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CMA Annual Meeting 2008: Day one

The first full day of the 2008 Annual Meeting of the Canadian Medical Association, here in Montreal, is drawing to a close as I type. The last few doctors are trickling out of the conference halls and stepping out into a rainstorm of biblical proportions in Montreal's downtown. Those hoping for some "retail therapy" tonight, as CMA General Council Speaker Dr Margaret Kirwan joked early this morning, will unfortunately be trudging up and down Saint Catherine Street in a downpour. (Bicycle-riding journalists, like yours truly, keep a close eye on the weather.)

So, what happened here on day one? Here are my notes on Monday's goings-on:

  • 8:25am -- Outside the front door of the hotel is a big campaign sign on a lamppost, touting Conservative candidate Guy Dufort as the best choice for Westmount-Ville Marie in next month's by-election. A sign of things to come? Perhaps not: the left-wing group Canadian Doctors for Medicare stand on the sidewalk adjacent to Mr Dufort's smiling face during the day handing out pro-medicare political tracts.
  • 8:30am -- Pomp and circumstance as the annual meeting's General Council begins. Bagpipes (no joke: really, there were bagpipes) welcome a procession of robed figures to the large ballroom where General Council is being held. It's the CMA's executive, with outgoing president Dr Brian Day looking somewhat tired and not entirely thrilled with the costume. (Brian, if you're reading: Sorry if you actually liked the robe, but you sure didn't look like it.)
  • 8:35am -- Everyone gets seated up on the stage and a physician member of the Resolutions Committee stands up to lead the assembled doctors in our national anthem. The music comes on the speaker system but it's not "Oh Canada" -- at least not at first; the opening strains feature aboriginal-sounding drumming and legato strings. As the interminably long intro to the song continues, three giant video screens facing the crowd display what I suppose are meant to be inspiring Canadian images. Trees. Rivers. Lakes. Cliffs. Mounties. Parliament. Children. Perhaps it was the fact that the coffee had run out in the lobby just outside the ballroom before the meeting began, but I wasn't impressed. (The coffee drought may have accounted for the fact that by the 8:30am starting time, only three reporters had showed.) Anyway, the song finally got around to becoming "Oh Canada" and everyone stood, etc. etc.
  • 8:40am -- Dr Kirwan welcomes a long list of distinguished members and special guests. As well as guests from the World Medical Association and national medical associations from the UK, Israel, Russia and the EU, a delegation of doctors is here from Ireland and Dr Kirwan makes an attempt at levity -- in French for some reason I cannot fathom. Canadians and Irish are so much alike, she says: we both like to "avoir du fun." Oui...
  • 8:45am -- Dr Kirwan introduces Dr Brian Day, the outgoing president, who in turn introduces Dr Robert Ouellet, the incoming president, who in turn introduces Dr Yves Bolduc, Quebec's fairly new Health Minister and this morning's guest speaker. Dr Bolduc steps to the podium and promptly spills his glass of water. He looks alarmed momentarily, then recovers. "It's just the water. Nobody's hurt." A true physician. Dr Bolduc speaks mostly in generalities about valuing physicians' input and hoping for partnerships and such. (What on earth does "...the responsibilisation of all actors..." mean, regardless of the context?) The Quebec Medical Association's president, Dr Jean-Bernard Trudeau, thanks the minister and generously offers him the medical profession's support. He'll need it, especially given the fights that his predecessor as Minister of Health, Dr Philippe Couillard, provoked with some of the province's doctors.
  • 9:05am -- Eventually the first motions are read. After the first one (just a motion to start the process, basically) is moved, there are a few moments in which doctors are to vote electronically using little remote controls. In the interim, the first few bars of Chicago's excellent song "25 or 6 to 4" play, rather incongruously. (And no, it's not actually about LSD, according to the songwriter.)
  • 11:30am -- (We'll skip past the mental health discussion for now, except to say that funding for the Mental Health Commission of Canada was extended for five years more than it had been initially last year.) Federal Health Minister Tony Clement's turn to speak. It's all going peachy until he comes to the topic that everyone's been wondering if he'll address here: his disagreement with the vast majority (80% or so) of Canadian doctors, and the leadership of the Canadian Medical Association, about harm reduction and supervised injection sites for drug addicts. More on this tomorrow. Suffice it to say for the moment that it wasn't pretty and Mr Clement faced harsh words from a number of doctors, including Drs Day and Ouellet, afterwards.
  • 3:30pm -- After hours of talking about governance review ended abruptly and rather discordantly, the conference broke into two sessions: one on activity-based funding and the other on doctors getting politically involved. The political presentation consisted of questions being asked of Liberal MP Martha Hall Findlay, former New Brunswick Premier Bernard Lord, and NDP MP Thomas Mulcair. Some doctors complained the medical profession isn't listened to enough, others asked how much starting a parliamentary campaign costs, and another still asked how he could participate given how busy his life as an emergency physician is -- "beyond just giving money." Bernard Lord's response: "Donating money is good." Show up at local meetings and meet your MP, Mr Lord said.
Photo: Health Canada
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  1. sharon19 August, 2008 11:00 AM

    Considering activity-based funding:

    This is the heart of the activity ( See CMA description):

    "the focus is not necessarily on the patient, but rather on the "type and volume" of service delivered. "

    Considering the players ( their roles, responsibilities, legislated standards ) someone in the mix should pay close attention to three points covering A. & B. categories:


    1.Pareto efficiency in Economics


    'For instance, if a change in economic policy dictates that a legally protected monopoly ceases to exist and that market subsequently becomes competitive and more efficient, the monopolist will be made worse off.
    However, the loss to the monopolist will be more than offset by the gain in efficiency.
    This means the monopolist can be compensated for its loss while still leaving an efficiency gain to be realized by others in the economy.
    Thus, the requirement of nobody being made worse off for a gain to others is met.'

    end of excerpt

    Oh yeah???....

    Review " compensation principle" here:

    Of course, we have all heard of the " pareto principle" i.e.( 80 % of the work is performed by 20% of the people) and the ethic "nobody being made worse off for a gain to others "


    2. dependence on "deductive" reasoning

    I emailed the author of " Blink" and commented upon the following:

    A comparison of two frontline professional clusters, (police on patrol and emergency physicians)profiled the following in two chapters:

    + emergency physicians could forgo ALL the time-wasting investigative procedures that slowed treatment initiation ( with examples ) and proceed to action.

    + police on patrol wrongfully interrupted the life of said author by initiating arrest of him on the very " basics" of evidence ( his appearance)

    My email to him centered on the question.............. " duh "?

    NOTE: Interestingly his comments were celebrated by the medical community ........ duh ?????

    3. attraction to "inductive" reasoning

    The same author penned a book about " exponential growth" which eloquently solicited an " AHA" from readers ("Tipping Point")

    {However the same illustration was more completely expressed by David Suzuki in his ? Facing the Future" compilation of articles.}

    Test yourself on this:
    If the number of reporters attending the convention doubled every day..... and on the 4th day they filled the press gallery ...what day was the press gallery "half" full ?


    how does this relate to the core focus of " activity-based funding"?

    i.e.TYPE and VOLUME of service delivered

    What will be the "basis" for your thinking and questioning?


    Q- is the volume impacted by " exponential growth"?

    If so how can an " unchecked growth state" become a " checked" state?
    ? removal / control of service
    ?removal/ control of service providers?
    ?removal/control of users?

    Is removal indicative of thoughtful planning and preparation?
    Is control "selective" in methods chosen?

    Here is a challenge...... find out how the pharmaceutical industry advanced from making millions in an "aggregated" activity..... to making "billions" in an "integrated" activity.

    Hmmmmm .... maybe "removal/control" should be changed to " expansion/management"?

    P.S. If you do not know the difference between "equity" and " equality" ... this post is not for you :)

  2. Sam Solomon19 August, 2008 2:36 PM

    Interestingly, Malcolm Gladwell (the Canadian-born author of Blink and The Tipping Point, who you refer to you above) changed his mind on some aspects of public/private healthcare funding.

    You can read his comments about Canada's healthcare system in a 2000 debate with Adam Gopnik, published
    in Washington Monthly.

    Earlier this year, when he and Mr Gopnik debate again (this time about Canadian identity, hosted by Maclean's), Mr Gladwell admitted that he'd changed his mind about the merits of Canada's universal, taxpayer-funded healthcare system.

  3. sharon19 August, 2008 9:04 PM

    " Improv" raised to an "art form".


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