Utah


janet gyenes

f you look at a map of mainland US, the state of Utah is an oddshaped rectangle with a smaller rectangle snipped from the top corner. Hard lines. Sharp corners. But when you find yourself on the ground, surrounded by Utah’s vast vermilion cliffs, scrubby Joshua trees and California condors cruising on thermals through electric-blue skies, those precisely scribed boundaries become beautifully blurry. >> continued on page 8

Spring 2019 Just For Canadian doctors




Meet Corinna. Lipitor prescriber. There are many good reasons to prescribe LIPITOR. LIPITOR (atorvastatin calcium) is indicated as an adjunct to lifestyle changes, including diet, for the reduction of elevated total cholesterol (total-C), LDL-C, triglycerides (TG), apolipoprotein B (apo B), the Total-C/HDL-C ratio and for increasing HDL-C in hyperlipidemic and dyslipidemic conditions, including: • Primary hypercholesterolemia (Type IIa); • Combined (mixed) hyperlipidemia (Type IIb), including familial combined hyperlipidemia, regardless of whether cholesterol or triglycerides are the lipid abnormality of concern; • Dysbetalipoproteinemia (Type III); • Hypertriglyceridemia (Type IV); • Familial hypercholesterolemia (homozygous and heterozygous).

For homozygous familial hypercholesterolemia, LIPITOR should be used as an adjunct to treatments such as LDL apheresis, or as monotherapy if such treatments are not available. • An adjunct to diet to reduce total-C, LDL-C, and apo B levels in boys and postmenarchal girls, 10 to 17 years of age with heterozygous familial hypercholesterolemia, if after an adequate trial of diet therapy the following findings are still present: o LDL-C remains >4.9 mmol/L (190 mg/dL) or o LDL-C remains >4.1 mmol/L (160 mg/dL) and: — there is a positive family history of premature cardiovascular disease or — two or more other CVD risk factors are present in the pediatric patient

For LIPITOR patients, there are many good reasons to join the Pfizer OriginalsTM Program.

Encourage your patients to visit PfizerOriginals.ca to sign up for tips and tools to help them receive the original brand LIPITOR or other Pfizer original brand name medications that you’ve prescribed. Participating brands:* Accupril (Quinapril)* - PrAccuretic (Quinapril HCl/Hydrochlorathiazide)* - PrAlesse (Ethinyl estradiol and levonorgestrel)* Aricept (Doneprezil)* - PrAromasin (Exemestane)* - PrArthrotec (Diclofenac and misoprostol)* - PrCaduet (Amlodipine besylate/ Atorvastatin calcium)* - PrCelebrex (Celecoxib)* - PrDetrol (Tolterodine)* - PrDetrol LA (Tolterodine)* - PrEffexor XR (Venlafaxine)* Pr Lipitor (Atorvastatin)* - PrLyrica (Pregabalin)* - PrNorvasc (Amlodipine)* - PrRelpax (Eletriptan)* - PrVfend (Voriconazole)* Pr Xalacom (Latanoprost-Timolol)* - PrXalatan (Latanoprost)* - PrZoloft (Sertraline)* - PrZyvoxam (Linezolid)* Pr Pr

* Subject to change. The Pfizer Originals Program is available in all provinces except Quebec. Pfizer products covered under the Pfizer Originals Program vary by province and drug plan type.

ACCURETIC is indicated for the treatment of essential hypertension in patients for whom combination therapy is appropriate. CADUET is indicated in patients for whom treatment with both amlodipine and atorvastatin is appropriate, specifically, patients at cardiovascular risk. NORVASC is indicated in the treatment of mild to moderate essential hypertension. ACCUPRIL is indicated in the treatment of essential hypertension. It is usually administered in association with other drugs, particularly thiazide diuretics.

all aglow selfcare



get fresh

It’s time for a spring revamp… 3 ways to get that “new season, new you” glow happening Written + produced by Catherine Tse

Consult the Product Monographs at: • LIPITOR: http://www.pfizer.ca/pm/ en/LIPITOR.pdf • ACCURETIC: http://www.pfizer.ca/ pm/en/ACCURETIC.pdf • CADUET: http://www.pfizer.ca/pm/ en/CADUET.pdf • NORVASC: http://www.pfizer.ca/ pm/en/NORVASC.pdf

refresh Make mornings more civilized with Philips’ Somneo Sleep and Wake-Up Light, which will gradually light up your room, mimicking sunrise, before your alarm goes off. The light gently prepares your body to wake up while staying in synch with your circadian rhythm. At night, the light can also simulate sunset, helping you fall asleep in a relaxed state. philips.ca; $219.99, available at amazon.ca inhale Deeply intoxicating with luscious geranium and rose notes balanced by earthy, calming frankincense, Londonbased Aromatherapy Associates’ Equilibrium Bath and Shower Oil will multitask your cleansing routine into a holistic treatment. Blended to infuse your senses with strength, comfort and a positive frame of mind. Use two to three capfuls of oil massaged onto your torso before stepping into your bath or shower. $85, aromatherapyassociatescanada.com

• ACCUPRIL: http://www.pfizer.ca/ pm/en/ACCUPRIL.pdf for contraindications, warnings, precautions, adverse reactions, interactions, dosing, and conditions of clinical use. The Product Monographs are also available by calling 1-800-463-6001.

© 2018 Pfizer Canada Inc. Kirkland, Quebec H9J 2M5 TM and ® are trademarks of Pfizer Inc. or its affiliates and are used under license by Pfizer Canada Inc. ® Pfizer Inc., used under license PP-LIP-CAN-0015-EN

relax If a cashmere sweater could take on candle form, it would be Bastide’s Au Coin du Feu. “At the Fireside” is creamy, amber-warm and a little bit smoky, immediately transporting you to a French country manor scented by the smouldering embers of a glowing hearth. bastide.com; $85, available at holtrenfrew.com

li gh te n u p!

Spring 2019 Just For Canadian doctors




heat it up

natural arena

Hit some high notes in the natural amphitheatre of the desert

desert vibes



n the hush of summer’s heat I’m lulled by those limitless skies while floating in a swimming pool at the Inn on the Cliff in St. George. Situated in the southwest corner of the state, St. George isn’t far from that perfectly drawn corner on the map where Utah, Nevada and Arizona intersect and where the Mojave Desert’s shifting sands breach the borders. All seems still in this dreamscape that’s encircled by a galaxy of natural wonders like Snow Canyon State Park and Zion National Park. But there are vibrations of music in the air. Lots. Katy Perry’s anthemic song Rise was filmed nearby on the ancient lava flows and sculpted dunes of Snow Canyon and Sand Hollow state parks. And not long after casting myself adrift in St. George I’m standing backstage at another dot on the map where music and nature meld together on a grand scale—the Tuacahn Amphitheatre and Center for the Arts, which sits in the shadow of Red Cliffs National Conservation Area. Heather Riddell, who works in Tuacahn’s box office, is giving a small group of us a behind-thescenes tour, pointing out the tunnel under the stage. “There aren’t any curtains here because we’re outside in a canyon,” she says. “They’d be bleached and ripped.” The muscular backdrop of rusty-red cliffs will be supporting cast members in the performance of Disney’s Newsies that I’ll see tonight. It’s Broadway in the desert, the set dressed as New York City in 1899. Some 2,000 seats curve around the stage, which will witness rotating productions of The Little Mermaid, Disney’s When You Wish and The Sound of Music during the 2019 season. Every year, new and established actors from across Utah and the US join the theatre company that has produced more than 50 major musical theatre productions since it opened in 1995. A day later I’m still humming show tunes as I wander the Riverside Walk in Zion National Park, which starts at the Temple of Sinawava, another natural amphitheatre composed of 915-metre cliffs, hanging gardens and murmuring waterfalls that spill into the Virgin River. Mormon pioneers named this 110-year-old park—Utah’s first—for the ancient Hebrew word that means “sanctuary.” More than 4.5 million people visit annually, revelling in the rhapsody of canyon colours year-round. And when those supercharged skies turn signal orange, they retreat to the O.C. Tanner Amphitheater for its summer Twilight Concert Series and the Zion Canyon Music Festival that’s held every September. Bluegrass, rock, classical, country and folk music echo through this boundless red-rock wonderland—one that can’t be constrained by lines drawn on a map. — Janet Gyenes Just For Canadian doctors Spring 2019

w a r ml spe l



Setting the stage for “Broadway in the desert” at Tuacahn Amphitheatre and Center for the Arts

if you go To hit those high notes when exploring southwestern Utah, go to visitutah.com.

janet gyenes



D r . k e l l e n s i lv e r t h o r n

Dr. Kellen Silverthorn is Just For Canadian Doctors’ automotive writer. He tries to keep one convertible and/or one track-day car in the family fleet.

Auto-nomously yours The future of cars is not in your hands…

Nuro r1


n December 18, 2018, Silicon Valley startup, Nuro, debuted the first fleet of driverless robo-delivery vehicles operating on public roads. Nuro beat a host of rivals to this important autonomous vehicle (AV) first. Far larger rivals Waymo (Google), General Motors, Apple and Uber are nursing collective bruised egos. While Nuro’s bespoke electric R1 models will initially only serve clients of a single Scottsdale, Arizona, grocery store, this debut is still a very big deal. It may ultimately outshine Michigan’s 1913 Ford Model T production line in significance to human mobility. Today’s AVs are traceable back to research-and-development work by the US military. Driverless military vehicles preclude driver casualties in hostile settings. In 2006 and 2007, the US military offered millions of dollars in DARPA (Defense Advanced Research Projects Agency) prizes to industry and academia for driverless vehicle advancements in semi-controlled environments. Advancements a decade ago hinged on two key (figurative) building blocks. The first was the adoption of the aerospace practice of “fly-by-wire.” Instead of pilots operating old-school mechanical or hydraulic sticks and pedals, the controls operated by pilots in 21st-century jets were more akin to a digital rheostat. Today’s airline pilots’ actions send an electronic signal to the tail rudder motor instructing it to deviate left or right. In cars, parallel advancements translated to steer-by-wire, brake-by-wire and throttle-by-wire. Great, so “by-wire” driverless car prototypes could now follow robo-friendly digital commands, but how does the car know where it should go? That was the second main building block recruited: LIDAR (LIght Detection And Ranging). Somewhat akin to a 3D ultrasound scanner, a vehicle-mounted LIDAR broadcasts very short pulses of laser light 360 degrees around the vehicle, and from the laser light that’s reflected back, LIDAR plots its environment in that instant. Even early LIDAR versions in 2007 generated a million data points per second. Google/Waymo and others spent the last decade (and billions of dollars) pro-

gramming driving algorithms from LIDAR’s instantaneous feedback. Importantly, Waymo’s testing provided early-on conclusive evidence of the futility of handing vehicle control back to a human driver when an emergency arose. We humans took too long to re-orient from texting on our smartphones. So, the most advanced AV algorithms make all the navigating calls, even in emergencies. Proponents, regulators and their lawyers are confident that today’s best robo algorithms are statistically safer than human drivers. Given that 94% of modern road collisions are attributed to human error, there is wide scope for road safety improvement. Even greater safety is envisioned when AVs communicate with one another in real-time. Zero fatalities, zero emissions and zero congestion are the laudable goals of our future vehicle fleet—so says General Motors. To get there we’ll rely progressively on shared/hailed rides in public-access driverless electric vehicles. It’s estimated that future urban centres could meet transportation needs with just 15% of the current number of cars. That would mean far less traffic, and far less need for parking. Approaching any one of these laudable “zero” goals would be a disruptor of the status quo. A possible congestion “solution” that reduces cars to an eighth of today’s numbers would affect auto sales (obviously!). And a far greater proportion of those car sales than today’s would be to fleets, rather than individuals. Having all three “zero goals” confront the auto industry over the same decades is unprecedented. A mash-up of auto company winners and losers and new entrants is all but assured. Four of the five brands mentioned above in this article are not known car companies. Vehicle manufacturers are not the only ones who should expect disruption. “Driver” is the number one job description in the

developed world, whether it be of taxi, truck, courier, Tuk-Tuk etc. That job-loss pain will be real (stay tuned in Paris). The workforce will ultimately adapt to driverless cars—just as it did to ATMs, self-operated elevators, e-mail and Amazon. The stakes in this transformation couldn’t be higher for not only Detroit and Silicon Valley, but also Asia and Europe. Both China and the US are emerging as powerhouses in AV technology. In a parallel universe, these two titans would collaborate for the greater

The autonomous (and cute!) Nuro R1

good. Don’t hold your breath in ours. On a more positive note, whole new industries will unfold that serve the wants and needs of millions of commuters who will be freed from mentally attending to their daily driving chores. Perhaps we’ll be role-playing in our virtual reality headsets, or power napping? Ironically, I’d use the time freed-up for SIM auto racing.

Spring 2019 Just For Canadian doctors


the thirsty doctor lisa kadane Lisa Kadane is a newspaper and magazine writer who likes to travel and partake in the destination’s preferred tipple, whether it’s rum, wine, a margarita or whisky sour. She’s been sharing her thoughts on spirits and cocktails since 2010.

Terroir-based tipples Cocktails, suds and spirits foraged from land and sea


eep in a rainforest on the outskirts of Tofino, our group of foragers treads silently over the mossy ground, looking for mushrooms. Leading the fungi charge is Nick Nutting, executive chef at Wolf in the Fog restaurant, and his wife Hailey Pasemko, the restaurant’s bar manager. “It’s a fun thing to do on a day off,” says Pasemko as she scours the ground for yellow-orange chanterelles and brownishwhite matsutakes, which are called pine mushrooms in Canada. After searching the forest floor for an hour we’ve collected a 10-pound haul of ’shrooms. The Wolf and the Fog team will transform them into a rich risotto, decadent mushrooms on toast, and a pine mushroom-infused vodka that will become the star ingredient in a savoury sake martini. As the morning progresses she points out red huckleberries and cynamoka berries, which are tart and sweet (similar to huckleberries, but with more depth) and that she uses to make syrups, infusions and bitters. At the height of berry season, Pasemko picks the salmon berries and salal berries that form part of the forest backdrop on the island’s rugged coast. “With the salal berries, I’ve been making a BC version of sloe gin fortified with syrup,” Pasemko says. She adds it to her Snow Monkey cocktail (see recipe), a drink

that marries the sweet gin with sake, amaro and lime juice. Towering above us are cedars, trees emblematic of the west coast, whose planks flavour salmon and whose wood chips infuse spirits such as whisky. Pasemko uses them to add the flavour of smoky, earthy wood to her delicious Cedar Sour. Using foraged ingredients in the kitchen and behind the bar isn’t unique to Tofino, of course—bars, restaurants, breweries and distilleries from Vancouver to Halifax add local fruits, herbs and grains into their creations. But many of Pasemko’s wild, found items are unique to Vancouver Island, and give her cocktail list a sense of place—what winemakers call “terroir.” “A lot of these ingredients are important to here, but not easy to find in other places. I’ve never seen cynamoka berries outside of Tofino,” Pasemko says. Other artisanal producers in Tofino are just as keen to add in a taste of their isolated home to inventive tipples. The Tofino Craft Distillery makes an Old Growth Cedar Gin from western red cedar tips that are added to the botanical basket during fermentation. “It’s so robust,” says distillery co-owner Neil Campbell. “It’s a little flavour of the Pacific Northwest.” The Long Beach Lodge adds Campbell’s spirit to their Cedar Gin Julep, a twist on a classic julep with port, berries, mint and charred cedar bitters.

“Tofino seems to have a real focus on high-quality ingredients in food and drinks—it’s a really foodie town,” says Hannah Nicholls with Tofino Brewing. “It’s a philosophy that has gone into almost every restaurant here.” But because the Vancouver Island outpost has no agriculture, “you have to get kind of inventive with it,” Nicholls says. To that end, the brewery uses kombu kelp, a variety that grows naturally on the west coast, to flavour its popular Kelp Stout. The hearty brew has chocolate notes, plus a slight saltiness and umami savouriness thanks to its seaweed ingredient. Tofino Brewing also makes a spruce tree beer every spring with locally foraged spruce tips, and it created a fruit-forward beer featuring salal berries a couple of years ago. Back at Wolf in the Fog, we dine on Dungeness crab with pine-mushroom risotto, porcini and chanterelle mushrooms on toasted sourdough, and goat cheese ice cream drizzled with salal and huckleberries. We tip it back with BC wine, Cedar Sours, and Caesars made with smoked salmoninfused vodka that are garnished with local seafood. It’s fair to say we’re drinking in as much of Tofino as we can.

1.5 oz Odd Society Spirits Salal Gin (Pasemko infuses her own gin with salal berries, then boosts the flavour with salal syrup, so swapping in Odd Society’s Salal Gin is a useful hack!) 0.5 oz Gekkeikan Sake 0.5 oz Amaro Nonino 0.5 oz lime juice 6 drops Bittermens Tiki Bitters Combine above ingredients in a shaker. Add ice, shake and strain into a small Collins glass over crushed ice. Garnish: 2 x salal leaves dipped in icing sugar —Recipe by Hailey Pasemko, Wolf in the Fog


Just For Canadian doctors Spring 2019

Old Growth Cedar Gin by Tofino Distillery and Kelp Stou t by Tofino Bre wing

cocktail photo courtesy of wolf in the fog

the foraged cocktail*

* Snow Monkey

Recommend the Pfizer Originals Program to your patients prescribed Pfizer original brand medications

The Pfizer Originals Program —with the Medication Identifier tool— is part of our commitment to helping your patients prescribed Pfizer original brand medications. Encourage your patients to visit


Participating brands:*

Accupril®(Quinaprilhydrochloride)–PrAccuretic®(Quinaprilhydrochlorideandhydrochlorothiazide)–PrAlesse®(Levonorgestrelandethinylestradiol) Aricept® (Donepezil HCI) – PrAromasin® (Exemestane) – PrArthrotec® (Diclofenac sodium and misoprostol tablets) – PrCaduet® (Amlodipine besylate/Atorvastatin calcium) – PrCelebrex® (Celecoxib) – Pr Detrol® (Tolterodine L-tartrate) – Pr Detrol® LA (Tolterodine L-tartrate extended-release capsules) – Pr Effexor® XR (Venlafaxine HCI) – Pr Lipitor® (Atorvastatin calcium tablets) – Pr Lyrica® (Pregabalin) – Pr Norvasc® (Amlodipine besylate) Pr Relpax® (Elitriptan hydrobromide) – PrVfend® (Voriconazole) – PrXalacom® (Latanoprost and timolol ophthalmic solution) – PrXalatan® (Latanoprost ophthalmic solution) – PrZoloft® (Sertraline hyrdrochloride) – PrZyvoxam® (Linezolid tablets) Pr Pr

© 2018 Pfizer Canada Inc. Kirkland, Quebec H9J 2M5

TM and ® are trademarks of Pfizer Inc. or its affiliates and are used under license by Pfizer Canada Inc. ® Pfizer Inc., used under license.


* Subject to change. Pfizer products covered under the Pfizer Originals Program vary by province and drug plan.

pay i t f o r w a r d

r o b e r ta s ta l e y

Roberta Staley is a Vancouver-based magazine writer, editor and documentary filmmaker.

Your money or your life


he bicycle had been a gift from neighbours to welcome 12-yearold Samir, who had immigrated to Canada from Afghanistan with his mom after his father was killed by insurgents in the war-torn Central Asian country. Samir fell off the bike, breaking his forearm. His mother took him to the ER of a nearby Toronto hospital. But Samir and his mother hadn’t been in Canada long enough to qualify for the Ontario Health Insurance Plan (OHIP). Hospital administrators demanded $500 up front. “It might as well have been $5 million,” says Dr. Paul Caulford, co-founder of the Canadian Centre for Refugee and Immigrant Health Care (CCRIHC) in the east Toronto district of Scarborough. “They left the ER; they were embarrassed,” Caulford says. Samir’s first day of school in Canada was supposed to be the next day. Instead, he stayed home, his broken limb supported by a pillow, weeping with pain. Then, Samir’s mother found out about the CCRIHC’s free medical clinic and brought her teary-eyed son in for help. Samir’s arm was swollen to twice its size. Caulford walked the boy into the hospital’s ER department and demanded an X-ray and cast. A few weeks later, Samir returned to CCRIHC to have it signed by staff. Such an incident isn’t unusual, says Caulford. That’s because Canada’s healthcare system is woven into the nation’s immigration policies in a way that is Byzantine in its complexity, leaving landed immigrants, permanent residents, those on visitor or student visas and refugees undergoing appeals without access to healthcare, sometimes for years. Across Canada today, an estimated 500,000 to one million people are without health insurance, Caulford says. Samir’s case took place in the late aughts, but a similar case happened only last year. A Guatemalan student, studying to be a Personal Support Worker, took her six-year-old son Louis to ER after he fell in the playground, breaking an arm. While at


the hospital, the mom was informed that, to afford rent. Up to 45 patients are seen unbeknownst to her, her OHIP had expired. every evening, he says. The problems the She was told to pay hundreds of dollars up CCRIHC physicians confront are myriad and front—money she didn’t have. In this case, include mental health issues stemming the CCRIHC paid the medical bill for the from war trauma, infectious diseases like emergency work and undertook follow-up tuberculosis and malaria or pneumonia and care on Louis. “It is not prudent, humanitarthe ravages of untreated chronic diseases ian or wise for a country to deny healthcare like hypertension, diabetes, heart disease to another human being,” says Caulford. and cancers. Because such ailments “There are so many folks uninsured in go untreated while in Canada we can’t call ourselves a healthcare limbo, the universal system anymore.” patients’ illnesses Dr. Paul Caulford, coBorn and raised in Toronto, worsen to the founder of the Canadian Caulford’s mother is a point where Centre for Refugee and Bulgarian refugee who came hospitalization Immigrant Health Care, with to Canada as a girl in the is required a medically uninsured six year mid-1920s. His wife, Marta, when insurance old. “Children are the fastest is a refugee from Hungary. finally kicks in, growing group of uninsured creating a huge newcomers in clinic,” says downstream Caulford. cost to the system, Caulford says. One of the more shocking things is the denial of pregnancy care to women whose immigrant status is indeterminate, with clinics demanding $2,000 up front before health care is provided. “Your money or your life,” Caulford says. “Many things we have seen around the denial of care shock us.” Caulford’s future as a physician was sealed Ontario, British Columbia, Manitoba, when, at age 12, he embraced the concept New Brunswick and Quebec all require new of supporting others in difficulty following permanent residents to wait three months the death of a beloved family friend. In 1999, before they are eligible to receive publicly he co-founded the Community Volunteer funded healthcare. In Ontario, the threeClinic for Uninsured Refugees after a teenmonth wait policy was implemented in ager named Aisha nearly died from sickle 1994 and also applies to temporary foreign cell anemia when denied medical care due workers and returning Canadians who have to a lack of insurance. been out of the country for five months or The evening-only clinic was run out of a longer. Ottawa provides the Interim Federal church basement by four nurse and physiHealth Program (IFHP) for refugee claimants. cian volunteers. Today, Caulford estimates However, the system is so cumbersome that the CCRIHC has 5,000 patients, with about many physicians refuse to sign on, and refu1,500 new ones every year replacing those gees lose coverage if their claim is denied, who finally find a family physician. Caulford says. In 2015, the clinic was renamed the Until such policies are changed, new CCRIHC, says Caulford. Almost all of the Canadians will needlessly suffer and even patients are homeless, residing in shelters, die, Caulford says. “In the beginning, we couch surfing or living in basement suites asked, ‘how could this be happening in while working two jobs under the table Canada?’ We are still asking 20 years later.”

Just For Canadian doctors Spring 2019

photos courtesy of Dr. Paul Caulford

Canada’s universal healthcare isn’t so universal, after all

Ring of Kerry

Tory Island

@Andrew Stewart

Unseen Ireland: Circumnavigate by Sea

Garnish Gardens

Cliffs of Moher

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travel the world

An Irish tale t s a e a n c i e n t e a st c o h t On a togr


+ ph o ry

phy by

Barb Sligl

if you go

Explore Ireland’s Ancient East (irelandsancienteast.com) by starting just north of Dublin in Carlingford (visitcarlingford.com) in County Louth (visitlouth.ie). For more on Ireland, go to ireland.com.

travel the world


Trim Castle bottom, from left Tholsel Gate in Carlingford; on the slopes of Slieve Foy, the mountain that looms above the village of Carlingford, where you might come across “rag trees” (or wishing or fairy trees) adorned with scraps of cloth and ribbons; guide Diarmaid Rankin in the Carlingford Friary/Abbey/Priory (depending on whose story it is)

his is traditional Ireland at its best,” says my guide and local “islander,” Diarmaid Rankin. We’re on the east coast, midway between Dublin and Belfast, on the shores of Carlingford Lough, where sweet-faced tufts of sheep graze on shamrock green at the foot of Slieve Foy, the highest of the Cooley Mountains. The Vikings came here in the ninth century. And then the Normans. Hugh de Lacy began building King John’s Castle in 1190 (the king being the brother of Richard the Lionheart). Another Norman ruin, Taaffes Castle, is set right within the medieval village of Carlingford that grew around it. Rankin looks up at the square-and-squat fortress of massive stone walls from the 12th century. The pre-Gothic structure is still standing because, as Rankin says, “It was a bit forgotten about.” This land of legends has been left almost untouched on the Cooley Peninsula, sheltered beneath the broad shoulders of Slieve Foy for centuries. And yet it’s been witness to wild stories, battles and creatures across a string of historical epochs. The history here is so rich, that it’s been dubbed “Ireland’s Ancient East.” I follow Rankin under Tholsel Gate, the medieval boundary of the town that dates from 1450 (and once a dungeon as well), to the abbey that’s not an abbey, that’s a priory that’s not a priory, that’s a friary. Rankin’s wry description becomes a bit of a refrain as the day continues. Things morph. Stories change. What was truth yesterday may be fable tomorrow. Or vice versa. Amid the roofless ruin’s still-soaring stone walls, he stands and sings a circa-14th-century “plain song” in a mash-up of Latin and Gaelic to showcase the friary’s astounding acoustics. The notes reverberate and seem to hover, aloft and ageless. Afterwards, we walk back to the main street to have lunch at a pub in the old town. The battered cod, minted mushy peas, champ (an Irish dish of mashed potatoes and scallions) and Friary pale ale (brewed by Carlingford Brewing Company right here on the Cooley Peninsula) are classic, local comfort food for the cool-and-overcast spring day. I ask Rankin about the abbey that’s not an abbey, that’s a priory that’s not a priory, that’s a friary. It’s a lovely mouthful. He tells me that there are no incorrect stories; the story told on that day is the “right” one. Like the tale he then shares. P. J. O’Hare, the original owner of PJ’s, the pub we’re in, had leprechaun encounters. There’s a glint in Rankin’s eye, but he continues. O’Hare found the bones of a leprechaun (as well as a green suit and four pieces of gold). Apparently, a couple hundred of these folk (Rankin clarifies to be more exact: it’s 236 or 237 leprechauns) live on Slieve Foy, that mountain overlooking Carlingford Lough (and, in fact, since 2009, they’ve been protected by the EU under the European Habitats Directive; “It is illegal to hunt leprechauns now under EU law,” says Rankin). Fact or fiction or superstition, leprechauns are indeed part of the culture and heritage here. There’s even a “leprechaun whisperer” in the town, who’s also written a book, The Last Leprechauns of Ireland, and started the annual Carlingford National Leprechaun Hunt (as in a search party, of sorts; this year, it takes place on May 12). It’s hard not to crack a smile, but Rankin himself has a perpetual grin on his face. He has his story, and the leprechaun whisperer has his, as did the late P. J. O’Hare. “I have my story, that my father told me whenever we walked up the Slieve and looked at the Gap to the north,” says Rankin of the local landmark and legends surrounding it. He now tells a story to his son, who’ll then tell his own. And as we sit in the pub over a pint of Friary ale, I hear another story with multiple versions at the same table. Táin Bó Cúailnge (the “Cattle Raid of Cooley”), or simply the Taín, is an epic tale that’s Ireland’s Beowulf or Iliad (a saga that involves a queen, her husband, jealousy, betrayal, revenge, battles and exploits, the Hound of Ulster…and two mythic bulls). It took place in these hills, beyond Slieve Foy, and signposts for the 40-km Taín Way hiking route, which follows the central character Queen Mebh’s march with her army, are seen throughout town. The infamous brown bull of Cooley, over whom the fierce battle was fought, is also very much present (in hearts and minds, but also on the logo of the Friary beer I’m drinking, as Rankin points out). After lunch, we trudge part way up Slieve Foy, past crumbling rock walls and long-deserted outposts. I’m on alert for leprechauns but the only other creatures out on this misty afternoon are sheep, lots and lots of sheep. Big fuzzy balls, full-coated in late spring, dot the green swathes of slopes. And wee bits of fluff. Lambs, born mere weeks ago, are baa’ing alongside their mothers. Ancient Carlingford and the moody lough are spread below. From here, it’s only 11 km to the border of Northern Ireland, and the Irish Sea is just beyond. And yet, this place feels utterly isolated. How wild and brave to march across these slopes, as Mebh did in another time. As did the Vikings and the Normans. Nearby are more castles and battles—from Trim Castle (another Spring 2019 Just For Canadian doctors


travel the world Hugh de Lacy fortification) and the Battle of the Boyne (an alltoo-true war with repercussions that shaped western politics for centuries). Ireland’s east coast thrums with threads of history that have been pulled this way and that. As we descend and return to the village, Rankin points out a fairy tree. The gnarly and moss-covered specimen is a blackthorn, long associated with folklore and magic, and stands alone (farmers won’t touch it, says Rankin). A pot next to it holds offerings to Queen Sadhbh, the fairy who lives beneath the tree with her daughters and subjects. “They are friends of the last leprechauns of Ireland,” says a plaque at the tree’s base. I’m not sure what to make of any of it. But I recall being entranced when, earlier in the day, Rankin and another Irishman spontaneously recited The Fairies by Irish poet William Allingham. They knew the words by heart and slipped into an easy rhythm together: Up the airy mountain / Down the rushy glen / We darn’t go a-hunting / For fear of little men / Wee folk, good folk / Trooping all together / Green jacket, red cap / And white owl’s feather… I don’t have a coin to drop in the pot for Queen Sadhbh, but as I walk away, I look back and glimpse a streak of long, wind-blown hair against the rock wall behind the fairy tree. Or maybe it’s a horse’s mane… I have my own story now, formed on a hillside in Ireland’s ancient east. clockwise, from top One of the denizens on Slieve Foy in the Cooley Peninsula (not pictured: the leprechauns and fairies); the ruins of Carlingford Friary, also known as Carlingford Abbey, also called Carlingford Priory…; the most commonly seen creatures on the green swathes of land in Ireland, especially in springtime


Just For Canadian doctors Spring 2019

dublin / nanaimo / berlin / flagstaff / singapore … | c a l e n d a r


A n intern ation a l guide to c ontinuing medical Education

spr ing 2019 + beyond


[go] For more

on Dublin: visit dublin.com. For more on Ireland, see page 14.

top, from left Stepping into one of Dublin’s most infamous bars; Doorman and William Scott painting at Merrion Hotel; Street scene, Temple Bar neighbourhood; A Guinness, of course bottom, from left Doorway to choir school at St. Patrick’s Cathedral; Trinity College’s Old Library; Exhibit at The Little Museum of Dublin; School girls in the National Gallery of Ireland

From books and art to beer and revelry: dublin (CME events in Dublin are highlighted in blue.)

barb sligl


ublin’s streets seem to echo the words of poets, playwrights, novelists…James Joyce, Oscar Wilde, Jonathan Swift, William Butler Yeats, George Bernard Shaw, Samuel Beckett. Their statues also seem to greet you everywhere, from a louche-looking Wilde lounging upon a rock in Merrion Square (in a natty pink-and-green smoking jacket) to a bespectacled Joyce musing in the courtyard of the Merrion Hotel. The conversations continue with these colourful figures of literature in the Dublin Writers Museum (writersmuseum.com), where their verse and letters are showcased within an original 18th-century house. On the other side of the Liffey River, across the slender arch and ironwork of the pedestrian Ha’penny Bridge (named so because that’s what it used to cost to cross it when it opened in 1816), and in another graceful Georgian building, is the whimsical Little Museum of Dublin(littlemuseum.ie). The lively guided tour is a celebration of the city’s charming, somewhat ribald character and history, from its official founding in 988 AD to the days of U2 (with a pack of U2 condoms on exhibit)

and the first woman elected as President of Ireland, Mary Robinson, who famously said: “I was elected by the women of Ireland, who instead of rocking the cradle, rocked the system.” More of Dublin’s bewitching personality is on display in the Temple Bar neighbourhood (a reference to the old word for a raised sandbank, “barr,” as well as the man who settled here in 1599, Sir William Temple). Today, the network of cobblestone streets and lanes is full of pubs, including the eponymous Temple Bar (site of Sir Temple’s home; thetemplebarpub.com), where ordering a pint will, of course, get you the local standby of Guinness. Back across the Liffey, the Guinness Storehouse (guinness-storehouse.com), part of the active St. James’s Gate brewery that’s been churning out the dark, delicious brew since 1759, is a destination itself—part history museum, part beer wonderland and even part school where you learn that optimal flavour, aroma and colour is achieved at 232°C (“roasted to a black state of perfection,” as the guide says), or, more importantly, how to pull a perfect pint (“the Guinness surge”). And, yes,

“Guinness is good for you,” as the renowned slogan goes. Beer, bars, bards. And books. At Trinity College (tcd.ie/visitors/book-of-kells), see the legendary Book of Kells (the oldest book in the world, it was scribed in 800 AD and has existed longer than Dublin) and then visit the early-18th-century Long Room in the Old Library, a glorious, two-storey, wall-to-wall display of some 200,000 tomes. Find a spot amidst the constant crowds to be still and behold the collection. Afterwards, explore more back-in-time beauty: St. Patrick’s Cathedral (where Swift is buried) and the National Gallery of Ireland (where you can see canvases by Yeats, an accomplished painter as well as poet). After gazing at a still life of Scottish-Irish painter William Scott in the National Gallery (nationalgallery. ie), cross the street to find another one in the lobby of the Merrion Hotel (merrionhotel.com). With a private collection of 19th- and 20th-century art that’s set amidst the grand interiors of a restored Georgian building (with that Joyce statue in the courtyard), it’s as if you’re ensconced in Dublin’s artistic heart. — Barb Sligl

Spring 2019 Just For Canadian doctors







Apr 18

Bethesda Maryland

Dissecting Spinal Pain Circuits For The Development Of Novel Viral Gene Therapies

Pittsburgh Center for Pain Research University of Pittsburgh School of Medicine



Aug 28-29

Rome Italy

9th International Conference On Alternative & Traditional Medicine

Pulsus Events

traditional medicine@ pulsusevents. org

traditionalalternative medicine. cmesociety. com

Oct 12-16

San Diego California

2019 Academy Of Integrative Health & Medicine Annual Conference

Academy of Integrative Health & Medicine (AIHM)



May 09-12

Chicago Illinois

Topics In Anesthesia + ACLS/PALS

Northwest Anaesthesia Seminars



Aug 19-20

Tokyo Japan

19th Edition Of International Conference On Dermatology And Melanoma



dermatology. euroscicon. com

Nov 04-07

Sedona Arizona

Sedona Red Rock & Grand Canyon Adventure 2019 Encore Symposium

Encore Symposiums



Feb 01-08 2020

Aspen Colorado

Aspen Anesthesia Seminar

Holiday Seminars


holiday seminars.com

May 04-07 2020

New Orleans Louisianna

Anesthesia Update In The Big Easy

Cornerstone Anesthesia Conferences


cornerstone anesthesia conferences. com

May 09-11

Indianapolis Indiana

Weinstein 2019 Cardiovascular Development And Regeneration Conference

Indiana University School of Medicine


iu.cloud-cme. com

May 19-22

Las Vegas Nevada

The Society For Cardiovascular Angiography And Interventions Scientific Sessions 2019

The Society for Cardiovascular Angiography and Interventions


scai.org/ scai2019

Jun 23-26

Orlando Florida

15th Annual Complex Cardiovascular Catheter Therapeutics: Advanced Endovascular And Coronary Intervention Global Summit (C3)

C3 Interventional Academy


c3conference. net

Sep 08-11

Singapore Singapore

Computing In Cardiology Conference 2019

Computing In Cardiology (CinC)



Oct 12-26

Japan, Korea & China Cruise

Essential Topics In Cardiology And Pulmonology: 2019 Update

Continuing Education, Inc./University at Sea


continuingedu cation.net

Oct 24-27

Montréal Quebec

Canadian Cardiovascular Congress 2019

Canadian Cardiovascular Congress


cardio congress.org

new CE to be placed

Norwegian Fjords on Holland America

Rome to Barcelona on Windstar

Egypt & the Nile on Uniworld





1980 SE






Medical Seminar at Sea & Scandinavian Healthcare June 7 – 21, 2020

Sleep Medicine & Effective Planning for Healthy Aging October 31 – November 11, 2020

Call Toll Free 877-737-7005

Just For Canadian doctors Spring 2019



Exploring Medicine & Mediterranean Healthcare October 22 – 29, 2019


Medical/Dental Heathcare Needs July 29 – August 5, 2019


Circle Iceland Cruise on Ponant


Current Medical Issues & Updates July 14 – 21, 2019

Visit our website for more exciting trips! • Japan on Windstar Last Minute Sale! • New Zealand & Australia • Taiwan, Philippines, Borneo & Indonesia

Alaska & Inside Passage on Princess




Professional Education Society — CME/CE Cruise & Travel Seminars




Alternative Medicine

cme when where

MORE CME Full-access CME calendar and destinations at justforcanadiandoctors.com/cme/




a divisio

MORE CME Full-access CME calendar and destinations at justforcanadiandoctors.com/cme/


Emergency Medicine



cme when where







Apr 03-07

Rancho Mirage California

Noah Worcester Dermatological Society (Noah) 61st Annual Meeting

Noah Worcester Dermatological Society



May 09-11

Nashville Tennessee

Music City SCALE -14th Annual Symposium For Cosmetic & Medical Dermatolgy

Tennessee Society for Laser Medicine and Surgery


tnlasersociety. com

Jun 27-30

Calgary Alberta

CDA 94th Annual Conference

Canadian Dermatology 800-267-3376 Association

dermatology. ca

Oct 03-06

Budenheim Germany

16th International Workshop On Langerhans Cells

Conventus Congressmanagement & Marketing GmbH



Jan 11-13 2020

Moshi Kilimanjaro Tanzania

Tropical Dermatology In Tanzania - A Unique Experience At The Regional Dermatology Training Centre

American Academy of Dermatology



Mar 30

Dublin Ireland

12th All-Ireland Conference Of The Primary Care Diabetes Society

Diabetes on the Net

44-20-3735 8244


Oct 30Nov 02

Boston Massachusetts

ISPAD 2019 - 45th Annual Conference

International Society for Pediatric and Adolescent Diabetes



Dec 06-07

Singapore Singapore

Dermatology, Skin Care And Skin Professionals Meet 2019

Lexis Conferences


lexis conferences. com/skincare

Apr 28May 01

Scottsdale Arizona



Jun 11-22

Northern & Western Europe Cruise

Topics in Critical Care And Pulmonary Medicine: 2019 Update

Continuing Education, Inc./University at Sea


continuingedu cation.net

Jan 08-11 2020

New Providence Bahamas

Topics In Emergency Medicine

Northwest Seminars


northwest seminars.com

Jan 09-11 2020

San Diego California

National Association of EMS Physicians Annual Meeting 2020

National Association of EMS Physicians



Apr 07-09

Los Angeles California

American Association Of Endocrine Surgeons (AAES) 40th Annual Meeting

American Association of Endocrine Surgeons (AAES)


endocrine surgery.org

Apr 28May 01

Glasgow Scotland

26th European Congress On Obesity (ECO 2019)

European Congress On Obesity



Aug 31Sep 03

Kraków Małopolskie Poland

41st ESPEN Congress On Clinical Nutrition & Metabolism

MCI Suisse SA


espen congress.com

Jan 20-22 2020

Haikou China

International Symposium On Diabetes

FLC Event



new CE to Emergency Department Emergency Department Practice Management be placed Practice Management Association (EDPMA) Solutions Summit 2019 Association

Boston University School of Medicine Continuing Medical Education Spring 2019 Just For Canadian doctors







Gorgan Iran

The New Congress Of Common Cancers Of The Gastrointestinal Tract 2019

Golestan University of Medical Sciences



May 18-21

San Diego California

Digestive Disease Week (DDW 2019)

Digestive Disease Week



Dec 05-07

New York New York

Gastroenterology, Hepatology & Nutrition 36th Annual Conference

Columbia University Medicine



Jun 09-12

Dublin Ireland

27th European Conference On General Thoracic Surgery

European Society of Thoracic Surgeons

44 -84-1519795


Jul 14-21

Alaskan Cruise

Current Medical Issues & Updates/ 7-Night Cruise Roundtrip Seattle On Star Princess

Professional Education Society

877-737-7005 See Ad Page 18


Oct 22-29

Yachting the Rivieras: Rome to Barcelona

Exploring Medicine & The Mediterranean Healthcare Model / 7-Night Cruise On Windstar Wind Surf

Professional Education Society

877-737-7005 See Ad Page 18


Oct 30Nov 02

Vancouver British Columbia

Family Medicine Forum 2019

The College of Family Physicians of Canada



Nov 07-09

Prague Czech Republic

Modern Molecular-Biochemical Markers In Clinical And Experimental Medicine

European Scientific Center Biomarkers



Jun 07-21 2020

Norwegian Fjords & the Midnight Sun

Medical Seminar At Sea & The Scandinavian Healthcare System/14-Night Cruise Along Norway’s Scenic Coast On Holland America’s Newest Ship



May 02-04

Halifax Nova Scotia

The Canadian Geriatrics Society 39th Annual Scientific Meeting

Canadian Geriatrics Society


thecanadian geriatric ssociety.wild apricot.org

Aug 09-11

Galveston Texas

Texas Geriatrics Society And Texas Society For Post-Acute And Long-Term Care Medicine TMDA Annual Conference

Texas Geriatrics Society

See website

texasgeriatrics. org

May 31- Chicago Jun 04 Illinois

ASCO Annual Meeting

American Society of Clinical Oncology



Dec 07-10

Orlando Florida

61st American Society Of Hematology Annual Meeting & Exposition

American Society Of Hematology


hematology. org

May 06-09

Boston Massachusetts

Gastrointestinal, Liver, And Pancreatic Pathology 2019

Harvard Medical School


hms.harvard. edu

May 15-18

Toronto Ontario

International Liver Transplantation Society 25th Annual International Congress 2019

International Liver Transplantation Society



May 06-11

Ljubljana Slovenia

37​th Annual Meeting Of The European Society For Paediatric Infectious Diseases

European Society for Paediatric Infectious Diseases

See website

espidmeeting. org

Nov 07-09

Johannesburg South Africa

8th Federation Of Infectious Diseases Societies Of Southern Africa Congress

Federation of Infectious Diseases Societies of Southern Africa



Infectious & Chronic Diseases


General & Family Medicine


May 01-03




cme when where

MORE CME Full-access CME calendar and destinations at justforcanadiandoctors.com/cme/

new CE toProfessional Education be placedSociety

NYU Radiology CME Presents

38th Annual Head to Toe Imaging Conference December 16-20, 2019 • The New York Hilton Midtown • New York City

Earn over 40 AMA PRA Category I Credits www.med.nyu.edu/courses/cme/h2t19


Just For Canadian doctors Spring 2019

MORE CME Full-access CME calendar and destinations at justforcanadiandoctors.com/cme/


Nutritional Medicine


Mental Health

Internal Medicine

cme when where







May 06-10

Hilton Head Island South Carolina

Controversies In Internal Medicine

Boston University School of Medicine

617-358-5005 See Ad Page 19


May 16-18

Aspen Colorado

Trending Topics In Internal Medicine 2019

Mayo Foundation for Education and Research


gimeducation. mayo.edu

Aug 01-03

San Diego California

Primary Care Network (PCN) Destination Conference

Primary Care Network


primarycare network.org

Apr 13-27

French Polynesia Cruise (m/s Paul Gauguin)

Medical CBT For Stress And Anxiety: Ten-Minute Techniques For Real Doctors

CBT Canada



May 10-11

Richmond British Columbia

20th Canadian Collaborative Mental Health Care Conference

Hamilton Family Health Team



Jun 03-07

Galway Ireland

Towards Psychotherapy Integration: Mind-Brain-Gene

Boston University School of Medicine





Summer Symposia For Mental Health Professionals

University new Boston CE to School of Medicine be placed

Jul 08-19

Cape Cod Massachusetts

• Transformational Moments: How Master Clinicians Think, Talk, And Listen When Facing The Most Challenging Of Clinical Tasks • Forgiveness: Mindfulness And Compassion In Action • Clinical Psychopharmacology: Overview And Recent Advances • Challenging Clients: Creative Use Of Best Practices

May 30Jun 01

Łódź Poland

VI Scientific And Training Conference Of The Polish Neurological Society

Via Medica

48-58-320 9494


Jan 10-12 2020

Fort Lauderdale Florida

American Society For Peripheral Nerve (ASPN) Annual Meeting 2020

American Society for Peripheral Nerve


peripheral nerve.org

Apr 06

Vancouver British Columbia

Nutrition In Primary Care: Update And Controversies

International Society for Orthomolecular Medicine

See website See Ad Page 21

isom.ca/event/ npc-bc

May 31Jun 02

Vancouver British Columbia

48th Annual International Orthomolecular Medicine Today Conference

International Society for Orthomolecular Medicine

See website See Ad Page 21

isom.ca/event/ omt2019

Mar 20-23

Vienna Austria

St.Gallen International Breast Cancer Conference: Primary Therapy Of Early Breast Cancer Evidence, Controversies, Consensus

St.Gallen Oncology Conferences


oncoconfer ences.ch

Aug 03-04

Newry Maine

Hormone-Dependent Cancers Gordon Research Seminar - Overcoming Endocrine Resistance And Metastasis In HormoneDependent Cancers

Gordon Research Conferences



Jan 09-11 2020

Houston Texas

NRG Oncology Meeting

NRG Oncology


nrgoncology. org

48th Annual International Conference

Orthomolecular Medicine Today The Annual International Orthomolecular Medicine Today Conference is a continuing education event for medical doctors, nurse practitioners, pharmacists, and other health care professionals. The Conference provides a forum for leading clinicians and researchers to present current advances in orthomolecular oncology, immunology and general medicine. Learn about the safe and effective use of naturally-occurring molecules for improving patient outcomes.

Fairmont Hotel Vancouver May 31 – June 2, 2019

Information & Registration: www.isom.ca Spring 2019 Just For Canadian doctors




Wilderness and Travel Medicine


Primary Care


Pain Management


cme when where

MORE CME Full-access CME calendar and destinations at justforcanadiandoctors.com/cme/





Jun 19-22

Montréal Québec

Canadian Orthopaedic Association Annual Meeting And International Combined Orthopaedic Research Societies (ICORS)

Canadian Orthopaedic Association

514 874-9003


Oct 22-25

Berlin Germany

DKOU 2019 - German Congress Of Orthopaedics And Traumatology

Intercongress GmbH



Jul 25-28

Lake Buena Vista Florida

Headache Update

Diamond Headache Clinic

312-867-9104 See Ad Page 2


Aug 06-15

Blue Danube River Cruise Conference

Topics In Family Medicine, Palliative Care, And Pain Management

Continuing Education, Inc./University at Sea

866-456-9464 See Ad Page 31

continuingedu cation.net

Sep 05-08

Dublin Ireland

IHC 2019: 19th Congress Of The International Headache Society

International Headache 44-1-730-71Society 5274

mci-group. com

Nov 23

Chicago Illinois

Update In Headache 2019

Diamond Headache Clinic

312-867-9104 See Ad Page 2


Apr 07-10

Buenos Aires Argentina

World Congress Of Pediatric ENT

Argentine Association of Pediatric ENT and Speech Therapy

info@ wcpediatricent. com.ar

wcpediatricent. com.ar

Apr 15-19

Hilton Head Island South Carolina

Current Clinical Pediatrics

617-358-5005 See Ad Page 19


Jul 08-12

Palm Coast Florida

new CE to 10th Annual Essentials Inbe Primary Care placed Summer Conference

Boston University School of Medicine Continuing Education Company


cmemeeting. org

Sep 22Oct 01

Spain, France & Italy Cruise

Primary Care 2019 Update: Type 2 Diabetes, Metabolic Syndrome And Obesity

Continuing Education, Inc./University at Sea

866-456-9464 See Ad Page 31

continuingedu cation.net

May 20-22

New York New York

NYU’s 2019 Advanced Imaging Of The Musculoskeletal System: Up Your Game

New York University Department of Radiology

212-263-3936 See Ad Page 20

med.nyu.edu/ courses/cme/ sports19

Jul 22-26

Fairmont Southampton Bermuda

NYU’s Clinical Imaging Symposium In Bermuda

New York University Department of Radiology

212-263-3936 See Ad Page 20

med.nyu.edu/ courses/cme/ bermuda19

Oct 21-25

Charleston South Carolina

NYU’s Fall Radiology Symposium In Charleston

New York University Department of Radiology


med.nyu.edu/ courses/cme/ sc19

May 24

Nanaimo British Columbia

5th Annual Rural Locum Forum

Rural Coordination Centre of BC

conference@ rccbc.ca


Nov 01-10

Flagstaff Arizona

Wilderness First Responder Course

National Outdoor Leadership School



For feedback, requests or to have your course featured please email cme@inprintpublications.com or submit your course via www.justforcanadiandoctors.com


Just For Canadian doctors Spring 2019

t h e w e a lt h y d o c t o r M a n f r e d p u r t z k i Manfred Purtzki, CPA, CA, is a principal in the Vancouver office of Purtzki Johansen & Associates. He can be reached at: Manfred@purtzki.com or 604-669-7558.

Split that income

Four ways to reduce the damage that TOSI puts on your personal taxes


ince the new Tax On Split Income (TOSI) rules were implemented last year, doctors have been working with their accountants to try to minimize the resulting (and drastic) increase in personal taxes. The good news is that there are ways to do so, like these four strategies that allow you, as a physician, to still income-split with family members in lower tax brackets.

Minimize TOSI’s resulting (and drastic) personal tax increase

at any time in the past, then any dividend received from the medical practice will not be subject to TOSI. CRA has clarified that it will generally accept timesheets, payroll records, schedules or logbooks as sufficient proof to establish the employment. It’s very important then, to keep your payroll records for at least five years. The CRA says it will consider the following factors when deciding whether a family member qualifies for this exemption: a. The type of duties performed as they relate to the clinic’s activities. b. The individual’s education, training and experience. c. Any particular knowledge, skills or knowhow possessed by the individual. 2


The 20-hour-per-week exemption

This is a big one. To qualify for the exemption, the family member must prove that he/she has worked on average at least 20 hours a week in the practice in the current year. This exclusion will also apply if the 20-hour-per-week test has been satisfied in a total of five previous taxation years. This applies regardless of when in the past these five years occurred, and the five years do not have to be in succession. So, if a family member has worked at least 20 hours a week on average for five years

Reasonable remuneration

TOSI rules do not apply to salaries paid to family members for actual work performed, provided that the salaries are reasonable. A good test of reasonableness is to pay the family member what you would have paid to a third party. 3

The age exemption

The government did not want to upset retirement planning for doctors, who are in the sunset of their medical careers. If you are 65 years or older in 2019, you’re allowed to income-split with your spouse without

any restrictions. The spouse’s age does not matter. 4 The lifetime capital gains exemption

4 ways to lower that personal income


When you sell your medical practice, which may include the clinic real estate, by selling the shares of the corporation, you will benefit from the $848,252 lifetime capital gains exemption. However, this exemption only applies in the event of a share sale. The exemption extends to all company shareholders. If you have a family trust, with four family members as beneficiaries, your total entitlement will be $3,393,000. Make sure you qualify for this exemption. To access the capital exemption, the shares must be “qualifying small business shares” and meet the following three conditions. a. At the time of sale, 90% of the fair market value of the corporate assets must be used in an active practice. b. During the 24 months prior to the sale of the shares, 50% of the fair market value of the corporation’s assets must have been used in an active business. c. You must have owned the shares 24 months prior to the sale.

at your

service Spring 2019 Just For Canadian doctors


travel at home

History’s harbour

In Kingston, Ontario, history 's in full regalia story by


Mark Stevens + photography by Sharon Matthews Stevens

t’s early morning. The rising sun backlights the sky-reaching pines that sprout from the ridges of Cedar Island; it highlights the rippled cobalt waters of Lake Ontario with dabs of orange and pink. Those waters lap the shores of Kingston, Ontario. They nuzzle the harbour just beyond the limestone train station (circa 1855) beside a nineteenth-century locomotive, just past the neoclassical façade of city hall, an imposing building begun in 1842 when Kingston was declared the capital of the Province of Canada. Here, tour boats and sailboats and pleasure craft of every stripe strain at their dock lines like thoroughbreds in the starting gates of a horse race. I stand beside my wife, taking in the scene. I note the implacable ramparts of old Fort Henry dominating the slopes overlooking Navy Bay. Around the corner the stone remnants of Fort Frontenac, built four centuries ago, rest in peace. In the immediate foreground, surrounded by those impatient watercraft, a round stone bastion rises up from the very waters of the lake, right in the middle of this marina named Confederation Basin. It is a Martello tower, a small defensive fort erected through the empire by the British military during the Napoleonic Wars. Six stand guard in the Kingston area. We’ll visit one later today (the Murney Tower is open to the public and has three floors of military and domestic artifacts), but for now we’re happy to take in the view. We’ve just begun our homage to heritage here in Kingston, a quintessential Canadian rite of passage, and our first waypoint couldn’t be more appropriate. For these are the waters of history’s harbour. But Kingston’s legacy—and primacy as a Canadian must-do destination—is hardly limited to this photogenic shoreline. Minutes later we embark on a hop-on, hop-off trolley bus tour to delve deeper into our history lesson. The trolley lurches into motion. We pass the site of Ontario’s oldest market, we pass the Royal Military College and Fort Henry; we drive along city streets decorated by a ransom of limestone mansions. We stop at Bellevue House, Sir John A. MacDonald’s restored residence; we climb from the trolley to check out the Penitentiary Museum. Inside we encounter grisly displays of instruments of torture, of simple tools like toothbrushes transformed into weapons. Then we cross the street to another haven of history: the “Kingston Pen.” During the prison tour, we stand in one of a collection of cells radiating outward from a central gun tower like wagon wheel spokes. We visit the segregation wing. We wonder about ghosts. Back outside these somber walls we discover another historic harbour, this one full of happier stories. In the waters outside Olympic Portsmouth Harbour, a concatenation of sailboats weaves and bobs in a huge regatta. For a short time Kingston was Canada’s capital. To this day it’s Canada’s sailing capital. During the Montréal Olympics, Kingston hosted the sailing events. After the end of our trolley tour we discover that sailing’s only one option for the energetic. On our way back downtown we notice a sign that says “Ahoy Rentals” guarding a wooden lakeshore building. We consider our options. “Book kayaks, a sailboat cruise, canoes,” says proprietor Andrew Kelm. “Book a bike, a stand-up paddleboard. Even do early morning yoga on those boards out on the water.”


Just For Canadian doctors Spring 2019

Buglers sound the start of the weekly Fort Henry Sunset Ceremony below, from left The Trolley (stopped at the Penitentiary Museum) offers a great Kingston overview; St. George’s Cathedral, venue for free summer concerts; Kingston’s a sailor’s paradise, host to numerous regattas next page The Thousand Islands… of which there are actually almost 2,000

travel at home

if you go

For all the information you need for your lesson in history, from accommodation packages and guides to the area’s 26 museums and historic sites, log on to: visit kingston.ca.

travel at home

Just For Canadian doctors Spring 2019



st le


th e

Th o u

sand Islands

We see history, we hear history, we taste it on our very tongues. As night falls, the soldiers lower Canada’s flag followed by a bugle dirge. We march from the fort, stopping on the ramparts for one last look. We take in Kingston city hall’s dome across Navy Bay, illuminated in the evening, sky-reaching church spires, moon-dappled rippled waters. The waters of history’s harbour.


wealth of galleries to artist studios to dance.” But the wealth of history and culture doesn’t end here. It flows east as surely as the nearby St. Lawrence River. In Gananoque we book live theatre at the Gananoque Playhouse, a historic waterside venue that offers a whole summer playlist of shows. The surrounding waters are rife with stories. Throughout the Thousand Islands, landforms are named for navy ships and admirals, and a nearby cove is where the French ambushed the English in 1760 and pirates hid their treasure and rum-runners found secret lairs for their liquid loot. Appealing as this adjacent region is, I desert it with regret to spend our final night at the Sunset Ceremony at the Fort Henry National Historic Site. So back to Kingston. The parade square soldiers in scarlet tunics quickstep, boot leather slapping the tarmac. They form a battle formation; they split into opposing groups. Gun crews trundle cannons in massive carriages across the square. Now artillery barrages reverberate inside the fortress walls. Fire exploding from the barrels of 50 muskets lights up the night sky. Gun smoke shrouds the parade ground.

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But we save that for later. For now we stroll downtown streets, planning strategy. Lunch beside the harbour? Maybe patio-dining in the shade of a limestone carriageway? Then we register the sound of music emanating from St. George’s Anglican Cathedral (circa 1828) and we forego lunch (for now), marching instead into the church to be serenaded by a professional string quartet in a noontime concert. Tonight we’re lured, in a bar mere metres from the water’s edge, by jazz riffs. We stop in for a drink at Monte’s, tapping our feet to the samba grooves of the 20th Century Jazz Band led by local musician Craig Jones. We while away the evening in a rustic bar lined in dark wood and those ubiquitous limestone walls. And now I realize that Kingston’s allures are not limited to history or outdoor pursuits. “Kingston punches way above its weight when it comes to the arts,” says Josephine Matyas, a local travel writer. Matyas, who has written for Kingston Life for 17 years, explains: “The university here creates an interesting mix of people who demand a rich culture. Kingston delivers: from great music to a


n hour’s sail from Kingston, ON, on the American side of the St. Lawrence River, there’s a miniature medieval castle. Turrets of rough-hewn stone, capped by candlesnuffer roofs of cedar shingles, rise from sun-dappled waters. Steep roofs of red clay tiles and multiple chimneys constructed from quarried granite reach skyward out of the lush green quilt of pines and oaks. But this romantic if Lilliputian “castle” is a mere electrical powerhouse servicing Boldt Castle—a full-scale Rhineland fantasy despite its location on an island smack dab in the middle of this numerical archipelago. No coincidence that its driving force, George C. Boldt, was born in Prussia. Cue the Wagner overture. Cue the epiphany. For days you’ve bonded with history on the Canadian side of the St. Lawrence. Think 23 museums and historic sites, from hilltop forts to a UNESCO designated historic canal. Now you’re sailing across the border, into the US and past the hotel where they invented a salad dressing, a motorboat museum and an island that was given away during an episode of The Price is Right sometime in the 1960s. Oh, and a castle. Welcome to the river’s other side. Welcome to history’s other side. For all its Trumpian overkill (begun in 1900, the castle is six stories and encompasses 120 rooms; its construction lasted four years and employed 300 workmen yet it still wasn’t finished; owner Boldt changed

the island’s name from “Hart” to “Heart” and ordered that the shoreline be modified so it more closely resembled that romantic shape), the Boldt Castle was an enormous labour of love. Hardly surprising, it’s one of New York state’s most soughtafter wedding venues. This six-acre island includes an Italian garden replete with central fountain, a “gate” modeled after a Roman arch and several castle rooms that have been refurbished to look as if Mr. and Mrs. Boldt had actually lived here. For here’s the back story— and the really romantic part. Boldt got wildly rich partly due to his management of the Waldorf-Astoria Hotel in New York and his ownership of some other properties. He fell in love with a lady named Louise. They married. He began this castle as a symbol of his love. Construction began in 1900. Fast forward to January, 1904. Louise died and George sent a telegram ordering the immediate cessation of construction. Neither he nor his children ever set foot on the island again, leaving things up to the Thousand Islands Bridge Corporation, which finally finished the job in 1977 and maintains the site today. Touring these grounds on a late spring or summer afternoon, en route back to Gananoque, you might feel the tug of this heart-shaped isle. Sure, the Canadian side of the St. Lawrence offers up a heaping helping of history. But here—on history’s other side— you’ve discovered a love story for the ages. — Mark Stevens

Solve SUDOKU #2 for a chance to win a $50 Amazon gift card! Fill in the grid so that every row, column and 3x3 square contains the digits 1 through 9. $50 Amazon Gift Card winner: Dr. Jennifer Kask of Campbell River, BC

sudoku 1 easier solution on page 28

History’s Other Side


sudoku 2 harder solution in next issue

[go] For more on the “castle”: boldtcastle.com. To visit, take Gananoque Boat Line’s Thousand Islands tour (bring your passport!): ganboat line.com.

3 5 6 4 3 2 3 6 2 1 4 7 1 2 7 9 2 8


2 9 7 4 1 3 5 9 8 4 5 8 7 6

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4 7 4

9 1 9 7 6 6 3 8 4

7 2

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sudoku Contest Rules: 1. Entry form must be accompanied with solved puzzle. Only correctly solved puzzles entered into random draw. 2. Send puzzle + entry form to Just For Canadian Doctors, 200 – 896 Cambie St., Vancouver, BC, V6B 2P6 or fax 604-681-0456. Entries must be received by May 17, 2019. 3. Prize: $50 Amazon Gift Card. 4. Contest can be changed and/or cancelled without prior notice. 5. All entries become property of In Print Publications. 6. Employees of In Print Publications and its affiliates are not eligible to participate. 7. In Print Publications is not responsible for lost or stolen prizes. Spring 2019 Just For Canadian doctors


d o c t o r o n a s o a p b o x d r . c h r i s p e n g i l ly Dr. Chris Pengilly is Just For Canadian Doctors’ current affairs columnist. Please send your comments to him via his website at drpeng.ca.

Electronic medical record

Going electronic is the

Hints towards optimal use of EMR

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Just For Canadian doctors Spring 2019

single field template for encounter records. Unless you have typing skills of about 70 words per minute or better, typing in the information can be time consuming, tiring and expensive. Fortunately, over the past couple of years voice recognition has reached the point of being very usable. It’s my observation that this facility alone improves the quality and safety of the encounter. Building up a cumulative patient profile is important. It’s often this transfer of information to the EMR that puts off many physicians from adopting the EMR. Again, I refer to the provincial medical organisations to negotiate a one-time payment for the physician to hire a nurse, medical student or medical transcriptionist to transfer the data. A patient’s vital signs should be entered in the appropriate EMR tab. If it is entered into the encounter note alone, it will be difficult to find for future reference and any trends will not be readily apparent. Most EMRs are continuing to develop patient recall and preventative care facilities. These can often be dealt with by a practice nurse or well-trained office assistant. This will increase income from appropriate necessary recalls. Finally the majority of EMRs will have the ability to check for optimum billing. The EMR vendor should be able to teach one member of the office staff to use this facility to ensure that you are fairly remunerated for all that you do. At this stage, the EMR is a worthwhile but not yet perfect work-in-progress, and it will continue to improve.

sudoku 2 harder solution 5 8 6 4 3 9 7 1 2 9 2 3 1 7 6 5 8 4 7 4 1 8 2 5 3 6 9 4 3 8 2 5 7 6 9 1 1 9 7 6 8 3 4 2 5 6 5 2 9 4 1 8 3 7 2 6 4 7 1 8 9 5 3 3 1 9 5 6 4 2 7 8 8 7 5 3 9 2 1 4 6

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solution from page 27

will do, and things that it will not do… Here’s my take on the basic pros and cons. • It will not save you money, though there is a good chance it will increase your billing. • It will not save a lot of time. • It will, however, improve the quality of your medical records. • It will, if utilised appropriately, improve quality of patient care. And for those who have adopted the EMR, optimal utilisation can moderate the first two bullets above and enhance the latter two. I’ve had the privilege of over 30 years of peer assessing practices; my experience has revealed a few common errors that result in suboptimal use of the EMR. It grieves me to see this expensive utility being used as a simple notepad… A very common one, which can directly affect patient safety, is entering (or not) the drug allergy status of the patient. Leaving the “Drug Allergies” tab blank can mean that either the patient has no allergies or that the patient was not asked. This has the potential for a disastrous error. Most EMRs should make it easy to enter “NKDA” with one click of the mouse. The next one is that most EMRs offer templates for office encounters. Usually there is a variety of these. The one I commonly see employed is the SOAP format with an individual field for each of the four parameters. It takes time to go from field to field, and cutting-and-pasting (which I find I frequently employ) can be quite laborious. I suggest that it’s best to choose a basic

solution from Winter 2019 contest


t the last count—National Physician Survey (CMA) 2015—75% of physicians across the nation were using the electronic medical record (EMR). This was a dramatic improvement from the previous survey in 2007 when just 25% of doctors were using EMRs. Utilisation is not evenly distributed across the nation. Leading the pack are Alberta (87%), British Columbia (85%) and Ontario (83%). The later adopters include New Brunswick (62%), Québec (64%) and Newfoundland and Labrador (68%). The rate of adoption seems to be roughly related to provincial financial assistance for setup costs. New Brunswick, for example, had no setup funding at all until 2013. Unfortunately there has been a golden opportunity missed, at early intervention, to make sure that all the EMRs, hospitals, facilities and physician offices are easily able to communicate with each other. The need for this communication has been recognised for some time now, but the longer this is not addressed, the more difficult it becomes. Commercial interests are at least in some part to blame—and I fear will continue to hamper the process. Nevertheless, I suggest that individual physicians and provincial medical societies constantly put pressure on provincial and federal governments to address this. I’m sure that we can all think of situations where integrated electronic medical records would have saved time and money—and, even more importantly, have improved patient outcomes. For those who are still considering adopting the EMR, there are things that it


sudoku 1 easier solution 7 3 9 5 8 1 6 2 4 5 6 8 4 3 2 7 9 1 1 2 4 6 7 9 3 5 8 3 5 6 8 9 7 4 1 2 9 8 2 1 4 3 5 7 6 4 7 1 2 5 6 8 3 9 2 1 5 7 6 8 9 4 3 6 4 3 9 2 5 1 8 7 8 9 7 3 1 4 2 6 5

Puzzle by websudoku.com


s m a l l ta l k

doctors’ picks + pleasures dr. lorne porayko is, as he says, intense. From practising muay thai (his form of relaxation) to embodying Kia Ha Ha (Maori for “Be Strong” and his motto), this doctor is all in. He knows how to splurge (a great Pinot Noir!) and who to travel with (his wife, Jennifer). Next up, you’ll find him either fishing off the Queen Charlottes (Haida Gwaii), returning to Vietnam or on an African safari. Meanwhile, his next project is helping fellow physician and allied professional colleagues in understanding and setting up a pension plan (3pfinancial.com). So they can travel too…

I live, practise in: Victoria, BC My training: MD 1993 FRCPC Anaesthesiology & Critical Care Why I was drawn to medicine: My Dad was my hero…and

A “wow” hotel/ resort I’d happily stay at again: Raffles Hotel in Singapore A favourite place that I keep returning to: Vietnam Can’t believe I’ve never been to: Africa…can hardly wait!

I always travel with: Jennifer, my significantly better half Favourite city: Istanbul Favourite book: Atlas Shrugged Favourite film: Tombstone Must-see TV: None really

I’d describe my home as: Very expensive :-( My car: Honda Accord—faster than I need My last splurge: A great Pinot Noir Most-frequented store: Amazon (hate shopping!) I have too many: T-shirts (my wife thinks so, anyway)

Celebrity crush: Nope I’d want this with me if stranded on a desert island: Books My secret to relaxing and relieving tension: Sparring A talent I wish I had: Anything artistic

Mu ay Thai master + adventu re seeker

happened to be a neurosurgeon! My last trip: Huatulco, Mexico Most exotic place I’ve travelled to: Rural Vietnam— very cool! The best souvenir I’ve brought back from a trip: Samurai sword


book + chocolate lover Dream vacation: African safari & wine tour If I could travel to any time, I’d go to: 2100 My jet lag cure: Melatonin

Just For Canadian doctors Spring 2019

Favourite music/ band: Depends on the context ;-)

My fridge is always stocked with: Wine, fruit and yogurt

My first job: Computer geek

Guilty pleasure: Dark chocolate

Gadget or gear that I can’t do without: iPad

Go-to exercise: Muay Thai Favourite spectator sport: Any martial art

The word that best describes me: Intense I’m inspired by: Heroic acts My motto: Kia Ha Ha (Maori for “Be Strong”) A cause that’s close to my heart: SPCA

Dr. Porayko’s favourite film and book, and a few of his forms of stress relief (above, second from left): Muay Thai, a form of martial arts (he’s even taken lessons while travelling in Mexico), ziplining in Sooke, BC, and fishing in Baja.

A big challenge I’ve faced: Legionella pneumonia (nearly finished me)

Something I haven’t done yet that’s on my must-do list: Fish off the Queen Charlottes

One thing I’d change about myself: Tolerance for dissent

If I wasn’t a doctor, I’d be: Computer geek, probably

photos courtesy of lorne porayko

My name: Lorne David Porayko, MD, FRCPC, CIM

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