Actualités

New models of care delivery: Taber, Alta, family physician Dr Rob Wedel, former Chair of the Board of the College of Family Physicians of Canada (CFPC), was installed as 2003-2004 CFPC President at the Family Medicine Forum in Calgary, Alta, in October. Dr Wedel, an active family physician and researcher, has practised at the Associate Medical Clinic in Taber for more than 20 years. For the last 3 years, he has led a pilot project in Taber that introduced new models of care delivery, including integrated primary care, interdisciplinary team care, and enhanced roles for nurses. This project recently received additional funding to continue on an ongoing basis. Dr Wedel is Medical Director of the Regional Palliative Care Program in the Chinook Health Region and is a Fellow of the CFPC. He enjoys spending time with his wife, Marilyn (petting the horses), and his collection of purebred Arabian horses and foals, as well as various cats and kittens on their acreage in Taber. He has two grown children.

Appreciation awards presented to British Columbia College executives at Annual General Meeting: From left, Mr Rob Nijjar, Member of the Legislative Assembly for Vancouver-Kingsway, presents a gift to Dr Susan Knoll, Past President of the BC College, at the College’s 16th Annual Conference in Richmond last fall. Dr Cal Gutkin, Executive Director of the College of Family Physicians of Canada, spoke to members of the College at the Annual General Meeting. Outgoing President, Dr Ranbir Mann, said 2002-2003 had been “the most successful year in memory” with record membership numbers, a strong financial position, and a close relationship with the provincial Ministry of Health. To the delight of members in attendance, Dr Mann canceled a proposed fee increase for the coming year.

Making things better: Dr Paul Wong, incoming President of the British Columbia College of Family Physicians, addressed the Annual General Meeting at the College’s 16th Annual Conference in Richmond. Dr Wong, who practises in Vancouver, said he wanted to get involved on the College’s Executive Committee to “help make things better.” He plans to build on initiatives begun in 2002-2003 and to continue to find ways to increase membership beyond the record level (1926 members) reached the previous year.

British Columbia Minister of Health Mr Colin Hansen honours Family Physician of the Year, Dr Art Macgregor: From left, Dr Paul Wong, incoming President of the BC College, Mr Hansen, Dr Macgregor, and Dr Cal Gutkin, Executive Director of the College of Family Physicians of Canada. Mr Hansen, who attended the College’s reception during the 16th Annual Conference in Richmond, said he was going to “help Cal find the Palomar Club” after Dr Gutkin had expressed an interest in visiting the place in Vancouver where the College was founded in 1954. Dr Macgregor, who is a Past President of both the BC College and the national College, said he made the decision to be a doctor at age 7 and is “past apologizing for still working.” Claiming to be one of the 55% of family physicians not burned out, he said being a family doctor has “suited me perfectly all my life.”

Vaccines—what’s new, what’s to come: Dr Simon Dobson, an infectious disease specialist, speaks with family physician Dr Elizabeth Brodkin after a session entitled “Newer vaccines: what can be expected?” at the 16th Annual Conference of the British Columbia College of Family Physicians in Richmond. Dr Dobson, who is on staff in the Division of Infectious Diseases at the BC Children’s Hospital in Vancouver, presented a session on “newish” vaccines: universal infant hepatitis B, pneumococcal, meningococcal, varicella, smallpox, and rubella (during pregnancy). He mentioned that adolescent pertussis boosters (“natural immunity wears out over time”) and a new measles-mumps-rubella vaccine were on the horizon. Dr Dobson particularly pointed out the serious complications of chickenpox and mentioned that, although varicella vaccine has proven cost-effective, it is not yet on the BC drug program.

Audit abandoned without explanation: Dr Julian Lisinski presented “MSC Audits and You: The Whole Story” during the BC College’s 16th Annual Conference in Richmond. Dr Lisinski’s presentation was an impassioned plea for changes to Medical Services Commision (MSC) audits, which, he said, rip apart lives and families. “Family practice is threatened by what has been called a vicious, arbitrary kangaroo court,” he said. “Huge sums have been levied on practitioners. I paid almost half a million dollars and, as a result of giving this talk, I may be punished and audited again.”

“In spring 2000, I heard I was to be audited because I was ‘seeing too many patients.’ I had inherited a lot of chronic patients in my practice. The auditors arrived and took 80 charts, interrogated my staff, and refused to check for more information. When I protested my innocence, I was told to keep quiet. It seemed everybody thought me guilty.”

“Audits in BC are shrouded in silence,” he said. “A hearing was scheduled, and it took me more than 200 hours to prepare my defence. After the report was sent in, the audit process was abandoned without explanation. All ‘victims’ of this process are humiliated and scarred.”

Just before Dr Lisinski spoke, William Clark, a lawyer with Harper Grey Easton in Vancouver, talked about the medicolegal consequences of physicians’ Mini Profiles, which describe the way they practise. “General practice is being aggressively audited in BC,” he said. “Be careful with charting, and be specific about patients’ illnesses.” Pointing out that the vast majority of audits do not lead to charges, he nonetheless counseled physicians to “read the Guide to Fees carefully and be careful with language and terminology in billing components.”

Adding to the current debate about hormone replacement therapy (HRT): Dr Timothy Rowe, a Vancouver specialist, spoke about “The place of HRT in the Post-WHI era” at the British Columbia College’s 16th Annual Conference in Richmond: “Although the pendulum has swung to the negative regarding HRT,” he said, “it has proven benefits. It can reduce vasomotor symptoms; improve sleep patterns, energy and libido levels, and cognition; aid in remission of depression and improve dysthymia; and increase skin thickness.” The Women’s Health Initiative, a set of trials designed to assess interventions in postmenopausal women, found risks associated with HRT. “After the dust has settled,” said Dr Rowe, “HRT is still the best treatment for significant menopausal symptoms and should be prescribed in the lowest effective dose for the shortest time necessary. Alternative therapies must be considered, but the evidence is strong that HRT is ‘good’ early in the postmenopausal years and only ‘bad’ later in menopause.”

Family physician named as President of Coalition: Now serving as President of the Canadian Coalition for High Blood Pressure Prevention and Control, Dr Robert J. Petrella is the first family physician to be named to the position. An interagency organization of professional, voluntary, and governmental organizations and health agencies interested in prevention and control of high blood pressure in Canada, the Coalition leads efforts to develop the Canadian Hypertension Guidelines and provides standardized educational materials for its industry partners. During his tenure, Dr Petrella hopes to develop educational activities aimed at increasing public awareness of the risks of hypertension, to support workplace programs to screen for hypertension control, to educate media on issues related to hypertension, to encourage healthy lifestyle and behavioural approaches to hypertension prevention and control, and to develop physicians’ tools and skills for hypertension management.

Briefing

Taking a bite out of childhood obesity

Canada’s physiotherapists are concerned that a growing epidemic of childhood obesity will result in a new generation of Canadians facing ongoing health problems and chronic disorders. Last fall, Statistics Canada reported that 37% of Canadian children aged 2 to 11 were overweight. Along with increased risk of heart disease, diabetes, and other medical disorders, obese people can develop musculoskeletal problems due to stress on the major weight-bearing joints. According to a Health Canada study of physical inactivity levels of children and adolescents by province and territory, Quebec had the highest levels at 70%, followed by Newfoundland at 61% and Alberta at 57%. Only 10% of the 15 800 Canadian schools currently have good physical education programs daily. Alberta has recently announced that it will phase in 20 to 30 minutes of daily physical education for all elementary and secondary school students over the next 2 years.

Another travel hazard: dirty hands

An American Society for Microbiology survey reveals that as many as 30% of travelers do not wash hands after using public restrooms at airports. More than 30% of people using restrooms in New York airports, 19% in Miami’s airport, and 27% in Chicago’s airport are not stopping to wash their hands. The survey, conducted by Wirthlin Worldwide in August 2003, observed 7541 people in public washrooms in New York, Chicago, San Francisco, Dallas, Miami, and Toronto. In contrast to airports in the United States, nearly all travelers using airport restrooms in Toronto, Ont, a city that experienced a major severe acute respiratory symdrome (SARS) outbreak, washed almost every time.

Dr Donald Low, Chief of the Department of Microbiology at the University of Toronto and Toronto‘s Mount Sinai Hospital, and one of the lead investigators of the Toronto SARS outbreak, said he was not surprised by either the almost universal hand washing at Toronto’s airport or the low levels in other cities. “Our experience with SARS was such a wake-up call. People in the hospital here have changed their hand-washing habits.”