The Flu Pandemic and You by Vincent Lam, MD and Colin Lee, MD. Mississauga: Doubleday Canada, 2006. ISBN 987-0-385-66277-2. Paperback, 344 pages. $14.95.
Are we all going to die? If so, when? Should I get a flu shot? Can you trust your bird? Can your bird trust you? The Flu Pandemic and You offers a common sense, practical reference that answers these questions and many more. Perfect for your patients seeking a no-nonsense guide to the next inevitable flu pandemic. This book’s excellent table of contents and index allow readers to quickly access the information they seek. The chapters are well organized and begin with an excellent feature, “This Chapter in One Page,” which summarizes each chapter’s content. Topics range from the background and science of influenza, including vaccines and antivirals, all the way to practical ways to decrease spread and keep your family safe. Drs Lam and Lee relay this information with a rational, reassuring tone. They have a unique perspective on pandemics as they both worked as emergency physicians during the SARS outbreak in Toronto in 2003. An added bonus is a foreword by world-renowned Canadian author Margaret Atwood, who draws parallels between SARS, influenza, and her novel, Oryx and Crake. I strongly recommend this book for the layperson who wants to become better informed about influenza and its pandemic potential. Physicians looking for a medically oriented review need to look no further then the world’s greatest provincial medical journal (they might want to buy the book as well).
On 7 November 2006 Dr Vincent Lam was named the 2006 Giller Prize winner for his short story collection Bloodletting and Miraculous Cures, (Doubleday Canada, 2006) a series of interlinked stories, populated by medical students and young doctors, that reflect on Dr Lam’s experience as an emergency room physician. The Giller is one of Canada’s top literary prizes.—Ed
SARS taught those involved with health care delivery that Canada is sorely unprepared to respond to a major pandemic. The already overburdened health care system has little wiggle room to accommodate a major demand on hospitals and a limited number of health care workers.
The government of BC has undertaken a major pandemic planning initiative by the Ministry of Health. A pandemic planning group has been established to develop plans in six key areas: communications, public health, clinical care, logistics, coordination with the health authorities, and human resources.
The objective is to develop operational plans that can be implemented when a pandemic hits BC. As important, the hope is to develop response models that can be used for any major event that disrupts the normal operation of the health care system. This would include things like an earthquake, a major train or plane crash, or even a severe, multi-vehicle car accident.
Dr Tracey Parnell is heading the clinical care working group and Dr Bill Mackie, chair of the BCMA General Assembly, is sitting as the BCMA’s representative on the group. The group is working on developing a response model that can be adopted by all the health authorities to ensure continuity across the province.
The overall approach to the province’s pandemic planning is to engage physicians and other health care providers in the planning. The planning group knows that no plan can be effective without incorporating the experience front-line providers have. This bottom-up approach is intended to ensure the response plans are usable and can be implemented successfully.
The planning teams will be traveling throughout the province meeting with physicians, nurses, hospital administrators, and others. The BCMA encourages its members to attend these sessions and provide input on the various issues.
The clinical care group is responsible for trying to determine how many physicians will be prepared to work during a pandemic. There are many issues to deal with when planning for physician involvement, and the BCMA also wants your input on this subject. A member poll is planned for early 2007. Watch for it and please participate.
If you have ideas you want to share on the topic of disaster and pandemic planning or the key questions you believe need to be addressed, please send your comments to firstname.lastname@example.org.
—Geraldine Vance, APR
Director, BCMA Communications
Recently, letters were sent out to physicians who are eligible for the Physicians’ Disability Insurance (PDI) Plan but who have not applied for coverage to remind them about this important negotiated benefit.
All physicians who earn fee-for-service, sessional, or non-salaried service contract income are eligible to apply for the PDI benefit. As this is a negotiated benefit, every effort is made to provide some level of coverage. However, the benefit is medically underwritten and the insurer has the right to impose limitations and exclusions or, in rare cases where a physician is deemed uninsurable, to decline to issue coverage altogether.
The amount of coverage is based on your previous calendar year earnings, as reported to the BCMA by the government and health authorities, and an overhead factor based on your type of practice as assigned by MSP. The monthly benefit amount can increase (or decrease) each year, depending on the amount of eligible income you earn for that year. The maximum monthly benefit is $6100, usually payable after only 14 days of disability or from the first day of hospitalization if earlier, and the benefits paid to you are non-taxable. Because the benefits are non-taxable, the premium attributed is deemed a taxable benefit and is included on the T4A issued to you by the BCMA each year.
If you are eligible for the PDI benefit but have not yet applied for coverage, I encourage you to call one of the BCMA insurance administrators shown below to request an application. Applications can also be downloaded from the BCMA web site, www.bcma.org, under the PDI section of the Insurance drop-down menu located on the BCMA home page.
If you already have disability insurance but would like to see how the PDI benefit can complement that coverage and possibly provide you with premium savings, you can call your financial advisor at MD Management and ask to have an analysis done by MD’s insurance experts.
Do not overlook the opportunity to apply for this valuable negotiated benefit!
• Ms Lorie Arlitt
1 800 665-2262, ext. 2818
• Ms Karen Paul
1 800 665-2262, ext. 2836
—Sandie Braid, CEBS
The recent election of the new director-general of the World Health Organization reveals once again the close ties that Canada has had with WHO from the beginning. In 1948 it was this country’s deputy minister of health, Dr G. Brock Chisholm, who was unanimously appointed as the first director-general of the organization, and the latest, seventh, leader is Dr Margaret Chan, who graduated from the University of Western Ontario.
The accelerated process for the current nomination and election follows the premature and sudden death, last May, of director-general Dr Jong-Wook Lee. The director-general is WHO’s chief technical, scientific, and administrative officer and, as head of one of the major UN agencies, enjoys a top position in the United Nations hierarchy. Although within the UN system, WHO, with headquarters in Geneva, Switzerland, is entirely independent and free from the world body in New York.
After her MD degree from Canada, Dr Chan pursued specialization in public health at the National University of Singapore. She joined the Hong Kong Department of Health in 1978, and was appointed director of health in 1994. In that capacity she launched new services focusing on disease prevention and health promotion. She also introduced new and imaginative initiatives to improve communicable disease surveillance and response, enhance training in public health, and promote primary health care “from the diaper to the grave.” In the past few years she has became particularly known for her robust record of fighting diseases first in Hong Kong, and more recently at WHO. During her 9-year tenure as director of health, Dr Chan confronted the first human outbreak of H5N1 avian influenza in 1997, and later successfully defeated SARS in Hong Kong in 2003. In that year she joined WHO and rapidly rose to the post of assistant director-general for communicable diseases, with particular focus on pandemic influenza, a position of leadership coupled with success that must have weighed much in favor of her appointment to the top position.
In her acceptance speech Dr Chan said, “what matters most to me is people,” and pinpointed two groups as immediate targets for action and criteria of performance: improvements in the health of people in Africa and progress in the health of women. As director-general she will focus on six issues for WHO: health development, health security, capacity, information and knowledge, partnership, and performance. She underlined the importance of strong systems of health delivery at the local level. “You cannot deliver health care if the staff you trained at home are working abroad,” she said, referring to the sad shortage of physicians in, and damaging brain drain from, developing countries. Alluding to the extra-scientific responsibility of leaders, Dr Chan said aloud what is mostly murmured—that lack of resources and too little political will among governments are often the true killers.
Dr Chan has a world vision and commitment that reminds us of her erstwhile Canadian predecessor. For the health of the world, we wish her—and WHO—well.
—S.W.A. Gunn, MD
Former head, WHO Emergency Operations
Physician Information Technology Office
The Physician Information Technology Office (PITO) Steering Committee was formed and met for the first time in June following the ratification of the 2006 Agreement, and was busy over the summer and early fall setting the ball in motion. While setting PITO up, the PITO Steering Committee has initiated five key activities that are setting the direction for the initiative:
• Selection of the PITO program director
• Creation and direction of PITO Clinical Advisory Group
• Electronic medical records (EMRs) vendor selection
• Core data set
• Site visits and research
Please visit the member web site and click on Agreement News Update for more information about these initiatives.
Over the next 2 to 3 months, PITO will be focused on the following activities:
• Issuing the EMR request for proposals and proceeding with the EMR vendor selection process.
• Increasing active communication with physicians regarding PITO and EMRs.
• Setting up the office for PITO.
• Developing detailed funding criteria, processes, and guidelines
• Planning the initial set of PITO EMR pilot projects.
Application services provider
An integral part of using information technology in a physician practice setting is the use of an EMR that contains specific patient information that would previously have been held in paper records. One way that EMRs can be stored and accessed is by using an application service provider (ASP). Please go to the member web site and click on Agreement News Update to read about what an ASP is, as well as its benefits and challenges.
General Practice Services Committee
If you submitted claims for codes 13050 or 13051 between 1 April 2006 and 4 May 2006, you will need to resubmit them in order to receive the increased fee:
• Debit claims for 13050 and 13051.
• Resubmit these claims using the new codes 14050 and 14051 respectively
Please remember to submit your billings if you are in a maternity care network.
The 2006–07 sessional rates increase of 8.34% is currently being implemented, as is the 2006–07 salary and service contract rates increase of 2.84%. All of these rates will increase by 2%, 2%, and 3% in the fiscal years of 2007–08, 2008–09, and 2009–10 respectively.
The 2006 agreement provides for $10 million in one-time funding to be paid to specialist physicians who were practising in BC during the 2005–06 fiscal year. These funds are being distributed by lump sum, with an adjustment for those physicians earning less than $100000 during 2005–06. All specialists, regardless of mode of remuneration (i.e., fee-for-service or alternative payment) are eligible to bill MSP for this payment.
Please note that to be eligible for payment, claims must be submitted between 15 October 2006 and 31 January 2007. Go to the BCMA member web site to print the claim form and for more information. Click on the Agreement News Update button, then on General Compensation in the left-hand side navigation bar.
The MOCAP committee has defined its mandate and selected its members. Go to the BCMA member web site and click on the Agreement News Update button, then on MOCAP in the left-hand side navigation bar.
Your new 2007 pocket calendar and its new cover are both included with this issue of the BC Medical Journal. In addition to all of the useful information you can find at your fingertips, we have noted important benefits and insurance deadlines in each month to serve as a handy reminder.
—Sandie Braid, CEBS
Perinatal depression—which can occur at any time from conception to one year after childbirth—is a significant health issue. The research literature indicates that 10% to 20% of women are affected by perinatal depression. BC data indicate that 12% of women between conception and 1 month postnatal receive physician services for depression.
The Ministry of Health (MoH) Service Plan for 2005–06 to 2007–08 includes strategic initiatives to strengthen perinatal and maternal health services. One specific initiative focuses on perinatal depression. During the 2006–07 fiscal year, health authorities have been asked to prepare regional plans consistent with this framework document that will strengthen perinatal depression services.
The overall objective of the Perinatal Depression Framework is to help ensure that every perinatal woman in BC experiences an optimal journey from conception to motherhood. The framework document was produced to help guide the development of regionally appropriate strategies for addressing depression at the local level. It was produced by BC Reproductive Mental Health Program (RMHP), part of BC Women’s Hospital and Health Centre, in partnership with the MoH, Mental Health and Addictions Branch, and Healthy Children, Women and Seniors Branch. It is based on the expertise of the RMHP, a review of relevant literature, and several consultations.
Physicians can educate women by using the following resources:
• Guide to Postpartum Blues and Postpartum Depression (pamphlet).
• The Edinburgh Postnatal Depression Scale (to screen women at 28 to 32 weeks and 6 to 8 weeks postpartum).
• The RMH Best Practices Guidelines (being revised).
• Self-Care Program for Women with Postpartum Depression and Anxiety (110-page patient guide).
A Cognitive Behavior Therapy Self Management Program (soon to be available).
These resources, including the Perinatal Depression Framework document, are available on the BC Women’s web site at www.bcwomens.ca; the framework is available at www.bcwomens.ca/Services/HealthServices/ReproductiveMentalHealth/AffiliationsPartnerships.htm.
If you are interested in the implementation of the Perinatal Depression Framework within your health authority, please contact either the director or manager of Mental Health and Addictions or Public Health Nursing. If you would like to discuss this initiative, please contact Dr Shaila Misri or Dr Deirdre Ryan, psychiatrists, or Doris Bodnar, outreach coordinator, with the BC Reproductive Mental Health Program at 604 875-2025 or
—Doris Bodnar, MSN
Physicians are often the first to notice, or to be called upon to intervene with a patient who may be having problems related to abuse of alcohol or other drugs. Peer support can be a very helpful component of any treatment program for those with substance use issues. Twelve-step programs have been the only referral option for peer support in the past, but now there are others. By giving people more options they are more likely to choose one.
LifeRing is a peer support program that now has meetings all over the world. It is based on three principles: sobriety, secularity, and self-help. The sobriety principle emphasizes that LifeRing is an abstinence-based program. Those attending will be encouraged to take abstinence as their goal. LifeRing is a secular program, meaning that there is no reference to God or religion during the meetings. And LifeRing is a self-help program, meaning that people gather to learn from one another. No one has the answer and no one has all the answers.
SMART is another option for peer support. SMART stands for self management and recovery training. It is based on the principles of responsibility for one’s own thoughts, feelings, and behaviors; staying motivated to change; learning how to deal with urges and cravings; and developing a balanced lifestyle. SMART is grounded in cognitive therapy and tries to teach people how to make changes in what they are thinking, feeling, and doing. SMART now also has meetings all over the world.
Both of these programs have excellent web sites with a wealth of information for those seeking help and the locations of meetings in different areas.
Three Bridges Addictions Team
Thank you to all those who completed and returned the BCRCP questionnaire entitled Practitioner Use of Clinical Practice Guidelines. This brief questionnaire was included in the September issue along with the new Hypertension in Pregnancy BCRCP guideline. In order to improve the care of pregnant women in BC, a guideline implementation model is being developed based on your input regarding the facilitators and barriers to guideline use.
In appreciation of everyone’s time, those who returned a completed questionnaire by 15 September were entered into a draw for an Apple 2 GB iPod Nano. The winner of this draw was Anne Leblond. Congratulations Anne!
For more information on hypertension in pregnancy and the delivery of this new model, please visit www.obstgyn.ca/mfmresearch/guidelines.
—Peter von Dadelszen, Diane Sawchuck, Sarah Gilgoff
On behalf of the BCRCP Hypertension Taskforce
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.
BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:
- Only the first three authors are listed, followed by "et al."
- There is no period after the journal name.
- Page numbers are not abbreviated.
For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org