A VERY BUSY SUMMER! Enjoy the fall! MEMBER SATISFACTION SURVEY. Member services Training Communication THE QMA WANTS TO HEAR FROM YOU.

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1 QUÉBEC MEDICAL ASSOCIATION October 2013 A VERY BUSY SUMMER! Fall is back, and I hope that you all had a chance to enjoy the holidays and recharge your batteries. At the Québec Medical Association, the summer was very busy! In May, your association conducted a survey of Québec physicians to learn their opinion on appropriate endof-life care. Then on September 17, in the wake of Bill 52 An Act respecting end-of-life care, the QMA submitted a brief at the Québec National Assembly s parliamentary commission. In June, a delegation of members from the Canadian Medical Association and the QMA visited the Cree community in James Bay and the Inuit community in Northern Québec to learn more about the challenges faced by aboriginal and northern communities. In August, our delegates attended the CMA General Council, and debated their motions related to end-of-life care and violence in hockey, among other things. Both topics elicited considerable passion among delegates. An gave you an overview of this work. In September, at the QMA s initiative, a Québec delegation comprised of the main medical stakeholders in Québec and led by the QMA went on a mission to New Hampshire to attend the Preventing Overdiagnosis conference. With respect to the PMI leadership program, two new courses were created to meet your needs. A survey to assess your satisfaction with the services offered by the QMA is being prepared. And Membership Services has just completed the tour of the medical faculties, during which 600 new first-year medical students joined the QMA. A warm welcome to future colleagues! Your association is more active than ever. I invite you to read this edition of QMA Info to learn a bit more about our efforts. Enjoy the fall! Dr. Laurent Marcoux, M.D., M. Sc. MEMBER SATISFACTION SURVEY Member services Training Communication THE QMA WANTS TO HEAR FROM YOU. Share your comments and needs with us! Watch for the survey in your or postal mail starting the week of November 3.

2 QMA SURVEY AMONG PHYSICIANS 66% of Québec Physicians Recognize Medical Aid in Dying as Appropriate End-of-Life Care Last May, the QMA conducted a survey of Québec physicians to learn their opinion on the topic of appropriate endof-life care. The QMA has been following this issue closely for several years, prompting it to become involved in the Collège des médecins du Québec consultation on the matter in 2009, and to table a brief before the Select Committee on Dying with Dignity in This recent survey of Québec physicians fuelled the discussion of the QMA s professional affairs team for preparing the brief that the Association submitted on September 17, 2013, as part of the Québec National Assembly s parliamentary commission on Bill 52. Here are some of the highlights of the survey findings: The majority of physicians (66%) agree with recognizing medical aid in dying as appropriate end-of-life care. Of the ones who are likely to be asked by a patient, 41% would agree to provide medical aid in dying if their patient met the eligibility criteria. Almost all of the physicians (94%) who responded agree with amending the Act respecting health services and social services to recognize the right to receive palliative care. The great majority of them (73%) agree with legislative amendments that would make the anticipated medical directives restrictive. Figure 1: Level of agreement with the recommendations of the Select Committee Respondent base: n=1,201 Question: Do you agree or disagree with the following recommendations from the Select Committee on Dying with Dignity Report? Figure 2: Level of agreement with the recognition of medical aid in dying, according to the type of practice Respondent base: n=1,201 Question: Do you agree or disagree with the following recommendations from the Select Committee on Dying with Dignity Report: Recognizing medical aid in dying as appropriate end-of-life care?

3 Figure 3: Possibility of a request for medical aid in dying Respondent base: n=1,201 Question: Given your type of practice, do you think that a patient could file a request for medical aid in dying? Figure 4: Acceptance of a request for medical aid in dying Respondent base: Those who are likely to receive a request for medical aid in dying (n=844) Question: In the event that a patient who requests medical aid in dying meets eligibility criteria, would you accept to grant the patient s request? INSURANCE COVERAGE TAILORED TO YOUR MEDICAL CLINIC Have you reviewed the commercial insurance coverage for your medical clinic recently? Are you sure that your clinic is properly covered in the event of a claim? DPA Assurances Division Groupe offers a commercial insurance product designed especially for medical clinics at very competitive rates. How can you benefit from this offer? Contact DPA now at or visit the Web site at com/en/qma.html. Provide your insurance coverage renewal date and DPA will follow up within 30 days before this expiry date. The experts at DPA can help you assess your insurance needs, explain the coverage and provide advice.

4 THE QMA AT THE PARLIAMENTARY COMMISSION ON BILL 52 On September 17, 2013, Dr. Laurent Marcoux, President of the QMA, Dr. Claude Roy, Chairman of the Professional Affairs Committee, and Normand Laberge, Executive Director, presented the Committee on Health and Social Services with a brief on Bill 52 respecting end-of-life care from the Québec Medical Association. The main organizations in the health care system each had an opportunity to contribute during the three weeks of special consultations and public hearings. Social acceptance of the concept of medical aid in dying is growing in Québec. The public debate in the last four years has helped define the concepts and take into consideration all of the issues and stakeholders. In addition, 66% of Québec physicians recognized medical aid in dying as appropriate end-of-life care when polled in a survey last May. The QMA proposed amendments intended to clarify certain points so that the legislative framework respects the right of access to these services for the public, and the right to conscientious objection for physicians. Essentially, the recommendations covered the development and accessibility of palliative care, the preparation of clinical protocols and the legal protection of physicians, and the tightening of criteria allowing access to medical aid in dying in order to avoid any deviations. We invite you to read the QMA s Brief on Bill 52 (in French only), available on the Association s Web site in the section Find a document/briefs. THE QMA AND CMA MEET WITH CREE AND INUIT COMMUNITIES IN QUÉBEC Last June, a delegation of QMA and CMA members travelled to meet with the Cree of James Bay and the Inuit of Northern Québec to get a better portrait of the challenges faced by health care and social service providers in these regions. During the visits to Chisasibi and Puvirnituk, the delegates were able to talk to numerous stakeholders regarding the interactions between social problems and health problems, including the shortage of housing, domestic and sexual violence, substance addiction, mental health and isolation. In addition, as noted by Lisa Petagumskum, Assistant Executive Director of the Cree Board of Health, Our communities used to deal with their problems through traditional ceremonies, not through social services. Dr. Marcoux added, We are integrating traditional ways of life with new or western ways. If we go too fast, we will erase what was here before. This Nation must conserve its identity in order to determine its future. To find out more about this visit, read Patrick McDonagh s article on the Web site, in the QMA in the News section. Dr. Laurent Marcoux, QMA President and Director of Medical Affairs and Services at the Cree Board of Health and Social Services of James Bay, arranged the visit of a delegation comprised of Dr. Anna Reid, Canadian Medical Association President at the time, Carole Deburggraeve, CMA Associate Director of Member Engagement, Normand Laberge, QMA Executive Director, and himself. This effort was part of the CMA s wide-ranging consultations across Canada on social determinants that took place last spring. In July, a report titled What makes us sick? was released by the CMA.

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6 OPTIMISATION DE LA PRATIQUE CLINIQUE MIEUX CHOISIR 8 avril 2013 En éliminant le surdiagnostic et le surtraitement à tous les niveaux dans le système de la santé c est environ cinq milliards de dollars qui pourraient être économisés par le gouvernement québécois. You can read this report (in French only) on the Web site, in the Find a document / Briefs section. MISSION TO NEW HAMPSHIRE Update on Optimizing Clinical Practice The Québec Medical Association is continuing its consultations and efforts to make the issue of overdiagnosis a priority for the medical community and government authorities over the next few years. On April 8, 2013, the QMA already addressed the urgent need to optimize clinical practice in order to redirect approximately $5 billion to those activities that are most useful and relevant to patients. This public position statement did not go unnoticed. Dr. Réjean Hébert, Minister of Health and Social Services, welcomed the QMA s effort in support of rationalizing the use of diagnostic tests. The QMA embarked on a new phase in its endeavours to enhance awareness of the problems related to optimizing clinical practice by organizing a Québec delegation of representatives of the main health care organizations to attend the Preventing Overdiagnosis conference in New Hampshire. This international conference took place from September 10 to 12, 2013, and was organized by an alliance of the world s most respected medical journals, the British Medical Journal and a trusted US consumer advocate organization, Consumer Reports, The Dartmouth Institute for Health Policy & Clinical Practice and Australia s Bond University. The delegation, made up of about 15 physicians, physician-managers and research and assessment professionals from the organizations below, had an opportunity to join the QMA and discuss the topic of best practices with their counterparts from Australia, England and the US: - Association québécoise d établissements de santé et de services sociaux - Association des conseils des médecins, dentistes et pharmaciens du Québec - Institut national d excellence en santé et en services sociaux - Institut national de santé publique du Québec - Ordre des pharmaciens du Québec - Ordre des infirmières et infirmiers du Québec - Fédération des médecins omnipraticiens du Québec - Fédération des médecins spécialistes du Québec Optimisation de la pratique clinique le constat est FAit. MAintenAnt, Agissons! Le 8 avril dernier, l Association médicale du Québec a tiré la sonnette d alarme en se prononçant sur l urgence d optimiser la pratique clinique. En rendant public un document de réflexion intitulé Optimisation de la pratique clinique : Mieux choisir, l AMQ a déclaré que l utilisation inappropriée des ressources mine notre réseau de la santé et que l heure est venue de s y attaquer. Le surdiagnostic, le surtraitement, les lacunes dans la coordination des soins, les infections nosocomiales, les erreurs de médication, les incidents évitables et les réadmissions à tous les niveaux dans le réseau représentent environ cinq milliards de dollars qui pourraient être investis dans des activités plus utiles et pertinentes pour les patients. Cette prise de position publique n est pas passée sous silence. Dr Réjean Hébert, ministre de la Santé et des Services sociaux, a salué l effort de l AMQ visant à plaider en faveur d une rationalisation de l utilisation des tests diagnostiques. Dans le contexte où notre système de santé déjà essoufflé subira encore plus de pression au cours des prochaines années avec la diminution de la part fédérale des dépenses provinciales au chapitre des soins de santé et la pression croissante des maladies chroniques, il est prioritaire que les médecins se réapproprient leur place dans le débat social et qu ils reprennent le contrôle et le leadership de leur profession. Agissons! Convaincue de l importance d agir dans les plus brefs délais, l AMQ poursuivra sa sensibilisation aux problèmes reliés à l optimisation de la pratique clinique en participant, du 10 au 12 septembre, à la conférence Preventing Overdiagnosis, au New Hampshire. Au moment d écrire ces lignes, l Association québécoise d établissements de santé et de services sociaux et l Institut national de santé publique du Québec avaient confirmé leur participation à la mission avec les représentants de l Association médicale du Québec. Cette conférence est organisée par le Dartmouth Institute for Health Policy & Clinical Practice, en partenariat avec le journal BMJ, Consumer Reports et Bond University. Les membres de la délégation choisiront parmi les 90 présentations et les nombreux ateliers les sujets qui permettront de mettre en branle des pistes de solution et des stratégies d intervention correspondant à la réalité du système de santé québécois. Pour la suite des choses L optimisation de la pratique clinique est un enjeu de société au Québec mais aussi une tendance occidentale. Il n y a pas qu ici qu il faut revoir nos façons de faire. Prenons l exemple du programme Choosing Wisely, une initiative de la ABIM Foundation (American Board of Internal Medicine) aux États-Unis. Ce programme vise à éliminer les tests, les examens ou les interventions jugés non pertinents ou inutiles et privilégie une approche incitative, basée sur la communication entre le médecin et son patient. Un modèle intéressant en voie d être mis en place au Canada par un comité stratégique. C est la volonté d agir des médecins et de tous les professionnels concernés gravitant dans le domaine de la santé qui fera foi du succès de l opération. Tous doivent accepter de revoir les façons de faire, même celles les mieux ancrées, afin d éliminer les dépenses inutiles et de réinvestir les sommes dégagées dans des activités cliniques plus appropriées, plus pertinentes et efficaces. Il est de notre devoir professionnel de tous nous engager dans ce débat de société. À titre de président de l Association médicale du Québec, je vous invite à faire partie de la solution en reprenant en main notre système de soins. Le président, Laurent Marcoux, M.D. M. Sc. Programme de leadership Pmi Par des médecins, pour des médecins. Leadership inspiré. Résultats tangibles. ConnaissanCe de soi et leadership efficace Québec 16 au 18 septembre 2013 Mobiliser les autres Québec 19 au 21 septembre 2013 négociation et gestion des Conflits Montréal 8 au 10 octobre 2013 orchestrer le ChangeMent et l innovation Québec 23 et 24 octobre 2013 Montréal 6 et 7 novembre 2013 dépense et bon sens : les finances et l économie Pour les leaders en santé Québec 5 au 7 novembre 2013 Montréal 27 au 29 novembre 2013 laissez-vous inspirer au ou contactez-nous pour en apprendre davantage. Courriel : info@amq.ca Article published in L Actualité médicale. Available (in French only) in the Find a Document / Publications section of the Web site. More than 320 scientists, physicians, policy-makers and consumer advocates from almost 30 countries across six continents attended this conference on preventing overdiagnosis and other related problems of overmedicalization, overdetection, diagnosis creep and overtreatment. The four main vehicles of diagnostic and therapeutic inflation were also identified: professional caregivers, patients and the pressure groups that bring them together, systemic components and the professional culture. Physicians are not the only ones responsible for this state of affairs. But their leadership is part of the solution. The QMA is continuing its work. Stay tuned for more on this issue. The Québec delegation, led by the QMA, leaving for the Preventing Overdiagnosis conference.

7 PMI: LEADERSHIP DEVELOPMENT FOR PHYSICIANS By physicians, for physicians. In partnership with TWO NEW COURSES ADD SOLID VALUE TO THE PMI LEADERSHIP PROGRAM The PMI leadership program team has just added two new courses to its training schedule. Two courses in French will be available to help you fill your management needs. Offered as a 2.5-day course, Dépenses, sens et bon sens : le système de santé son financement, ses contraintes, ses possibilités (dollars, sense and common sense: the health care system funding, constraints and possibilities) will help you answer the question: How much is enough health care? You will learn how to resolve daily economic dilemmas, as well as other fundamental economic issues in health. Orchestrer le changement et l innovation (leading change and innovation) invites you to learn the art and science of managing change. During this 2-day course, you will learn how to develop strategies to motivate, implement and sustain change. You will also learn how to operationalize change management theories and overcome opposition to change both internal and external. Naturally, the solid value of the other PMI leadership program courses should not be overlooked: Négociation et gestion des conflits (negotiation and conflict management), Connaissance de soi et leadership efficace (self-awareness and effective leadership) and Mobiliser les autres (engaging others). Some 85 physicians have taken these three courses and are already putting them to good use in their practice. Check the training schedule now and add them to your agenda! schedule ORCHESTRER LE CHANGEMENT ET L INNOVATION November 6 and 7, 2013 November 6 and 7, 2014 November 24 and 25, 2014 DÉPENSES, SENS ET BON SENS : LE SYSTÈME DE SANTÉ - SON FINANCEMENT, SES CONTRAINTES, SES POSSIBILITÉS December 9 to 11, 2013 January 13 to 15, 2014 September 17 to 19, 2014 October 15 to 17, 2014 NÉGOCIATION ET GESTION DES CONFLITS March 12 to 14, 2014 May 13 to 15, 2014 CONNAISSANCE DE SOI ET LEADERSHIP EFFICACE April 2 to 4, 2014 September 29 and 30, October 1, 2014 MOBILISER LES AUTRES April 28 to 30, 2014 October 29 to 31, 2014 Are you interested in these courses, but would rather take them in English? Check the PMI course schedule offered by the Canadian Medical Association.

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