Canadian Medicine

I just got off the phone with Dr Anne Doig, who today was elected the Saskatchewan Medical Association's nominee to be the next Canadian Medical Association president.

Voting in the election ended last night and counting was completed today. Dr Doig, a family physician and the only woman of the seven candidates, won on the fourth ballot.

The first thing she said to me was, "I'm relieved the process is over." But she quickly qualified that. "Obviously I'm very pleased that this is the outcome."

In our interview, we talked about her six children, her passion for competitive swimming and her days as a grain farmer. We also spoke about her thoughts on wait times guarantees, her opinion on the appropriate role of the private sector in healthcare delivery -- a topic about which she sounded less interested than current CMA president Brian Day and current president-elect Robert Ouellet -- and her physician father's role in the 1962 in Saskatchewan, in which many doctors went on strike to protest the advent of a universal healthcare system.

My Q&A with Dr Doig will appear in print in the next issue of the .

You can read what she wrote for the SMA's election package last fall (PDF) or by simply clicking READ MORE:

A few weeks ago, the SMA called for nominations for Saskatchewan’s candidate for President-Elect of the CMA. Several of my colleagues did me the honour of asking me to stand for nomination. Their confidence in me is deeply humbling, and I am grateful for their trust.

For more years than I care to admit, I have been a strong supporter of our collegial organization. As a small child and a new immigrant to Saskatchewan, I watched as my father and his colleagues fought the political battles for preservation of the doctor-patient relationship during the lead up to the Medicare “crisis” in 1962. The crux of that battle was not opposition to a publicly funded (or insured) system of medical care. Rather, physicians fought vigorously to defend the patient’s right to appropriate medical care, independent from the influence of government’s fiscal policies. 45 years later, little has changed.

As a practising family physician for the past 30 years, I am committed above all to the ethical principle of putting patients first. This commitment to patients drives my interest and involvement in organized medical representation. I believe that Canada’s physicians are best fitted to advocate for high quality care for Canadians. If we surrender our advocacy position to others, whether health professionals, business interests, or politicians, it is our patients who will suffer. We must remain the authoritative voice that speaks for the patient first. Moreover, our voices must be loudest for those who cannot speak for themselves—our poor, our children, and our elderly.

A recent Ipsos-Reid poll suggested that the level of public confidence in the medical profession is directly proportional to patients having reasonable access to a personal family physician, reasonable wait times to see their primary physician, and appropriate amounts of time spent with their physician in an appointment. In the political climate of today, all physicians but in particular family physicians, have suffered infringements on their care. Managing surgical wait times has received particular attention, but a larger challenge, and one that is fundamental to the long term sustainability of a public system of medical care, is appropriate, timely access to the skills and services of competent family and specialist physicians.

At a recent meeting of the Western Conference of the SMA, AMA, BCMA, and MMA, Dr. Lyle Oberg, a physician and Minister of Finance for the province of Alberta, challenged those present to lead the changes that will be necessary in order to sustain our system of publicly funded health care. Dr. Oberg was unequivocal—the status quo is not sustainable. In every province, health care spending exceeds 40% of the provincial budget. Dr. Oberg challenged physicians to develop their own solutions to the looming crisis lest they become easy targets for solutions derived by others. Dr. Oberg’s message, however, was not one of physician self-interest, but rather the insistence that physicians must drive and direct the individual and systemic changes to sustain Canadian health care.

Current models of medical education teach young physicians to work in a collaborative, multi-disciplinary manner. Their skills and knowledge are critical in developing solutions to the present crisis. As the mother of six young adults, I am keenly aware of the skills that our young people possess, as well as their desire to achieve balance in their personal and professional lives. We must engage our young colleagues in both the internal and the public debates about medical care.

Physician self-regulation is integral to our ability to be effective, honest, and independent advocates for our patients. In Alberta, Bill 41, which has reached second reading in the provincial legislature, threatens the heart of physician self-regulation by permitting government to override the authority of the College of Physicians and Surgeons. In Saskatchewan, our College has enacted changes to its Bylaws that end independent collegial review of adverse events in prenatal and perinatal care and in anaesthetic and operative care. Such abrogation of our professional responsibility to be self-critical should be anathema to any thinking physician. We must remain leaders in quality and safety across the continuum of care.

In August of this year, the CMA published its Strategic Plan for the next five years. The strategic goal of a strong and effective CMA underpins the other four equal goals of a healthy population, healthy patients, a healthy profession, and healthy physicians. Those goals resonate strongly with my personal philosophy and commitment if chosen to represent our profession as Saskatchewan’s next President-Elect of the CMA.

And here's Dr Doig's CV:

Professional Qualifications:
MD, 1976. LMCC, 1977. CCFP, 1978. FCFP, 1994.

Medical Staff Appointment:
Active Staff, Saskatoon Regional Health Authority Practitioner Staff

Faculty Appointment:
Clinical Associate Professor, Department of Obstetrics, Gynecology and Reproductive Sciences,
University of Saskatchewan

Medical Practice:
Family Physician, City Centre Family Physicians PC Inc., Saskatoon, continuously since 1978

Professional Memberships:
Saskatoon Regional Medical Staff Association; Saskatchewan Medical Association; Canadian Medical Association; College of Physician and Surgeons of Saskatchewan; Canadian Medical Protective Association; College of Family Physicians of Canada (including Section of Teachers), Society of Obstetricians and Gynecologists of Canada; University of Saskatchewan College of Medicine Alumni Association; University of Alberta Health Law Institute; Canadian Association of Medical Education.

Current Appointments:
CMA: Chair, Committee on Bylaws.
SMA: Honorary Treasurer, Board of Directors; Chair, Finance Committee; Member, Board of
Directors; Member, Representative Assembly; Chair, Legislative Committee; Member, Member Advisory Committee; Member, Awards and Appointments Committee; Member, Medical Benevolent Society; Observer, Joint Medical Professional Review Committee. Former Speaker and Deputy Speaker of Representative Assembly. Saskatoon Regional Health Authority: Member, Midwifery Advisory Committee. University of Saskatchewan College of Medicine: Member, Undergraduate Curriculum Committee and Sub-committee on Assessment and Awards. Saskatchewan Cancer Agency: Medical Advisor, Population Health Division (Screening Program for Breast Cancer and Prevention Program for Cervical Cancer.)

Community Service:
Lay reader, Holy Spirit Roman Catholic Church, 1997-present. Member, Senior Choir, All Saints Anglican Church, 1963-1979 and 2004-present. Member, Advisory Panel, Heritage Scholarship Trust Fund, 1988-present. Level V (Master) Official, Swimming, 2004-present. Member, Legislative and Policy Committee, Swimming/Natation Canada, 2003-present. Chair, Governance Task Force, Swimming/Natation Canada, 2002-2003. Member, Board of Directors, Saskatchewan Blue Cross, 1995-2007. Past President, Member of Board of Directors, Swim Saskatchewan, Inc., 1994-2007. Past President, Member of Board of Directors, Saskatoon Goldfins Swim Club, 1991-1997. Baptismal Preparation for Infants; Catechesis of Children, Holy Spirit Roman Catholic Church, 1982-1993.

Awards and Achievements:
Saskatchewan Centennial Leadership Award, 2005; Sask Sport Volunteer Award, 2005; SNC
President’s Award, 2003; 17th Honorary Alumni Lecturer, U of S College of Medicine Alumni
Association, 2003; “Excellence in Teaching” Award, Association of Professors of Obstetrics and
Gynecology, 1996; Nominee, YWCA “Woman of the Year” (Business, Labour and the Professions) 1992; “Best Clinical Teacher in Family Medicine, 1989-1990” from the Housestaff of Saskatoon City Hospital.

Personal:
Married (Robert J. Cowan, P. Eng.). We have six adult children.

Photo: Saskatchewan Medical Association

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The latest edition of Grand Rounds is .

Canadian Medicine appears not once but twice, for "Why does the media muck up health coverage?" and "Manitoba judge disagrees with MDs in 'Canada's Terry Schiavo' case."

Make sure you also check out the following posts -- my picks for the top Grand Rounds entries:

• A South African general surgeon at Other Things Amanzi recounts in which parents of severely injured children under his care refused treatments for religious reasons.
• The delivered by a Canadian medical student, who blogs as Vitum Medicinus, to the families of people who had donated their bodies to medical education. ("I don't get the chance to thank the people our cadavers once were, and sometimes I wish I could.")
• A to be published in the March issue of Addictive Behaviors found that among Brazilian med students, "the most frequently used substances [by men] were alcohol (80.5%), cannabis (25.3%), solvents (25.2%), and tobacco (25.2%), whereas among female students the most frequently used drugs were alcohol (72.6%), tobacco (14.6%), solvents (10.5%), and tranquillizers (7.5%)." Blogged about by David Bradely at the .
  
• Barbara Kivowitz, from In Sickness and In Health, writes about research that found testicular and cervical cancer patients have an .
• An interview with Dr Nick Genes, the man behind Grand Rounds, from .
• "Abel Pharmboy" at Terry Sigillata ... while it was actually happening, using his handheld computer. (Highly recommended -- it's very funny, surprisingly enough.)
  

UPDATE, February 27: I forgot to mention that there's a with ScienceRoll editor Bertalan Mesko, conducted by Dr Nick Genes, online at Medscape. (Subscription required.)


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Catherine Armessen's third novel, , about a pair of first-year medical students, has been selected as , to be presented March 19.

Just as Catherine Armessen is no ordinary writer -- she's a physician, too ("Quand un médecin écrit... et bien!" about her is titled) -- the Prix Littré is no ordinary literary prize. It's exclusively for doctor-writers. And the organization that hands out the prize, the , also gives out seven other literary prizes to doctors and students each year.

All this to say: why doesn't Canada have its own doctor-writer prize?

Canada's got a surfeit of good doctor-writers at the moment: Toronto internist and 2006 Giller Prize-winner , controversial British Columbia internist/novelist/reporter , and Montreal neurologist come to mind. All are practising physicians. All have published critically acclaimed fiction in the last year or two. And all of their most recent novels (Bloodletting & Miraculous Cures, Consumption and Garcia's Heart, respectively) are about doctors or medical students.

My top candidate to administer the as-yet-nonexistent Canadian doctor-writer prize is Dalhousie University's program, which last year held a medical mystery writing contest with Dr Lam, called .

BECOME A DOCTOR-WRITER
Are you a doctor, and interested in becoming a writer? American psychiatrist and author David Hellerstein :

How do you find time to write? When do you write?

As a busy doctor who has always worked full time, and yet who has been able to publish several books, along with essays, stories, and professional articles, I am always asked that question, and I never have a good answer. Of course it is best for any writer if he or she can find a regular time to write. The people who ask this question with most urgency are fellow physicians, or physicians-in-training, medical students or residents. How could any doctor find a regular time to write? At some phases of my career, I have indeed had regular times to write. On some rotations there is "library time," and who knows if you are reading a medical journal or writing a short story? Other times, there is practically no free time in which one is not exhausted or overwhelmed. And yet, there is always some down time--between cases, waiting for the patient who hasn't shown up, during a particularly dull medical lecture at weekly Grand Rounds. For a doctor, there is often no extended time to write, but there is practically never "no time" to jot some notes. And notes can be the start of an essay or a story, and eventually a book.

One other thing of note is that doctors are fabulously hard workers, and many doctors juggle research, practice, teaching, administration, and writing. Perhaps not creative writing, but some sort of writing nonetheless.

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New Brunswick scientist (right) has attained the kind of worldwide fame often lusted after but only seldom attained by Canadian chemical-contamination biologists. International news organizations including and have recently covered her long-running study on the effects on fish of synthetic estrogen, which is expelled in the urine of women on birth control pills, of which were presented last week at the annual meeting of the American Association for the Advancement of Science in Boston.

It's not every day someone is rewarded so thoroughly for poisoning an entire lake.

Here's what her new study, a version of which was (PDF), is all about, according to :

"We’ve known for some time that estrogen can adversely affect the reproductive health of fish, but ours was the first study to show the long-term impact on the sustainability of wild fish populations," explains Kidd. "What we demonstrated is that estrogen can wipe out entire populations of small fish — a key food source for larger fish whose survival could in turn be threatened over the longer term."

Kidd was given an entire lake to experiment on, in Ontario.

To better understand the impacts of estrogen on fish, the researchers conducted a seven-year, whole-lake study at the Experimental Lakes Area in northwestern Ontario. Over three summers, they added tiny amounts — low parts per trillion — of the synthetic estrogen used in birth control pills to the lake to recreate concentrations measured in municipal wastewater.

During that period, they observed that chronic exposure to estrogen led to the near extinction of the lake’s fathead minnow population as well significant declines in larger fish, such as pearl dace and lake trout.

"The good news," writes James Randerson of The Guardian,

"is that three years after the team stopped adding oestrogen, the fish populations have recovered. So the effects of oestrogen pollution can be reversed. There is now a strong case for better sewage treatment to break down synthetic oestrogens before they make it into the environment."

, Kidd emphasized that she doesn't want any women to get the message that they should stop taking oral contraceptives to save the fish. "Once we treat our wastewater … we can remove up to 95 per cent, sometimes 100 per cent of these estrogens."


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Vancouver AIDS and addictions researchers Evan Wood, Julio Montaner and Thomas Kerr have fired off yet another angry missive about the Conservative government's conflation of ideology with evidence when it comes to drug policy.

, the three authors, who all work at Vancouver's safe-injection site, take federal Health Minister Tony Clement to task for giving equal weight in his study on the merits of harm reduction to biased lobbyists as he does to evidence-based scientific research. (Subscription to The Lancet is required to access the article.)

Wood, Montaner and Kerr wrote about the same subject in for the National Review of Medicine last September that accompanied on harm reduction, addiction treatment and the new federal anti-drug strategy that was released in the fall.

For my article, I spoke to Dr Keith Martin, a Liberal Member of Parliament in British Columbia, who pointed me to Prime Minister Stephen Harper wrote before he became leader of the Conservative Party:

Stephen Harper's attitude about how society should treat drug addicts was outlined in a 2003 essay he wrote about the Left called "Rediscovering the Right Agenda," published in Report magazine:

"This descent into nihilism... leads to silliness such as moral neutrality on the use of marijuana or harder drugs mixed with its random moral crusades on tobacco. It explains the lack of moral censure on personal foibles of all kinds, extenuating even criminal behaviour with moral outrage at bourgeois society, which is then tangentially blamed for deviant behaviour."

Dr Martin says Mr Harper's position on substance abuse was the reason he opted not to join the newly formed Conservative Party, though he had been a member of the Canadian Alliance. "I suspect they see [substance abuse] as some kind of personal weakness — that people have a choice," says Dr Martin.

The new article in The Lancet Infectious Diseases features a very apt Isaac Asimov quote:

The saddest aspect of life right now is that science gathers knowledge faster than society gathers wisdom.

- Isaac Asimov

That does an effective job of summing up the current situation on addiction medicine policy in Canada, it seems.


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