Cannabis: Raise the legal age to 21

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Cannabis: Raise the legal age to 21

As promised during the election campaign, the CAQ has tabled a bill to raise the legal age for cannabis consumption. “I want to send a very clear message to young people: Using cannabis is dangerous and can cause serious problems such as schizophrenia,” stated Premier François Legault. If he could have done so, the Junior Minister of Health and Social Services, Lionel Carmant, would have increased the minimum age from 18 to 25. By setting it at 21, he says he made a “compromise between science and social acceptability.” 

Bill 2 has received the support of the Fédération des médecins spécialistes du Québec (FMSQ), the Association des médecins psychiatres du Québec (AMPQ), and the Association des médecins d’urgence du Québec (AMUQ). Conversely, while the Association pour la santé publique du Québec (ASPQ) and the Association des spécialistes en médecine préventive du Québec do not consider cannabis to be harmless, they stressed that “raising the legal age for purchasing and possessing cannabis runs counter to the conclusions of the consultations held throughout Québec, and to those of the Forum of Experts, who were 60-67% in favour of a legal age in line with that for alcohol and tobacco.”

Public health studies “clearly” show that it’s best to delay the first use of cannabis for as long as possible; of course, this means guarding against the risk of trivialization, but prevention science also shows that there are better strategies than repression to delay the onset of cannabis use. 

The AMPQ acknowledges that there are two schools of thought, each with its own opinion on the subject. The association recognizes that young people who already use cannabis will continue to do so regardless of the legal age. “However, other people believe this barrier will delay the onset of cannabis use and that it will protect young people, who psychiatrists and emergency physicians see all too often in their EDs in a state of psychosis,” stressed Dr. Karine J. Igartua, president of the AMPQ.

For its part, the FMSQ ensures that each speciality approaches the subject from a very specific angle, but 71.8% of its members disagree with a legal age of 18, while more than 80% are in favour of the age being set at 21 or 25 for health reasons.

On Twitter, several physicians got into a heated debate as to whether increasing the age to 21 has any impact on the clinical and social effects of cannabis consumption.

 

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2018 Symposium for Physician Executives

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2018 Symposium for Physician Executives

Action Gestionnaires2018 4The QMA’s 4th Symposium for Physician Executives took place on November 30 in Montréal; the highly popular event drew more than a hundred participants. In his opening speech, QMA president Dr. Hugo Viens gave a post-election briefing on the province’s medical-political issues.

This was followed by an engaging presentation by Pierre Lainey, full-time lecturer in the Management Department at HEC Montréal, who stressed the importance of physician executives developing their political sense. According to him, it’s possible to have a lot of power, but zero influence! However, to be an effective leader, you need to be able to decode your environment, rely on your allies, and turn your enemies into friends. Far from being manipulative, someone with political sense takes a strategic approach to building their influence.

Pierre Lainey sees influence as “the ability to get other people to do what you want them to do,” which implies being or becoming—in the eyes of your allies and opponents—someone who not only talks the talks, but also walks the walk. Hence the importance of developing alliances, which allow you to influence your opponents through your allies when you can’t do it directly. According to Mr. Lainey, this strategy needs to be carried out openly, because “when the other person knows what you want, it’s not manipulation, it’s influence.”

Dr. Daniel Roux, head of the family medicine group at Clinique Nouvelle-Beauce and member of the Executive Committee of the QMA’s Physician Executives Group.

For his part, Jean Poitras, psychologist and professor in the Human Resources Management Department at HEC Montréal, talked about how to deal with so-called “toxic” individuals. Bad news: You can’t change them. “Beaver will always remain a beaver,” the psychologist explained. Worse still, there’s no point in waiting for these people to quit or to realize that they’re poisoning the water. These types thrive in environments that are just like them: toxic! What’s more, organizations rarely get rid of them, either because they don’t see them as toxic (toxic people can also be charming, intelligent and productive, and aren’t often called out for their bad behaviour for fear of reprisals) or because they think these people are indispensable.

Since it’s impossible to manage a toxic person, the only solution left is to manage their environment, either by decontaminating it, if it’s been polluted, or by preserving it, if it’s still healthy. “The situation won’t be perfect, or even like it was before, but the workplace will go back to being functional,” Mr. Poitras explained. He recommends a three-pronged approach to containing a toxic individual.

They need to be presented with a strong, unified organization that has made a pact to support and assist its members. A good starting point may be to establish a professional code of conduct and/or to draft policies on permissible behaviours.

Since toxic people also generally have followers, who are themselves outcasts from the group or who feel they have something to gain by standing with the toxic person, you need to start by enlisting these colleagues. Once they’ve realigned with the group, they will become allies in containing the toxic individual. Lastly, you need to keep involving the group in the decision-making process in order to defuse new attempts by the toxic individual to cause trouble.

 

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Choosing Wisely Canada National Meeting in Montréal: Registration is now open!

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Choosing Wisely Canada National Meeting in Montréal: Registration is now open!

Interested in the topic of over-diagnosis? Want to find out how this approach to medicine could affect your practice? Want to be able to discuss it with your patients? It’s time to register for the 4th Choosing Wisely Canada National Meeting, which will take place on Monday, May 27 at Centre Mont-Royal, in Montréal. In partnership with the Canadian Medical Association and co‑hosted by the Québec Medical Association, the event will be held under the theme Taking Action.

The group facilitators are looking forward to interacting with you during the following workshops:

  • Hospital Implementation (quality improvement): Sébastien Landry, Director of Medical Services, Hôpital Montfort, and Dr. Jeremy Friedman, Pediatrician, SickKids Hospital
  • Audit and Feedback (measurement and evaluation): Dr. Kelly Burak, Gastroenterologist, and Dr. Shawn Dowling, Emergency Physician, both from University of Calgary
  • De-implementation (deprescribing): Jeremy Grimshaw, Implementation Scientist, Ottawa Hospital Research Institute
  • Teaching and Learning Choosing Wisely at the Undergraduate Level (medical education): Dr. Kimberly Wintemute, Family Physician, North York General Family Health Team
  • Patient and Public Engagement (patient engagement): Dr. Karen Born, Knowledge Translation Team, and Amy Ma, Patient Advison, both from Choosing Wisely Canada

Note that the event will be accredited (CPD) and that simultaneous interpretation will be available.

Register now to reserve your place. All past editions of the annual Choosing Wisely Canada National Meeting have sold out!

  • Registration before April 1: $175
  • Registration after April 1: $200 (until full)

To register: https://choosingwiselycanada.org/cwc2019/

We look forward to discussing deprescribing and the appropriateness of care with you!

 

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2019 Canadian Conference on Physician Leadership: pre-conference courses

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2019 Canadian Conference on Physician Leadership: pre-conference courses

During the two days leading up to the next Canadian Conference on Physician Leadership, on April 24 and 25, 2019, physicians will have the opportunity to take part in various leadership training courses.

• Building and Leading Teams – 2 days

Physicians are forced to act as experts – not only because of their training, but also because the structure and culture of the health system force them into that expert role. As a result, physicians can struggle when asked to practice systems thinking and engage in the transformation of the health and disease care system.

• Leading with Emotional Intelligence – 2 days

Emotional intelligence (EI) is considered a critical healthcare leadership competency, where it been demonstrated to impact effectiveness in all clinical settings—from the boardroom and chairperson’s office to the ward and bedside. EI can be defined as the ability to identify, express and manage both your own emotions and others, in order to motivate, cope with stress, and help make good decisions. EI has been shown to impact the quality of care, communication, stress / burnout. This course is targeted for all physicians, regardless where they are along their career trajectory since emotional skills are always relevant. The course will utilize an indepth assessment that will highlight emotional strengths and derailers.

• Personal Leadership: Identifying your Core Values & Vision – 2 days

To lead others, you must first know yourself. Personal leadership and self-awareness is having a strong sense of self, and knowing what your strengths and weaknesses are. This core course promotes greater self-awareness as you learn to examine your values and principles, thinking patterns, assumptions and leadership vision.

• CSPL Leading Coalitions: Navigating Cultural and Professional Silos – 1 day, 25 April

The increasing complexity of the health care system requires the formation of successful coalitions between stakeholders with different values and interests. Coalitions are strategic relations between organizations, societies/associations, community agencies, and other independent bodies for the purpose of working together to achieve a common goal. This course helps stakeholders in the health care system, especially physicians, understand various types of coalitions, experience the challenges and opportunities of cultural diversity, and learn the skills and theory needed to lead coalitions toward achieving results. Using experiential and interactive exercises, virtual yet realistic coalitions will be created, as well as situations that trigger visceral reactions to the experience of cultural differences and misunderstanding within coalitions.

• SAEGIS New — Just Culture – 1 day, 25 April

Learn how to create and manage a “just culture.” A just culture establishes a consistent organizational mindset that positively impacts the work environment and work outcomes. It allows an organization, fairly and consistently, to manage mistakes and errors in a way that does not automatically punish and to analyze system design and human behaviours to understand what happened and why. This allows for true learning and system improvement. Central to its application is the Just Culture AlgorithmTM, an effective tool to provide a just and consistent analysis of human behavioural choices and how they should be managed.

The 2019 Canadian Conference on Physician Leadership will take place on April 26 and 27, 2019, at the Fairmont Queen Elizabeth Hotel, Montreal. The theme of this year’s conference is “Diversity, Inclusion & Engagement: The Leadership Challenge.”

 

For more information and to register, visit www.physicianleadershipconference.com.

 

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Two QMA members receive a Prix Profession santé

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Two QMA members receive a Prix Profession santé

QMA members Dr. Anne Fournier and Dr. Guylène Thériault have been awarded a 2018 Prix Profession santé. Dr. Fournier won in the “Pratique novatrice” (Innovative practice) category, for creating a mobile pediatric cardiology clinic, and Dr. Thériault, a QMA Board member, in the “Partage des connaissances” (Knowledge sharing) category, for her fight against overdiagnosis.

The Prix Profession santé are awarded by the magazine of the same name to physicians, nurses and pharmacists who distinguish themselves through their innovative methods, interdisciplinary partnerships, or teaching skills.

Dr. Gilles Brousseau nominated Dr. Thériault for her work on writing summaries and information sheets to aid in the joint decision-making process, and to improve patient history-taking in order to reduce overdiagnosis.

The family physician was also honoured for her remarkable presentation skills during lectures and workshops on the scientific quality of information and the relevance of medical acts. She also adapted the literature review tool EBMPICO into French, based on the PICO approach (Patient/Population/Intervention/Indicator/Compare/Control/Outcome). This tool is used to find answers to clinical questions according to an evidence-based medicine approach.

Dr. Fournier’s mobile pediatric cardiology clinic has now spread to more than a dozen institutions, from Abitibi to the Laurentians, the Outaouais, and the Mauricie region, over a territory as large as a European country. It has “saved families 400,000 kilometres of travelling,” stressed Dr. Jean‑Luc Bigras, Chief of Pediatric Cardiology at the CHU Sainte-Justine, in his nomination letter.

Along with a technician, the pediatric cardiologist from the CHU Sainte-Justine sees 30 patients a day, four days a week, in Gatineau, Trois-Rivières or Amos.

Congratulations to the winners!

 

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Introduction to medical practice management: Understanding and fulfilling your role in the organization

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Introduction to medical practice management: Understanding and fulfilling your role in the organization

The new training course entitled Introduction to medical practice management, offered by the Québec Medical Association, is intended for public healthcare institutions that want to give their physician executives the tools they need to increase their autonomy and strengthen their influence.

This comprehensive training course covers basic knowledge about the structural, financial, human and legal aspects of physician executives’ working environments. This knowledge is vitally important to physician executives being able to more effectively take on their managerial role and more easily carry out their assigned responsibilities.

The trainers—a management expert and a physician who has worked in management positions—will take the participants through a series of practical exercises, role-playing games, case studies, and theoretical presentations related to their work environments. The training course is tailored to the rules and regulations of each healthcare institution that requests it.

The training is accredited (CPD) and offered only in French.

For more information, visit the Offre de service section in the Physician executives tab of the QMA’s website or email Catherine Hamel at catherine.hamel@amq.ca.

 

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The spiral of new technologies

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The spiral of new technologies

adam headshotGeneral internal medicine specialist and health technology entrepreneur Dr. Adam Hofmann joined the QMA’s Board of Directors in April 2018. Dr. Hofmann is the creator of a Web and mobile app that allows physicians to communicate more efficiently. He’s also a regular contributor to the English-language media on the subject of technology and healthcare. QMA-Info met with him to try to gain better insight into the rocky relationship that Québec physicians have with new technologies. At a time when almost everyone owns a mobile phone, makes online transactions, and uses connected devices, it’s hard to understand why some physicians in Québec are still resisting using electronic medical records (EMRs).

Dr. Hofmann points out the paradox in this situation: “Yes, doctors are usually the first people to take an interest in science and innovation. Just look at how quick they are to embrace new drugs or advances in the field of genetics. But they aren’t necessarily up to speed when it comes to communicating information or putting innovations into practice.” Most doctors in Québec work in the public healthcare network, in environments over which they have no real control. “The perfect example of this is doctors who still send their consultation requests by fax—a technology from 1990s that’s neither secure nor efficient,” Dr. Hofmann lamented.

Emerging from the IT paradox in Québec’s healthcare system

According to Dr. Hofmann, in order to upgrade, the government needs to “put pressure” on physicians while also helping them transition to the new technologies. “If we give them the tools, they’ll end up using them in their daily practice once they realize that they’re faster, more secure and time-saving,” he explained.

Still, it’s a valid question why Québec is lagging so far behind, especially since it’s been several years since other Canadian provinces digitized their public systems and started using electronic medical records. “If we’re being honest with ourselves, we need to admit that the rest of Canada and the United States are less sensitive about these things. So, a technology developed in Alberta will be more readily accepted in British Columbia or Ontario, for example. But, quite simply, there are also a lot fewer options when it comes to the importing and exporting of new technologies in Québec, largely because of the language barrier,” Dr. Hofmann stated.

So, yes, Dr. Hofmann definitely feels that Québec is trailing the pack when it comes to innovation. But this can also be seen as an opportunity to learn from others’ mistakes and to design better systems. “We stand to gain from all this, so let’s do it,” Dr. Hofmann urged. While the United States are light years ahead of us in terms of electronic medical records, our neighbours to the south continue to discover unexpected effects of incorporating EMRs into their practices, as Dr. Atul Gawande describes in an excellent piece written for The New Yorker entitled Why Doctors Hate Their Computers. The electronic medical record has become much more than a simple tool doctors use to follow their patients—hospitals use them to improve the relevance and quality of care, monitor patient safety, ensure compliance with protocols and best practices, define the population needs of a given territory, etc. This is not a seamless process; in fact, having to enter information in the computer creates more office work for physicians, weighing down their practice. Studies also show that it’s one of the factors contributing to the increased burnout rate among U.S. physicians since 2014. Several hospitals have already found organizational and technological solutions to these new challenges, but increasingly people are realizing that adapting to new technologies is a never-ending cycle.

Proliferation of new technologies

This will also be one of the challenges we face with artificial intelligence. “As a technology, it’s still in its infancy, and we’ll need to make sure we fully understand all of its possible benefits, but also its other effects,” Dr. Hofmann stated. He realizes that not all technologies will be winners and reminds us that we’ll need to learn to always balance physicians and patients in the equation.

But is it possible to ignore artificial intelligence or the proliferation of connected health devices? “No,” he replied. Solutions exist that have already been proven effective. Last spring, a study showed that an artificial intelligence system, specifically a convolutional neural network, could be more effective than dermatologists at identifying skin lesions and moles. Other similar advances have taken place in radiology, pediatrics, etc.

We’ve embarked on an endless spiral of innovation and there’s no getting off it now—unless we no longer want to be able to give patients the care they deserve. The upshot: Physicians need to learn to deal with these advances and make them a part of their everyday practice.

 

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Rules of Moderation for Comments Submitted to QMA-Info

Wishing to promote quality discussions among its members, the QMA welcomes your opinions and invites you to comment on its articles. But first, we would like to lay down a few rules to ensure a tone of moderation in members’ comments.
To begin with, your comments will be read before they are published—not to censure the content, but rather to ensure a friendly forum for discussion.  
So, in order for your comments to be published, we ask you to abide by the following rules:

• Do not overuse capital letters: putting everything you want to say in capital letters is akin to shouting;
• Avoid making discriminatory statements: obviously, statements that may be construed as racist or sexist will not be tolerated;
• Refrain from making aggressive or violent statements: you are free to disagree with something you’ve read, but avoid overreacting;
• Do not insult people: As physicians, we must foster collegiality in our communications with one other.

Our goal, of course, is to promote good discussions.
Thank you for your understanding.

 

 

To comment on this article or view the other comments, click here.
Comments in both languages are grouped in the French version.

Twitter and Facebook messages of the month

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Are you interested in the latest medical news, the future of the medical profession and health issues? Then join our community in the social media, where the opinion leaders express their views! Our communities are growing. Follow us and connect with us!

twitter @amquebec

facebook www.facebook.com/AMQ.QUEBEC

 

Messages on Twitter

 

 

 

 

 

 

 

 

 

Messages on Facebook

 

 

 

 

 

 

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Partnership between Le Point en santé et services sociaux and the QMA

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Partnership between Le Point en santé et services sociaux and the QMA

The QMA has just signed a partnership agreement with Le Point en santé et services sociaux, which is dedicated to knowledge transfer in the health sector. This three-year agreement will involve enriching the content and expanding the readership of Le Point’s flagship publication Le Point en santé et services sociaux.

Like the QMA, Le Point works to improve Québec’s healthcare system, develop effective healthcare practices, and transfer knowledge and practices that are tailored to the situations of the various care and services settings.

QMA Board of Directors member Dr. Michèle Pelletier will be appointed to the magazine’s editorial committee. The QMA will also be invited to sit on the steering committees of all conferences organized by Le Point en santé et services sociaux, as well as serve as a partner for these events, at its discretion.

 

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CMA’s Community engagement platform

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CMA’s Community engagement platform

Canadian Medical Association is launching online discussions on it new community engagement platform:

  • Equity and diversity in medicine: Dr. Gigi Osler, CMA president, is proud to be hosting this discussion with CMA members and looks forward to hearing their thoughts and experiences as we work towards a new policy (open until Apr. 1);
  • Digital health literacy: All platform users, including stakeholder organizations, are welcome to review and provide input on the first member proposal being considered for adoption by the CMA (open until Mar. 6).

In addition to these opportunities, a discussion on the physician workforce and physician health and wellness will be held online until April 1, 2019.

The CMA’s community engagement platform is a space to get involved and collaborate with physicians, patients and other medical professionals who share your desire to make a difference. Just log in at community.cma.ca, using your cma.ca username and password and complete your profile. Then you’re ready to explore and engage with communities of interest, your peers and the CMA.

 

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Free training for residents to help them increase their credibility

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Free training for residents to help them increase their credibility

The Québec Medical Association is offering all resident members a free training program (only in French) entitled Résident crédible: une stratégie pour gagner en crédibilité. The program expands on your university studies and gives you the tools you need to excel in your residency.

Custom-designed to your situation, the program includes online personality tests, a half-day of classroom training focused on actions and practices, the practical application of your knowledge, a virtual classroom, and individual coaching, as needed.

This program will help you:

  • Decode the various personality types;
  • Define your leadership style;
  • Understand the culture and networks of power;
  • Develop your emotional intelligence;
  • Identify stress factors.

The next classroom session will take place on Saturday, April 13, 2019, in Montréal and the next virtual classroom is scheduled for Saturday, May 11.

For more information or to register, visit our website and click on Credible Resident in the Courses and CPD tab or email Mélissa Bourgoin at dpc@amq.ca.

 

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Results of the November 2018 survey

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Results of the November 2018 survey

Do patients sometimes fail to show up for their appointments?