Medical Society of PEI THE PULSE - SPRING 2013 1
The Pulse
Spring 2013
Better Access, Better Care. is it true?
On March 19th, the Government of PEI announced what the Minister of Health called “major changes” to the way health care will be delivered in rural PEI. Under the rubric “Better Access, Better Care”, he outlined a series of significant changes which, he believes, have the potential to improve the delivery of health care in West Prince and King’s County, while shifting most of the responsibility for acute care delivery to the QEH in Charlottetown and PCH in Summerside. Here’s what our government hopes to achieve. First, let me say that it is encouraging that a PEI government seems prepared to make unpopular decisions in the hope of improving quality and achieving better utilization of limited resources. Good for them. However, as they have also demonstrated in the past, governments are not always willing to stick to their guns when communities mount vigorous opposition to their plans, e.g. last year’s plan to centralize hemodialysis services in Charlottetown and Summerside. One of the changes announced the other day was to leave things the way they are, i.e. leave the hemodialysis units in Souris and Alberton, thus reversing a position they took last year to move these
programs from rural to urban PEI. If it made sense to centralize these programs last year, but doesn’t now, one must assume that the compelling reasons for imposing a significant hardship on patients in rural PEI with chronic renal failure have changed dramatically in the past 12 months. The cynical among you might think that it has simply become politically unpalatable to make such a move at this time. Besides, if Alberton and Souris get to keep their hemodialysis programs, the other proposed changes might not seem so draconian.
local resource has always been that it keeps the frail elderly, who occupy the vast majority of these beds, in their home community, close to family support, an often unconsidered resource. There is a growing suspicion amongst health administrators and planners, fueled by external utilization reviews, that many of these patients shouldn’t even be in hospital. If they were in larger communities with reasonable access to home care services, 7 days a week, that might well be the case, but it isn’t true in West Prince, and it isn’t true in Eastern Kings either.
Right Brain
So, how will these changes, should they ever come to pass, improve the way health care is delivered in rural PEI? Let me review the government’s plans, as I understand them. Minister Currie wants to convert O’Leary Hospital and Souris Hospital into strictly Alternate Level of Care (ALC) facilities. Currently, each of these facilities has a mix of acute care, palliative care, respite care and long-term [manor] beds. In my experience, many of the acute care beds in rural PEI are occupied by patients awaiting long-term care placement. The acuity level of the patients in these beds is relatively low, as it should be. The benefit of this
Minister Currie also wants to convert Stewart Memorial Hospital in Tyne Valley to a Long Term Care (LTC) facility. While creating more long term care beds in rural PEI seems to afford an opportunity to move many of those bed blockers out of the QEH and PCH, freeing up more acute care beds in Charlottetown and Summerside, I am concerned that frail elderly patients will be relocated far from their family and community supports. If that happens, there will be no shortage of long-term care beds in the province as research has shown that the dementing elderly do not tolerate relocation and unfamiliar
downtown Charlottetown.
Released, June 2013 The Medical Society proudly announces the fourth annual Right Brain Released Art Show. Last year’s robustly creative artists presented their many talents in the visual arts genre at The Guild Gallery,
This year we are encouraging you to get an early start on your art piece(s) to ensure inclusion in this richly received exhibition.
Please submit your Artwork to the MSPEI Office by May 24, 2013
2 THE PULSE - SPRING 2013 Medical Society of PEI
environments well, and turnover in LTC is sure to increase. Unless attention is paid to the availability of LTC beds in Queen’s and East Prince for local residents, this strategy won’t work. Sick elderly moved from West Prince to Summerside or from Eastern Kings to Charlottetown are more likely to suffer the same fate. Care needs to be taken that LTC beds in West Prince and Eastern Kings are used only for residents of those districts. LTC patients from Southern Kings, Queens and East Prince need to stay in their own regions for the same reasons. Adequate resources need to be put in place for the early repatriation of patients to their rural communities by providing sufficient numbers of restorative and palliative beds in O’Leary, Alberton, Tyne Valley, Souris and Montague. This would help offload some of the pressure on acute care beds at the QEH and PCH, which should be used strictly for acute care problems.
While I can understand the value of dedicated transportation vehicles taking non-emergent patients between Island facilities and off-island, I am not sure that the addition of another emergency response vehicle [ERV] in West Prince and King’s County can be justified. If there is an ongoing major issue with response times in these areas and government has to improve response times, the extra resources will be welcomed. Otherwise, positioning an ERV in Alberton and Souris, where emergency ambulances are currently stationed, will only add value if the ambulance is already out on a call and unable to respond in a timely fashion, a situation which arises infrequently in such a low volume service. If the ERV is staffed with a paramedic[s], it may very well reduce the role of the paramedic-staffed emergency ambulance to that of transport vehicle. Kind of defeats the purpose, don’t you think? Sounds good, though.
The most worrisome health issue for rural Islanders has always been their access to emergency services. It is easy to understand their angst, living in a harsh and isolated environment where travel is often an uncertain proposition. Most people see their local physician as their only real access to life-saving care, and take great comfort in his/her availability, 24/7. Theirs is a false security, based on fading memories of the good old days when the local doc was at their beck and call. This is no longer the case. As we have all witnessed, it is getting harder and harder to recruit physicians to rural practices, both here and across North America. It is even more difficult to keep physicians in isolated communities for a whole host of reasons, including professional isolation, spousal pressure, lack of local amenities, the seduction of easy relocation anywhere in the world and incessant patient demands in an underserviced environment. Unless we can figure out how to make the rural community a more attractive practice destination, it will always be a challenge. Turning the Emergency Department [ED] at Western Hospital in Alberton into a Collaborative Emergency Center [CEC] is an attempt to make the best of a bad situation in a community which lacks the resources to attract and hold on to physicians willing and trained to deal with emergencies. Only five of the current eleven physicians in West Prince cover the ED in Alberton, and locum physicians prepared to work in West Prince are very difficult to find. Souris has had a high turnover of physicians for years, for all of the same reasons found in West Prince. Government has reached the point where it is willing to consider replacing physicians with nurse practitioners [NP], paramedics, physician assistants, social workers or anyone else who is more readily available and willing to lend a hand. It is not clear that the physicians of West Prince who do not currently work in the ED at Western will be prepared to provide back-up call at night to the NP, RN or paramedic working in the ED. This is the model being proposed for Western Hospital. The issue of professional liability will have to be clarified up front, i.e. if the physician gives advice to a nurse but doesn’t see the patient, what is the doc’s responsibility ? One of the major reasons for taking the physician out of the ED at Western Hospital at night is so that they will be able to work in their offices the day after their ED shift. This is currently a big problem because the docs have been working 24 hour ED shifts, and next day offices get cancelled sometimes. In my opinion, rural PEI lacks adequate timely access to basic medical services, and successful efforts to rectify this problem should have a major impact on patient volumes in walk-in clinics and local EDs. I believe that the people of PEI, both rural and urban, would benefit most if primary care providers focused on meeting patient demand in their offices, keeping them out of the EDs and walk-in clinics.
The introduction of a 24 hour a day patient information service “8-1-1 Telehealth” seems like a good idea, but I wonder whether, in the end, it will result in fewer or more contacts with the health care system overall, i.e. if I am worried and call the help line, will the advice I receive replace further contact with other health providers regarding my current issue, or will I still seek follow up care from my family doctor or others, effectively increasing the cost to the system? It’s kind of like people going to a walk-in clinic or urgent care centre because they are worried that they will have to wait eight hours to be seen in Emergency, then being referred to Emergency after being seen in the clinic. This results in an obvious duplication of effort and is not that uncommon. It’s hard to know whether we are simply adding another layer of service for the worried well or if the introduction of such a service actually will reduce visits to doctors, emergency departments or walk-in clinics. I haven’t seen any recent research on this subject, which suggests that this is a question which may be difficult to answer. From a political perspective, the introduction of tele-health should be positive. From a patient’s perspective it may result in a lessening of their reliance on their family doctor for health advice, which could be both positive and negative. It will certainly be a change.
“I hope against hope that government will stand strong against the inevitable political backlash that will ensue and, for once, will stick to their guns. After all, if this doesn’t work, they can always change it again. Sooner or later, we’ll get it right.”
One of the issues identified in the most recent speech from the throne not mentioned in these recently announced changes is access to mental health and addiction services. In a province with a reputation for addiction problems, this was a bit of a surprise. Maybe a separate announcement is yet to come. I am afraid that there is an increasing iatrogenic component to addictions as prescription medications surpass alcohol, a major Island problem, as the most common reason for detox admission and addiction treatment. Our methadone maintenance program has a very long wait list, and it’s not about heroin addiction. Overall, I believe that the changes being introduced to the health care system are positive and, hopefully, reflect a willingness by our political leaders to make the right decision for the right reasons. As always there is a “yeh, but”, which is my inner cynic talking. I hope against hope that government will stand strong against the inevitable political backlash that will ensue and, for once, will stick to their guns. After all, if this doesn’t work, they can always change it again. Sooner or later, we’ll get it right. Submitted by:
Dr. Desmond Colohan is a chronic pain consultant in Charlottetown with a special interest in health-care policy.
Medical Society of PEI THE PULSE - SPRING 2013 3
President’s Letter - March 27 Hello again,
MEMBER @ A GLANCE
From my perspective, there is a lot going on worthy of mentioning in this letter and no shortage of challenging issues. One that rises above the usual background noise is the government decision to roll out plans to “adjust” the system focusing on the role of the rural hospitals. For many, these announcements have been a long time coming along with the evolving public reaction. The feelings of these communities must be acknowledged and our role as their caregivers is critical. The media and the public understandably express concern by focusing on what amounts to “fear.” Fear of the impact to the community, fear of job loss, and fear of loss of access to care. We must be prepared to demonstrate decisively to these communities that the Medical Society is there to insure that the system works for them effectively and their health interests are protected. The system may change and be adjusted but in the end the system should be better than the one they have now. The government’s efforts to make changes to the system come at a time when we are looking critically at what the Medical Society’s role is in shaping our healthcare system. Our strategic planning exercise, which is nearly complete, articulates the Society’s investment in engaging robustly in this process with some potent language embracing our mandate to be stewards of this system on behalf of physicians, for the patients we care for, and even the varied allied health professionals who are an indispensable part of the team. So how do we go about this important work? We do so by driving the conversation, exploring the positions, and having a voice that speaks with relevance and credibility. In short, we need a healthy system just as much as our patients do and it is up to us to be willing to be responsible for it. So express your opinion, engage in this process and get involved. We have a huge opportunity at this point in time to build a better system going forward. This is a letter that wants a response from the members. I will be standing by my mailbox. Let me know what you are thinking and how you would like to get involved. Best Wishes, Dave bannon@pei.sympatico.ca
Engaging Members in the Medical Society Dear Member: As you are probably aware the dynamics of the Society’s membership are changing: the Generation X (those born between the early 1960s and early 1980s) and Ys (born after the early 1980s) are quickly increasing as a portion of the membership. Demographers indicate that values of the Y Generation are more like those of the boomers than the Xers in that they recognize the value of belonging to an organization. Due to influences from these demographics the Society must become more concerned with which population will be attracted to becoming involved with the Society’s programs and policy initiatives. What are the best practices for engaging members? • We need to work on issues that matters to members • We need to demonstrate that their work makes a positive difference • We need to provide an enjoyable opportunity for involvement • We need to ask members to get involved: most people can’t say ‘no’ • We need to recognize the importance of personal and professional recognition What has changed about getting involved over the past 20 years? • The amount of time per involvement opportunity has declined • Members’ preference has moved towards project-based involvement versus position based involvement. How can we nurture the core (those 2-5% of the membership who seem to be involved in everything) so they don’t feel like they’re being alienated/ made redundant? • The Society’s programs, services, products, and policies must serve the interests of core members as well as the rest of the membership • Actions should not be taken that conflict with the interests of core members To accomplish these goals I’d like to foster a clear understanding of the Society and its mandate and foster open lines with all members, especially those who have never served in the Society and perhaps rekindle interest in members who have served in the past. If you’d like to get involved with the Society’s great works, either long or short term, please do not hesitate to contact me or any of your colleagues who have or are currently serving. If you have a colleague that you feel would be a great addition to any of the Society’s various committees or projects, please let them know. Respectfully submitted, Sandy Irwin, Executive Director airwin@mspei.org
Jeremy Beck Occupation: Gastroenterologist Family: There are a few Becks around…. Education: B.Sc. in chemistry at UPEI ’03, Dal Med ’07, U of Ottawa Internal Medicine and GI residency ‘12 Favourite Food: Pizza and anything potato Shoe Size: 10 If you were a car, what model would you be?: Perhaps I’m like my ’05 Honda Civic – dependable and not too flashy! Biggest pet peeve?: Phony people How many hours of sleep do you get a night?: 6 Golf or a good walk spoiled@?: Both boring. Ultimate Frisbee or hockey all day for me! What soothes your soul?: Music Most recent place traveled/visited?: Europe – Italy (Amalfi coast = amazing), Paris and Zurich If you were not a physician, what would you be doing?: No clue! Last or current book read?: A Game of Thrones Pets?: Never What colour pen do you use to write prescriptions?: Whatsever in my pocket. Usually blue I guess Favourite website?: Tsn.ca What are you listening to on your car stereo?: Whatever ‘s on.
4 THE PULSE - SPRING 2013 Medical Society of PEI
Medical Society of PEI 158th Annual General Meeting June 21-22, 2013 Dalvay by the Sea *tentative schedule Friday, June 21 9:00 -10:00 CME TBA 9:00 am-12:30 pm Registration -Dalvay by the Sea 1:00pm Golf Tournament Stanhope Golf Resort OR 1:00 pm Photo Boot Camp with Holland College Photography Instructor - Chris Wilkinson (http://www.spinphoto.ca/) bring your “point and shoot” or DSLR camera. Meet in Dalvay Lobby 7:00 pm Fun Night – Lobster/ Music Saturday, June 22 8:30-9 CME TBA 10:00-Noon Spouse’s Photo Session/ Nature walk
10:00- Noon Business Session & Children’s Program Strategic Plan Announcement This will be offered 12:00 pm Member’s Lunch for both days email heather@mspei.org 12:30 Guest Luncheon – for information. Meet in Dalvay Lobby 1:00pm Panel Discussion/CME Primary Healthcare in PEI 6:30-7:00pm President’s Reception & Presentation of awards 7:00-9:00PM President’s Dinner
Registration Forms and further information will be arriving in the next month. Watch your mailbox and register early for this great event!
Medical Society of PEI THE PULSE - SPRING 2013 5
PEI Meconium Study – Key Messages A multidisciplinary team of
hol metabolites (fatty acid eth-
timated cost of FASD in Canada
researchers on PEI recently
yl esters or FAEEs) are formed
each year is about $5.3 billion
completed an anonymous,
by the baby and are deposited
and in the Atlantic region about
provincial, population-based
in the meconium.
$57 million. A medical diagnosis
study to determine the inci-
is needed and includes a com-
dence of prenatal fetal alcohol
Meconium samples for this
prehensive history and physical
exposure in PEI newborns. The
study were analyzed for FAEEs
and neurobehavioural assess-
team consisted of researchers
at the Motherisk Laboratory us-
ment with a multidisciplinary
and clinicians from UPEI, the
ing a test they developed. The
approach.
QEH and PCH hospitals, the PEI
positive cut off for this test is
Reproductive Care Program,
greater than 2 nmol total FAEE
The effects of alcohol on the
and the Motherisk Lab at the
per gram of meconium. This
developing fetus can cause a
Toronto Sick Kids Hospital.
cut off reflects heavy ( more
range of physical disabilities,
than 2 drinks per day) and
brain and central nervous sys-
The PEI Meconium Study,
binge ( more than 5 drinks per
tem disabilities, and behav-
funded by the Canadian Asso-
occasion) drinking during the
ioural problems. The effects
ciation of Pediatric Health Cen-
fourth to ninth months of preg-
that a child is born with are per-
tres through the Public Health
nancy. This underestimates all
manent and are known as the
Agency of Canada, was led
drinking during pregnancy.
primary disabilities. Secondary
by Dr. Janet Bryanton, Associ-
disabilities are disabilities that
ate Professor, UPEI School of
Prior to this study, PEI had
an individual may develop as a
Nursing and Dr. Kathy Bigsby,
no reliable data about the in-
result of interaction with what
Pediatrician, Queen Elizabeth
cidence of alcohol use during
society expects from children
Hospital.
pregnancy. This more accu-
as they grow and develop into
rate information will provide
adulthood.
study year will likely exhibit FASD. This is comparable to the incidence of FASD reported in other general populations. Whereas not drinking is the best choice for a woman who is or might become pregnant there are many complex factors that may influence why a pregnant woman may use alcohol. It is also important to remember that alcohol use and misuse spans all segments of society. Lack of information or advice about the potential harm is rarely the main issue. Some women who have a difficult time stopping drinking during pregnancy may have a history of complex issues including trauma, abuse, mental illness, and poverty. Results of this study provide a baseline to begin discussion about an integrated approach
From November 2010 to
a baseline for an integrated
November 2011, a meconium
approach to prevention, early
The impact of alcohol on the
sample was collected from the
identification, and interven-
fetus can range in severity and
diaper of 1307 live PEI new-
tion for Fetal Alcohol Spectrum
depends on factors such as how
borns, including those born
Disorder (FASD) and to future
much, when, and how often the Delivery of Health Care to
at the IWK in Halifax. To main-
research and policy initiatives.
mother drinks, and the mother’s
tain anonymity of samples, no
and baby’s genetic makeup and
identifying information was
Fetal Alcohol Spectrum Disor-
health. The Society of Obstetri-
collected. To our knowledge,
der (FASD) is an umbrella term
cians and Gynecologists of Can-
this is the first province-wide
that includes a wide range of
ada recommends that there is
study in Canada to involve me-
physical, cognitive, and behav-
no safe time or amount to drink
conium sampling from all live
ioural disabilities resulting from
when a woman is pregnant.
newborns for a full year.
alcohol consumption by pregnant women. It is one of the
Of the study results obtained,
Meconium is the first bowel
leading preventable causes of
39 samples (3.1%) were FAEE-
movement of a newborn. It
developmental disability and
positive. Based on previous
is formed by the fetus after
birth defects in Canada. FASD
research, it is expected that
about 13 weeks of pregnancy,
is a significant public health
about 40% of babies with FAEE-
when swallowing of amniotic
concern, as it has a profound
positive meconium will exhibit
fluid begins. When a mother
impact on individuals, families,
FASD. Therefore, at least 16 PEI
drinks during pregnancy, alco-
and society in general. The es-
babies (~1.3%) born during the
to prevention, early identification, and intervention for FASD using a multifaceted approach. Children and Youth in the Maritime Provinces Westin Nova Scotian Hotel, Halifax, May 27 & 28, 2013 The target audience includes family physicians, family practice nurses, pediatric nurse practitioners, child and youth mental health care workers as well as pediatricians. • Current status: site of care delivery; practice of referral for pediatric specialist care • The role of the community health centre • Measuring health outcomes of children • Effective health care delivery for children and youth: • from vulnerable populations • with mental health problems • with complex problems • The role of the school system in child and youth health and wellness For More Info: http://pediatricroadmap.ca/ denise.doucette@iwk.nshealth.ca 902-470-8229.
6 THE PULSE - SPRING 2013 Medical Society of PEI
attention artistic doctors and students! Dear Colleagues, I am trying to work my way into clinical retirement and will no longer be able to follow the patients you have referred to me. I will continue to see new consults for as long as I can until other pain physicians on PEI are able to see all new referrals. I will continue to follow my patients on methadone and medical marijuana for now, and to deliver acupuncture services. Thanks for your support over the past six years. Des Colohan
“Right Brain, Released”, the mega-successful 4th annual art show of the Medical Society of PEI, will take place at the Gallery @ the Guild in downtown Charlottetown for the entire month of June, 2013. This is a great honour to have such a coveted art space during high season for an entire month and we are very excited. But we need your submissions to fill the walls and make this year’s art show the best one yet! All MSPEI members are welcome to submit art, including paintings, drawings, photography, sculpture, pottery, fibre art, or other artistic original creations. All submissions must be ready to display (or hang), original art, and new pieces (not yet shown in our, or any other, art show previously). All members are encouraged to come to the show and support our artist colleagues, and further notice will be sent about the opening night reception. All submissions must be at the Medical Society building (or other arrangements made) by May 24, 2013, and do not worry - another reminder announcement will be sent closer to this date. For more information about the show, or to offer to help, please contact Heather Mullen at heather@mspei.org or Jenni Zelin at j.zelin@utoronto.ca.
get creative now!
Medical Society of PEI THE PULSE - SPRING 2013 7
CMA’s latest town halls tackle social determinants of health
By COLLEEN GALASSO Canadian Medical Association The Canadian Medical Association (CMA) kicked off a new round of cross-Canada town hall discussions to seek public input on how factors outside of the health care system affect the health of Canadians, and how they can be mitigated. CMA president Dr. Anna Reid said it was both considerate and economically logical to tackle the factors behind the high demand for health services. She pointed out that an estimated 20 per cent of the $200 billion Canada spends on health care each year can be attributed to socio-economic disparities. “There is nothing more frustrating than diagnosing a health problem and prescribing treatment for a patient in the knowledge that the cause of the illness will persist,” she said. The first town hall meeting, held February 8 in Winnipeg, focused on factors that cause poor health outcomes among Aboriginal Canadians. Issues such as poverty and inadequate housing have resulted in far lower life expectancy than in the rest of the population.
MARK YOUR CALENDAR Be sure to join us for these upcoming member events!
JUNE S
M
T
W
T
F
S 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Date Event
Information
Location
Time
MAY 24
DEADLINE FOR ART SUBMISSIONS
Drop off your artwork at MSPEI - or if you wish to transport your own work please contact heather@mspei.org
MSPEI 2 Myrtle Street, Stratford
Before 5:00 PM
JUNE 4
ART SHOW OPENING GALA
Bring your family & friends to the opening gala of the 4th Annual Art Show
Gallery@ theGuild, Charlottetown
7:00-9:00PM
JUNE 4-28
RIGHT BRAIN RELEASED - ART SHOW
Third Annual Member Art show Gallery@ the Guild, Charlottetown.
Gallery@ theGuild, Charlottetown
ALL DAY
JUNE 21-22
ANNUAL GENERAL MEETING OF MSPEI
CME, Golf, Photo Boot Camp & Fun Night - family friendly event
DALVAY BEACH RESORT
ALL DAY
JULY 12
ANNUAL STUDENT & RESIDENT BBQ
Meet your colleagues of tomorrow.
MSPEI 2 Myrtle Street, Stratford
NOON - 2:00 PM
The second town hall meeting took place in Hamilton on March 6. It addressed the “staggering disparities” in the lifespans of people living in different parts of the city (richer versus poorer neighbourhoods). Meetings are planned for Charlottetown on March 28, Calgary on April 23, and Montreal on May 8. The meetings, held in partnership with Maclean’s and CPAC, are part of the CMA’s ongoing health care transformation initiative. Admission to the town halls is complimentary. Registration opens a couple of weeks prior to the dates of each. To register, go to www2.macleans.ca/inconversation-with-macleanshealth-series
8 THE PULSE - SPRING 2013 Medical Society of PEI
“From Peer to Peer”
Jean-Marie Auffrey. M. D. - Atlantic Provinces Medical Peer Review, March 2013 Physicians who completes a Physician Questionnaire prior to peer review are also asked to complete a brief informal selfevaluation form which asks them to identify what they might view as strengths and weaknesses, areas in which they would like to have more clinical knowledge, plans for upcoming CME and where they see their practices in five years. The information provided is not considered when arriving at assessment results – the onsite or offsite chart review, physician demographics and assessor observation determine that outcome. It does, however, allow us to review what issues are of concern to physicians and to pass this information along – anonymously, of course – to the Medical Societies or Associations who are involved in the well-being and educational development of their members. It also provides a snapshot of what physicians think about the challenges they face each day. The results from the questionnaires of 2012 indicate that Family Physicians feel they would like to have more clinical knowledge about Chronic Pain, Diabetes and Geriatrics. Dermatology, however, was the number #1 issue identified by GP’s, especially in areas where there is no specialist in the field. One physician noted that the incidence of skin cancer was high in his area and said, “I am doing an increasing number of skin assessments and procedures.” Another suggested that, “my practice is aging (as am I!) and I do a lot of geriatric medicine…the confused elderly are always difficult.” Most of those who identified the above issues also said they hoped to do CME in these areas within the next twelve months.
Paediatric Obesity, Prostate Cancer, and Electronic Medical Records. Emergency Physicians are interested in a better understanding of the ER Department ultrasound process. One Radiologist expressed an enjoyment of “the new protocols and advancements for evaluating patients…my practice is VERY different from 20 years ago.” Another agreed, noting, however, that “it’s sometimes difficult to keep up with the latest applications for our ‘high end’ imaging modalities such as MRI.” One Obstetrician/Gynaecologist took time to thoughtfully comment on several issues. When speaking of possible self-identified deficiencies, the physician suggested that “medical knowledge is expanding exponentially…all MD’s are hard pressed to keep up, especially in areas outside their area of expertise.” At the same time, this physician was enthusiastic about the future. In response to the question, “in five years I would like my practice to be…” the response was, “innovative – incorporating new surgical techniques, building on my existing surgical skill set and ongoing teaching of students and colleagues in a mentoring capacity to my junior colleagues’ specialty.” We appreciate the time taken by physicians to respond to this portion of the Physician Questionnaire. We know the Medical Societies and Associations find the data useful – we hope that physicians themselves find it a worthwhile exercise as well.
Not surprisingly, specialists identified a desire for more clinical knowledge and CME plans related to their field of practice. Some of the issues noted included Paediatric Orthopaedics,
Marijuana Medical Access Program
Recent media coverage details concerns over proposed regulatory changes to Health Canada’s“Marijuana Medical Access Program”. The Canadian Medical Association has heard from members that the proposed changes to medical marijuana regulations are not acceptable. The CMA’s major concern is that the proposed changes, which were announced Dec. 16, 2012, would in effect download responsibility for managing the drug to physicians and other providers. In addition, recent polling carried out for the CMA also found that Canadians believe the government should treat medical marijuana with the same rigour as other prescription drugs. Those polled also agree that Health Canada should maintain its current role authorizing the use of this substance. The poll was released Feb. 28, the same day the CMA submitted a brief to Health Canada outlining physicians’ concerns about the proposed changes. While this issue is one where the CMA seeks specific action from Health Canada, the CMA wants to ensure that our provincial/ territorial colleagues are informed. Further, to this end, the CMA has drafted a letter that you may wish to send this to your local MP. For the letter template or more information on this please contact grassroots@cma.ca
PEI Palliative Care Conference - May 30 & 31, 2013 Loyalist Lakeview Resort, Summerside, PEI Sponsored by: Health PEI Thursday, May 30, 2013
Friday, May 31, 2013
“A Patient’s Right To Be In Control” - Doug Smith, BA, MDiv, MA, MS, Author and Speaker, MacFarland, Wisconsin, USA Nutrition Break/Exhibits
“Communication Essentials for Difficult Situations” - Sandra Campbell, BA, MSW, PhD, Health Consultant, Waterloo, ON
“Quality Agenda in Palliative Care” - James Downar, MD, MHSC, FRCP C, University Health Network, Toronto, ON LUNCH (provided)/Exhibits
“Communication in Palliative Care with Particular Reference to the Management of End Stage Renal Disease” - Gerry Farrell, MD, Medical Director of Palliative Care, P.C. H. Authority, New Glasgow, NS Break
“Refractory Dyspnea: Recent Insights and Innovations” - Graeme Rocker, MD, FRCP C, Division Head, Respirology, Halifax Infirmary, Halifax, NS
“How to Value a Person’s Spirituality” - Doug Smith, BA, MDiv, MA, MS, Author and Speaker, MacFarland, Wisconsin, USA
“Effective Pain Management in Palliative Care” - Paul Daeninck, MD, MSc, FRCP C, CancerCare Manitoba, Winnipeg, MB
Contact mpjenkins@gov.pe.ca or heather@mspei.org for a registration form.
Medical Society of PEI THE PULSE - SPRING 2013 9
Medical Marijuana Background In 2001, Health Canada enacted a preliminary set of “marihuana medical access regulations” (MMAR). These were in response to an Ontario Court of Appeal finding that banning marijuana for medicinal purposes violated the Charter of Rights and Freedoms.1 The MMARs, as enacted, were designed to establish a framework to allow the use of marijuana for the relief of pain, nausea and other symptoms by people suffering from serious illness where conventional treatments had failed. In developing the preliminary MMARs, Health Canada asked for feedback from key stakeholders, including the Canadian Medical Association (CMA). While recognizing the needs of those suffering from terminal illness or chronic disease, CMA raised strong objections to the proposed regulations. In particular, there were concerns about the lack of evidence on the risks and benefits associated with the use of marijuana. This made it difficult for physicians to properly advise their patients and properly manage doses or potential side effects. Additionally, there were concerns about medico-legal liability, corroborated by the Canadian Medical Protective Association (CMPA). While acknowledging some of the concerns of the CMA, the regulations were passed in July 2001, without sufficient change to gain CMA’s support. There remained fundamental concerns about quality, safety and efficacy of medical marijuana. The medico-legal liability concerns remained, prompting the CMPA to issue an information sheet for physicians and to encourage those uncomfortable with the regulations to refrain from prescribing marijuana to patients. In January 2003, the Ontario Superior Court ruled that the MMARs failed to provide a legal supply of marijuana for those persons entitled to possess it for medicinal purposes. Therefore, the regulations were deemed constitutionally invalid with no force or effect. The decision was suspended for six months in order to give Health Canada time to remedy the situation. 2 Subsequently, in 2003, Health Canada presented an ‘’Interim Policy”, which included provisions for the production and distribution of medical marijuana to authorized patients. CMA vigorously opposed this policy, which exacerbated rather than addressed the fundamental concerns of the profession by making physicians part of the supply chain. The CMA raised strong concerns about the implications of both the original regulations and the interim policy for both patients and physicians, stating that physicians should not be put in the untenable position of gatekeepers for a proposed medical intervention that had not undergone established regulatory review processes as required for all other prescription medicines. At General Council in 2003, delegates passed the following motions: That Canadian Medical Association strongly oppose the use of marijuana for medical reasons in the absence of supporting scientific evidence. That Canadian Medical Association recommends that physicians not participate in the dispensing of medical marijuana under the existing Medical Marijuana Access Regulations. New regulations (introduced in June 2005) reduced the onus on physicians to declare the need for, and dose of marijuana, focusing instead on an attestation of diagnosis and failure of conventional therapies. These amendments were seen as an improvement to the previous MMARs as they reduced the obligation of a physician to declare that the proposed therapy was efficacious. While continuing to oppose the medical use of marijuana and recommending that physicians not participate in the program because of the failure of governments and manufacturers to provide adequate information regarding safety, CMA accepts that physicians who feel qualified to recommend medical marijuana to their patients do so in accordance with the regulations. Current Situation The MMARs have undergone a number of further revisions since 2005. For the most part, these revisions have been in response to decisions from various courts across the country. Courts have consistently sided with patients’ rights to relieve symptoms of terminal disease or certain chronic conditions, despite the limited data on the effectiveness of marijuana. Courts have not addressed the ethical position in which physicians are placed as a result of becoming the gate keeper for access to a medication without full knowledge of its effectiveness, proper dosage, or short and long-term side effects. As of June 2009, there were 4,029 people licensed to possess dried marijuana for medical purposes.3
In 2009, General Council passed a resolution urging the CMA to: a) update its policy on medical marijuana; and b) ask the federal government to update themedical marijuana access program and regulations following appropriate consultations with stakeholders and scientific advisory committees, and reinstate support for research into the safety and efficacy of medical marijuana and cannabinoids. Following the passage of this resolution, the Office for Public Health (OPH) began a review of the published literature on medical marijuana. Evidence exists about pharmaceutically prepared, orally administered marijuana alternatives. Commonly referred to as cannabinoids, these drugs utilize the active ingredient in marijuana, delta-9-tetra-hydrocannabional (THC), and are dispensed in pill or vaporized format.4 Pharmaceutical cannabinoids have undergone clinical trials to demonstrate safety and effectiveness, and have been approved for use through the Food and Drug Act of Canada. Of note is that in this format, the toxic by-products of smoked marijuana are avoided. 5 In summary, there remains scant evidence regarding the effectiveness of the herbal form of marijuana (e.g. smoked) as accessed through Health Canada’s MMAR program. The generalizability of the conclusions from published studies are limited by methodology (double blind placebo controlled trials are not possible; previous users of marijuana are often excluded) and very small sample sizes. While it may be the case that medical marijuana is efficacious, scientific evidence comparable to other prescription pharmaceuticals is still lacking. Additionally, there is insufficient information about long-term effects and pharmacodymanics such as interactions with other medications and dose- response curves. The OPH met with representatives from the Controlled Substances and Tobacco Directorate of Health Canada, which oversees the MMARs. Concerns regarding the limited data on effectiveness, the difficulties with assessing proper dosage, long term health effects of inhaled marijuana and pharmacodymanics were shared. As previously noted, the Federal government is constrained by the decisions of Canadian courts. They are currently reviewing the MMARs and plan to consult further with CMA regarding research, physician responsibilities and education programs for Canada’s physicians. The OPH met with Margaret Bloodworth, a contractor hired by Health Canada to do a full assessment of the program. CMA Position: The CMA has always recognized and acknowledged the unique requirements of those individuals suffering from a terminal illness or chronic disease for which conventional therapies have not been effective and for whom marijuana for medicinal purposes may provide relief. However, there are a number of problems with the current Medical Marijuana access program. In order to find a solution to these outstanding problems, CMA makes the following recommendations. 1. The advancement of scientific knowledge about medical marijuana must be encouraged. Given that there are currently over 4,000 patients receiving medical marijuana from Health Canada, CMA encourages the Government to properly study the safety, efficacy, most appropriate amount to be used, and the most effective delivery mechanism for treatment of specific conditions. The same safety and evidence standards should apply to medical marijuana as to pharmaceutical products under the FDA. 2. With the increasing number of patients being authorized to possess medical marijuana, it is imperative that physicians know and understand the regulations and the use of medical marijuana in their practice settings. As such, CMA calls on the Government to work with the CMA, The College of Family Physicians of Canada, the Royal College of Physicians and Surgeons, and other relevant stakeholders, to develop compulsory education and licensing programs for physicians who authorize the use of marijuana for their patients. 3. Finally, until the problems with the MMARs are rectified, CMA lacks the basis upon which to revise its current policy. Physicians who wish to authorize the use of marijuana for patients in their practices should consult relevant CMPA policy and guidelines in order to ensure appropriate medico-legal protection. References 1 Regina v. Terrance Parker. Available at: http://www.ontariocourts.on.ca/decisions/2000/july/par ker.htm 2 Hitzigv.Canada,2003CanLII3451(ONS.C.). Available at: http://www.canlii.org/en/on/onsc/doc/2003/2003canlii3 451/2003canlii3451.html 3 Health Canada (2009) Marihuana for Medical Purposes Statistics June 5, 2009. Available at: (http://www.hc-sc.gc.ca/dhp- mps/marihuana/stat/_2009/ june-juin-eng.php 4 Ware, Mark A.; Kahan, Meldon, and Anita Srivastava (2006) “Is there a role for marijuana in medical practice?” Canadian Family Physician Vol 52: December pp. 1531-1533. 5 Engels, Frederike K. et.al. (2007) “Medicinal cannabis in oncology.” European Journal of Cancer. 43(2007) pp. 2638-2644,
© 2011 Canadian Medical Association. You may, for your non-commercial use, reproduce, in whole or in part and in any form or manner, unlimited copies of CMA Policy Statements provided that credit is given to the original source. Any other use, including republishing, redistribution, storage in a retrieval system or posting on a Web site requires explicit permission from CMA. Please contact the Permissions Coordinator, Publications, CMA, 1867 Alta Vista Dr., Ottawa ON K1G 3Y6; fax 613 565-2382; permissions@cma.ca. Correspondence and requests for additional copies should be addressed to the Member Service Centre, Canadian Medical Association, 1867 Alta Vista Drive, Ottawa, ON K1G 3Y6; tel 888 855-2555 or 613 731-8610 x2307; fax 613 236-8864. All polices of the CMA are available electronically through CMA Online (www.cma.ca).
10 THE PULSE - SPRING 2013 Medical Society of PEI
ROYAL CANADIAN MOUNTED POLICE (RCMP) IMPORTANT INFORMATION FOR PHYSICIANS AND HOSPITALS REGARDING BASIC, SUPPLEMENTAL / EXTENDED AND OCCUPATIONAL HEALTH CARE SERVICES FOR RCMP MEMBERS
Information from Health Canada on Healthy Eating With
March
being
Nutrition Month, Health
March 2013 - PROVINCIAL/TERRITORIAL BASIC HEALTH CARE
Canada
invites
Effective April 1, 2013, eligible RCMP members will receive coverage of their basic health care through their respective home province/territory health insurance plans. The province/territory will process all eligible basic health services as they do for other residents of the province/territory in which the member resides.
to
the
RCMP members should be billed for services at the provincial/territorial rates as they are now insurable under the Canada Health Act.
eatwell.
By now, all eligible RCMP members should have received, or will soon be receiving, a provincial/territorial health card which they must present for basic medical and hospital services starting April 1, 2013.
This site offers information
visit
Canadians’
you
Healthy
website
at
healthycanadians.gc.ca/
on nutrition and lifestyle, including: • How to read nutrition facts tables •
Cooking
and
meal
planning tips • Grocery shopping tips • Ideas for healthy eating when eating out In addition you may wish to check the Healthy Eating Toolbox at http://www.hcsc.gc.ca/fn-an/nutrition/
You’re Invited
par t/tb-bo/index- eng. php. This Health Canada site provides ready-touse
resource
for
consumers,
material health
professionals, educators, and media. (Note that resources can easily be downloaded, customized and printed.) You may also sign up for the Food and Nutrition RSS Feed (http://www.hc-sc.gc.ca/ fn-an/_feeds-fils/indexeng.php) to get updates on the latest information. Join on
the
conversation
Facebook:
https://
w w w. f a c e b o o k . c o m / *ad edited in size for publication
HealthyCanadians.
Medical Society of PEI THE PULSE - SPRING 2013 11
MSPEI Summer Education Students 2013
HELPING WITH
USED MEDICAL SUPPLIES
2nd Year Medical Students Ben Cairns, Memorial University Harrison Carmichael, University of Toronto
Volunteers in Summerside and DeSable, P.E.I., recently spent a Saturday loading donated medical supplies into a shipping container bound for an impoverished area in the Dominican Republic.
Dr. Don Clark
Jacyln DesRoches, Dalhousie University Taylor Ferrier, University of Ottawa
Dr. Don Clark, Desable loading coordinator, said the shipment includes a wide variety of equipment. “Beds, stretchers, chairs, bedside tables… EKG machines, cardiac monitors and specialized cribs” said Clark. “We’ve shipped dialysis machines. We’ve shipped a wide variety of equipment.”
Matthew Havenga, Dalhousie University Kyle MacDonald, Memorial University Stephen Reid, McGill University Mark Robbins, University of Ottawa
For months, the Rotary Club of Summerside and FAME Canada have been gathering used hospital equipment from across the province.
Megan Tesch, Memorial University James Zafiris, SABA University
Summerside Organizer Dr. Marvin Clark said the donations will help medical professionals deal with a menacing health care crisis in many of the Dominican’s communities. “Wheelchairs, canes, crutches, dressings, suture material. That kind of thing, the everyday kind of encounters they have where people are unable to even get their wounds dressed, let alone with clean dressings and stuff,” said Marvin Clark.
1st Year Medical Students
Dr. Marvin Clark
Craig Malone, Memorial University Jeffrey MacDougald, University of Toronto Jhase Sniderman, University of Ottawa Joseph Wonnacott, Memorial University