2014 A YEAR OF ACTION AHEAD

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1 QUÉBEC MEDICAL ASSOCIATION Your Association was very busy in 2013, and numerous issues are already starting to stack up for The report on optimizing clinical practice released last April, and then the Québec delegation s participation, led by the QMA, in the Preventing Overdiagnosis conference in New Hampshire in September, continue to have offshoots. A steering committee composed of seven representatives from the health care system was created in the wake of this mission to New Hampshire, and your Board of Directors just gave it the mandate to organize the first symposium on overdiagnosis to take place on April 2, A first in Québec! On January 11, our fourth-year student members who are getting ready to start residency will be able to participate in an interview simulation to prepare for the CaRMS. This is a new service offered to them by the QMA. December A YEAR OF ACTION AHEAD with the Rotman School of Management. This training, which will take place from June 16 to 20, 2014, will enable you to develop your skills as a manager and strategist. You can find out more about these topics by reading the last 2013 edition of QMA-info will definitely be as busy as This past fall, you shared your expectations with us regarding services, training and communications in a member satisfaction survey. We have listened and our teams are already at work. The year 2014 will be bustling. Some of you were also selected to respond to the satisfaction survey produced by the CMA. A collaborative, co-ordinated effort is currently getting under way between the CMA and the QMA to align our actions in order to better meet your expectations and needs. In 2014, we will continue to monitor developments in the bill related to end-of-life care and other current issues for the entire medical profession in Québec and for the benefit of the public s health. Optimizing clinical practice will be at the centre of our actions. On February 1, the 7 th edition of the Colloque médical étudiant du Québec will take place. The QMA Students Group invites all students to take part in this annual meeting with the theme of leadership and extreme medicine. This coming March, April and May, the PMI leadership program training will start up again in Montréal and Québec City. I invite you to check the training schedule and to sign up. Medical leadership is everyone s concern. You are also invited to be part of the first QMA cohort to participate in the CMA s new training program in partnership Until then, I wish you and your families all the very best for the holiday season. Take advantage of every moment with your loved ones. May 2014 bring you happiness, joy and health! Sincerely, Dr Laurent Marcoux, M.D., M.Sc. President CaRMS: QMA SUPPORT FOR MEMBERS The CaRMS interviews are fast approaching, along with the stress that goes with them! To help its student members prepare and stand out during the interviews, the QMA is offering workshops for students who are getting ready for the next phase in their training: residency. On Saturday, January 11, 2014, interview simulation workshops led by resident physicians will take place in Montréal. In groups of eight, students will take turns responding to potential questions. The groups will be divided into three specializations: family medicine, internal medicine and surgery. This exercise will give students a chance to get some expert advice from residents who also stood out during the CaRMS interviews. To complete the day, financial advisors will be on hand to advise students on the best way to manage the financial aspect of CaRMS in order to help with their transition to residency. By the end of the day, students will have the tools to perform at their full potential. To get an idea of the workshop, watch the video with the comments of three resident physicians at: Are you preparing your CaRMS interviews? Take advantage of this opportunity to practise! You can register for the workshop by completing the online form at: secure/carms/formulairev2.php.

2 par Fabienne Papin 12 L actualité médicale 6 novembre La dre LiSa SCHwartz Le dr SteVen woloshin Le dr otis BrawLey FIRST QUÉBEC SYMPOSIUM ON OVERDIAGNOSIS AND A STEERING COMMITTEE ON OPTIMIZING CLINICAL PRACTICE The Québec Medical Association is more active than ever when it comes to the matter of optimization. After releasing its report on optimizing clinical practice last April and leading a Québec delegation to the Preventing Overdiagnosis conference in New Hampshire, the QMA has reached the third milestone in its commitment to this issue by organizing the first Québec symposium on overdiagnosis and by creating a steering committee on optimizing clinical practice. Awareness and action Formed in the wake of the Québec delegation to New Hampshire, the steering committee on optimizing clinical practice has the mandate to: Propose strategies to make all partners in the health care system more aware of the importance of being concerned about optimizing clinical practice; Develop and propose an action plan for optimizing clinical practice; Provide guidance for organizing a symposium on optimization in the spring of 2014; Ensure that, individually, members act as liaisons with their respective environments to increase support for the project to optimize clinical practice. The committee is composed of representatives from the health care system: Dr. Claude Roy, chairman of the steering committee and Chairman of the Professional Affairs Committee at the QMA; Dr. Véronique Déry, Chief Scientific Advisor at INESSS; Dr. Michèle Pelletier, Director of the organization of services, medical and academic affairs at AQESSS; Jean Rousseau, Ph.D., Division head, analysis of policies for screening and addressing chronic diseases at INSPQ; Dr. Jean Tremblay, Secretary-treasurer of ACMDP; Normand Laberge, QMA Executive Director; Robert Nadon, Director of Professional Affairs at the QMA. First Québec symposium on overdiagnosis Recognizing that overdiagnosis and overtreatment are growing topics worldwide in discussions about the quality and effectiveness of heath care, and that the momentum is right to launch a serious discussion in Québec, the committee was mandated by the QMA s Board of Directors on November 29 to provide guidance for this first symposium. It will take place on Wednesday, April 2, 2014, in Montréal. This meeting, to which the faculties of medicine, federations, professional orders and associations, and health services user groups will be invited, will help make the main organizations in the health care system more aware of the phenomenon of overdiagnosis and mobilize them around concrete objectives. The steering committee and the professional affairs team at the QMA are already at work. The symposium is taking shape. The next committee meeting is planned for January We will keep you informed of the progress on this current issue! Dossier > Surdiagnostic et surtraitement aux états-unis : une épidémie à contenir Les dangers de l overdose médicale Preventing overdiagnosis, une conférence organisée par l université américaine Dartmouth affichait complet des semaines avant sa tenue à Hanover dans le New Hampshire du 10 au 12 septembre dernier. ur place, plus de 300 scientifiques, cliniciens, décideurs lées, elles ne se rendent pas compte nières ne soient vraiment réveil- et défendeurs des consommateurs venus de 30 pays ont Bref, on recommande à des per- qu elles en sont atteintes». discuté de la façon de prévenir la sonnes de prendre des médicaments pour diminuer des symp- surmédicalisation, qui englobe notamment le surdiagnostic, le surdépistage et le surtraitement. Un exemple typique de la dérive autômes dont elles ne souffrent pas! Cette «overdose médicale» se retrouve partout en Occident, de lon les Drs Lisa Schwartz et Steven quel fait face le monde médical, se- façon plus ou moins criante. Les Woloshin, professeurs de médecine organisateurs américains ont cependant reconnu qu avec leur sysvrage Overdiagnosed. à Dartmouth et co-auteurs de l outème de santé ultra-défensif et le Nous devons faire face à une véritable «campagne de peur», précise matraquage publicitaire qu ils connaissent, ils doivent faire face à le Dr Woloshin. un phénomène d une ampleur sans Selon les deux médecins, il existe commune mesure. deux types de surdiagnostic : C est que chez nos voisins du > celui qui consiste à diagnostiquer des anomalies qui ne comme il devient de plus en plus difficile de savoir sud l industrie pharmaceutique a «pignon sur télé», où elle vante dégénèreront jamais en où se situe la frontière entre quelqu un de malade et quelqu un jusqu à plus soif des pilules pour symptômes ou qui n entraîneront pas la mort; qui ne l est pas, nous devons nous attendre à ce que la soigner certains troubles comme le syndrome des jambes sans repos. À en croire les publicités et les des expériences ordinaires les gens en patients rapportera de l argent. > celui qui incite à médicaliser surmédicalisation se multiplie. du moins tant que transformer articles qui inondent les magazines américains, ce problème de la solution? faire de cette question un enjeu de société de la vie. santé «qui peut mener au suicide» Dans les deux cas, le résultat est le et inciter le milieu médical à mieux définir l ampleur du problème est «le trouble le plus commun même : les diagnostics et les traitements qui s ensuivent nuisent à et les actions à prendre pour le contrer. dont les médecins n ont jamais entendu parler». Le plus drôle ou le ceux qui les subissent. pire, selon les points de vue, est Et comme il devient de plus en que ceux qui peuvent en souffrir plus difficile de savoir où se situe la milieu médical à mieux définir reusement les gens n ont pas beaucoup de respect pour la science.» essaient de nous vendre quelque la cadence car «beaucoup de gens ne s aperçoivent pas forcément frontière entre quelqu un de malade et quelqu un qui ne l est pas, tions à prendre pour le contrer. Mais on ne peut occulter que, si la chose derrière de bons concepts». l ampleur du problème et les ac- qu ils en souffrent. On a en effet pu lire dans un magazine (The Observer) que «le syn- que la surmédicalisation se multi- CanCer et SurdiagnoStiC va s effondrer en raison des coûts de ler de cette corruption. nous devons nous attendre à ce tendance se maintient, l économie Or, selon lui, personne ne veut pardrome des jambes sans repos est plie. Du moins tant que transformer les gens en patients rapportera médical en chef de la Société amé- «Les gens pensent que consomments et trop tôt. Certaines procé- Pour le Dr Otis Brawley, directeur santé. «On consomme trop de médica- un trouble du sommeil assez sérieux, qui touche un grand nombre de l argent. ricaine du cancer, il y a souvent mer de plus en plus est bon pour dures sont aussi devenues trop fréquentes», explique le Dr Brawley de personnes. Leur sommeil est La solution? Faire de cette question un enjeu de société et inciter le sances et les croyances. «Malheu- qui le système ne peut plus soutenir (voir encadré ci-contre), pour qui une confusion entre les connais- eux», souligne le Dr Brawley, pour affecté et, à moins que ces der- on S The QMA s work has been recognized by scientific journals La médecine souffre d une nouvelle maladie : Mammographies de dépistage faites à des femmes trop jeunes, formule sanguine à chaque emp, scans systématiques en cas de maux de dos, césariennes «de confort», statines en prévention primaire, antibiotiques pour des otites bénignes... en voulant prévenir, soigner toujours plus tôt, les médecins se sont mis à diagnostiquer ou à traiter des maladies qui n en sont parfois pas, et ce, souvent au détriment des patients. Vous doutez que la surmédicalisation soit un enjeu de santé? Pourtant, le surdiagnostic est déjà une réalité aux États-unis et au Québec, comme a pu le constater L actualité médicale en accompagnant une délégation québécoise à Hanover dans le new Hampshire. The QMA s commitment and actions related to optimization are creating a buzz. Led by the QMA, the Québec delegation composed of representatives of the main health care organizations to attend the Preventing Overdiagnosis conference in New Hampshire was the topic of a story by journalist Fabienne Papin, from L Actualité médicale. Eight pages of this specialized publication were devoted to the event and to interviews with different people. Read the in-depth article in the QMA in the News section on your Association s Web site. The British Medical Journal also highlighted the QMA s work in the area of optimization. The article, titled Too Photos : fabienne PaPin Much Medicine: from evidence to action and written by Ray Moynihan, senior research fellow, Carl Heneghan, professor of evidence-based medicine and Fiona Godlee, editor in chief, mentions the first two milestones of the issue being addressed by the QMA and the work that has been started to ensure that the initiative continues. Read about it in the QMA in the News section.

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4 2014 Colloque médical étudiant du Québec LEADERSHIP AND EXTREME MEDICINE The QMA Students Group is very pleased to invite the members of the student medical community to the 7 th edition of its Colloque médical étudiant du Québec (CMEQ) that will take place on Saturday, February 1, 2014, with the theme of leadership and extreme medicine. Five speakers will share their experiences related to leadership and medical care in extreme conditions: Dr. Caroline Tanguay A forensic pathologist working on the Lac-Mégantic disaster, Dr. Tanguay will talk about the issues, difficult conditions, feeling of helplessness, and unexpected successes of such disasters. Dr. Marc Dauphin A recently retired senior medical officer of a military base, Dr. Dauphin will talk about practising medicine in combat zones. Dr. Vincent Demers A family physician, Dr. Demers will share his experience related to the issues of treating the homeless and marginal groups. Dr. Francisco Diaz-Mitoma A leader in clinical virology and human vaccines, Dr. Diaz-Mitoma will talk about entrepreneurship and scientific research management. Sylvain Martel With a Ph.D. in biomedical engineering, Mr. Martel will discuss the question of using new technology approaches in medicine, namely nanosystems and nanorobotics. CMEQ participants will also have an opportunity to network with the students from the four faculties of medicine in Québec at a cocktail afterwards! Information: Place: Pavillon Roger-Gaudry at Université de Montréal, 2900 Édouard-Montpetit, Montréal Time: 8 a.m. to 4 p.m. Admission: - Member: $25 - Non-member: $45 (includes the QMA membership fee and related privileges for the current year) Breakfast, lunch and snacks will be served Charter bus service provided by the QMA at no extra cost for students in Sherbrooke and Québec City Presentations given in French (except for Dr. Francisco Diaz-Mitoma) For more details about these renowned speakers, the event program and registration, visit the event Web site at www. amq.ca/cmeq. Participants can already submit their questions for the speakers on Twitter: #CMEQ and register now using the online form at inscription.php National Health Policy and Negotiations Conference PHYSICIAN LEADERSHIP IN BUILDING THE HEALTH CARE SYSTEM The 2013 National Health Policy and Negotiations Conference, organized by the Canadian Medical Association (CMA), was held in October. A QMA delegation attended this conference, providing an official link between its members and the Canadian medical profession in this strategic issue. The Québec delegates were able to talk to their provincial and territorial counterparts at workshops and conferences on the question of changes to the health care system. As part of the negotiation workshop led by Ellen Zweibel, a professor at the University of Ottawa, participants learned how to recognize and overcome obstacles, assess the results, and then how to prepare themselves based on the interests and apply the strategies of collaborative negotiation between governments and medical associations. This workshop fostered a significant exchange of information among participants. Dr. Jason Sutherland from the University of British Columbia, Dr. Scott Wooder from the Ontario Medical Association, and Dr. William Hnydyk from the Alberta Medical Association covered the shared economic models and the possibilities of implementing them in a Canadian context. Kevin Doucette from the CMA shared a contextual analysis, while Kevin Chapman from Doctors Nova Scotia presented the distribution by discipline of postdoctoral fellows in Nova Scotia. Last but not least, the CMA was proud to welcome Dr. Howard Brody, a professor at the University of Texas, who presented the American initiative Choosing Wisely. This campaign addressed the five main challenges faced by the American medical associations in 2009 related to overdiagnosis and overtreament. Dr Brody then spoke about issues still to be faced. The CMA is already actively preparing the 2014 edition of this annual meeting. The QMA will be there to represent its members in this very current issue. Congratulations to Ms. Geneviève Roy-Proulx, from Université de Sherbrooke, winner of the 2013 contest Become a member of the Québec Medical Association and get a chance to win a tablet or $500 in cash! from TD Insurance Meloche Monnex.

5 DYNAMED: FREE ACCESS TO A $395 CLINICAL TOOL Did you know that as a member of the QMA and the CMA, you have free access to DynaMed? This clinical tool that you can consult at the point of care, in the office or at a patient s bedside, is one of the most popular products offered on the CMA website ( In collaboration with McMaster University s Health Information Research Unit, DynaMed provides daily systematic surveillance of more than 500 journals and then updates over 3,200 medical topic summaries. A recent BMJ study found that DynaMed is markedly quicker than its competitors in updating its clinical information, and it also ranked highest in a Journal of Clinical Epidemiology study of clinical decision-support tools. Are you interested? DynaMed is available on the CMA website ( or as an app for the iphone or ipad, or for Android or BlackBerry devices. Watch the short DynaMed video online ( ytplayer), and then sign up. Do you need sign-up assistance or the free DynaMed app serial number? Contact the CMA s Member Service Centre (cmamsc@cma.ca or ). As a member of the QMA and the CMA, you can consult DynaMed in real time wherever you are, but in addition, you are also saving $395 in consultation fees per year. This is your tool. Make it your own! In addition to DynaMed, you have access to six other online clinical tools on the CMA site ( clinicalresources/pointofcaretools). Watch for the upcoming editions of QMA-info to learn more about them. NEW CMA TRAINING PROGRAM IN PARTNERSHIP WITH THE ROTMAN SCHOOL OF MANAGEMENT Do you want to develop your skills as a manager and strategist? The Québec Medical Association is offering three members an opportunity to take the program Integrative Thinking for Collaborative Decision-Making: A New Approach to Transforming Canada s Health Care System presented by the Canadian Medical Association and Rotman School of Management at the University of Toronto. To be held from June 16 to 20, 2014, in Vancouver, this training will allow you to develop the following themes: the Canadian health care system, health economics and social responsibility, innovation, creativity and design, ethical decision-making and the ability to influence change in the health care system. Because the training will be given entirely in English, participants must be fluently bilingual or English-speaking. The QMA and CMA will each contribute $2,500 per registration, thus reducing the registration fees to $2,000 for participants, who must also pay for their travel and accommodations. LES FORMATIONS PMI : COMMENT DEVENIR UN LEADER Are you interested in this training? To submit your application, you must meet the following criteria: Have five or more years of experience as a leader in the health care field Have demonstrated the desire to continue your professional development Be involved in transforming the health care system Bring about or carry out significant changes in the health care system Send your résumé and the registration form available in the Services and Resources/Physicians section on your Association s Web site at Mélissa Bourgoin, Professional Services Coordinator: melissa.bourgoin@amq.ca, by 5 p.m. on January 23, You can also contact Ms. Bourgoin for more detailed information. Please remember that the QMA s offices are closed from December 23 to January 5. En partenariat avec NÉGOCIATION ET GESTION DES CONFLITS Où : Hôtel Le Westin Montréal, Montréal Quand : du 12 au 14 mars 2014 Où : Manoir Victoria, Québec Quand : du 13 au 15 mai 2014 MOBILISER LES AUTRES Où : Hôtel Le Place D Armes, Montréal Quand : du 28 au 30 avril 2014 CONNAISSANCE DE SOI ET LEADERSHIP EFFICACE Où : Hôtel Le Place D Armes, Montréal Quand : du 2 au 4 avril 2014 For continuing education in English, visit the Canadian Medical Association s Web site at:

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