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OCTOBER, 2015 Edmonton Zone Medical Staff Association Publication
P
OCTOBER, 2015
Edmonton Zone Medical Staff
Association Publication
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Columns: President’s Corner ......................................................................... page 3 Letter from Editor ........................................................................... page 4 Dr. Stan Houston………………………………………………………page 5 & 6 Faculty of Medicine & Dentistry………………………………………page 7 EZ LabLink……………………………………………………………. page 8-10 AHS Information……………………………………………………….page 11 Covenant Health……………………………………………………….page 11
Please contact your Executive and or Representatives with any concerns or issues.
EZMSA Executive – 2015 President - Dr. Shelley Duggan Phone: 780-468-3377 Vice President – Dr. Randy Naiker Phone: 780-484-7575 Past President – Dr. Robert Broad Phone: 780-735-2924
Secretary-Treasurer– Dr. Michael Jacka Ph780-907-6097 Editor – Dr. Richard Bergstrom Ph 780-407-8861 Member at Large – Dr. Marjan Abbasi Ph 780-735-2362 Member at Large – Dr. Matthew Tennant Ph 780-448-1801
Dr. Mike Chatenay Grey Nuns phone: 780-468-3377 Dr. Randy Naiker MCH & Villa Caritas phone: 780-484-7574 Dr. Jacek Slatnik RAH phone: 780-735-5935 Dr. Gordon Goplen UAH phone: 780-439-4945 Dr. Christopher Lee Leduc Phone: (780) 986-2712 Dr. Bob Black Interim Sr.VP Medicine & CMO CH 780-735-2924
Dr. Donna Klay Devon phone: 789-987-3315 Dr. Ashraff Khan Redwater & Fort Sask. phone: 780-475-3681 Dr. Melanie Currie Stony Plain & Spruce Grove phone: 780-962-9888 Dr. E. Mori-Torres Glenrose phone: 780-421-3925 Dr. Jennifer Stickney-Lee & Dr. Hark Sidhu, Continuing Care: Supportive Living phone: 735-8800 & 780-944-8675
Dr. Sean Cahill Strathcona & Sherwood Park phone: 780-464-0123 Dr. Mike Hogan St. Albert & Area phone: 780-407-8887 Dr. Christine Kyriakides Child Health phone: 780-455-5437 Dr. Asad Brahim Community Mental Health phone: 780-342-5355 Dr. Robert Pearcey Cross Cancer Institute phone: 780-432-8755 Dr. Sameea Qureshi, PARA
Dr. Karthikeyan Ganapathy AHE Dr. Zahid Latif, AHE Dr. Saranjeev Lalh Oral Max Surgeons & Dentistry Phone: 780-439-4399 Dr. Justin Bolko PCN Lead Phone: Dr. Carolyn O’Hara-Pathology and Lab Phone: 780-451-3702 Dr. George Wood – Pathology and Lab Phone: 780-735-2776
AMA REP FORUM DELEGATES: Dr. Matthew Tennant, Dr. Padraic Carr, Dr. Sean Cahill, Dr. Susan Hutchison, Dr. Michael Jacka, Dr. Hark Sidhu, Dr. Chris Rudnisky, Dr. Melanie Currie – Suburban, Dr. Randy Naiker, Dr. Shelley Duggan, Dr. Michael Hogan EZMSA Administration: Laurie Wear, Phone 780-735-2924 Fax 780-735-9091 [email protected]
Editor, Dr. Richard Bergstrom
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EZMSA PRESIDENT’S CORNER
Dr. Shelley Duggan, President Phone: 780-468-3377
Immunization for Health Care Workers Getting the proper immunizations protects you and your patients. There are resources from Alberta Health Services to help you understand what immunizations to get and when.
AHS Population and Public Health will work with occupational health programs to provide consistent immunization recommendations for all HCWs. AHS Population and Public Health or Zone Public Health is responsible for distributing, monitoring and promoting the use of vaccines supplied by AH for occupational health purposes. This includes information related to storage and handling of vaccines, eligibility criteria, guidelines for assessment of history of immunization and/or evidence of immunity of HCWs and the documentation of vaccines administered. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
EZMSA Waitlist Survey
Thank you for the continued feedback from those that participated in the yearly EZMSA Waitlist Survey. Drs. Naiker and O’Hara attended a meeting with the Minister of Health September 28, to share in a discussion regarding the results of the 2014 survey. The
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Letter from the Editor
Dr. Richard Bergstrom
results of the waitlist survey are widely shared with various stakeholders and continue to be one of the benchmarks for improving healthcare within our zone. The Survey has been carried out annually since 1997. The EZMSA carries out an annual survey of physicians in the zone with office practices. There are three separate surveys, one for Family Physicians, one for Surgeons (including Obstetrics and Gynecology) and one for non-surgical Specialists (Medicine, Pediatrics and Psychiatry). The survey was sent to all physicians in active practice with whom we had a valid email address/fax number for. 2015 survey is currently a work in progress.
If you have a “cancerboard” email address you have now had your email changed to albertahealthservices.ca and I would suggest you change it while doing your AMA membership renewal. Membership renewals have been sent out. To ensure you are a member of our EZMSA the 2015/16 membership package will be sent by mail (Canada Post) in the fall. Please ensure AMA has a current email address or mailing address. All AMA/CMA membership packages include information regarding zones and sections. https://www.albertadoctors.org/leaders-partners/leaders/zmsas
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Mirror, mirror on the wall... It was a good day today. We celebrated the life of one of our anesthesia colleagues who died well before his time. In remembrance of him and his work presence we have a Global Outreach award that supports an individual traveling to provide medical care in a third world country. We have had great success in finding people who “make a difference”. We invited the family each year and it is now feeling like a reunion and a celebration as opposed to the true sombre nature and feelings of loss that were so apparent the first year. When the presentation was done, my Chairman (the individual for me who sets the standard for excellence as a
Chairman...once you experience the best that is all you want to settle for) noted that in speaking to the audience they were engaged and he asked me how I did that. I said that it was quite simple, you must be the audience! He looked at me somewhat quizzical and I explained further. When speaking to an audience you must think about them, not about yourself. You literally lose yourself in audience. You must emotionally connect with them. Tell them a story, something that makes it real. Tell them something that is meaningful to them. Tell them something that resonates with their values and beliefs. This is not about smoke and mirrors, rather truth and values.
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I noted and will continue to believe that we are a service industry. We serve our patients; yet, as I have said before we are not their servants. It is our expertise and experience they rely on. Yet, we need to make sure that we have a shared understanding of what the patient wants, understands and the risks involved in achieving same. I think that is the conversation that results in true consent. Now, what about “Mirror Mirror on the Wall”? In the fairy tale it was about “Who is the fairest one of all?” I think it is easy to enter a slippery slope being a physician. We are held in such high regard by the population it is easy to see ourselves as important. Well, we have a degree of importance but it is not about “us”, it is about “what we do”. One of my comments is that I am not important but what I do is indispensable. Our job as physicians/doctors is to be a benefit to those who seek our knowledge and ability. The act of being a physician can and should empower us to provide care, not feed our ego. One of the mentors in my past told me a great story. As anesthesiologists we are pretty good at iv’s, managing airways, cardiovascular mayhem, all that stuff. Yet, as this wonderfully strong woman said that as soon as you thought you were good, you would turn the corner and a big wet fish would slap you in the face. How true. Medicine is magnificent to practice but is also incredibly humbling. When we practice medicine and see ourselves as “The DOCTOR” we miss the real meaning in our work. We are all vital in the provision of care, we all matter, we all make a difference. I would suggest that we all look in the mirror and see the person who looks back at us. See the person who knows we make such a difference in so many individual’s lives. See the person who sees our successes, our failures and then works to live a life worth living. Life is so much more than “ourselves”, it is so rich and wonderful here in Canada. Yet, as I always say, let us not loosen our grip on what needs to be improved, for our patients see us as their protectors. What a privilege; it is all about them. So when we look in the mirror we see the person who is the true vision of “A Doctor”.
----------------------------------------------------------------------------------------------------------------------------- Plans moving forward to Government around safe injection services. Increasing awareness of the fentanyl epidemic. As most clinicians are aware, a
substantial number of people within the Edmonton zone inject drugs. Accurate numbers are impossible to ascertain, but Edmonton’s needle exchange program, Streetworks, distributed over 1.4 million needles last year, meeting only an undetermined fraction of the actual need. Injection drug use crosses all ethnic, socioeconomic, gender, and geographic lines. Fifty percent of people who use drugs in Edmonton experience their first injection before the age of 19 while Streetworks has many clients who are over 55 years. At the same time, injection drug use is perhaps the quintessential example of an outcome
of negative social determinants of health and unhealthy public policy. Many of the individuals we see for injection drug use have complicated and often shocking histories of family dysfunction and addiction, neglect, abuse, poverty, foster care etc. In the longer-term, addressing these social factors, including some of the specific issues raised by the Truth and Reconciliation Commission in regard to Indigenous people, could contribute to reducing problematic substance use. Certainly, the total and costly failure of a punitive and legal approach to substance use, ie the “War on Drugs” is now widely recognized
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But even if preventive measures are more effective in the future, there remains a substantial, ongoing need for measures to mitigate the harms for people already using drugs, and engage individuals who use drugs in care. We, as health care workers have a professional obligation to those of our patients who use drugs, and we are uniquely placed to advocate for evidence based policies and services. Drug injection is associated with a variety of harms to the individual including the risk of overdose, acquisition of blood-borne pathogens, both minor and life-threatening bacterial infections and adverse psychological, social and economic consequences. An individual's drug use may also have adverse effects on his or her family and friends and substantial economic costs to the community and the healthcare system. Conversely, people who use injection drugs would much rather be healthy than ill, and have usually tried to stop using substances several times. While, as with most medical conditions, we don't have all the answers, there is a growing body of evidence around what does work. The term "Harm Reduction" as applied to people who inject drugs, describes a pragmatic philosophical approach and a range of strategies. A Harm Reduction approach recognizes that immediate abstinence as the only option is likely to fail. The aim of Harm Reduction is to minimize harm to the individual and society and maximize the ability of an individual to improve his or her health and safety. Harm Reduction requires action at 2 levels – direct patient services and drug policy. Examples of specific harm reduction services/programs include needle exchange, opiate dependency programs such as methadone maintenance, community naloxone programs and more recently, safe injection services. In clinical practice, it also involves creating a milieu within the physician-patient interaction that is honest, open and works in smaller steps to help patients improve their own health, recognizing that abstinence is often not a realistic near term goal. The immediate goal may be for the patient to achieve greater stability. Studies have consistently shown that using a harm reduction approach increases the likelihood that people who inject drugs will access further services, including detox and treatment.
Edmonton has operated a needle exchange program, Streetworks, since 1990 in the face of constant struggles for adequate funding support. The program includes health services, education, referrals, resource development, support for pregnant women who are homeless use substances (HER Pregnancy Program), an overdose prevention program, truthful drug education for street-involved youth, and a drug users coalition (Alberta Addicts Who Educate and Advocate Responsibly). A study led by the School of Public Health found
Edmonton's needle exchange program to be cost saving, not just cost effective. Injection drug use is the only HIV risk behavior which has shown a consistent decline in attributable new HIV infections over approximately 15 years in Alberta, almost certainly due in large part to these harm reduction measures. Streetworks also initiated Canada's first community naloxone program which is now being replicated across Alberta and in BC and Ontario. A coalition of agencies and individuals in Edmonton is now exploring
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the possibility of establishing medically supervised safe injection services. Local resources for opiate maintenance therapy exist, but fall far short of the need, particularly after OxyContin was
withdrawn with the market, now increasingly replaced by much more unsafe alternatives such as heroin and fentanyl.
As physicians, we should have an understanding of the basic principles and elements of Harm Reduction. We can apply these approaches more widely to the benefit of our own patients. We also need to advocate for adequate access to these services in our community.
Note recent change in address & phone # Stan Houston MD DTM&H FRCPC
Professor of Medicine & Public Health
Director, Northern Alberta HIV Program
1-131 Clinical Sciences Building
11350 83 Ave.T6G 2G3
Secretary Janet McDonald 780 492-9975, [email protected]
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Neil E Gibson OMM,CD,BSc,MSc,DOHS,DTMH,MD,FACP, FRCPC
Associate Dean, Clinical Faculty Director of Simulation Clinical Professor Department of Medicine Division of Critical Care Medicine
I have been pleased so far with the Faculty’s commitment to listen to Clinical Faculty in the context of the Strategic Planning process. Many of you may have been involved with Departmental focus sessions, and I would like to ensure that all Clinical Faculty have the opportunity to participate. There is a simple and straightforward electronic means to make your views known. If you use the following web address, it will take you directly to the FoMD strategic planning webpage. The roadmaps currently defined are listed, and for Clinical Faculty, the Education and People roadmaps are the most important. You will also find that there should be Clinical Faculty input in the Governance, Research and Partnerships initiatives. The webpage can be found at https://www.med.ualberta.ca/strategic-plan. You will also see that there is a link that will take you to a simple and short survey that will take you through the various roadmaps and will allow you to provide input to the planning process.
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The feedback that you provide will next be reviewed at the Strategic Planning update retreat is November 12th, so I encourage you to respond before then. Dr. Jahangir and I will be in attendance, and will do our best to represent your interests, and this activity is always more powerful when we have feedback from Clinical Faculty. If you prefer to be less structured, we are always open to comments and thoughts and can be reached at [email protected] or [email protected] We look forward to your input. Until next month.
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Carolyn O'Hara, MD FRCPC
Medical/Scientific Director and Zone Clinical Department Head, AHS Laboratory Services, Edmonton Zone [email protected]
EZ LabLink Laboratory Information/Stats/Education/Bulletins of Interest. October 14, 2015
AHS, Dynalife extend laboratory services contract One-year extension means continuity of patient care for Albertans EDMONTON – Alberta Health Services (AHS) has signed a one-year extension to its existing contract with Dynalife Diagnostic Laboratory Services to provide laboratory services in Edmonton and parts of northern and central Alberta. The extension, to March 31, 2017, is on the same terms and scope as the existing agreement and ensures continuity of laboratory services for Albertans. The current contract is worth just over $130 million annually. “It was important to take immediate steps to ensure the people of Edmonton and central and northern Alberta continue to receive high-quality lab services,” says Vickie Kaminski, AHS President and CEO. “This agreement gives confidence to patients and health care providers that this very important health care service will continue without disruption.” An extension was necessary to ensure continuity of patient care following the cancellation in August of a Request for Proposals for laboratory services in Edmonton and parts of northern and central Alberta. Work continues to ensure the long-term stability of laboratory services. That includes working closely with the Government of Alberta as it leads a review of all laboratory services in the province. Dynalife runs northern Alberta’s primary testing facility and 27 community collections sites in Edmonton and surrounding area, along with five community collection sites and four health centre locations in northern and central Alberta. Dynalife staff perform about 17 million lab tests annually on behalf of AHS – about 55 per cent of all lab tests in Edmonton and northern Alberta. “Dynalife’s team of more than 1,100 employees remains committed to serving Alberta’s communities with high-quality and dependable laboratory services,” says Dynalife CEO Jason Pincock. “Dynalife will continue to work collaboratively with AHS and Alberta Health to explore future opportunities for delivering and enhancing this essential health service.”
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Dynalife is a major Canadian medical laboratory offering a complete range of diagnostic testing services. With its main testing facility located in Edmonton, Dynalife has provided high-quality laboratory services across Canada, including in Alberta, for more than 50 years. Alberta Health Services is the provincial health authority responsible for planning and delivering health supports and services for more than four million adults and children living in Alberta. Its mission is to provide a patient-focused, quality health system that is accessible and sustainable for all Albertans. ------------------------------------------------------------------------------------------------------------------------------
Effective October 14, 2015 new ordering criteria for Hemoglobin A1c (HbA1c) were implemented, and are aligned with the following recommendation from 2013 Canadian Diabetes Association (Can J Diabetes 37 (2013) S35-39): "For most individuals with diabetes, A1C should be measured every 3 months to ensure that glycemic goals are being met or maintained. Testing at least every 6 months should be performed in adults during periods of treatment and lifestyle stability when glycemic targets have been consistently achieved." The exception is pregnant patients requiring treatment - the maximum ordering frequency is 30 days rather than 90 days. Laboratory bulletin from September 29th • Order frequency will be limited to one HbA1c request within a 90 day period. • Order frequency for pregnant females between the ages of 15 – 45 years (inclusive) will be limited to one HbA1c request within a 30 day period. This is intended for those individuals who are pregnant and require treatment. • The new criteria align with the following recommendation by the 2013 Canadian Diabetes Association. Can J Diabetes 37 (2013) S35-39 For most individuals with diabetes, A1C should be measured every 3 months to ensure that glycemic goals are being met or maintained. Testing at least every 6 months should be performed in adults during periods of treatment and lifestyle stability when glycemic targets have been consistently achieved. Action Required: • Do not order HbA1c with a frequency of greater than once every 90 days: Exception – for pregnant patients requiring treatment – do not order HbA1c with a frequency greater than once every 30 days. Why this is important: • The Laboratory Information System (LIS) will not accept test requests for HbA1c if ordered with a frequency greater than specified above. Inquiries and feedback may be directed to: Dr. Connie Prosser PhD, FCACB o ph: 780-407-8492 [email protected]
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Patient letter for more information
Carolyn O'Hara, MD FRCPC
Medical/Scientific Director and Zone Clinical Department Head, AHS Laboratory Services, Edmonton Zone [email protected]
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Work Together to Keep Our Communities Healthy – Flu Immunization Dr. Ada Bennett, Acting Chief Medical Officer of Health and Dr. Gerry Preddy Senior Medical Officer of Health
regarding flu immunizations.
Key Messages:
Please assist us in advocating with your health care providers to get immunized and encourage them to recommend immunizations to their patients and clients.
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Timing is important - the sooner you get your flu shot, the sooner you will protect yourself and those you care for.
Physician Recruitment - Provincial Clinical Knowledge Leads for Clinical Knowledge &
Content Management (CKCM) Service Please see attached letter for more information on the areas/disciplines being recruited
Interested candidates should forward a Letter of Interest and an up-to-date Curriculum Vitae
NO LATER THAN October 25, 2015 to: Beth Christensen, CKCM
Phone: 587-892-6081 Fax 403-943-6827
If you have any questions about the positions, please contact Beth Christensen, CKCM at
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SUBMISSIONS: EZMSA monthly newsletter welcomes submissions (articles, notices, and letters to the editors), announcements, photos, etc.) from practitioners and healthcare providers in Alberta. If possible please limited articles to 600 words or less. Dr. Richard Bergstrom, Editor [email protected] Laurie Wear, Phone 780-735-2924 Fax 780-735-9091, [email protected]
