July Messenger 2020

College of Physicians and Surgeons of Alberta CPSA, Messenger


Nominations for the 2020 Council Election

How to get ready now!

Although nominations don’t officially open until Aug. 14, here’s some information on how you can get ready now.

  • Ensure you meet the eligibility requirements
  • Find three colleagues to endorse your nomination using this form. Once completed and signed, scan and save it as you will be uploading it to the online Physician Candidate Profile form, available on Aug. 14 when nominations open.

Virtual info session on becoming a CPSA Councillor

Did you miss Council President Dr. John Bradley’s June 25 Zoom session on becoming a CPSA Councillor?

Check out this recording to find out why you should run, what’s involved and more about key dates for the upcoming election.

  • Find or take a black and white head shot of yourself for the Physician Candidate Profile form. If your photo is in colour, no worries—we will convert your photo to black and white for you.
  • Think about or draft responses to the following questions, which are on the official Candidate Profile Form. Please note the set character limits for each question to ensure fair submissions.
    1. Medical training & experience? (600 characters)
    2. Motivation for running? (2,100 characters)
    3. Unique experience, i.e. governance, communication, financial management? (600 characters)
    4. Additional information? (450 characters)

As a reminder, here are the key dates for the 2020 Council Election:

Key date

What’s happening?

Aug. 14, 2020

Nominations open - we’ll send you an email notice. If you’re interested in running this year, you must submit your nomination using our official CPSA Nomination and Candidate Profile forms.

Sept. 9, 2020

Nominations close – you will have until 4:15 p.m. (MT) to submit your official forms into CPSA.

Sept. 16, 2020

Voting opens – this year, eligible physicians will access their ballot and see who is running via our secure CPSA Physician Portal. This is new and will simplify the voting process.

Oct. 14, 2020

Voting closes – CPSA Council will approve the successful candidates as soon as possible. We’ll notify all candidates of the results.

Nov. 12, 2020

Official announcement – we’ll announce our new Council members to the entire profession via The Messenger.

Jan. 1, 2021

Newly elected Councillors start their three-year term.

 Questions about the 2020 Council election? Email elections@cpsa.ab.ca.


Consultation 018: we want to hear from you!

Through Consultation 018, we are seeking your feedback on three of our standards: Advertising, Conflict of Interest and Practising Outside of Established Medicine (formerly Complementary and Alternative Medicine).

Review current standards and proposed changes 
Please visit our consultation page to review the current standards and our proposed amendments.

Have your say
Ready to provide your feedback? Share your thoughts online, by email or through a brief survey by Aug. 9.

1. Advertising standard
Review online
Send us an email
Complete the survey

2. Conflict of Interest standard
Review online
Send us an email
Complete the survey

3. Practising Outside of Established Medicine (formerly Complementary and Alternative Medicine) standard
Review online
Send us an email 
Complete the survey

Your feedback helps us develop clear, reasonable expectations and helpful, applicable resources. We appreciate the time you take and the input you provide.

Questions? Please contact Chantelle Dick, CPSA Standards of Practice Coordinator, at Chantelle.Dick@cpsa.ab.ca.


Connect Care planning resumes with new timelines and sequence

After pausing the roll-out of Connect Care as a response to Alberta’s pandemic planning, Alberta Health Services is resuming their work on this important project.

Waves 2 and 3 of Connect Care were temporarily delayed in March, given the significantly increased demands on frontline physicians, staff and services, and the increased health risks our patients and healthcare teams faced due to COVID-19. As the province slowly re-opens, AHS plans to move forward carefully with preparations for the next waves of Connect Care. In addition to updating launch dates, AHS has also updated which areas will be a part of each launch.

For detailed information, please review AHS’ Connect Care implementation timeline and read their message to providers.

The next launch dates are:

  • Wave 2: Launch date - Saturday, October 24, 2020
  • Wave 3: Launch date - Saturday, February 27, 2021
  • Wave 4: Launch date - Saturday, June 5, 2021

Dr. Seyara Shwetz: resident and “wellness champion”

2020 U of A recipient of the Dr. Marnie Hinton Award for Resident Physician Health

Her colleagues describe her as a “wellness champion,” and others couldn’t agree more.

On June 18, in a virtual Zoom meeting, the University of Alberta honoured Dr. Seyara Shwetz, a fourth-year pediatric emergency medicine resident, with the Dr. Marnie Hinton Award for Resident Physician Health.

Dr. Seyara Shwetz during the virtual award ceremony on June 18.

Seyara’s dedication and influence in resident physician health started in 2016, and has spread locally, regionally, nationally and internationally. In a short time, she’s amassed an impressive list of accomplishments, including:

  • Helping develop a wellness curriculum for Saskatchewan’s emergency medicine residents;
  • Helping to ensure resiliency training funding for Saskatchewan’s incoming first-year residents, and taking this further to travel across Canada to provide resiliency workshops;
  • Contributing to the creation of national call room standards and the development of pro-wellness language infographics; and
  • Collaborating with national wellness leaders, through the AFMC, to enhance accommodations for resident learners.

And her hard work continues. The “Pro-Wellness” initiative is being presented at the next International Conference on Physician Health, expected to take place in spring 2021.

“I never expected to be recognized for my work on wellness initiatives, and I am honoured to receive an award for something I’m so passionate about,” says Shwetz. “My goal has always been to enhance the joy we experience in the workplace, and I hope I can continue to make a positive difference as my career continues.”

Even with the award presented virtually, those attending saw why her colleagues also describe Seyara as a kind, funny and empathetic person who tries to connect with everyone who crosses her path. As they said, this year there was no other person at the University of Alberta more deserving of this recognition.

Congratulations, Seyara!

Dr. Marnie Hinton, a long-time Alberta physician, dedicated her life to physician health. For nearly 25 years, she worked with doctors struggling with addiction through CPSA’s Physicians Aftercare Program, sharing her wisdom about healthy sobriety and even taking members to recovery meetings in her off hours. The Dr. Marnie Hinton Award for Resident Physician Health is awarded annually to medical residents who have a demonstrated an interest in physician health. The award is jointly sponsored by CPSA and AMA’s Physician and Family Support Program, with special thanks to Bennett Jones LLP for their generous contribution. See more about this award.


Delivering bad news in a new physician/patient environment

With COVID-19 altering how physicians deliver their standard of care and virtual appointments being more common, a new and challenging issue that has arisen for physicians is how and when to give bad news to your patients.

It’s understood that physicians and surgeons have historically been taught, in order to apply their technical expertise, they have to be detached emotionally. However, patients can easily interpret this distance as insensitivity or a lack of compassion. Especially during these pandemic times, it is important to keep in mind the role of emotional intelligence in providing good patient care on a more human level.

Preparing to give bad news

Taking a few minutes to prepare to deliver bad news gives you the time to review the diagnosis thoroughly, plan what you are going to say and anticipate the patient’s questions so you can reply with clarity and sincerity, and avoid appearing uncertain or unsure about what you are saying.

It is best to give bad news in person. If the diagnosis allows for a few days to wait, not delaying future treatment or surgery, see the patient in person.

In-person visits have been complicated by necessary practice changes physicians have made to help prevent the spread of COVID-19. In cases where bad news must be delivered, consider if it is possible to have a physically-distanced in-person meeting with the patient and their loved one or, if physical distancing is not possible, if personal protective equipment can be used to allow for a safe face-to-face appointment to take place.

While time is often a limited resource for physicians, scheduling additional time for the appointment may also be necessary to ensure the patient has the opportunity to ask all the questions they have.

Telephone bad news: only as a last resort

Do not let your staff give bad news to patients over the phone. This is a cold and distant approach. The primary care physician knows the patient and their circumstances best, and is better equipped to answer questions other medical office staff members cannot, and should not, answer.

If you are providing bad news over the phone, take care to ensure the patient is not driving or in a risky environment, such as operating heavy equipment. Bad news can cognitively impair a patient and completely distract them from their environment—putting them, and potentially others, at risk. Ask the patient if you’re reaching them at a good time and if they have a support person with them, as it will help.

Finding the right words

You do not need to talk to break the silence immediately after giving the bad news, which can be uncomfortable without the patient across from you and not being able to see the patient’s non-verbal response.

Do not say, “I know how you’re feeling,” or, “The same thing happened to one of my own family members or an acquaintance.” Instead say, “This must be difficult for you,” thus opening the door for a patient to express their feelings. Avoid using jargon and speak in layman’s terms that a patient can easily understand.

If the patient starts talking, do not interrupt them. Research reflects the average patient talks for 18 seconds in an in-person appointment before the physician interrupts them1. It’s important to show patience for your patient—allowing the discussion to occur at their pace and according to their emotions2.

Instead of asking your patient if they have any questions, ask, “What questions do you have?” Posing your question this way invites the patient to ask what’s on their mind, while the former can often result in the patient saying they do not have any questions.

Reflective listening and empathy results in better physician/patient conversation outcomes, whether in person or during a virtual care visit, and are especially helpful when giving bad news to patients.

References

  1. Buckman R. (1992). How to Break Bad News, a guide for health care professionals. University of Toronto Press, Toronto.
  2. CMPA (2015). After the diagnosis: How to communicate with terminally ill patients. https://www.cmpa-acpm.ca/en/advice-publications/browse-articles/2015/after-the-diagnosis-how-to-communicate-with-terminally-ill-patients

Additional resources


Professional Conduct reports

Ponoka Physician sanctioned for unprofessional conduct

Dr. Robert Halse, a Family Physician from Ponoka, admitted to charges of unprofessional conduct and was sanctioned by a CPSA hearing tribunal.

Background

In April 2018, Dr. Halse saw a patient who was exhibiting symptoms of a stroke. According to a joint submission from Dr. Halse and CPSA, Dr. Halse failed to send his patient for an emergency CT scan as treatment guidelines recommend. The patient was also not told he shouldn’t drive as doing so could pose a risk to himself or the public. Dr. Halse also failed to properly supervise a medical student who examined the patient at the Ponoka Hospital’s emergency department at Dr. Halse’s request.

The hearing tribunal accepted Dr. Halse’s admission of unprofessional conduct, agreeing the care he provided was inadequate and lacking in the skill expected from a family physician, and ordered the following sanctions:

  1. Halse will receive a reprimand.
  2. Dr Halse cannot supervise medical learners unless he receives written approval from CPSA’s Complaints Director.
  3. At his own cost, Dr. Halse will undergo a review of his practice.
  4. If Dr. Halse would like to continue supervising medical learners, the practice review must include an assessment of his supervision skills.
  5. Halse must implement any changes recommended in the practice review and as determined by the Complaints Director.
  6. The hearing tribunal will make the final decision if there is disagreement on the changes required to Dr. Halse’s practice.
  7. Halse is responsible for 75 per cent of the costs of the investigation and hearing.

Commentary

When considering their order on sanction, the hearing tribunal acknowledged that Dr. Halse accepted responsibility for his conduct, which avoided a prolonged disciplinary process. They also recognized the seriousness of a physician failing to meet the expected level of care, especially when that failure results in an adverse outcome for the patient (in this case, permanent disability). The sanctions issued (relating to education and remediation especially) reinforce the importance of meeting required standards relating to patient care and the supervision of medical learners.

Edmonton physician found not guilty of unprofessional conduct

A CPSA hearing tribunal found Dr. Gulnaz (“Gul”) Jiwa, an Obstetrics and Gynecology Practitioner from Edmonton, not guilty of charges of unprofessional conduct.

Background

During a surgical procedure in December 2016, Dr. Jiwa removed a cyst and performed a partial left salpingectomy on her patient. Prior to surgery, the patient declined to sign a consent form and verbally advised a nurse that she did not want her fallopian tube removed. Dr. Jiwa was not advised of this conversation and did not confirm whether the patient had signed the consent form. Dr. Jiwa also failed to ensure the partial salpingectomy was documented in the surgery’s Operative Report (created by a post-graduate trainee but ultimately, still Dr. Jiwa’s responsibility).

The hearing tribunal recognized that CPSA’s standard of practice on Informed Consent does not specify consent must be in writing−it was well documented the patient gave verbal consent during a preoperative office visit and was advised by Dr. Jiwa that a salpingectomy was possible. The tribunal also accepted that failing to ensure the Operative Report’s accuracy was an oversight and did not materially impact the patient’s care.

Commentary

Unprofessional conduct occurs when a physician displays a lack of knowledge, skill or judgment in their provision of services. Such conduct can arise if a physician breaches the Health Professions Act, the CMA’s Code of Ethics and Professionalism or CPSA’s Standards of Practice. In dismissing the charges against Dr. Jiwa, the hearing tribunal ruled that while several errors may have been made, they did not meet the threshold of unprofessional conduct.

Physician guilty of self-prescribing and personal relationship with patient

A CPSA hearing tribunal found Dr. Altaf Khumree, a General Practitioner from Strathmore, guilty of unprofessional conduct.

Background

In 2011, Dr. Khumree committed a boundary violation when he entered into an inappropriate relationship with a patient. He continued providing medical care to this patient after their involvement became personal and failed to disclose the relationship to CPSA when he renewed his practice permit. Dr. Khumree also did not inform CPSA that he had been charged with a criminal offense (impaired driving). Additionally, on several occasions between 2012 and 2015, Dr. Khumree inappropriately prescribed medication to himself, including opioids and other drugs prone to abuse.

Dr. Khumree admitted to the allegations against him and agreed to undergo further assessment of his fitness to practise medicine. Sanction will be determined after this assessment is complete.

Commentary

A sexual relationship with any patient is a serious violation of important boundaries that must be maintained, given the inherent power imbalance that exists between physicians and their patients. In this case, Dr. Khumree was treating his patient for mental health concerns, putting the patient in an even more vulnerable position.

A required physician assessment will clarify for the hearing tribunal whether Dr. Khumree’s alcohol use disorder impacted his conduct. Sanctions under Bill 21, An Act to Protect Patients, will not apply to this case as the complaint predates the change in legislation.

Physician sanctioned for inappropriate relationship with patient

Dr. Moises Lasaleta, a General Practitioner from Calgary, admitted to entering into a personal relationship with a patient and was sanctioned by a CPSA hearing tribunal for unprofessional conduct.

Background

In 2016, Dr. Lasaleta entered into a personal relationship with a patient for whom he’d been providing care since 2013. He did not end the physician/patient relationship as required by CPSA’s Standards of Practice and failed to maintain appropriate boundaries with his patient.

Dr. Lasaleta has not been in practice since 2018. He admitted to the allegations against him and the hearing tribunal ordered the following sanctions:

  • If Dr. Lasaleta is issued a practice permit in the future, it will be suspended for 12 months. The suspension will be considered served due to the time he has been out of practice.
  • Before he is issued a practice permit, Dr. Lasaleta must (at his own cost) complete an assessment to determine whether he is fit to return to practice. If the assessment finds him unfit to practise medicine, he will not be reinstated.
  • Lasaleta must also complete additional treatments recommended in the assessment, to the satisfaction of CPSA’s Complaints Director.
  • If Dr. Lasaleta’s practice permit is reinstated, it will include any practice conditions put in place by CPSA, in addition to any conditions recommended by the above-mentioned assessment.
  • If there is any disagreement between Dr. Lasaleta and CPSA over practice conditions, or whether assessment and treatment requirements have been met, final determination will be made by the hearing tribunal.
  • Lasaleta is responsible for all costs associated with the investigation and hearing (totalling $12,731.70), as well as future costs for monitoring of any practice conditions.

Commentary

Sanctions under Bill 21, An Act to Protect Patients, did not apply to this case given the timing of the complaint. In making their decision, the hearing tribunal recognized the seriousness of Dr. Lasaleta’s conduct and the importance of deterring such behaviour. A 12-month suspension is significant and sends a message that boundary violations will not be tolerated.

Physician from Sherwood Park guilty of unprofessional conduct

A CPSA hearing tribunal recently found Dr. John Slanina, a General Practitioner from Sherwood Park, guilty of unprofessional conduct. Sanctions will be determined at a later date and Dr. Slanina’s practice permit remains active.

Background

Throughout 2015 and 2016, Dr. Slanina began providing medical care to a woman with whom he was in a personal relationship. According to the charges, Dr. Slanina did not maintain appropriate professional boundaries by providing care for his partner and failed to inform CPSA he was in a relationship with a patient. He also did not create clinical records for the care he was providing. After their personal relationship ended and his former partner complained about his conduct to CPSA, Dr. Slanina filed a defamation lawsuit (including the CPSA complaint) against her on the advice of a lawyer. The lawsuit has since been withdrawn.

Commentary

The hearing tribunal determined that while physicians can provide care to family members in emergency situations, Dr. Slanina issued several prescriptions and ordered a number of tests (for which he received the results as the referring physician) for his then-partner, establishing a physician/patient relationship. Having a personal relationship with a patient, even if it predates the provision of care, is inappropriate. Furthermore, patients who complain about healthcare professionals to their regulators should not face the threat of being sued. Physicians being held accountable for behaviour that goes against expected standards of practice is a vital component of self-regulation.