SMA Digest - Spring 2017 | v. 57, i. 1

A publication of the Saskatchewan Medical Association Volume 57 | Issue 1

DIGEST

SPRING 2017

THE STORY KEEPER local physician provides holistic, culturally safe care in indigenous communities

DOCTORS CHOOSING WISELY

Cypress physicians take the lead in accountability

DEVELOPING QI SKILLS

ON THE FRONT LINES OF A MENTAL HEALTH CRISIS

in the physician community through new program

PHYSICIANS EFFECTING

POSITIVE CHANGE

Grits for Grieving Guys provides recipe for success Spring 2017 | VOLUME 57 ISSUE 1 SMA Digest is the official member magazine of the Saskatchewan Medical Association. It is published twice per year and is distributed to nearly 90 per cent of practising physicians in Saskatchewan.

Every Saturday for five weeks they gathered – widowers who were taught how to cook basic recipes by medical students Jacqueline Carverhill and Thea Hedemann. The pair, who developed their Grits for Grieving Guys class under the SMA program FLIP, provided the men with a recipe on how to move forward in life at a difficult time.

Editorial board

SMA staff: Editor: Maria Ryhorski Girard Hengen Ivan Muzychka Physician representatives: Dr. Jim Cross Dr. Werner Oberholzer Dr. Susan Shaw

Upcoming issues

The next issue of SMA Digest will be distributed in fall 2017.

Advertising

The deadline for booking and submitting advertising for the next issue is Monday, July 24, 2017. Rates for display advertising are available upon request. Classified ad placement is free for members promoting physician, locum and practice opportunities; ads should be submitted via email and must not exceed 150 words.

Feedback

Member feedback is valuable and encouraged. Please direct comments, letters, ideas and advertising inquiries to: Maria Ryhorski Communications Advisor Saskatchewan Medical Association 201-2174 Airport Drive Saskatoon, SK, S7L 6M6 (306) 244-2196 maria.ryhorski@sma.sk.ca

SMA mission

The SMA is a member-based organization that promotes the honour and integrity of the profession.

We: • Provide a common voice for physicians • Support the educational, professional, economic and personal wellbeing of physicians • Advocate for a high-quality, patientcentred health-care system

The Story Keeper The connection between Dr. Joel Schindel and the First Nations communities he serves is palpable and is something that has been carefully nurtured since he arrived almost four years ago. Indigenous communities across Canada face greater health challenges than many others, but Dr. Schindel is working to alleviate some of these challenges through Comprehensive Indigenous Community Care Clinics.

CONTENTS

33

20

2 4 6 8 10 12 16 19 20 23 24

Dr. Sara Dungavell had just graduated from her psychiatric residency program when she was called to serve the people of La Loche following the fatal shootings in the community in January 2016.

Doubting her experience in handling the situation, she nonetheless found solace in the stories of courage and resilience of the people there.

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A note from the president Leading in uncertain times: Strategies for coping with change Survey indicates support for health system redesign Celebrating 50 years Growing strong leaders Celebrating what brings you joy

HEALTH CARE On the front lines of a mental health crisis Doctors choosing wisely The Story Keeper Toronto doc has some big ideas Innovations Stroke care: When every second counts Eyes opened to benefits of iron infusions

26 28 30 32 On the front lines of a mental health crisis

YOUR SMA

33 34 36 38

Physicians develop QI skills through new program In their own words: CQIP participants discuss their projects Provincial initiative aims to improve health-care safety Duty of care essential when using pooled referrals

STUDENTS & RESIDENTS Grits for Grieving Guys provides recipe for success Coming full circle with SMA Roadmap La Loche: Roadmap 2017 Roadmap 2016/17 Photo Contest winners

40 COURSES & CONFERENCES 42 ANNOUNCEMENTS & CLASSIFIEDS 44 IN MEMORIAM

PRESIDENT’S NOTE

a note

Welcome to the spring issue of the SMA Digest magazine!

The theme of this issue is physicians effecting positive change.

A simple truth is that our health system is changing right beneath our feet.

It’s often a tumultuous system, one that’s constantly changing shape and even direction. We are continually buffeted by political and demographic currents. Trying to effect system change – let alone practise medicine – in such a dynamic environment can be challenging. Dr. Danielle Martin, well-known physician leader (p. 23), says effecting health system change is like trying to redesign the plane while in flight. I know the physicians of this province are up to the task of building a better health system.

The magazine you’re holding is filled with good examples of local innovation, leadership and positive change.

Dr. Joel Schindel is making a huge difference through his work with Beardy’s & Okemasis First Nation and One Arrow First Nation communities (p. 20), while the Cypress Regional Medical Association’s work with Choosing Wisely Canada is helping push a valuable national program at the local level (p. 19). Our medical students, too, are doing new and

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SMA DIGEST | SPRING 2017

interesting things as you’ll see when you read about Grits for Grieving Guys (p. 33), a compassionate project that Jacqueline Carverhill and her fellow student Thea Hedemann led in Saskatoon this past winter.

Of course, many Saskatchewan physicians are still working toward greater participation in health system redesign. In this issue of SMA Digest you’ll find out more about the results of a survey we did back in the early part of this year, and what we are doing next (p. 6). I am encouraged by the feedback I have received on health system redesign, and I feel that we are on the threshold of a true transformation.

We have many challenges as physicians these days. Participating in redesign work is one way to improve the experiences and outcomes for our patients while making Saskatchewan a better place to practise medicine. I can think of no better goals for the SMA to have.

I hope you enjoy this issue of SMA Digest!

Sincerely,

DR. INTHERAN PILLAY SMA president president@sma.sk.ca

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our proud history This year we mark 50 years since the birth of the SMA as an independent body. Guided by its membership, the SMA has led the profession through five decades of providing care in an ever-changing health-care landscape. It will continue to do so as physicians actively participate in the redesign of our health system, leading the changes that will result in a system that provides better care to patients, better work experiences for physicians, and is sustainable going into the future.

then and now

years

SASKATCHEWAN

MEDICAL ASSOCIATION

OUR MEMBERS

OUR STAFF

1,122 members in 1967 3,546 members in 2017

3 staff members in 1967 39 staff members in 2017

OUR HOME

1966-1970

2014 - present

SMA DIGEST | SPRING 2017

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LEADING IN UNCERTAIN TIMES strategies for coping with change

by Girard Hengen

B

eing able to lead is one thing, but first people have to like you and you have to be available to them.

That’s the advice Ottawa psychiatrist Dr. Mamta Gautam gives Saskatchewan doctors who will be looked on to help lead the health system as it undergoes a redesign.

Dr. Gautam was a guest speaker at the Saskatchewan Medical Association Representative Assembly in Regina in November 2016, providing physicians with strategies for “Leading Change Successfully.”

Tip #1 Keep in mind the 3 A’s of leadership. affability

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People think leaders have to have certain capabilities. Often leadership training mainly provides people with the abilities they will need, and that includes doctors, Dr. Gautum said.

“But the ability to lead is actually the third, and it’s the other two things that you need to have, and more so in uncertain times,” she said. “The first is affability, people have to like you, they have to see you as a likable person and someone they can relate to and someone that they can trust and respect. So the affability is really important.”

Next is availability. “You have to be there, part of what you do when you are available is you are present, you are listening, you are understanding some of the resistance, you are communicating and explaining what is going on, you’re giving positive feedback. All of that is important,” she said.

Next comes ability – something doctors have – “and you do have to know what you are doing, but the other two are really important as well,” she advises doctors.

Tip #2 In uncertain times be sure to:

LEADERSHIP

availability

The three A’s of leadership – ability, affability and availability – are generally well-known, but the order of importance is often misplaced, she said in an interview.

ability

1. Motivate 2. Provide direction 3. Provide resources 4. Build capacity

EMOTIONAL RESPONSE Dr. Gautam also told doctors at the SMA Representative Assembly to be on the lookout for emotional responses to change.

“Change happens through people so you really have to understand the people who are going through the change and help them prepare and support them through it.

“

PEOPLE ARE VERY GOOD AT UNDERSTANDING HOW TO IMPLEMENT CHANGE, WHAT WE ARE LESS GOOD AT IS REALIZING IT’S NOT ONLY THE CHANGE BUT THE TRANSITION PEOPLE ARE GOING THROUGH.

“The biggest thing that I wanted to say is… people are very good at understanding how to implement change, what we are less good at is realizing it’s not only the change but the transition people are going through.

Tip #3 When addressing resistance: 1. Encourage people to speak openly, and express thoughts and feelings about change.

2. Listen carefully.

3. Treat resistance as a problem to solve, not as a character flaw.

4. Bring people together to discuss and deal with perceived problems.

“There can be resistance, the big thing is to understand the resistance and work with it, not to get put off and judge the person, but really just say, ‘This is understandable, you’re going through this transition period and how can I support you through it?’ ”

TAKE CARE OF YOURSELF To take care of others, Dr. Gautam says physicians have to take care of themselves. That includes the mind and the body.

“Remember to laugh and have fun, and the big thing is to see this not as a luxury or an indulgence, but really as an investment. Taking care of yourself is the most unselfish thing you can do.” ◆

Tip #4 Remember the 5 C’s of resilience: COMMITMENT

CARE FOR SELF

Eat, sleep and exercise; make time for yourself first.

Remind yourself why you took on this task in the first place, does it still align with your values?

RESILIENCE

CALMNESS

Know how to recognize when you might be upset or under stress; use strategies to relax and manage stress effectively.

CONTROL

Understand your own health and the early signs of burnout.

CARING CONNECTIONS

Who can you count on to support, mentor or coach you? As a leader you need support systems at work and at home.

SMA DIGEST | SPRING 2017

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survey indicates support for

HEALTH SYSTEM REDESIGN

By Ivan Muzychka

•

I

89 per cent think doctors have an obligation to influence care beyond their own practices.

•

98 per cent think care is improved when delivered by teams working to maximum scope of practice.

•

74 per cent think the compensation method for Saskatchewan doctors enables them to practise highquality medicine.

•

On the issue of accountability, the vast majority (88 per cent) of respondents think the profession needs to promote public reporting on health system performance.

•

86 per cent want to know how their practice compares to that of their peers.

•

76 per cent of Saskatchewan doctors use data from their practices to improve their own performance.

n January 2017, the Saskatchewan Medical Association surveyed members about health system redesign. The results indicated most physicians in the province believe they have the ability to help lead and redesign a health system that is accountable, provides better care for patients and offers better value for the public.

It also found most doctors are outward-looking – they want to influence the system beyond their own practices. Physicians also support a team-based approach to care, with decision-making that is shared among other health-care professionals.

“Over the last year our members told us very clearly that a fragmented health system was diminishing patient care and wasting resources,” said Dr. Intheran Pillay, SMA president. “Our survey confirms for us that these views are more widely shared among the province’s physicians. We are keen to continue talking with our colleagues about these issues, and are looking to work with the Ministry of Health, and other key health-care stakeholders, on how we can build a better, more integrated health system for the people of Saskatchewan.”

Almost 650 doctors completed the SMA survey, which asked physicians questions about their views on team-based care, data and accountability, compensation and physician participation in health system redesign. Respondents included specialists (45 per cent), family doctors (43 per cent) and students/residents (12 per cent). The survey took place from Jan. 16 to Feb. 5, 2017.

Results of the survey include: •

87 per cent think Saskatchewan doctors should be responsible for using health-care resources wisely.

•

68 per cent believe Saskatchewan doctors have the skills to help lead and redesign the health system.

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SMA DIGEST | SPRING 2017

Dr. Pillay said the survey also indicated that a large number of doctors are reporting that they are at risk of burnout, a statistic he finds troubling. One in two specialists identify as being at risk of burnout, as do two out of three general practitioners.

“Burnout is a very real concern for physicians,” Dr. Pillay said.

“The data we gathered here would seem to confirm that we have a large number of physicians who are managing, but are signalling a very high level of stress. Many physicians recognize this problem and are ready to work on solutions that will lessen the rate of burnout within their profession.”

The SMA survey results come at a time when physician leadership is being affirmed. The Saskatchewan Advisory Panel on Health System Structure Report, issued in early January, includes as one of its recommendations: “Ensure physicians play an active role in the planning, management and governance of the health system to achieve shared responsibility and accountability for health system performance.” ◆

what we learned Demographics

45% specialists, 43% family physicians, 12% trainees 69% Regina/Saskatoon, 18% regional centres, 13% elsewhere 56% paid fee-for-service, 44% paid other methods

Leadership

Data

Stewardship

Physicians are ready to lead. 89% want to influence care beyond their practice and 68% feel they have the skills to help lead health system redesign.

76% of physicians report using practice-generated data to improve their own performance. 86% want to compare their practice to their peers.

Seven of eight respondents think physicians are responsible for resource stewardship.

Teams

Burnout

Compensation

There is overwhelming support for intra- and inter-professional collaboration. Most physicians believe care is better when professions work to their maximum scope.

Physicians are under considerable stress. 62% of respondents reported feeling at risk of burnout. If you feel at risk, please contact our Physician Health Program at 306 244 2196.

There is strong support for moving away from volume-driven payment.

74% feel their payment method allows them to practise good medicine.

SMA DIGEST | SPRING 2017

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Dr. M. A. Baltzan, SMA president, (centre) presents first SMA Golf Award to Dr. D. McAlpine

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Tariff Committee meeting, 1970 (clockwise from left): Dr. A. E. Somerville, Dr. A. Thomson, Mr. Ed Hobday, Dr. J. G. Monks, Dr. C. T. Wolan

celebrating To learn more about our proud history (and the Paranoid Players), please visit our website:

www.sma.sk.ca/50years

years

SASKATCHEWAN

MEDICAL ASSOCIATION

First SMA Chain of Office

Dr. Baltzan, first| SPRING SMA president 8 M. A. SMA DIGEST 2017

SMA office from 1970 - 1995 | 211 4th Ave. S., Saskatoon

1968 SMA Board of Directors (l to r): Dr. Matthew Davis, Dr. I. Bean, Dr. M. A. Baltzan (president), Dr. Park Rich, Dr. Jerry Monks, Dr. Lewis Cawsey, Dr. K. Miller, Dr. Ernie Baergen (CEO)

Dr. Ernie Baergen, executive secretary and first SMA CEO

1967 Representative Assembly: Dr. M. A. Baltzan, SMA president (far left); Dr. J. P. Falkingham, CPSS president (third from right); Dr. N. J. Belliveau, CMA president (far right)

Three of the Paranoid Players - (l to r) Dr. J. A. Mann, Dr. W. W. Hathway, Dr. L. M. Loewen - SMA compete for| the Ritchie DIGEST SPRING 2017Cup in 1967.

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GROWING STRONG LEADERS

“

There is a real need for physicians to become more engaged with the SMA and provide leadership in health care...

Physicians have frontline knowledge of the problems that exist and can contribute towards solutions.

- Dr. John Gjevre

The health system is entering a period of change and never before has strong physician leadership been more important. SMA in-house CMA Physician Leadership Institute (PLI) courses can help you build a strong foundation for future leadership roles you may take on.

Did you know?

• In-house PLI courses are heavily subsidized by the SMA down to an enrolment cost of $650.

• Taking the courses in-house saves you out-of-province travel and time away from your practice.

• We sponsor three seats each for students and for residents, per course, because building strong leaders starts early.

• Taking PLI courses can help you obtain your Canadian Certified Physician Executive (CCPE) Credential.

To learn more contact Delilah Dueck

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delilah.dueck@sma.sk.ca 306.657.4568 www.sma.sk.ca/pli SMA DIGEST | SPRING 2017

DR. JOHN GJEVRE | 6 PLIs attended

Internal Medicine, Saskatoon Why did you decide to attend a PLI? Generally, they are very useful and provide information/knowledge not learned in residency. There is a real need for physicians to become more engaged with the SMA and provide leadership in health care. For many years, physicians have been shunted to the sides while MBAs and nurse administrators ran the system. However, physicians have front-line knowledge of the problems that exist and can contribute toward solutions. We need to help patients and the health-care system by focusing our united abilities toward practical reallife solutions.

Which PLI stood out the most?

I really enjoyed the course on conflict management which I took last spring. It helped me understand some of the issues interacting both with other physicians and members of the health-care team. Also, although it was not a PLI course, the SMA and CMPA sponsored a workshop in October 2016 on disruptive behaviors in physicians. That course complemented the earlier PLI course and helped to further improve my understanding and perspectives on conflicts in the health-care workplace.

How have you applied what you’ve learned?

I took the quality measurement course a couple of years ago which I found quite useful. I have always been interested in how to improve outcomes for our patients, both individually as well as system-wide.

The quality measurement course reviewed simple measurement concepts that are useful in quality improvement initiatives which I have been engaged in. You need to understand how to measure things in order to know that you are improving!

DR. JULIET SOPER | 10 PLIs attended

DR. MARY-MAGDALENE DODD | 2 PLIs attended

JESSE LEONTOWICZ | 1 PLI attended

Paediatrics, Regina

Ophthalmology resident, Saskatoon

Student, Class of 2019, Regina

Why did you decide to attend a PLI?

Why did you decide to attend a PLI?

Why did you decide to attend a PLI?

Initially I attended because RQHR sponsored attendance to support physicians in leadership roles within the health region. I have continued to attend and register for further PLI courses because they help in my daily work. The structure of the PLI courses is particularly important in their success: Each course is facilitated by an experienced physician leader and a non-physician content expert. This structure ensures that the content knowledge including supporting literature is well presented and that the application of this knowledge to our health-care system is well explained by an experienced colleague.

I encountered a few challenging situations in my professional life that I felt the PLI courses I attended could help address. I am really interested in personal development and I think the PLI courses offer a great opportunity to begin that process. Residency is packed with information, but there are certain CanMEDS competencies, particularly collaborator, health advocate, leader and communicator, that the PLI courses specifically address.

There has been impressive encouragement from senior College of Medicine faculty to see ourselves (i.e. medical students) as future leaders in health care. Our vicedean, Dr. Kent Stobart, has consistently encouraged the medical students to seek out leadership training opportunities. My own interest comes from leadership roles I’ve been involved in. Taking these courses helps improve those leadership and interpersonal skills.

Which PLI stood out the most?

While the registration cost was initially prohibitive for a medical student to attend, I’m very thankful to the SMA for sponsoring medical students to attend the conference at no cost.

Which PLI stood out the most?

All of the PLIs I have attended stand out for the relevance of their content and the presentation skills of faculty. Some courses provided opportunity to reflect on personal style and leadership skills while others provided very practical tools I now use almost daily at work. For example, Conflict Management was invaluable in reinforcing the benefits of transparency, respect, and genuinely being curious about the other person’s position; Dollars and Sense gave me a much greater understanding of this very important and relevant aspect of our health-care system.

How have you applied what you’ve learned?

The PLI on quality measurement taught me to focus on identifying appropriate metrics when considering a quality improvement project, and to use run charts to understand when change was significant rather than due to chance variations. This has resulted in greater success with quality improvement projects subsequently.

I found both courses equally useful. I came away with new skills and a new perspective that I could apply right away. For example, I realized conversations that became arguments and bruised relationships could have been prevented with the knowledge I gained in the crucial conversations course.

I learned the importance of separating fact from story in creating a safe environment for dialogue. I also learned strategies on how to make it safe for people to tell their story and hopefully maintain relationships even in the context of opposing opinions.

I try to apply my new skills in every crucial conversation I have.

How have you applied what you’ve learned?

I came away from the strength-based leadership course way more attuned to what excited me and energized me. I saw more clearly that the patient population I found fun and the clinic days that seemed to fly by were such because I was using my strengths. Actually, before the course, I was considering a number of sub-specialties and after the course I felt the choice was clear. Indirectly, the course provided good evidence that the right choice for me was the subspecialty that made me want to get out of bed in the morning.

What stood out in the PLI you attended?

The art of negotiation is about knowing the person on the other side of the table.

Understanding the needs, wants, and personality of who you are negotiating with is key in reaching compromise. The course taught us and helped us put into practise how to defuse conflict and orchestrate a meaningful resolution. Applying these principles to a mock scenario involving hospital budget negotiations helped illustrate how right (or wrong!) negotiations can go.

How have you applied what you’ve learned?

Working on a research team can be exhilarating – but can also prove challenging if team members don’t get along. From the conflict management course, I learned the number one rule about conflict – prevent it at all costs! This can be done by setting out expectations of both parties at the start of the project. The initial conversation on expectations has helped immensely to prevent conflict in our team. ◆ SMA DIGEST | SPRING 2017

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“

THE THING I LOVE TO DO BEST OUTSIDE OF WORK ... BEING A GRANDPA. - Dr. Larry Sandomirski

“

“

ADRENALINE AND FREEDOM...

DOCS LOVE ADRENALINE -

SOARING TO NEW HEIGHTS AND LEARNING TO FLY. 12

SMA DIGEST | SPRING 2017

- Dr. Cynthia Ciezki, Resident

IT MAKES YOUR HEART BEAT FASTER - Dr. Werner Oberholzer

“

I LIKE TO GO ON AT LEAST ONE BIG ADVENTURE TRIP EVERY YEAR, FROM CANOEING NORTHERN SASKATCHEWAN, TO SAILING THE GEORGIA STRAIGHT IN BRITISH COLUMBIA. THIS PHOTO WAS TAKEN AT THE EDGE OF FLOE LAKE NEARING THE END OF MY FOUR-DAY BACKPACKING TRIP ALONG THE ROCKWALL HIGHLINE IN THE KOOTENAYS. IT RAINED EVERY DAY BUT MY CREW OF THREE OTHERS AND I MANAGED TO HAVE A PRETTY AWESOME TIME REGARDLESS OF THE WEATHER. FUN FACT: I JUMPED INTO THE LAKE SHORTLY AFTER THIS PICTURE WAS TAKEN AND IT WAS PROBABLY THE COLDEST WATER I HAVE EVER BEEN IN. -Eric Brenna, Class of 2018

CELEBRATING

Wellness isn’t just another class to take. Wellness needs to be incorporated into everything we do. It’s a holistic approach to life. Make time to do the things that bring your life joy and meaning. Here - we celebrate our members doing just that.

WHAT BRINGS YOU JOY SMA DIGEST | SPRING 2017

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“

I TRAINED ALL THROUGH SECOND YEAR MED FOR THIS RACE [2016 SASKATCHEWAN MARATHON] AND MY TIME FROM THAT RACE GOT ME MY 2017 BOSTON MARATHON QUALIFYING TIME, SO I WILL BE RUNNING THE BOSTON MARATHON THIS UPCOMING APRIL. - Caitlyn Howe, Class of 2018

“

AT OUR FAVOURITE SPIN STUDIO, THE WHEELHOUSE, IN REGINA.

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- Dr. Jennifer Waterhouse, Resident

SMA DIGEST | SPRING 2017

“

Never get so busy making a living that you forget to make

a life.

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EXITING THE SKYDIVE KAPOWASIN TWIN OTTER, 14,000 FEET ABOVE KAMLOOPS. - Dr. Dalibor Slavik

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HIKING IN THE JOTUNHEIMEN MOUNTAINS OF NORWAY OVER THE BESSEGGEN RIDGE (A STRENUOUS 10-HOUR HIKE).

- Dr. John Gjevre

““

TAKEN IN SANTIAGO, CHILE ... I TRULY ENJOY TRAVEL PHOTOGRAPHY - Dr. F. Oosman

“

I LIVE WELL WITH CHRONIC ILLNESS BECAUSE OF THE JOY MY KIDS, GRANDKIDS, DOGS, SINGING AND MY NEW HOBBY, PHOTOGRAPHY, BRING ME!

DIGEST | SPRING 2017 - Dr.SMA Susan MacDonald

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ON THE FRONT LINES OF A MENTAL HEALTH CRISIS Dr. Sara Dungavell was supposed to start providing mental health services in the North beginning in July 2016, but in January 2016 tragedy struck in La Loche. She was needed immediately. These are her words.

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SMA DIGEST | SPRING 2017

Dr. Sara Dungavell was supposed to start her job with Northern Medical Services last July. She graduated from the University of Saskatchewan’ psychiatric residency program in December 2015 and was looking forward to a few months off before she became the lone psychiatrist serving Saskatchewan’s northern communities. But then tragedy struck La Loche. On Jan. 22, 2016, a 17-year-old local teen shot and killed two people in their home, entered the La Loche Community School, and opened fire. Two people were killed in the school, leaving four dead in total, seven injured and a community shaken to its core. Dr. Dungavell was needed immediately.

Dr. Dungavell recounts her experiences as a new recruit serving on the front lines of a mental health crisis that was projected across the nation. Here are her words.

By Dr. Sara Dungavell Following graduation, I was terrified to go from being a supported resident to an attending physician and entirely on my own. But I had a plan.

I graduated in December 2015, took a month off with our new baby, and then I was to start back with familiar, teamoriented work that would build my confidence. In July, this theoretical, adequately confident, future me would take over Dr. Elena Shurshilova’s northern clinics in La Ronge and Stony Rapids.

That was the plan, but in January, the La Loche shootings happened.

I went to visit La Loche in February, and I heard the stories of courage and resilience in the people there. I learned that, during the shootings, they had pulled together and taken care of each other and had continued to do so every day since.

I met professionals who were doing their best to support the community, struggling with limited resources and high demands that made their jobs harder than anything they’d trained for in the south. But they kept on. I learned that what the community wanted most of all was people, programming and funding that stayed on. That was dependable. That was there.

The next month flew by. My first clinic was booked for April 1.

Whether I felt competent enough or not, at the end of February slim white envelopes filled with consults were already winging their way south to me in Saskatoon.

The problem with providing health care in an underserviced area is that it’s underserviced. The team that’s there is already struggling, and there’s no backup. There is only you.

Holding those patient stories in my hands, I was overwhelmed – sure that I shouldn’t be trusted with them. I shouldn’t be the one these people were reaching out to for help. A new physician, fresh out of residency – who was I to be able to help?

That self-doubt didn’t ease when I got there and saw how little psychiatry can do when confronted with overwhelming social determinants of health. They didn’t need me, they needed reliable and safe work; they needed high-quality education, supplied in a culturally sensitive way; they needed broad healthy community programs to repair generations of trauma, marginalization and abuse.

I was a tiny dusting of aid that most people were too burned-out to try or trust. During one clinic, only one person showed up. The same was repeated when I started in Stony Rapids. But as I near my one-year mark in La Loche, as I build trust slowly, the people who’ve been facing these inequities are reaching out. And I’m there to provide the biological and psychological expertise they wouldn’t otherwise have.

“

ON THOSE THREE DAYS A MONTH WHEN I GET ON A TINY PLANE TO FLY NORTH AND LEAVE MY SLEEPING CHILDREN BEHIND, I KNOW WHY I’M GOING. NO CHILD, YOUNG OR OLD, DESERVES TO BE STRUGGLING WITHOUT SUPPORT.

SMA DIGEST | SPRING 2017

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The family doctors, nurse practitioners and mental health workers there need specialist support. The communities need to know that when they need psychiatric care, they’ll get it from someone who will be back to modify treatment as necessary.

There are still so many communities that lack sufficient psychiatric care, and need professionals providing support in a huge variety of ways. There’s still so much I can’t do in the communities I am in, but I do what I can.

On those three days a month when I get on a tiny plane to fly north and leave my sleeping children behind, I know why I’m going. No child, young or old, deserves to be struggling without support. No Canadian deserves to live in a place where preventable causes of death, infant mortality rates and suicide rates are dramatically higher than in the rest of Canada.

At least I can be one of the people trying to help change it.

The theoretically confident me may never have appeared, but if I wait for her to get here, who will get started on this work? ◆

Family physicians It’s more than a practice ...it’s a lifestyle!

Northern Medical Services is seeking family physicians for full-time, itinerant contract and locum positions available in northern Saskatchewan. Experience practice in a remote setting and receive a competitive remuneration package (compensation $287,000$384,000 per annum depending upon qualifications and employment location) plus additional personal and professional benefits too numerous to mention.

Locum rate: $1510-$1820 per day plus on-call stipend.

Northern Medical Services Division of Academic Family Medicine College of Medicine University of Saskatchewan 404 - 333, 25th Street E Saskatoon, SK Canada S7K 0L4

Facebook “f ” Logo

www.northerndocs.ca Contact: E: nms.recruitment@usask.ca P: (306) 665-2898 F: (306) 665-6077 Toll-free: 1 (866) NMS-DOCS 1 (866) 667-3627

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SMA DIGEST | SPRING 2017

CMYK / .eps

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DOCTORS CHOOSING

WISELY

Dr. Kevin Wasko

By Girard Hengen

R

ather than talk about changing their health-care culture, physicians in the Cypress Health Region are choosing to do something about it.

They are taking elements of the Choosing Wisely Canada (CWC) national campaign and tailoring it for their local audience. Organized by physicians in partnership with the Canadian Medical Association, CWC is a campaign that encourages doctors and patients to talk about unnecessary tests and treatments – in other words to make smarter, more effective choices.

“We have a very active regional medical association (RMA) in Cypress, we have monthly meetings where we discuss a variety of topics, but a consistent theme that seemed to emerge through our discussions at those meetings was accountability in the system,” said Dr. Kevin Wasko, a family physician based in Swift Current and assistant clinical professor at the University of Saskatchewan College of Medicine.

“There’s a lot of talk about physician accountability and physicians choosing wisely, but that will only work if patients are also accountable for the system. And that’s where this recurrent theme came in, how do we communicate to our patients that their demands for care need to be tempered, while still meeting their care needs?”

The CWC has developed resources to help communicate the message. For example, national societies representing a range of specialty groups have provided lists of tests and treatments that are commonly used, overused or used inappropriately.

According to the CWC website: “Unnecessary tests and treatments do not add value to care. In fact, they take away from care by potentially exposing patients to harm, leading to more testing to investigate false positives and contribut-

ing to stress for patients. And of course unnecessary tests and treatments put increased strain on the resources of our health-care system.”

In the Cypress Health Region, the RMA and the regional health authority will partner to roll out a campaign that involves print and radio media, plus social media, which is expected to be the main promotional vehicle. Local healthcare providers will tackle certain topics, putting familiar faces to the various aspects of the campaign.

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THERE’S A LOT OF TALK ABOUT PHYSICIAN ACCOUNTABILITY AND PHYSICIANS CHOOSING WISELY, BUT THAT WILL ONLY WORK IF PATIENTS ARE ALSO ACCOUNTABLE FOR THE SYSTEM.

“We have a young cohort of physicians who really buy into the principles of system sustainability and I think that’s what’s going to drive this,” said Dr. Wasko, who is president of the Cypress RMA. “The health-care system is not sustainable in its current form and everyone has a role to play in ensuring that it can be sustainable, patients and physicians alike, so we’ve partnered with the local health system, the Cypress Health Region, to try to tailor a Choosing Wisely campaign that will be relevant to our patients and that can get that message out there so that if our local culture at least can be changed, maybe we can advance the principles of choosing wisely.” ◆ SMA DIGEST | SPRING 2017

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THE STORY

KEEPER

By Maria Ryhorski

You can feel the warmth shining through Dr. Joel Schindel’s smile as he speaks of his practice in Beardy’s & Okemasis First Nation and One Arrow First Nation.

“You go out there to a family, you know? People who care,” he says. “You care about them. They care about you.”

The connection between this dynamic young physician and the communities he serves is palpable and it is something that has been carefully nurtured since he arrived almost four years ago.

Indigenous communities across Canada face greater health challenges than many others do. These challenges are often tied to lack of access, as well as the other historic and socio-economic realities that touch many indigenous people, such as the legacy of residential schools.

Dr. Schindel is working to alleviate some of these challenges and empower the communities he serves through, what he calls, Comprehensive Indigenous Community Care (CICC) clinics. Historically, holistic care was the basis for health and

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wellness in First Nations communities. Today, this is often not the case. In collaboration with community members and a multi-disciplinary health-care team, Dr. Schindel is bringing back a holistic and culturally safe approach to care.

There are two CICC clinics per week in Beardy’s & Okemasis, and two in One Arrow. Each encompasses a proactive focus on chronic disease management, mental health wellness, prenatal care, elder services and annual complete physicals.

Integral to providing whole person care to his patients is getting to know their stories.

“It all comes back to treating the whole person and listening to them with sincerity,” says Dr. Schindel. “Just ask them a question. Ask them why. Ask them to explain more and be sincere in that. Get to know their story. That’s what it all comes down to – knowing their story.”

Each person’s unique story provides essential insights into their wellness, both physical and mental, and helps Dr. Schindel and his team work in collaboration with the patient to find the best treatment.

Being trusted with these stories is something Dr. Schindel sees as a privilege. And the conversations that lead to this awareness have emerged as one of his most valuable clinical tools.

“This is where I found new meaning in being a family physician,” he says. “The answer isn’t always in a prescription pad.

“I’ve heard stories about residential schools from survivors.

I’ve heard things that you wouldn’t believe an individual could go through and survive,” he says.

In many cases, the simple act of listening and providing a safe environment to talk brings about the most benefit. He also employs principles of cognitive behavioural therapy to empower his patients to become the drivers of their own health.

Trust is critical in Dr. Schindel’s relationship with his patients and a foundational piece of building that trust is providing a culturally safe environment.

“Cultural safety goes beyond just awareness of your cultural differences, to a place where you’re able to interact in sensitive ways,” says Dr. Schindel. “This means, even if you’re different than someone, the way you interact allows them to feel safe enough to be completely themselves.”

Trust is the key thing that this clinic brings, according to Dr. Schindel, and it enables whole person care. But it is not something that happens overnight.

“If you sincerely want to know someone’s story, I have found that often this helps them feel less like the ‘other’ that some have been made to feel like.

“Many have been feeling like the ‘other’ in their own home for so long. I think that when you can break that down, you’ll be successful.”

Dr. Schindel learns from his patients every day – listening with an awareness of his Somali-Canadian cultural background and theirs – gaining a better understanding of their story and how they can best work together.

When it comes to the physician-patient relationship “it’s not hierarchical,” he says. “There is respect – I respect them for their knowledge and they respect me for my knowledge.

And it’s an exchange, not a monologue.”

This openness and mutual respect has served Dr. Schindel well in his work, with the CICC clinics being well-received both by Dr. Schindel’s patients and the indigenous community, as well as by members of the medical community who have stepped forward to offer their support.

“Cultural collaboration works when we value each other for our benefits and our contributions while treating each other with mutual respect and appreciation. This collaboration is the way forward.” ◆ Note: The beadwork on Dr. Schindel’s stethoscope (see facing page) was created by beading experts at the Willow Cree Healing Lodge at Beardy’s & Okemasis First Nation.

Learn more about Dr. Schindel’s CICC clinics on the following page. »

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THIS IS WHERE I FOUND NEW MEANING IN BEING A FAMILY PHYSICIAN. THE ANSWER ISN’T ALWAYS IN A PRESCRIPTION PAD.

SMA DIGEST | SPRING 2017

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Chronic Disease Management

Dr. Schindel ensures a holistic teambased approach to education and management of chronic diseases such as Type 2 diabetes, coronary artery disease, COPD, congestive heart failure, rheumatoid arthritis, etc. Together with his team, he develops innovative solutions with the goal of ultimately reducing the level of disease progression and its burden on the individual, family and community.

Mental Health Wellness

Dedicated appointments for mental health issues are provided, with particular attention given to mood disorders, suicide prevention, and PTSD. CICC incorporates mental well-being as part of all services provided and works in collaboration with the already established onreserve mental health team.

Accommodating Prenatal Care

CICC includes reserved appointments for prenatal care, postpartum care, and the first month of infancy.

Follow up addresses both physical well-being and postpartum mental health screening.

Supportive Care

Where and when possible visits will be made to patients formally admitted to hospital. This serves to promote continuity of care, to reassure the patients and their families, and to facilitate the management of patients in the community following discharge.

Home Care Conferences

As part of continuity of care, Dr Schindel strives to allocate time to have case conferences with the home care team

The CICC model is quality and community focused.

It is made of eight distinct components.

Content courtesy of Dr. Joel Schindel

Walk-in Clinics

By facilitating quick access to have a wide variety of general medical problems addressed, walk-in clinics can both prevent delay in treatment and reduce complications. They also serve as a means to identify medical conditions that may have fallen through the cracks of the system.

Lastly, if urgent care is required, arrangements with local emergency departments will be made.

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Elder Services

Dr. Schindel has found that home visits are not a thing of the past and can be quite beneficial in providing quality care to elders with poor mobility. In many instances home visits are the most befitting way respected members of the community can receive the care they deserve in the comfort of their own homes. This will be done with the availability of nursing and home care staff. Home visits will be restricted to those who are most in need of such services.

Annual Complete Physicals

Annual checkups have their role in ensuring that adequate past medical, family and social histories are taken and are kept up-to-date.

By allotting more time for these cornerstone visits, proper disease screening, medication reviews, and medical documentation can be maintained. This benefits the individual ensuring that there is no gap in care and facilitates care when seen by specialists or other healthcare providers.

TORONTO DOC HAS SOME BIG IDEAS

By Ivan Muzychka

“I think people are tired of having negative conversations about health care. I think they are ready for constructive and positive conversations and I must say that right now Saskatchewan seems like the most fertile place in the country for the implementation of big ideas.”

- Dr. Danielle Martin Dr. Danielle Martin, well-known physician advocate and author of Better Now: Six Big Ideas to Improve Health Care for All Canadians, recently visited Saskatoon as part of her national book tour. Her book has been attracting attention across a spectrum of readers and is a mix of plain, but compelling storytelling with a generous dollop of data and academic rigour.

Dr. Martin’s six ideas to improve Canadian health care include: ensuring all Canadians have regular access to a family doctor or other primary care provider; bringing prescription drugs under medicare; reducing unnecessary tests and interventions; reorganizing health-care delivery to reduce wait times and improve quality; implementing a basic income system to alleviate poverty; and scaling up local innovations at a national level.

“Medicare is a work in progress,” Dr. Martin writes in her book, “but it’s a work worthy of our greatest efforts. It represents a promise to be the kind of country we can be proud of.” Her book, she says, “explains what I think needs to be done to deliver on that promise.”

She was also impressed with what’s been happening in health care and around the SMA. “I am so excited to hear what is happening in Saskatchewan around health system redesign,” she told the SMA. “My impression is that this work is truly a co-operative effort among physicians and government, and hopefully communities and patients too. This bodes really well for Saskatchewan to implement solutions across the entire province, rather than through a more fragmented approach through pilot projects, which we often see in the Canadian health-care system.” ◆ To read the SMA’s full interview with Dr. Martin, please visit: www.sma.sk.ca/news/167/toronto-physician-has-big-ideason-how-to-improve-health-care.html

Win an autographed copy of her book!

Question: What well-known American senator invited Dr. Martin to come to Washington to present her ideas and insights on Canadian health care to American lawmakers?

Send your answer to sma@sma.sk.ca and the first SMA member with the correct answer will win an autographed copy of Dr. Danielle Martin’s Better Now: Six Big Ideas to Improve Health Care for All Canadians.

SMA DIGEST | SPRING 2017

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INNOV STROKE CARE

when every second counts

Dr. Gary Hunter

Dr. Mike Kelly

By Girard Hengen When someone is having a stroke, every second counts.

That’s why innovations such as the Saskatoon Stroke Team and the Acute Stroke Pathway are making a difference, saving lives while providing more efficient care as physicians work alongside other health-care professionals.

“Over the last few years we saw a need for a more formalized program in order to optimize delivery of stroke care to our health region and the province,” said Dr. Gary Hunter, a neurologist and medical director of Acute Stroke and Inpatient Neurology for the College of Medicine.

The resources were in place, but after an innovative University of Calgary trial showed the benefits of endovascular stroke care, there was a thorough look at stroke care processes in Saskatoon involving people from every discipline, from EMS personnel to neurosurgeons.

The model works and is being used as a template for the province, Dr. Hunter says.

Patients who appropriately receive therapy with tissue plasminogen activator (tPA) have a much higher chance of remaining independent at home. Those who receive endovascular surgery see a 50 per cent reduction in mortality and 40 per cent reduction in disability. These therapies can only improve outcomes if patients recognize signs of stroke and call 911, which is where the Heart and Stroke Foundation’s FAST (Face, Arm, Speech, Time) campaign is really paying off, Dr. Hunter said. Teams are also working on a new screening tool to identify large vessel occlusions that may need endovascular treatment.

“We know that people are more likely to have a better outcome if they are admitted to a stroke unit versus not, and that probably reflects the high quality of care that’s delivered from the entire team,” said Dr. Hunter.

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The Royal University Hospital stroke unit has implemented several patient-focused practices that have reduced the length of stays and improved the overall experience for patients. The unit now does bedside rounds that include families and team members. A new app for delivering patient education is also in progress and RUH will be the first to use it in North America.

Another innovation in stroke care - the Acute Stroke Pathway - sees interdisciplinary team members play a role from the first call for an ambulance anywhere in the province to the final stages of treatment.

Formally launched in January but running since summer 2016, the pathway streamlines care based on Canadian best practice guidelines for stroke.

“Everything in the pathway is an implementation of those best practice guidelines. This work includes EMS bypass to stroke centres, emergency room management of stroke patients such as consultation, imaging and treatment – that’s all guideline-based care,” said neurosurgeon Dr. Mike Kelly, a professor in the College of Medicine and Saskatchewan Research Chair in Clinical Stroke Research.

The idea of the pathway is to identify stroke patients and get them to a primary or comprehensive stroke centre as quickly as possible to provide care.

It has taken three years to implement the pathway, but Dr. Kelly notes the physicians involved have had good working relationships with other members of the stroke teams, the regional health authorities and the government. The Health Quality Council has provided expertise with provincial tracking of stroke metrics.

“With stroke the patients are coming and you have to be able to deal with them. A system like this lets you have a good plan to do it efficiently and subsequently provide better care.” ◆

ATIONS

HEALTH CARE

EYES OPENED

to benefits of iron infusions

Dr. Ryan Lett

By Girard Hengen Regina anaesthesiologist Dr. Ryan Lett thought he had kept on top of developments in his field. He read the literature, studied the journals.

But a trip to an international conference proved to be enlightening for Dr. Lett, who learned of an innovative alternative to blood transfusions. Using IV iron infusions, instead of blood transfusions, exposes patients to less risk and would result in significant cost savings for the health-care system, Dr. Lett said.

“It’s becoming the standard of care around the world. In stable, anemic patients the evidence suggests that intravenous iron is among the best hematinic agents available.”

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IT’S BECOMING THE STANDARD OF CARE AROUND THE WORLD ... THE EVIDENCE SUGGESTS THAT INTRAVENOUS IRON IS AMONG THE BEST HEMATINIC AGENTS AVAILABLE.

Dr. Lett learned about IV iron infusions at the 16th World Congress of Anaesthesiologists in Hong Kong last summer.

The procedure is more common in Europe and Australia, but is not so well-known in his home province.

“I showed up and I actually thought I was up to date on everything, I didn’t expect to get much out of the meeting thinking I had read enough journals to keep up on everything,” he said of the congress. “When I came back I started reviewing some of the articles and literature that had been mentioned – and it’s in all of the major medical journals –

when you start looking, the preponderance of evidence supports preventative iron infusions where possible, and even treatment IV iron infusions when the patient is stable, being superior to blood transfusion.”

Many patients can be better prepared for surgery by using IV iron treatments to increase hemoglobin. Through this process, patients make their own hemoglobin so that by the time of surgery, they are much less likely to require a risky blood transfusion.

“There’s a host of reasons for not wanting to get a blood transfusion,” said Dr. Lett, citing risks such as increased chance of mortality, increased length of hospital stays, stroke, heart attack, infection and transfusion reactions.

Cost is also a consideration. Dr. Lett analyzed a cohort of 250 anemic patients in Saskatchewan needing surgery. To treat every patient’s anemia by blood transfusion would cost the province $196,000, but using IV iron would cost $60,000 – a savings of more than $130,000.

Another study performed by the Saskatchewan Transfusion Medicine Working Group found that at least 20 per cent of units of blood were given to stable, non-bleeding patients with hemoglobin levels greater than 70g/L. Dr. Lett said while that may seem insignificant, when applied to the 31,000 units of red cells transfused in the province every year, the cost savings if the blood was not given would amount to $2.6 million per year, not including the costs of complications and increased hospital stay in those patients receiving blood.

Dr. Lett says blood transfusions are a habit and habits are hard to change. There will always be a need for transfusions, but if there is to be a shift to greater use of iron infusions, it won’t be easy and it won’t be quick.

“The more you learn the more it becomes a possibility that transfusion might actually be replaced (by IV iron) in patients who are stable and are not bleeding.” ◆ SMA DIGEST | SPRING 2017

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PHYSICIANS DEVELOP QI SKILLS

through new program

By Shannon Boklaschuk, Health Quality Council

The new year started with a new challenge for 16 Saskatchewan doctors. They became the first participants in the new Clinical Quality Improvement Program (CQIP), which has been designed specifically for clinicians in Saskatchewan’s health system.

The Health Quality Council (HQC) – in collaboration with the Saskatchewan Medical Association (SMA) and the provincial Ministry of Health – launched CQIP in January 2017. It will run to November 2017.

“We were excited about the quantity and quality of our first group of CQIP applicants,” said Gary Teare, HQC’s CEO. “The inaugural cohort has a lot of diversity, both in the clinical quality improvement projects they are aiming to undertake and in their individual backgrounds as physicians.”

CQIP is an 11-month course designed to build capability for facilitating and leading successful health-care improvement work in Saskatchewan. The program includes a mix of theory and experiential learning, along with individual coaching and a community of practice for physicians actively working in a clinical context.

“At the SMA, we are excited about this new program. It will help physicians gain skills in leadership, teamwork, and the ability to lead quality initiatives,” said SMA President Dr. Intheran Pillay.

“In five to 10 years’ time, we hope with health system redesign that we have a seamless continuum of care, with quality, safety, and access as the hallmarks.”

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CQIP is a sister program to the internationally recognized mini-Advanced Training Program, which was developed by Intermountain Healthcare in Salt Lake City, Utah. Its content has been adapted by HQC for the Saskatchewan health-care system. CQIP is accredited through both the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons.

Dr. Gary Groot has been doing quality improvement work in the province for a few years since attending the Intermountain program. He describes it as one of “the most exciting things” he has done since starting his career. He is now involved with CQIP as coach/faculty.

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IN FIVE TO 10 YEARS’ TIME, WE HOPE WITH HEALTH SYSTEM REDESIGN THAT WE HAVE A SEAMLESS CONTINUUM OF CARE WITH QUALITY, SAFETY AND ACCESS AS THE HALLMARKS.

Dr. Groot said the theory and practical skills physicians will learn as part of CQIP will help them become leaders in their own areas of expertise “in making it easy to do the right thing for our patients.”

“Clinical quality improvement is about doing what we do best,” said Dr. Groot, who is a general surgical oncologist working in Saskatoon, as well as a quality improvement

researcher at the University of Saskatchewan and a clinical co-lead for the Ministry of Health Appropriateness of Care Program.

of physicians who are helping to improve the quality, the safety, the appropriateness, and processes in our healthcare system.

HQC board chair Dr. Susan Shaw, who practises critical care and anaesthesiology in the Saskatoon Health Region, said she is excited about the launch of CQIP because “all highperforming organizations in health care around the world have consistently identified that physician leadership – particularly in quality and safety – is important for the system to perform at the best level possible.

“We already have a number of physicians in Saskatchewan with a keen interest in quality improvement. This program represents an opportunity to extend that to a broader community,” he said.

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ALL HIGH-PERFORMING ORGANIZATIONS IN HEALTH CARE AROUND THE WORLD HAVE CONSISTENTLY IDENTIFIED THAT PHYSICIAN LEADERSHIP – PARTICULARLY IN QUALITY AND SAFETY – IS IMPORTANT FOR THE SYSTEM TO PERFORM AT THE BEST LEVEL POSSIBLE.

“I think that we’re well on our way in Saskatchewan to achieving this goal, and we can only do it by working with our doctors and helping them become the experts in quality improvement that they need to be,” said Dr. Shaw, who is also serving as CQIP coach/faculty.

One Saskatchewan-based quality improvement project that Dr. Shaw is particularly proud of is the elimination of catheter-related bloodstream infections in intensive care units in the Saskatoon Health Region. At one time, it was believed that catheter-related, or central line, infections “were just part of being sick,” she said.

“But we studied the problem, we learned from other systems, and we used quality improvement methodology to understand, tackle, and eliminate the problem of catheterrelated bloodstream infections. And I’m really proud that we’ve gone months, and years, without patients suffering that complication. That showed to me what you can do if you use the tools and you work in a team and you just keep moving forward,” Dr. Shaw said.

Mark Wyatt, a Ministry of Health Assistant Deputy Minister, said CQIP is important because “it will increase the number

This first cohort of CQIP participants indicated their areas of interest in their applications. For example, there will be improvement projects undertaken relating to paediatric mental health, HIV screening and testing, the management and care of chronic obstructive pulmonary disease (COPD), and antibiotic use in the intensive care unit. While the CQIP workshops will be based in Saskatoon for the first year, the project work will take place in the health regions or organizations in which the physicians work. ◆

The first cohort of CQIP participants includes:

Dr. Chantal Ansell – University of Saskatchewan Dr. Patricia Campbell – Prairie North Health Region (HR) Dr. Senthil Damodharan – Regina Qu’Appelle HR Dr. Shamsuddin Fakhir – Cypress HR Dr. Milo Fink – Regina Qu’Appelle HR Dr. Erin Hamilton – Prairie North HR Dr. Marcie Heggie – Sunrise HR Dr. Mark James – Saskatoon HR Dr. Maurice Ogaick – Saskatoon HR Dr. Shaqil Peermohamed – Saskatoon HR Dr. Henrike Rees – Saskatoon HR Dr. Rabia Shahid – Saskatoon HR Dr. Nicolette Sinclair – Saskatoon HR Dr. Niroshan Sothilingam – Saskatoon HR Dr. Ron Taylor – Regina Qu’Appelle HR Dr. Philip Wright – Saskatchewan Cancer Agency

The list of CQIP coaches/faculty includes: Dr. Vicki Cattell Dr. Phillip Fourie Dr. Gary Groot Dr. Cecil Hammond Dr. Jason Hosain Dr. David Kopriva Dr. Shabir Mia Dr. Mark Ogrady Dr. Susan Shaw Dr. Guruswamy Sridhar

SMA DIGEST | SPRING 2017

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IN THEIR OWN WORDS

CQIP participants discuss their projects Dr. Erin Hamilton and Dr. Shaqil Peermohamed are two of the first 16 CQIP participants. Here they answer several questions related to quality improvement and to their CQIP projects.

DR. SHAQIL PEERMOHAMED, SASKATOON HEALTH REGION Q: Why did you want to get involved in CQIP? A: Antimicrobial stewardship and quality improvement are parallel concepts targeting appropriateness of care and the optimization of patient safety. As the Saskatoon Health Region’s Antimicrobial Stewardship Physician Lead, I strive to enhance my knowledge improvement methodology. I am excited to be a part of the Clinical Quality Improvement Program’s inaugural cohort of physicians. Through this mentorship-based program, I will be equipped with the theory and tools needed to implement successful health-care improvement.

Q: What is your project about?

A: Antimicrobials are among the most commonly prescribed medications in hospitals; however, up to 50% of antimicrobial use has been shown to be inappropriate. Such inappropriate use of antimicrobials is associated with the development of antimicrobial resistance, increased rates of Clostridium difficile infection, prolonged hospital stay, and patient mortality. In fact, by 2050, more people will die from antibiotic-resistant organisms than cancer and diabetes combined. So it’s critical that we recognize the consequences of inappropriately prescribed antimicrobials and the impact on patient morbidity and mortality. Our quality improvement project aims to assess the impact of antimicrobial stewardship rounds in Royal University Hospital’s intensive care unit on antimicrobial usage and a variety of patient outcomes.

Q: Why did you choose that topic?

A: Antimicrobial stewardship is a core strategy that can be used to enhance patient safety, optimize antimicrobial usage, and ensure the right patient receives the right antibi28

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otic at the right dose and for the right duration. I am passionate about antimicrobial stewardship and this quality improvement study, in particular, as it emphasizes the importance of collaboration amongst health-care providers to work toward common goals of ensuring appropriateness of care and optimizing patient safety.

Q: What does quality improvement mean to you?

A: I believe quality improvement is a conduit to develop and implement innovative, collaborative, and sustainable strategies to improve our health-care system, prioritizing patient-centred care.

Q: Why is quality improvement important for physicians and other health-care professionals?

A: Our health-care system is rapidly evolving and we, as health-care workers, need to be adaptable and flexible; we are all working toward common goals of improving quality of care, optimizing patient safety, and ensuring appropriateness of care. We should continuously strive to incorporate quality improvement into daily practice, cultivating collaborative partnerships and successfully leading improvement in our health-care system.

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OUR HEALTH-CARE SYSTEM IS RAPIDLY EVOLVING AND WE, AS HEALTH-CARE WORKERS, NEED TO BE ADAPTABLE AND FLEXIBLE.

- Dr. Peermohamed

DR. ERIN HAMILTON, PRAIRIE NORTH HEALTH REGION Q: Why did you want to get involved in CQIP? A: I am involved in several teams where we see areas where we can improve and often have good ideas for improvements. However, despite initial enthusiasm, these good ideas often aren’t translated to lasting change due to lack of time, commitment, skills, or a multitude of other reasons.

This becomes frustrating both for myself and for the team and gradually erodes enthusiasm, confidence, and work satisfaction. I am hoping that by committing time to the program and learning skills for quality improvement, I will learn tools to help our teams develop and achieve meaningful and sustained changes.

Q: What is your project about?

A: My project will focus on increasing HIV testing and improving the connection to treatment and primary care for people living with HIV in our region. The improvement idea is to increase HIV testing of patients at all points of contact in our region. Anecdotally, we have heard that care providers continue to use risk-based testing and are hesitant to test for HIV in settings where they would not be involved in follow up, for example in the ER or through specialists.

We would like to confirm these barriers and explore and address further barriers to testing. To connect and retain patients in care, we would like to ensure we have a local care team in place that can assist in providing diagnosis, case management and initiate antiretroviral therapy.

Q: Why did you choose that topic?

A: The rates of HIV in Saskatchewan are climbing. We know that testing and treating HIV can dramatically reduce transmission rates. We know what to do, but are having difficulty putting this into practice. It seemed like a good fit for a quality improvement project.

Q: What does quality improvement mean to you?

A: It means continuous incremental change toward a better health-care system.

Q: Why is quality improvement important for physicians and other health-care professionals?

A: Our health-care system provides fantastic care for patients, most of the time. But when it doesn’t meet the needs of patients, or provide safe care, we should not just accept this. We all want to feel like we are providing the best care possible and feel proud of the system we are working in. A mindset of quality improvement is how we can do that. ◆

Dr Regan Arendse is pleased to announce that Dr Myat Nyo will join him in practice as a rheumatologist effective April 31st, 2017.

Dr. Nyo holds South African fellowships in internal medicine and rheumatology and has extensive academic medicine experience. He earned his medical degree from the Medical University of South Africa, Pretoria and completed his residencies in internal medicine and rheumatology at Groote Schuur Hospital, Cape Town. He has completed the European League Against Rheumatism (EULAR) Postgraduate course in Rheumatology and EULAR accredited Basic and Intermediate Level Musculoskeletal Ultrasound in Rheumatology courses.

Dr Nyo will share new referrals with Dr Arendse which may be faxed to the office at 1-306-2441930.

Drs. Arendse and Nyo look forward to assisting you in the management of your rheumatology patients.

SMA DIGEST | SPRING 2017

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PROVINCIAL INITIATIVE aims to improve health-care safety

By Shannon Boklaschuk, Health Quality Council Safety is a top priority in the provincial health system, and Saskatchewan’s physicians can play a big role in helping to make the systemic changes needed to reduce harm.

That’s the message from Kate Fast, lead of the provincial Safety Alert/Stop the Line Initiative. Safety Alert/Stop the Line, which is co-ordinated out of the Health Quality Council, is intended to support Saskatchewan’s health system in achieving the goal of zero harm to patients and staff by March 2020.

Fast is encouraging physicians and other health-care professionals to think about what they can do to support a culture of safety.

“As a physician, you are already involved. You are responsible for ensuring that your patients are safe. Safety Alert/ Stop the Line processes make it possible to stop any care process when a safety concern is identified, alert others, and get the help you need to fix issues. It also creates a clear process to escalate concerns so that safety can be restored,” she said.

“As a physician, you influence others by speaking up when a potentially harmful situation is recognized and by supporting others to do the same. You lead others by working together with your health-care team. Tell your team what your safety concerns are, ask them what improvements are being planned, and work with them to reduce risks.”

In October 2016, the Canadian Institute for Health Information (CIHI) and the Canadian Patient Safety Institute (CPSI)

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released a report called Measuring Patient Harm in Canadian Hospitals. The report included data indicating that patients suffered harm in more than 138,000 hospitalizations in Canada in 2014-2015, and noted that one in five of those hospitalizations involved more than one occurrence of harm.

“It’s estimated that on any given day more than 1,600 hospital beds across the country are occupied by a patient who suffered harm that extended his or her hospital stay. In addition to what these patients and their families go through, their continued need for treatment also has a cost to the system, in that it keeps other people from getting the help they need,” the report stated.

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IT’S ESTIMATED THAT ON ANY GIVEN DAY MORE THAN 1,600 HOSPITAL BEDS ACROSS THE COUNTRY ARE OCCUPIED BY A PATIENT WHO SUFFERED HARM THAT EXTENDED HIS OR HER HOSPITAL STAY.

The Safety Alert/Stop the Line Initiative encompasses processes, policies, and behavioural expectations that support patients, staff, and physicians to be safety inspectors, to

identify and fix potentially harmful mistakes in the moment, or to stop the line and call for additional help to restore safety.

Safety leaders across the province are committed to working collaboratively through a community of practice – the Safety Alert/Stop the Line Network – to adopt standard policies and processes to ensure that patients and staff across Saskatchewan experience the same safe care. The Safety Alert/Stop the Line Initiative project team supports the Network, connects with provincial leaders, and helps to align the Safety Alert/Stop the Line work with other quality improvement initiatives across the province. It is expected that

by March 31, 2018, all acute health-care facilities will have their Safety Alert/Stop the Line systems in place. The team is currently working with leaders of long-term care facilities to determine how similar processes in these settings will work, with implementation planned for 2019.

“Staff and providers come to work in the health system to make a positive difference for members of their community.

They do not intend harm to patients, and don’t expect to be harmed themselves while providing care to those in need,” Fast said.

HQC employee Kate Fast is working with others in Saskatchewan’s health system to improve patient and staff safety.

“Our goal is to ensure the system is designed to assist care providers in identifying potential harm to everyone in health-care settings and stopping it before it happens.” ◆

MAKING HEALTH-CARE SETTINGS SAFER IS EVERYONE’S RESPONSIBILITY. Assess the situation.

Ask for support from others, supervisors, or leaders.

Stop if you see

something that is unsafe.

Fix the unsafe situation if you can. If you can’t, then . . .

Escalate your

being SAFER means:

concern. Call in help from a team member or leader.

Report unsafe situations, environments, and

practices, including both instances of no harm and incidents that have resulted in harm to patients or staff. We can’t improve what we don’t know about.

SMA DIGEST | SPRING 2017

31

DUTY OF CARE ESSENTIAL

By Ivan Muzychka

The CMPA noted that more than one physician may owe a duty of care to a patient. When referred, the duty of care for the referring physician is suspended for matters within the scope of the consultant’s duty. When a physician relinquishes the care of a patient to another physician, it is incumbent on that physician to take reasonable steps to provide for the patient’s continued care until the new physician is in a position to take over. When many physicians are involved, they should establish a protocol or a best practice to ensure no breakdown occurs in the chain of communication.

Last spring, the Saskatchewan Medical Association (SMA) asked the Canadian Medical Protective Association (CMPA) about the liability risks related to the pooled referral management system used in Saskatchewan. The SMA wanted to know if physicians could be legally liable if a patient was to “fall through the cracks.”

The key point is that the referring physician is required to take reasonable steps until the specialist assumes care. A court would look to see what steps were taken to ensure continuity of care. Physicians should note that agreeing to see a patient is sufficient to create the doctor-patient relationship.

The CMPA advised that if a patient suffers harm, and alleges that it was caused by an unreliable referral system, all involved could potentially be named as defendants in the claim, including the referring physician, specialist, and the Ministry of Health.

Ultimately, physicians who fail to take reasonable steps regarding a patient’s continued care may be found to have breached the standard of care and may be liable for damages suffered by their patient.

when using pooled referrals

Legal responsibility of the physician is determined by whether the physician owes a duty of care to the patient.

This responsibility includes the obligation to act in the patient’s best interest, ensure continuity of care and attend as good medical practice requires.

Finally, the CMPA advised that courts have not addressed the extent to which governments, agencies, institutions and physicians might be held liable for wait times. Specialists need to prioritize queued patients once notified by the Ministry of Health. Physicians should work with the Ministry of Health to further refine the referral management system. ◆

DOWNTOWN MEDICAL Downtown Medical Office FOR LEASE

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downtown office offering exclusively medical neighbours including podiatrists, audiologists, ENTs, OBGYNs, family doctors and a pharmacy • 2,149 SF with three (3) private offices, three (3) exam rooms, staff room, kitchenette and in-suite washrooms; landlord will renovate to suit • Modern lobbies and elevators service three (3) floors with direct access to secure parking • Oversized loading zone out-front; patient parking readily available at adjacent Impark lots • Net Lease Rate $18.50/SF MLS ®

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Colliers McClocklin Real Estate Corp. | 306 664 4433 | www.colliers.com/saskatoon 32

SMA DIGEST | SPRING 2017

GRITS FOR GRIEVING GUYS

provides recipe for success

Jacqueline Carverhill and Thea Hedemann (pictured left to right)

By Girard Hengen Two University of Saskatchewan medical students who organized a cooking class for widowers taught the men about more than pots and pans.

“It’s a demographic that’s difficult sometimes to recruit in the sense that there’s a huge need there, but they’re just not used to picking up the phone to register for a program or they’ve gone through a huge change in their life and it might be scary to join a new program,” Carverhill said.

Jacqueline Carverhill and Thea Hedemann provided a recipe on how to move forward in life at a difficult time. Once the food preparation was done, things really started cooking.

They cooked “healthy comfort food,” Hedemann said, such as roast chicken, stuffed chicken breast and veggies, and chili.

“The talking and conversing has been the most beneficial part for the men and they really enjoy that part,” Hedemann said. “They enjoy the cooking, but when things are in the oven we have time to sit down and have coffee, talk about their wives, talk about their life now, talk about even their week. Those things have been really eye-opening.”

“One of the men sent me the recipe of his wife’s biscuits so we made that,” she said. “They turned out well.”

The cooking class – called Grits for Grieving Guys – completed its five-week program in Saskatoon on Feb. 4. It was established under the Saskatchewan Medical Association (SMA) program FLIP, or Fostering Leadership through Innovative Projects. The SMA partners with the College of Medicine Mentoring Program on FLIP, which aims to support and develop leadership in medical students.

Every Saturday, Grits for Grieving Guys participants gathered at Zion Lutheran Church, which donated its kitchen, to prepare meals and provide each other support, an important component of the program.

“We really wanted something that we could give back to our community in a tangible and realistic way,” Carverhill said.

“With that in mind we combined our interest in medicine with our love of cooking and came up with this idea and ran with it.”

Carverhill and Hedemann, both of Saskatoon, are secondyear medical students at the U of S. For Grits for Grieving Guys they sought help from physicians, people who work in palliative care and social workers, and partnered with the Saskatoon Funeral Home, which was instrumental in finding the original six participants.

The two medical students found rewards in their program, which nourished the bodies as well as the souls of the men who were grieving.

“

JUST THE EXCITEMENT THAT WE SENSE FROM THE MEN IN COMING TO THESE GROUPS EVERY WEEK - I THINK THAT’S THE SPECIAL PART OF IT ALL.

“The best thing that’s come from this is seeing the program come to fruition and the sense of, even if it’s something small that we’ve managed to do, just seeing the men and how they react each week and how even after we’ve brought them out of the church and we go back to clean up, turn off the lights, lock up, we go to our car and we see that some of the men are actually still talking to each other standing in the parking lot, or just the excitement that we sense from the men in coming to these groups every week,” Carverhill said. “I think that’s the special part of it all.” ◆

SMA DIGEST | SPRING 2017

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COMING FULL CIRCLE WITH SMA ROADMAP

By Maria Ryhorski

Sitting down with Roadmap Program veteran Dr. Reid Sonntag, almost three years after first meeting him on the 2013 tour to Arcola and Carlyle, it’s not hard to reconcile the slightly more serious resident before me with the fun-loving, life-of-the party student who is affectionately remembered by SMA Roadmap staff for volunteering both arms for beginners IV-practise in Ilea-la-Crosse. I caught up with Reid, now almost a year into his family medicine residency in Swift Current.

MR: So we’ve come full circle – two and a half years after the Roadmap Tour to Swift Current, here you are as a first-year resident. And I understand that you weren’t even initially interested in rural/regional practice – did your experience on the Roadmap Tours have any effect on this shift?

RS: Yeah it did. I had this impression in medical school that being a family doctor meant that you went to the clinic at 9 o’clock on Monday, left at 5, did that every day, and became a referral machine. I think that when I came to Swift Current for the Roadmap Tour, it was the start of me realizing what family docs can actually do.

I grew up in a rural community so you kind of have this picture of what a rural doc looks like – what they do – but it isn’t until you’re in the thick of things that you can really see that rural family doctors are true generalists.

I think it’s amazing that here in Swift Current there are family doctors who work in the Emergency, who work in the clinic, who have inpatients, and work in obstetrics as well. To me, that is just the epitome of what it means to be a physician.

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SMA DIGEST | SPRING 2017

“

IT’S NICE TO KNOW THAT ... BY THE END I’M GOING TO FEEL CONFIDENT NOT ONLY IN THE HOSPITAL, CLINIC AND EMERGENCY DEPARTMENT SETTING, BUT ALSO AT HOME. IT’S A NICE FEELING TO BE ABLE TO BE OF SERVICE NOT ONLY TO YOUR PATIENTS BUT ALSO TO YOUR FRIENDS AND FAMILY.

MR: What else appealed to you about family practice?

RS: After I was done this training I realized not only do I want to do these types of things because it would be a great career and I would get a lot of fulfillment out of that, but a generalist is also someone that can be a support for those close to them on a more personal level.

I have aging parents, and I have family that is having kids, and I have friends around me that have questions about their health, and it’s nice to know that as part of a wellrounded training program, by the end I’m going to feel confident not only in the hospital, clinic and emergency department setting, but also at home. If someone has a question about their parent’s medications, or has pregnancy concerns… you can be a resource to the ones that you love, the ones that are close to you. It’s a nice feeling to be able to be of service not only to your patients but also to your friends and family.

MR: What are some of the advantages of doing your residency in a smaller centre?

RS: We are the only residents here in Swift Current. Something that the Roadmap Program exposes you to is that, in a rural training program, if you are on a surgical rotation, you are next to the surgeon. If you are on urology, you are next to the urologist. If you are on obstetrics, you are the person. You are always the first line – all the time. It’s hard to beat that.

MR: Is it intimidating always being the first line?

RS: As the only learner, there’s a lot that is expected out of you. Everybody is kind of looking to you first for the answers, which does make it tough, and it can be stressful and nerve-wracking at times but I feel that for me, it’s good to have that fire under you – that fire to make you be the best.

MR: You are originally from a small town, but have been living in Saskatoon/ Regina for the past nine years – has it been difficult to adjust to living in a smaller centre?

RS: I think that in coming to a small community you have to make a decision – to enjoy it or not. If you come to a small community and you have this attitude that it doesn’t have a big enough movie theatre, it doesn’t have the types of gyms you like going to or the sports you like to play – you’re always going to be stuck in that negativity.

But I think if you come with the idea that, ‘Yes, I don’t know many people here. Yes, I’m going to be busy – but I’m going to do my damndest to have a great time here,’ then you can have a great time. Like last night we were able to go out on the town and let loose for a bit and that was an awesome feeling. To be able to go out and enjoy myself in Swift Current was such an affirmation that I’m in the right place. I had a fun time and I didn’t need the big city to have fun. You can create that on your own.

MR: Given the experiences you’ve had on the SMA Roadmap tours – what would you say to incoming medical students?

RS: I would tell them that you need to go on them. I would tell them that, even if you have an idea of where and how you want to practise after graduation, you don’t know what you might be missing until you go see as much as you can.

One thing about medical school is that you need to make so many tough decisions about where and how you want to practise. What kind of practice do you want to do? Do you want to specialize? Do you want to be a general practitioner? You have such a short period of time to decide. Four years is not a lot of time to go from zero medical training to done medical school and expected to know exactly what you want to practise for the rest of your life.

It’s way too difficult of a decision to make without exposing yourself to as much as possible. I think rural practice is amazing and I think the Roadmap Program is a great way to become exposed to such a great practice option. ◆ SMA DIGEST | SPRING 2017

35

“ “

THE LOCALS TALK ABOUT THE STRENGTH THAT THEY HAVE – THE STRENGTH OF THE COMMUNITY, THE STRENGTH OF THE PEOPLE, AND THEIR STRENGTH IN GETTING THROUGH THE THINGS THEY DO ON A DAILY BASIS GIVEN THE LACK OF RESOURCES AND LACK OF AVAILABLE MEDICINE.

- Kara Joudin

IT’S KIND OF LIT A FIRE UNDER ME TO REALLY LEARN AS MUCH AS I CAN AND I WANT TO COME UP TO PLACES LIKE THIS AND LEARN BECAUSE THE ATMOSPHERE IS SO DIFFERENT.

- Caitlyn Davidson (not pictured)

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SMA DIGEST | SPRING 2017

LA LOCHE ROADMAP 2017 La Loche certainly left an imprint on the minds of medical students and residents who travelled there on Feb. 4, 2017, with the SMA Roadmap Program. To learn more about the program visit www.sma.sk.ca/roadmap

“

I AM AMAZED ... BEING OUT THERE ON THE OPEN ICE, OPEN LAKE AND JUST GETTING THAT FEEL FOR NATURE, SEEING HOW THE COMMUNITY HERE, HOW THE PEOPLE HERE HUNT AND HOW THEY FISH AND HOW THEY SPEND THEIR LEISURE TIME, IT’S AMAZING ... I DON’T KNOW IF MY YEAR IS GOING TO GET ANY HIGHER THAN THIS. - Ibrahim Banun

“

“

BEING UP HERE WITH THE COMMUNITY, SPENDING TIME WITH THE PEOPLE, FOR MEDICAL STAFF, HEALTH WORKERS WHO WANT TO COME OUT HERE, IT HAS SO MUCH TO OFFER ... THE COMMUNITY IS SO TIGHTLY KNIT ... I FEEL LIKE, WORKING OUT HERE, YOU JOIN THE COMMUNITY. YOU BECOME PART OF THE FAMILY. - Ibrahim Banun

SMA DIGEST | SPRING 2017

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1

ROADMAP photo c

8

Every year, the Roadmap Program holds residents asking them to showcase rural and dozens of entries. In no particular order...

here

1.

2.

3.

4.

Eric Brenna, Class of 2018 Jackie Chou, FMR Amanda Klinger, FMR Abhinav Joshi, Class of 2017

7 77

38

SMA DIGEST | SPRING 2017

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2

3

contest winners a photo contest for medical students and regional Saskatchewan. This year we received

are the winners!

5.

6.

7.

8.

4

Anna Redekop, Class of 2018 Oshin Maheshwari, Class of 2018 Anna Redekop, Class of 2018 Ronelle Calver, Specialist resident

4

SMA DIGEST | SPRING 2017

5

39

&

COURSES CONFERENCES OPIOID SUBSTITUTION THERAPY CONFERENCE April 29-30 | Saskatoon, Sask. www.cps.sk.ca

MAY 2017 SPRING REPRESENTATIVE ASSEMBLY May 5-6 | Saskatoon, Sask.

To learn more or to register, please visit: www.sma.sk.ca/RA PLI LEADING CHANGE May 26-27 | Saskatoon, Sask. www.sma.sk.ca/PLI ONCOLOGY CONFERENCE May 26-27 | Regina, Sask. www.usask.ca/nursing/cedn

JUNE

PLI: SELF-AWARENESS AND EFFECTIVE LEADERSHIP June 23-24 | Regina, Sask. www.sma.sk.ca/PLI

SEPTEMBER

PLI: CRUCIAL CONVERSATIONS Sept. 29-30 | Regina, Sask. www.sma.sk.ca/PLI

OCTOBER

PLI: DOLLARS AND SENSE Nov. 17-18 | Saskatoon, Sask. www.sma.sk.ca/PLI

40

SMA DIGEST | SPRING 2017

FAMILY PHYSICIANS Pharmacy Interaction Limited is looking for family physicians to practise in a newly built medical clinic adjoining The Medicine Shoppe Pharmacy at 2553 Quance Street East in Regina. The clinic space has 6 exam rooms, one specialized for minor procedures, an injection room, reception area, waiting room, as well as a private learning centre for physicians and ample free parking.

Our pharmacy team delivers patient-focused care in a friendly, caring and relaxed atmosphere.

The pharmacy offers: •

a weight loss program

•

an on-site diabetes educator

•

smoking cessation programs (PACT trained pharmacists)

•

warfarin management with a collaborative prescribing agreement

•

free automated PACMED packaging

We are looking for physicians to care for many of our current pharmacy patients, to enhance patient care and to collaborate with.

This is a great opportunity to quickly grow a practice alongside an established business.

FOR MORE INFORMATION, PLEASE CONTACT: Allana Reaume Pharmacist/ Owner 306.550.4812 ms0304@store.medicineshoppe.ca

Maria

CROSSWORD

1 2 3

Hint: Many answers can be found within this issue of SMA Digest.

4

ACROSS 1. Rural relief doctor 3. Diabetes, COPD, CAD 4. SMA/CMA leadership course 5. First SMA president 6. Age of the SMA 9. IV iron infusions are an alternative to these 11. SMA mentorship program 12. After graduation but before own practice 13. From 12 health regions to one health authority 14. You won’t need antibiotics for these 15. The beat goes on 16. One of the 3As of leadership. Likeable.

17. A role for physicians 18. Saskatchewan pools these 19. First name of the SMA CEO 20. Current SMA president 23. CQIP: Clinical Quality ____ Program

24. Laproscopic. Cosmetic.

25. A preventative measure DOWN 1. Recent Physician of the Year 2. Bricks and mortar of health system 4. Health care provider 5. First SMA CEO 7. Appropriateness campaign encouraging conversations (two words) 8. “A dose of your own ____” 10. For closing wounds 13. Another word for professional group 18. Health system _______ 21. ____ Clinics – centering around holistic and culturally safe care 22. Program encouraging exploration of rural practice

1 3 4 5 6 9 11 12 13 14 15 16

6

5

8

7

9 10 11

12 13 14

15

16

17

18 19

20 21

22

23 24

25

Across Rural relief doctor Type of disease: Diabetes, COPD, coronary artery disease SMA/CMA leadership course The first president of the SMA. The anniversary year the SMA is celebrating IV iron infusions are an alternative to these SMA mentorship program After graduation but before independent practice From twlelve health regions to one health authority You won’t need antibiotics for these The beat goes on One of the three As of leadership meaning likeable.

A role for physicians Saskatchewan pools these First name of the SMA CEO last name of SMA president until May 2017 CQIP: Clinical Quality ______ Program Laproscopic. Cosmetic.

A preventative measure

1 2 4 5 7 8 10 13 18 21 22

Down Recent Physician of the Year Bricks and mortar of health system Health care provider First SMA CEO Appropriateness campaign encouraging conversations (two words) “A dose of your own ____” For closing wounds Another word for professional group Health system ________. _____Clinics – centering around wholistic and culturally appropriate care Program encouraging exploration of rural practice

SPACE FOR LEASE 17 18 19 20 23 24 25

Independent or shared space for medical professionals •

Newly renovated with open space, high ceilings and multiple windows.

•

Accessible from all across the city.

•

Free parking adjacent to our building, of high value in the winter months.

For further information please contact Trudy or Mohammed.

E: info@alphacenter.ca | T: 306.522.5511 | F: 306.522.5512 1501 Park Street (Corner of Park & Dewdney), Regina

www.alphacenter.ca

SMA DIGEST | SPRING 2017

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&

CLASSIFIEDS ANNOUNCEMENTS

Join our winning team and experience a deep personal satisfaction that is unique to us. We offer a relocation bonus to those physicians joining us from outside of the Regina area.

Services Include: Exam rooms, offices, clerical support, uninsured billing, medical supplies, utilities and free parking.

Other services available: Lab, X-ray, ECG located close to facility and future pharmacy on site.

Family physician split 77/23 Specialist split 80/20 Alternative funding arrangements available after first year Please email rfcpvg@yahoo.ca or call 306.530.1960 to discuss this opportunity

DR. C. DEMKIW-BARTEL RELOCATING Effective April 1, 2017, Dr. C. Demkiw-Bartel (www.theshedoc.com) will be relocating her medical and skincare practice to:

SMA LIFE INSURANCE Now

EVEN BETTER

Phone: 306.652.3496 Fax: 306.652.3493

 Lower premiums for

Dr Margaret Anne Porter (MD FRCP(C) psychiatry) has temporarily joined Dr. Renuka Prasad’s General Adult and Geriatric Psychiatry practice.

members ages 40 to 59.  Percentage of premiums

returned to all plan holders again for 2016!

For your insurance needs, contact insurance@sma.sk.ca.

For physicians, by physicians.

OSLER MEDICAL CENTRE (OMC)

We are looking for family physicians and specialists, full- or part-time who truly value their time with patients and do not want to spend precious time on administrative hassles.

OMC is best suited for physicians who want flexibility in their practice and the opportunity to attain a healthy work-life balance while increasing their earning potential. We have a brand new fully computerized facility equipped with a world class Accuro EMR system. We provide a better practice environment to help you deliver the best care to your patients by providing an efficient, low overhead administrative system and committed staff for a rewarding practice.

42

Avalon Medical Clinic 23-2605 Broadway Ave. Saskatoon, SK S7J 0Z5

SMA DIGEST | SPRING 2017

TEMPORARY RELOCATION: DR. M. A. PORTER

Referrals can be directed to the following until December 2017: 104-750 Spadina Cres. East Medical Arts Buiding Saskatoon SK S7K 3H3 Phone: 306.653.4843 Fax: 306.653.3190

MEDICAL OFFICE EQUIPMENT FOR SALE •

X2 black medical table in pristine shape: $1,000 (reg. $1,700)

•

X2 diagnostic board BP/ophthalmoscope/otoscope/ ear pieces: $750 (reg. $1,100)

•

Adult weight scale: $150 (reg. $300)

•

Digital infant scale: $200 (reg. $429)

•

Eight blood pressure cuff arm bands for use with digital blood pressure monitors, size medium: $20 each. Other offers will be considered if all eight are taken.

If you are interested in purchasing any of this equipment please email info@theshedoc.com.

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SMA DIGEST | SPRING 2017

43

IN MEMORIAM Dr. Thirza Smith Chair, SMA Board of Directors 1949 – 2017

“You could be a surgeon, you could be an obstetrician, you could do it all. She set the bar very high.”

Dr. Epp’s career intertwines that of Dr. Smith, who was an attending physician in obstetrics/gynaecology when Dr. Epp was a resident beginning in 1989. The two worked in partnership until Dr. Smith’s retirement about seven years ago.

“She had a major influence on all women coming into the specialty,” said Dr. Epp. “She was a huge pioneer for women in medicine.”

Dr. Smith started her medical career as a family physician in Michigan but returned to Saskatoon in the 1980s for a residency in obstetrics/gynaecology. She delivered some 10,000 babies during her 23-year career. In addition to her role on the SMA Board of Directors, she was involved in national and international organizations including the Society of Obstetricians and Gynaecologists of Canada and the Continental Gynecological Society.

Saskatchewan’s medical community is remembering Dr. Thirza Smith as a mentor and pioneer to the women who followed the path she laid for them – a doctor who never lost the compassionate touch with her patients and her loved ones.

Dr. Smith passed away Feb. 27, 2017, after an illness. She was chair of the Saskatchewan Medical Association (SMA) Board of Directors, capping a career that started in the 1980s as one of the only women in the male-dominated field of obstetrics/gynaecology.

“She was a huge positive force for young women in medicine to be able to pursue their dreams of whatever they wanted to do in medicine and not just feel like they had to be in that particular slot because that was the only way they would be able to manage a life with kids and a husband,” said Dr. Annette Epp.

44

SMA DIGEST | SPRING 2017

Dr. Joanne Sivertson was also a resident with Dr. Smith as her attending physician. The student-teacher dynamic morphed into a more personal relationship through their work with the SMA. Drs. Sivertson and Epp have been SMA board members during Dr. Smith’s term as chair.

“In my conversations with Dr. Smith I learned that she became an obstetrician during a time when it was still an ‘old boys’ club,’ ” Dr. Sivertson recalls. “She started her medical career as a family physician, but switched into O&G and required remarkable tenacity and competence to push the envelope and become a female specialist.”

“She was a presence when she walked in a room,” Dr. Epp said. “You knew she was there, but really that was a good thing, because in obstetrics, the rule is no matter what’s going on, no matter how crazy it is, you as an obstetrician better not be panicking. You better walk in the room and make everybody feel like it’s going to be okay, and she was the epitome of emphasizing that.”

Dr. Sivertson puts it another way: “Thirza was tough as nails, stubborn and committed, which served her well in her career. She was decisive and concise, which made her an excellent obstetrician, as well as a clear choice for SMA board chair.”

Dr. Smith was an inspiration to Dr. Sivertson, encouraging her to push for what she believed in.

“She made me feel capable and proud of my own skills…

Thirza was a force to be reckoned with. I have no doubt that her influence on the training and practice of obstetrics and gynaecology will persist for years to come.”

Dr. Intheran Pillay, president of the SMA, says Dr. Smith was committed to her job as board chair, worked hard at it, and made sure meetings stayed on track when discussions veered off course, which they were wont to do.

“She will be sadly missed by all,” said Dr. Pillay. “There are certain things that stand out for me. She was a real leader.

This job meant a lot to her, especially during her illness. It gave her a lot to look forward to coming to SMA meetings, being a part of the SMA.” On a personal note, he said Dr. Smith was “really warm and approachable.”

“She seemed to have a hard exterior but really was a soft person once you got beyond all of that, and I got to see that side of her as well. She was warm and caring and definitely cared deeply about her job with the SMA.” Dr. Smith also inspired others to look beyond their practices, to the outside world around them. She was communityminded, with a social conscience and a broad, world view, said Dr. Epp. And, no matter what the demands of her job, her family came first.

“She loved life, she loved to meet people, she loved to travel, she loved new experiences, she loved food, she loved getting together, but her kids were always part of that, and if you look at the pictures of her and her life she’s always with her family and now her grandchildren, and she never sacrificed her family for her career.”

Dr. Epp tells the story of a Christmas tradition, a potluck party Dr. Smith hosted every year. People young and old from all walks of life would gather for good food, fun and festivities. They would go caroling together. The event was famous throughout Saskatoon.

“People never forgot it and it was a Thirza tradition. There were a lot of parts of her that were outside of work, too, that I don’t think people should forget.”

Dr. Garth Andrew Bruce 1945 – 2016

Dr. Garth A. Bruce passed away peacefully on Nov. 30, 2016, in the palliative care unit at St. Paul’s Hospital in Saskatoon.

Garth was born in Whitewood on May 12, 1945. Brother Garry was born five minutes later much to everyone’s surprise, especially to their parents, Edith and Andrew Bruce. Their sister, Florence was born nine years later.

Garth grew up on the family farm near Langbank, where he enjoyed helping out with farm work, operating the farm machinery and looking after the livestock. He was active in 4-H clubs, participated in curling and playing ball. Kenosee Lake was a popular weekend destination where the boys took swimming lessons, golfed and tore up the dance floor.

Garth attended the University of Saskatchewan and graduated from the College of Medicine in 1970. He practised medicine in La Ronge for three years, after which he went to Toronto and specialized in paediatrics at Sick Children’s Hospital. He returned home to the Prairies where he practised in Regina for nine years, then to Saskatoon for the next 27 years.

He enjoyed helping his patients and their families, teaching medical students and working with paediatric residents.

Garth married Pam Reilly in 1986 and subsequently Ryan, Alison and Jessica joined Kim and Dean (from a previous marriage to Edith Dean). Camping and canoe trips to northern Saskatchewan, especially on the Churchill River, were highlights of the summer holidays. Winter vacations were spent skiing at Jasper or Panorama, and in later years travelling to the southern United States.

Garth touched many lives through his various roles as husband, father, grandfather, great-grandfather, brother, doctor, colleague, mentor, friend and teacher. He was the pillar of the family and will be deeply missed.

Dr. Jacob Abram Dick 1926 – 2016

Dr. Jacob Abram Dick passed away on Dec. 11, 2016, at Chilliwack General Hospital at the age of 90. He was born May 16, 1926, in Waldheim to Abram and Tina (Stobbe) Dick. The family had recently emigrated from Russia, and Jake was the first surviving child to be born in the new land. Abram purchased 160 acres of undeveloped prairie from the CPR for a dollar an acre near Glenbush and the family moved there to start a new life. They lived in a tiny log home and worked

SMA DIGEST | SPRING 2017

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hard to make ends meet. Money was tight during the Depression, but with his parents’ strong faith, and a home filled with love, they were blessed.

Jake often explored the sloughs and bushes nearby. He enjoyed identifying local birds and plants, a passion he continued throughout his life. Later he and his siblings worked to put each other through school, and Jake eventually graduated in 1956 from the University of Manitoba’s School of Medicine. Jake met Irene (Neufeld), the love of his life, in Winnipeg. They married and moved back to Saskatoon to raise their family, which grew to four children.

Jake pursued a medical career that spanned more than 40 years, taking a one-year break in Baltimore, Md., to pursue postgraduate studies at John Hopkins School of Medicine.

He had the privilege to deliver more than 3,000 babies and became a much-loved family doctor who did house calls.

He often developed lifelong relationships with his patients.

Along with career and family, Jake influenced a generation of boys through the Christian Service Brigade and directed several summer camps. He still found time to become an avid nature photographer, and also enjoyed hiking, horseback riding, fishing and canoeing. After retirement, he and Irene moved to Greendale, B.C., to be closer to their adult children. Continuing their lifelong relationship with God and service to community, they led several Bible study groups. During their evenings they enjoyed walking together along the Vedder River trails, spending many happy years together.

Dr. George Fraser Elliott 1928 – 2016

Dr. George Fraser Elliott passed away Sept. 18, 2016, in Stoughton. He was born Sept. 23, 1928, on a farm near Wawota, the third child of William and Maggie (Savage) Elliott.

George worked many jobs in order to graduate from high school and pay tuition at the University of Saskatchewan.

He earned a BA in 1955 and graduated from the School of Medicine in 1958. George met Jeanne Petrisor at university and they married in 1956.

After graduation, George and Jeanne moved to Regina where George served an internship at the Grey Nuns Hospital. He opened a private practice in his Second Avenue home in 1960. He later moved his practice to the Medical

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Arts Clinic in downtown Regina. In 1970 he became a medical officer of the Saskatchewan Workers’ Compensation Board, and had been promoted to director of medical services by the time he retired in 1988.

George was passionate about serving injured workers. He was proud of his role in the expansion of facilities and services of the Wascana Rehabilitation Centre, completed in 1989. George and Jeanne moved to Kelowna, B.C., in 1999.

They lived there until Jeanne’s death in 2013. George moved to live with his son Will in Forget, Sask., and later moved to New Hope Pioneer Lodge in Stoughton, where he was wellcared for until his death.

He is remembered as gentle, quiet, rock steady in a crisis and a dependable source of thoughtful advice.

Dr. Robert Douglas Forrest 1943 – 2016

Dr. Robert Douglas Forrest passed away peacefully Jan. 13, 2016. He was born Aug. 15, 1943, in Moose Jaw. Bob excelled in academics and sports. He loved basketball (he had a great right hook!) and a good game of tennis. He completed his MD at the University of Saskatchewan and went on to McGill University for his neurology residency. He acquired encephalitis when working on the children’s unit at Montreal Children’s Hospital. Against all odds, he relearned to speak and walk again, and then went on to relearn his medicine and practised for many more years in Montreal, Saskatchewan and B.C. Bob was a man of incredible perseverance, tenacity and resilience. He was well-respected by his peers and a mentor to many.

Dr. John V. B. Haver 1925 – 2017

Dr. John V. B. Haver (Jack) passed away peacefully on Jan. 24, 2017. Despite a valiant effort, he could not recover from recent surgery. He was 91.

Jack was born in Lemberg in 1925, and he proudly boasted of being raised in Saskatoon. He married his high school sweetheart Patricia, in 1947. Having achieved his BA and

BEd, he quickly found work teaching high school in Tisdale, where they had their first baby. Following that, they lived and worked, and had more children, in North Battleford, Fargo, N.D., and Grand Forks, N.D. Jack, however, had always wanted to be a doctor and, after having four children, he and Pat decided to move back to Saskatoon, where he had been accepted into the College of Medicine at the University of Saskatchewan. Life was all about juggling children, school and work for the next few years. There was no doubt it was a struggle, but they knew the rewards would be great, and they made it work.

Jack graduated in 1961 and they moved to Wynyard, where he practised medicine for 33 years. Small-town life suited both of them to a tee. Jack immersed himself in his work, built a large, successful medical practice, and made many lifelong friends. Besides his work, he involved himself in several local activities, including the Chamber of Commerce, the Lions Club and the Wynyard Curling Club, to name a few. Jack’s devotion to his friends never diminished. He stayed in continuous contact with his medical classmates, and was instrumental in organizing their class reunions every five years. Jack and Pat also loved to travel and, through that, they saw most of the world. He boasted of having set foot on every continent.

Jack retired at the age of 70, and he and Pat moved back to Saskatoon to be closer to family, but they never lost touch with their Wynyard friends, and truly treasured their relationships there. Having been successful in his life, Jack felt indebted to the two organizations he felt contributed most to his success and, in recognition of that, he proudly donated to both the City Hospital Foundation and the College of Medicine at the University of Saskatchewan.

With a personality larger than life, there was never any doubt when Jack entered a room. He had a tremendous sense of humour and loved a good joke. You never had to guess what he was thinking. His opinions were strong; his guidance was wise; his passion for life, love and liberty was generously shared. There is no doubt that his influence will resonate for years to come. Jack was predeceased by his wife, Patricia, in 2014. They had celebrated 67 years of marriage.

Dr. Malgorzata Humnicka-Szott 1953 – 2016

Dr. Malgorzata Humnicka-Szott passed away peacefully at the Rockyview Hospital on Sept. 11, 2016, at the age of 62.

She was a very accomplished physician and was very dedicated to her patients and family. Margaret is sadly missed by her husband of 39 years, Boguslaw of Saskatoon. Margaret was intelligent, charming and beautiful with the most amazing heart.

Dr. Patrick James Kavanagh 1934 – 2017

Dr. Patrick James Kavanagh died peacefully on Jan. 15, 2017.

He was born Feb. 24, 1934, and is survived by Doris, his wife of 62 years.

Pat practised medicine for 50 years and it was not only what he did but who he was. A thoughtful and caring doctor, he was universally respected and admired by his patients and colleagues. He was dedicated to his family, a proud and caring father, and a committed, loving husband to Doris. He had many friends captured by his easy smile, intelligence and caring nature, and even those who knew him only in passing spoke easily to the impact he had.

He craved adventure and travel, and enjoyed solitary pursuits. His love of fishing and golf was unsurpassed, and he sought out opportunities to explore a variety of experiences through travel and rural community living. Following education in the Maritimes at Mount Allison and Dalhousie universities, he began practising medicine in Nova Scotia and moved to Creston, B.C., in 1967, where he remained for 20 years. His practice included experiences in Australia, China and Bella Bella, then to Uranium City, where he served communities in the North for just over five years. He and Doris then moved to Invermere, B.C., where they have lived for the past 25 years, with Pat performing locums and vacation relief for local physicians until he ceased practising in 2009.

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Dr. Frederick Richard Morris

Dr. Melvin Orvald Opseth

Fred peacefully left this world in the presence of his family and surrounded by their love on Jan. 28, 2017. Fred was born in Eston, Sask. on Dec. 5, 1930. He graduated with his medical degree in 1957 from the University of Manitoba.

On completion of his residency he returned to Moose Jaw where he practised until 2007.

Dr. Melvin Opseth of Warman passed away after a lengthy illness on Jan. 5, 2017. Melvin was born on Dec. 27, 1933, in Prince Albert and raised on the family farm near Hagen.

He completed high school at Lutheran Collegiate Bible Institute in Outlook and graduated from the University of Saskatchewan with a degree in medicine in 1959.

In 2000, he attended the flight surgeon’s course and continued his work as a civilian flight surgeon at Canadian Armed Forces 15 Wing, Moose Jaw. He was honoured to serve as an Honorary Colonel, #2 CFFTS (Canadian Forces Flying Training School) at 15 Wing Moose Jaw from 2006 to 2011. He filled the role of mentor to countless young people considering a career in medicine, and to those pilots starting their career in the military.

In the early part of his medical career, Melvin worked as a general practitioner in Porcupine Plain, Saskatoon, Cudworth and Melfort. He decided to obtain his fellowship in pathology in 1979. He was instrumental in setting up the pathology department in Melfort in the mid-1980s. He continued his career in pathology in Prince Albert, Regina and Saskatoon, retiring from the provincial lab in Regina in 1998.

1930 – 2017

Fred served almost 50 years as a practising physician and took an active role in his profession. He was a member of the College of Physicians and Surgeons of Ontario, the Saskatchewan Medical Association, and the College of Physicians and Surgeons of Saskatchewan, where he also served as president for two terms. He served on a variety of committees including the Anesthetic and Post-Operative Death Committee, Discipline Committee and Medical Benevolent Committee.

He served 15 years as chief of surgery for both the Moose Jaw Union Hospital and Providence Hospital, and chaired the Credential Committee at the Moose Jaw Union Hospital.

He served on the boards of Providence Place, where he was recently appointed a life member, and on the board of the Saskatchewan Cancer Agency. He was the team doctor for the Central Collegiate football team for seven years, attending all of their games and organizing medical coverage for other league games. Former players referred to him as “Doc” whenever they met him.

Fred was raised on a farm and had a great love for the land.

He operated a grain farm north of Moose Jaw until his son Jim took over the role. Fred loved to lend a helping hand and advice whenever he could. He had a love of flying and had his private pilot’s licence and flew his own plane for a number of years. His time at 15 Wing was especially meaningful for him because of his love for the military and its history, and also for anything that had wings. He was able to spend several hours in the Hawk and Harvard aircrafts.

A particular highlight was accompanying the Snowbirds on one of their trips to the Air Show in Abbotsford. No matter what he was doing, he always had eyes to the sky.

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1933 – 2017

Dr. Gerald Sinclair 1929 – 2017

Dr. Laurie Jack “L. J.” Vassos 1953 – 2016

It is with great sadness that we announce the passing of Laurie Jack “Sweep” Vassos on Dec. 4, 2016. Laurie was born in Melville, Saskatchewan on Feb. 9, 1953. He spent his early years in Melville before moving to Saskatoon. Laurie attended the University of Saskatchewan and graduated from the College of Medicine in 1980. He practised as a family physician in Saskatoon for 35 years.

Laurie loved travelling, skiing, the mountains, and spending quality time with his family. He enjoyed visiting museums and art galleries with his daughter and shared an interest in the medical profession with his son. Friends and family will fondly recall his sense of humour, a characteristic that remained with him until the end.

He fought a brave and courageous battle with cancer, always setting goals for himself and planning celebrations with family. He possessed a remarkably positive attitude and never gave up hope.

His family would like to thank the staff at the Saskatoon Cancer Centre, RUH Oncology Day Centre, RUH 6100, Palliative Home Care, SPH 4B, and the SPH Palliative Care Team for their excellent care over the last few months.

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Photo by Lindsey Anderson, Class of 2017

Return undeliverable Canadian addresses to:

SASKATCHEWAN MEDICAL ASSOCIATION 201-2174 Airport Drive Saskatoon, SK Canada S7L 6M6

Mail to:

40007031