Access your online QMA member account any time

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Access your online QMA member account any time

From now on, all members of the Québec Medical Association can connect to the member section to manage their account. This service is accessible any time and allows members to edit their contact information in real time. For instance, a change to an e-mail address will be immediately taken into account by Membership Services. Furthermore, when memberships are renewed online, a receipt can be downloaded as soon as payment has been received.


How does it work?

To connect to the member section, you need a Collège des médecins du Québec permit number and password.

For students, the QMA gives you a temporary permit number when you join.


You don’t have a password yet?

Click the button below, then LOG IN (upper right corner of the screen), and click “First Connection” to get your password.

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If you have any questions, you can contact Membership Services.

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Health and Welfare Commissioner: a much-awaited reinstatement

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Health and Welfare Commissioner: a much-awaited reinstatement

Finance Minister Carlos Leitão removed the section on abolishing the Health and Welfare Commissioner (CSBE), as well as the one on the new responsibilities of INESSS which had been called on to take on some of the commissioner’s functions, on May 16, 2018, in the framework of the detailed study of Bill 150.

This bill concerning implementation of the Couillard government’s 2016 and 2017 budgets was slow to be discussed and the finance minister chose to remove about 100 sections, including those involving the abolition of the CSBE, to allow it to be adopted before the end of the parliamentary session.

Later in the evening, the Minister of Health and Social Services, Gaétan Barrette, confirmed on Twitter that the government’s current budget situation made it possible to reinstate the Commissioner.




The QMA issued a press release (in French only) that two years had been lost during which no objective performance assessment of the health care system had been possible. The QMA is also asking that the next Commissioner report to the National Assembly of Québec, and not the ministry, so that it is no longer dependent on a political and budget decision, as has been the case over the past two years.

“The announcement of Bill 20 and Bill 130 had repercussions, as did the suspension of a number of their sections and the latest agreements with the medical federations. But these repercussions could not be analysed with the required objectivity that a neutral agency would have been able to provide,” lamented QMA president Dr. Hugo Viens.

The return of the Commissioner, often described as the watchdog of the health and social services system, is excellent news for a multitude of organizations that had severely criticized its disappearance. As the QMA has always pointed out, Québec society needs a credible, independent accountability and responsibility mechanism for health care.

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Choosing Wisely Canada National Meeting

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Choosing Wisely Canada National Meeting

The QMA was in Toronto on April 23 to attend the Choosing Wisely Canada National Meeting. It was an inspiring event that showed that this national and local campaign is a success. Besides recommendations made by the different Canadian learned societies participating, the teams that implement projects in the different provinces also bring about improvements in patient care and health care systems. For those who could not attend, the key messages are below.


1)     The fear of being sued for not doing a test is a myth

When physicians in Canada, but also elsewhere in the world, are asked why they do or order so many tests, most often their first response is “out of fear of being sued.”

“Never has a physician been sued for not having done a test. However, many physicians have been sued for doing tests and not following up on them,” pointed out Dr. Hartley Stern, Executive Director/CEO of the Canadian Medical Protective Association in his closing presentation at the meeting. In short, following the recommendations of Choosing Wisely Canada does not create any problems in terms of professional liability.

It is a stubborn, undocumented myth from the legal aspect that persists within the medical profession without reason. Already in August 2017, as part of the international Preventing Overdiagnosis conference in Québec City, the QMA had organized a workshop on this topic to reassure participants. One year later, the Executive Director/CEO of the CMPA confirmed that “there is no risk in following the recommendations of Choosing Wisely Canada. If there is a risk, it is more likely in doing tests that we know are unnecessary and to forget to do the follow up.”


2)     Lack of Québec government support for the Choosing Wisely Canada campaign


At the meeting, many observers noted the Québec government’s inactivity and lack of support for the Choosing Wisely Canada campaign. At the opening of the meeting, it was stated that the federal government and all the provincial governments were partners in Choosing Wisely Canada, except for Québec where it is the medical association, the QMA, that is the communication channel between the French-language recommendations and the local partner. In truth, the QMA took on these roles because the Québec government failed to commit! The QMA is now responsible for the French-language component of the campaign and is the coordinator of Choosing Wisely Québec.


3)     The quality of care includes appropriateness

A quality health care system must be safe, efficient, effective and fair, in addition to providing care within reasonable timeframes and that is patient-centric. The Choosing Wisely Canada campaign deals with all these elements of quality control.

  • Safe: unnecessary tests or procedures cause damage
  • Efficient and effective: waste reduces the system’s performance
  • Fair and within timeframes: while some people undergo unnecessary tests, others wait
  • Patient-centric: unnecessary tests or procedures are contrary to the well-being of patients


4)     Using administrative data to define intervention targets

Dr. Joshua Tepper, President and Chief Executive Officer of Health Quality Ontario, made a strong impression with the audience. He explained that in his province, researchers used administrative data from the health care system to know which procedures to target. They compare the Choosing Wisely Canada recommendations with the percentage of overdiagnosis or overtreatment and the resulting costs. This gives them the scope of a problem and its cost. They can then guide decision-making to know when to intervene or not.



5)     Reducing unnecessary tests and treatments in health care

In 2014 when it was launched, the purpose of the Choosing Wisely Canada campaign was to help clinicians and patients engage in conversations about unnecessary tests and treatments, and make smart and effective care choices.

At the 2018 meeting, participants decided to put more emphasis on the actions aimed at reducing unnecessary tests and treatments in health care.  

Naturally, Choosing Wisely Canada will continue to equip clinicians and patients to help them have discussions about unnecessary care, but also plans to put more emphasis on supporting initiatives to implement measures aimed at reducing inappropriate care. This decision led to the creation of an “implementation research network”.


6)     The third era of medicine

A very interesting presentation by Dr. Dee Mangin, Professor and David Braley Nancy Gordon Chair in Family Medicine at McMaster University, helped to assess the current and past influences that shape the changing framework of medicine and to understand how Choosing Wisely Canada can be considered part of the current era of medicine.

According to her analysis, the first era of medicine was characterized primarily by the autonomy of medicine, a binary relationship between the physician and the patient, and the introduction of a social contract between the population and the medical community.

A second era followed based on accountability and market theory that focused on volume, the standardization of care and the introduction of care pathways or intervention protocols.

We are now entering an era of quality. People no longer die from general infections such as the Spanish flu, but rather from cancers and cardiovascular diseases. This results in drugs for many older people, to the point that today, the main cause of death among elderly patients is medication. So it is necessary to adjust medical practice to adapt to this new era.

Physicians must focus on professionalism and trust. Hence the importance of encouraging the Choosing Wisely Canada community to continue to improve patient care and the health care system.

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Studying physician empathy

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Whenever it meets with physicians in their environment, the QMA has observed that many of its members are committed to improving care and services on a daily basis. Great initiatives are taking shape everywhere. Some of them should even be implemented or adapted elsewhere, but for this to happen, we need to know that they exist! 

If you have set up a project that deserves more visibility or if you know of members colleagues who have done so, feel free to contact QMA. We would be pleased to showcase your achievements.

Studying physician empathy

Membre Barbeau MeunierDrawn by the importance of social determinants for improving the health of populations, Charles-Antoine Barbeau-Meunier decided that he wanted to be in on the action and not just the reflective process. So he swapped communications and sociology for medicine. “I felt that I could make a bigger difference,” he explained. He is a student at the Sherbrooke Faculty of Medicine and Health Sciences who, after completing a master’s degree in sociology, is currently doing a double doctoral program in medicine and biomedical imaging.

Currently, Mr. Barbeau-Meunier is alternating his research on multiple sclerosis with his medical education. A separate curriculum that has given him a little more time than his medical studies and has enabled him to return to his first passion, or the focus of his master’s thesis on empathy. His hypothesis was that empathy could be a foundation of social action and therefore make it possible to mitigate certain crises such as climate change.

His more flexible schedule as a researcher has also allowed him to submit a paper on the erosion of empathy among the next generation of medical professionals at the Association francophone pour le savoir (ACFAS) convention on May 8, 2018. Having done a systematic review of the literature, he found that it is not so much the medical curriculum that leads to an erosion of empathy among medical students but certain disruptive elements, namely the predominance of a performance-focused context and a culture of self-neglect during one’s medical studies.

In reaching this conclusion, Mr. Barbeau-Meunier based his findings on the definition of empathy as stated by neuroscientist Jean Decety, for whom empathy has a cognitive dimension, as well as emotional and behavioural dimensions. “The medical curriculum is actually a very good context for developing empathy, whether it is the feeling in itself or the ability to use it. However, it is also an environment that inhibits this behaviour,” Mr. Barbeau-Meunier pointed out.

Research in this field is still lacking, but several studies presented at the ACFAS are pointing in this direction. The lack of sleep, stressful and rigid working conditions, and a large volume of patients to see within tight time constraints can lead to an erosion of empathy by preventing students (or clinicians later on) from expressing their empathy.


The five pillars of empathy 

Several conditions are necessary for expressing empathy. Similar to the way he approached climate change in his master’s thesis, Mr. Barbeau-Meunier looked at how the medical context colours the ability of students to develop their empathy, as well as to use it.

To feel empathy, one must be able to connect with the other person. Through facial expressions and especially the eyes, it is possible to read the other person’s emotions and the transparency of their intentions. While this does not present a problem in health curriculums during which students have very frequent access to patients and exposure to all sorts of care contexts, we know that technology presents a variety of obstacles once they are in a hospital environment. For instance, it is difficult for patients to feel like they are being heard when physicians seems to be focusing all their attention on a computer.

It is also necessary to learn how to control one’s emotions, which is appearing more and more frequently in the literature, but is not always properly understood and expressed in the field. In the care context, suffering, vulnerability and death, among other things, can present a significant emotional burden or, at the very least, a chronic one. According to Mr. Barbeau-Meunier, this requires an effort of control, conscious or not, and the need to learn to recognize our emotions and to work with them.

But in the current medical culture, there is a taboo around the emotional dimension of care. There is a tendency to tell students to learn to ignore their emotions rather than to work with them. And that is where compassion fatigue gets the students just like practising physicians! “It’s not necessarily a bad thing to feel emotions, on the contrary, it is essential information to guide a clinician,” pointed out Mr. Barbeau-Meunier, who found that so much emphasis was put on the cognitive dimension of empathy that the emotional dimension, while very well recognized in the literature, was forgotten.

Once physicians are able to control their emotions, they can then turn their full attention to the other person. A strength of the curriculums according to Mr. Barbeau-Meunier. Students learn to develop good listening skills, to ask questions to get the information they need. However, there is a risk that students will no longer pay attention to themselves, since the target of their attention is the other person. They can then miss signals that convey needs or an appropriate response.

The social connection also plays an important role. People always have more empathy for those with whom they identify. But physicians are having more and more difficulty in identifying with their patients, because of increasingly diverse environments, but also because of the social status of physicians and the wage difference that can create discomfort with other health professionals or some patients.

Finally, it is necessary to consider the environment in which empathy is practised. While the medical environment can foster empathy, it can also sometimes promote putting other priorities first, for example by inciting a caregiver to see a patient as a bed to free up or a task to manage rather than as a suffering individual.

“My analysis allowed me to corroborate that we are developing a better capacity for empathy than before in medical studies, but that there are also essential elements that the context will drain and that will prevent empathy or make it more difficult to express,” explained Mr. Barbeau-Meunier.

So should we change the way empathy is taught? Of course, we can always reinforce the training and better equip future health professionals to be able to share their emotions with colleagues. But that will not change anything if we do nothing to evolve the system in which physicians practise. “You could have the most empathetic person, but if you don’t allow that person to express empathy, it will be useless,” concluded Mr. Barbeau-Meunier.

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Tribute to nursing

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Tribute to nursing

Four registered nurses at St. Mary’s Hospital Centre in Montreal in 1968 wanted Montréalers to have a daily remembrance of the role that nurses play in their lives and their contribution to society. We know that they are dedicated to their patients and their community, but their true worth is not always acknowledged.  

For instance, few people remember that Montréal’s first hospital, Hôtel-Dieu, was created by a nurse: Jeanne Mance! In fact, she had to wait until 2011 to be recognized as one of the founders of Montréal. However, the idea is not to honour just one woman, but the entire nursing profession. With the support of the City of Montréal and the Ordre des infirmières et infirmiers du Québec, the organizers have set up a fundraising campaign for a statue to pay tribute to nursing.


They hope that the statue will be ready for the 100th anniversary of the Ordre des infirmières et infirmiers du Québec in 2020. Out of the estimated $115,000 needed to complete this project, the campaign has raised close to $30,000 to date.

If you would like to contribute to this public art project, go to the Facebook page Tribute to Nursing Montreal/ Hommage à la Profession Infirmière Montréal.

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Migrant health? A challenging journey

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Migrant health? A challenging journey

The QMA and its Student Committee were proud partners of the 3rd edition of the Symposium sur les populations vulnérables held at the Université de Montréal on May 12, 2018. Bringing together about 100 students and professionals from many health disciplines and all the faculties in Québec, this symposium aims to raise participant awareness of the biopsychosocial issues of vulnerable Québec populations. The theme this year was migrant health, with workshops and conferences focused specifically on the health issues of their migration experience and integration into their receiving country.


Symposium populations vulnerables3Poignant testimony

Headlining the event, author Kim Thúy talked about how health and food conditions had marked her migration experience, to the point that serious allergies to eggs and fish disappeared when her body was subjected to extreme survival conditions. Through her stories, sometimes humorous and sometimes poignant, Ms. Thúy made her audience aware of the delicate role played by health professionals in contact with migrants during their migration journey. Seized with emotion, she described the moment in Malaysia during her health assessment when a female doctor quickly pulled open the elastic waist of her pants to confirm her gender before letting go.    

Symposium populations vulnerables2

“I still have a vivid memory of the elastic pinching my skin. Such a small act, really trivial, but which took away my dignity. As a physician, a health professional, your way of treating migrants is significant. It is the little things that respect or take away an individual’s dignity,” Ms. Thúy pointed out.


Going into exile is a necessity, not a choice!

Rachel Kiddell-Monroe is a member of the Board of Directors of MSF International (Doctors Without Borders). Early in her career, she gave up job opportunities as a lawyer to devote her time to advocating for the rights of migrants and trying to improve the conditions of their migration journey. Her activities have taken her to Indonesia, Djibouti, Rwanda, Republic of Congo and many countries in Latin America. Wherever she has gone, she and her colleagues have tried to create a “safe island in the midst of a sea of atrocities” for the people who had to leave behind their countries, their roots, their traditions and their language because of violent conflict. “There is a real human cost to countries’ indifference towards migrants.” Through striking images, to help participants better understand the state of health of migrants when they arrive in Québec, she showed the harsh reality of migrants in their home country and the health issues they face.  

After the conferences, six workshops were given for participants to learn more about topics such as addiction and mental health, the language barrier, the issues related to the absence of a status and medical coverage for migrants in their receiving country, and approaches to perinatal care with vulnerable mothers. In addition, the Canadian Medical Association offered the Advocacy and Leadership workshop, which allowed participants to better understand the principles of the protection of rights and how to become engaged physicians to advocate for access to health care for migrant populations. 

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Private healthcare: a threat or an ally to the public system?

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Private healthcare: a threat or an ally to the public system?

HugoCepsemAt the invitation of the Conseil des entreprises privées en santé et mieux-être (CEPSEM), QMA president Dr. Hugo Viens gave a presentation on May 17 about the issues related to the public‑private dynamic in the healthcare system.

In Dr. Viens’ opinion, the healthcare system clearly needs to be efficient, responsive and accountable, which is why we need to ask whether private healthcare is well and truly a threat, or whether it might be an ally to the public healthcare system.

“It’s time we rethink the way our healthcare system works, see it in a different light, and develop innovative solutions,” Dr. Viens pointed out.

A close look at the healthcare system reveals private services everywhere. The basket of services covered by the Québec government is centred on hospital care and medical acts performed by physicians. Yet, many health services that are essential, and even medically necessary, are not covered for a large proportion of the population (dental care, rehabilitation, social services, etc.).

The healthcare system is already rife with private services

A large portion of the healthcare system also falls under the private sector. In fact, nearly half of the government’s healthcare spending goes to private companies. With the exception of CLSCs and hospitals, medical services are provided at private offices, in family medicine groups, at super-clinics, and at polyclinics. And most of the expenses (for services, technologies, machines, transportation of materials, etc.) and equipment investments made by public institutions, such as hospitals and CLSCs, go to private companies.

Finally, since a large percentage of physicians are incorporated, their salaries are in fact paid to private entities.

Our “public” system is therefore a public payment system rather than a public resource management system. And not only does a large proportion of government spending end up in the hands of private companies, but the private sector already plays a large role in the operation of the healthcare system.

The population wants publicly funded healthcare

Moreover, when the population is asked what they want, their response is: quality healthcare, within reasonable wait times, paid for by the government. According to a CROP survey conducted as part of a 2017 study by Pôle Santé HEC Montréal, close to 70% of the population thinks it’s normal that several different types of organizations (private, non-profit or cooperative) can provide government-funded health and social services.

“Who pays the rent has no bearing on the patients. What matters is who pays for the health services,” Dr. Viens stressed. So, the taboo of private healthcare is a myth, and the QMA is unanimous in its position that medically necessary services must be covered by the healthcare system, regardless of who provides the service.

Private when it’s an added value

In this sense, there needs to be openness to going private in situations where this would add value to our health services. Dr. Viens then cited the example of the Chirurgie DIX30 clinic, where he is a partner, and of which he is the medical director. This clinic, which performs strictly day surgeries, is equipped with flexible, lightweight infrastructures that allow it to save money. As such, it is more efficient and responsive than very large infrastructures, such as hospitals.

As a private funded structure, it provides only services that are covered by the public plan, meaning patients don’t have to pay for the services they receive there. Their care is paid for by the companies who send their employees to the clinic. Other patients are transferred there by three local hospitals as part of a patient-centred activity-based funding pilot project. The government is actually in the process of establishing the cost of care episodes before implementing this type of funding in Québec hospitals. Two other clinics are also participating in this project.

Greater openness to private funded structures expected

Not only are patients satisfied with the quality of their care and the speed with which they are treated, but the professionals involved, including the physicians, are more efficient given their accountability, which is inherent to any private company. So, this is a good example of the public interests being served by the private sector.

Following Dr. Viens’ presentation, participants discussed the future of the healthcare system. Due to the system’s current performance and its instability following recent reforms, they feel that future governments are likely to resort to private funded structures as a means of supporting and improving the performance of the healthcare system.

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The effects of suspending Bill 130

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The effects of suspending Bill 130

On May 9, the Centre de recherche en gestion des services de santé CHU de Québec-Université Laval (CRGSS), in collaboration with Université Laval’s Institut d’éthique appliquée (IDÉA), organized an interesting symposium on the various facets of Bill 130 and their anticipated effects on the healthcare institutions. Legal experts, health network managers, physicians and professors came together to discuss the matter further.

Dr. Hugo Viens, QMA president, was invited to sit on a panel on professional status and the physician’s role within the healthcare institution. Dr. Viens reminded attendees of the fact that, during the parliamentary consultations on Bill 130, the QMA had insisted that most of the measures outlined in the bill were unnecessary, since the legislation in place at the time already addressed most of the issues raised by the minister. It’s mainly the application of the law that was causing problems for medical managers, hence the need to provide them with greater support.

The symposium participants fully supported this position by the QMA. The suspension of Bill 130 has made the situation in the healthcare institutions even more complicated. Note that Bill 130 was adopted on October 25, 2017, by the National Assembly, but that during the recent agreement reached with the FMSQ in February 2018, the provisions of Bill 130 dealing with physicians’ obligations were suspended. And since medical managers can also no longer apply the previous legislation, they have even fewer powers than they had before.  

Regardless of which political party emerges victorious from the fall elections, the outcome will change the political landscape in Québec, and the medical profession will be directly in the next government’s sights in terms of its plans to apply Bills 130 and 20.  

This means that the medical profession will have no choice but to demonstrate leadership and professionalism in laying the groundwork for cooperation in practice settings where adjustments will be needed.

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Upcoming courses offered by the QMA

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Upcoming courses offered by the QMA


logo leadershipmedicalMedical leadership training – PLI

  • Négociation et gestion des conflits (negotiation and conflict management) – SAGUENAY – June 6 to 8, 2018 (in French only)

This course will enable you to develop strategies to manage conflict within an organization, avoid the difficulties that conflicts can create, and learn how effective management of conflict can enhance creativity and innovation. Through a negotiation exercise, you will develop a planned approach and practise successful techniques to achieve results in interpersonal relations.
CPD credits: 21


  • Orchestrer le changement et l'innovation (leading change and innovation) – SAGUENAY – September 19 and 20, 2018 (in French only)

How to align people and organizations to build a shared vision and commitment to act is the central theme of this course. Using change management theories, you will learn to develop strategies to motivate, implement and sustain change, while also overcoming opposition to change. Through the presentation and discussion of issues and concrete exercises, you will cover different topics that include creating a resilient work environment and dealing with the impact of change.
CPD credits: 14


  • Connaissance de soi et leadership efficace (self-awareness and effective leadership) – QUÉBEC CITY – September 26, 27 and 28, 2018 (in French only)

Knowing how to manage your communication is essential. So is self-awareness. This continuing professional development course will give you insight into the personal attributes essential for effective medical leadership. Using the concept of emotional intelligence, you will improve your ability to influence and manage your environment by applying adapted techniques and exercises. At the end of this course, you will have discovered which type of medical leadership best suits you and be able to determine its effectiveness.
CPD credits: 17,25


  • Négociation et gestion des conflits (negotiation and conflict management) – MONTRÉAL – October 17 to 19, 2018 (in French only)

This course will enable you to develop strategies to manage conflict within an organization, avoid the difficulties that conflicts can create, and learn how effective management of conflict can enhance creativity and innovation. Through a negotiation exercise, you will develop a planned approach and practise successful techniques to achieve results in interpersonal relations.
CPD credits: 21

To find out more and to register, go to or contact QMA.

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Improving physician well-being is a shared responsibilit

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Improving physician well-being is a shared responsibility

For months, I’ve been telling anyone who will listen that, as physicians, we need to band together to effect change within the healthcare system. Of course, behind this stance by the QMA lie issues of access, health funding, and population health management. But, first and foremost, it’s a question of survival!

Physicians are paying a very steep price for the chaos that’s currently plaguing the system. Beyond the shortcomings in the healthcare system and the compassion fatigue inherent to our profession, we’re facing a workload as heavy as it is misunderstood by most people. But that’s not all: We’re also dealing with an increasing number of administrative restrictions, not to mention the expectations of our families and patients, and now those of the general public, as well.

There’s no way we’ll ever be able to measure up. While most of us manage to cope with the situation one way or another, sadly, others lose their way. I just read an article about the suicide rate among doctors that said that we’re still, in this day and age, afraid to get help because of the stigma attached to mental illness.

The article also mentions a survey of more than 2,000 physician-mothers. Close to half of them believed they met the criteria for a mental illness at some point in their careers, but had never sought help. And only 6% who received a formal diagnosis reported it to their licensing boards. And when it comes to mental illness, it’s a known fact that men are even less likely to consult. As a profession, we need to change the way we approach the health and well-being of doctors.

While the community has been mainly focused up to this point on what each individual physician is capable of doing, it’s really a shared responsibility. 

Our profession is at a crossroads. The Québec Health Record is a major undertaking, and the closer we get to the provincial elections, the louder the rhetoric is apt to get. And “doctor bashing” makes us an easy target, which is why it’s so important that we stand united in finding concrete solutions and in taking care of ourselves as a community.

Just as professionalism is a shared responsibility, improving the health and well-bring of physicians is something that concerns us all. By taking a positive leadership role, we’ll be able to support our colleagues, make our practice settings into healthier workplaces, and engage in the discussions needed to overhaul the healthcare system.

On behalf of the AMQ, I’d like to urge you all to take care of yourselves.

Dr. Hugo Viens, B.Sc., M.D., FRCSC 
President, Québec Medical Association



Need help?

Call the Québec Physicians’ Health Program (QPHP) at
514-397-0888 or 1 800 387-4166



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The QMA is supporting the IFMSA General Assembly in August 2018

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The QMA is supporting the IFMSA General Assembly in August 2018

logo IFMSATwice a year, in March and in August, the International Federation of Medical Students’ Associations (IFMSA) organizes a General Assembly that is attended by over 1000 medical students and young doctors from more than 100 countries.

This summer, IFMSA-Québec, the international and community division of the Fédération médicale étudiante du Québec (FMEQ), is hosting this event.

logo IFMSA AM2018The IFMSA General Assembly will be held from August 2 to 8, 2018, in Montréal. The theme for this meeting is “Social Accountability: Health Beyond the Hospital”. Participants will be asked to think about and discuss this topic. Throughout the week, different activities including training sessions and theme-based presentations will be on the agenda. The speakers will be announced shortly.

The Québec Medical Association is one of the main event sponsors.

To learn more, go to the event Web site

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Practising wisely: Dr. Vincent Demers’ story

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Practising wisely: Dr. Vincent Demers’ story

DrVincentDemersFamily physician and vice-president of the QMA, Dr. Vincent Demers provides care at home for geriatric patients who are losing their autonomy, in addition to treating vulnerable patients at the GMF ProActive Santé Neufchâtel and working with the SPOT community and teaching clinic. On May 2, 2018, he participated in the Practising Wisely: Reducing Unnecessary Testing and Treatment program. This training is a collaboration between the Québec Medical Association (QMA) and the Québec College of Family Physicians (CQMF). The six-hour course uses concrete examples (PPIs, screening, lower back pain, etc.) to discuss overprescription, overdiagnosis, overtreatment and excessive medical imaging. Dr. Demers agreed to talk to QMA Info about his participation in this program.

QMA INFO: Why did you decide to register for this course?

Dr. Demers: Medicine is evolving rapidly. I started my practice in 2004, and many guidelines have changed since then. They often contradict each other, leading us to change the recommendations we give our patients and creating confusion for them. I decided to register for this course mainly to acquire the tools to better address the needs of my patients who ask for screening tests and annual exams that they are used to getting, but which are no longer recommended. 


QMA INFO: How did you learn about overdiagnosis and overtreatment? And how did they impact your practice?

Dr. Demers: I often thought that I prescribed some tests to avoid missing a serious but unlikely diagnosis, or because it was expected from me by patients or colleagues to be a good physician. With experience, I realized that many tests or procedures could cause more damage than good to patients and increase their anxiety, without even getting into how the cost and use of resources affected our suffering health care system. The discussions and questions over the last few years about the appropriateness of certain screening, such as for prostate cancer with the PSA test, opened my eyes to this problem. There is still a culture in medicine to look for anomalies among asymptomatic patients and to attempt to treat them before symptoms appear, but without ensuring that this will have a real positive impact on mortality or morbidity.


QMA INFO: What are the obstacles for a practice that is concerned by overdiagnosis and overtreatment?

Dr. Demers: On the one hand, it is sometimes necessary to go against some practice guidelines developed in the US or expert recommendations that can be biased and funded by the pharmaceutical industry. We also have to be aware when we attend expert conferences. On the other hand, we have to break free from the culture of tests and exams that we have established among physicians and patients, and always ask ourselves about the appropriateness of each of our investigations and procedures. This requires time and energy, which is not easy in our practice conditions where we always seem to be rushing, but it is essential. I have noticed, for instance, that before recommending our patients to a specialist, more and more often there is a blind requirement for preliminary tests, even if we feel they are not appropriate. We need to get back to basics by involving and enlightening our patients on each of our decisions that concerns them, because often they don’t ask for that much and it’s more to reassure ourselves, as physicians, that we overdiagnose and overtreat our patients.


QMA INFO: Did you discover tools or ways of doing things that will help you in your practice?

Dr. Demers: The Choosing Wisely Canada initiative, the Canadian Task Force on Preventive Health Care, some Web sites such as TheNNT, and a number of tools from INESSS help me to think about my practice better. There is also information for patients, which helps guide our discussions better and debunk the myths.


QMA INFO: How do you broach the issue of overdiagnosis and overtreatment with your patients? Has that evolved in the last few years?

Dr. Demers: I explain to them that medical recommendations evolve, which is a sign of a critical and scientific approach. I take the time to explain the risks and benefits of the proposed tests. I sometimes use existing tables that show how many people out of 1000 will benefit from a test or procedure, and on the contrary, how many will suffer adverse effects. Among patients who have been using drugs for a long time, I periodically review with them the need to continue medication and I try to deprescribe the ones that no longer have a clear benefit. I have been much more aware of these issues in the last two years than before, I think the wind is changing in the medical culture.


QMA INFO: What do you plan to change in your practice after taking this course?

Dr. Demers: I have already started, I am trying to get back to basics, at the clinic, with the questionnaire and the physical exam, to consider the implications of each of my interventions and to get patients more involved in the decisions. The main obstacle is still the amount of time that that requires.


QMA INFO: Would you like to add anything else?

Dr. Demers: The course was excellent!

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