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AITING PATIENTLYSurgeons are busy and patients expect to wait when theycome to see us, but recently the whole problem has becomean issue. Patients joke that waiting rooms, in addition to old

National Geographic Magazines should havecopies of Tolstoy's War and Peace. On March20d in the comment section of The Montreal

Gazette, family physicians Holly Carsley and Orly Hermanrightly blame Draconian and misguided government policiesfor the chronic shortage of doctors in an article entitled "TheWaiting Game." But other factors are at work as well. Someof us are just disorganized. How often have you been sittingat lunch, say around 1:20 PM when your colleague announces,"I guess I have to go to clinic" - which starts at 12:30!

Editorial

With computers and "Palm Pilots'; we should be able to im-prove our daily schedules even far ahead of time. Perhaps itis not a good idea to have an office or clinic after a morningin the OR. Inevitably the surgeon will be late.

In the Surgical Clinics at the RVH years ago, we tried every-thing. Block appointments at one time held some promise.These consisted of the following:

First group New patients. These take the longest.Second group Consultations. Some medical

information will be available.Third group .......Patients who needed a procedure, i.e.

removal of a T-tube; endoscopy; removal ofsutures.

Fourth group ....Revisits

Thisdid not always work becausepatients would show up early"soas not to have to wait." There is nothing more stressful for a Sur-geon to arrive at clinic alone (without the help of Housestaff) onlyto see every chair in the hall occupied (seeaccompanying photo).

Going to clinic seems to have a very low priority in our dailyroutine. When a Surgical Resident is called to come down tothe OPD,it is not unusual to hear, "OK, I'll be right there afterI finish doing rounds, do some SCUT,work on the ward andthen go to the Emergency Room ... ::

Both patients and doctors must work together to alleviate thesituation. Patients must call to cancel appointments if they

THE SQUARE..z~3

cannot come and those without appointments should be seenlast. On the other hand, we should not keep any patient wait-ing more than 30 minutes. After that, it becomes cruel andunusual punishment. Like airlines, one must not overbook.

We do not need bigger and better waiting rooms with flow-ers and TV, we need to just stop patients from waiting .•

95f-~ nL!- ~ - nVIIJ-=

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"Age? Youmean now or when we first sat down?"

In most other pmvinces, it is the Postgraduate Dean's Of-fice that receives lump sum funding from the provincial Min-istry of Health, to be distributed as the Faculty of Medicinechooses, to the various residency programs.

In Quebec, an annualdecree, a law, regu-lates many aspects of

~ manpower planning including admissions to medical schools5" and residency positions. The policies leading up to this law~ are hammered out by a committee called the Table de con-~ certation, which receives recommendations from a workgroup~ called Comite du suivi. Both these committees have broad~ representation and are chaired by the Assistant Deputy Min-~ ister of Health or a delegate. The representatives include in-~ dividuals from the FMSQ (Federation des medecins specialistes~ du Quebec), FMOQ (Federation des medecins omnipraticiens du

Quebec), CREPUQ (Conseil des recteurs etprincipaux des universites du Quebec) (in-cluding a Dean from one of the Faculties ofMedicine and a Postgraduate Dean from oneof the other Faculties of Medicine in Que-bec), CMQ (College des medecins du Quebec),Regie regionales, FMRQ (Federation desMedecins Residents du Quebec), FAEMQ(Federation des Associations Etudiantes enMedecine du Quebec), and several other in-terested parties. After looking at many fac-

Anne-Marie MacLellan,M.D. tors including the aging of the population,physicians hours of work and type of work,

the feminization of the profession, the distribution of physi-cians within Quebec, the budgetary implications of addingphysicians to different specialties, and the needs assessmentfrom each individual FMSQAssociation, the Comite du suivi de-cides on the numbers of residency positions to be allotted toeach entry level specialty and to Family Medicine. This Com-mittee also decides on the priority/category for each specialty,which vary from A (top priority) to D (less need). Represen-tatives from the Ministry of Education (MEQ) are also mem-bers of the Table de concertation and Comite du suivi. It istheir responsibility to enforce the application of the law byverifying that the Faculties of Medicine allocate positions inconformity with the annual decree.

Le decret! The Decree

This type of planning and control can be thought of as quitedraconian. However, most students in Quebec have been ableto be admitted into the residency of their choice or have been

THE SQUARE...z24

able to transfer, within a year or two, to their preferred resi-dency. The exception is for D priority specialties, where thenumber of entries is fixed and capped.

I thought you might be interested to know of some of the pos-itive spin-offs of the decree. Let me enumerate some of them.Each resident is guaranteed complete funding in order to com-plete residency training leading to certification in either a spe-cialty or Family Medicine, unless of course, the resident has beenasked to withdraw from a program. In contrast, for the pastseveral years, the University of BChas not received full residencyfunding for all their graduating students from the BritishColumbia Ministry of Health! Quebec also provides funding fora resident to complete training even if the resident switchesprogram midstream and has to start over at a junior level. TheQuebec decree is very innovative in that it allows Canadian res-idents, graduates of other Canadian medical schools, who havestarted training elsewhere in Canada, to come to Quebec in ei-ther a specialty or in Family Medicine at an R-2 level or higher.There are 25 of these positions available for specialties and anew quota of 15 for Family Medicine.

An unlimited number of Retour de pratique positions (Re-en-try Positions) are also available for physicians, in order to com-plete full training in a specialty (except for D priority categorypositions) or in the third year Family Medicine program (ER,Care of the Elderly, Palliative Care).

Graduates of Quebec medical schools, who have started post-graduate training elsewhere in Canada,can return to Quebec af-ter the R-1 level to complete training in A, B, and C priorityspecialties. The hope is that by attracting residents to train inQuebec,they can then be enticed to stay and practice in Quebec.

As readers of TheSquare Knot, you are undoubtedly interestedin knowing what is happening with surgical residency posi-tions in the province. The following table demonstrates thevarying yearly assessment of the priority categories (i.e. theneed) for the different surgical specialties. ~

General Surgery

1996 1997 1998 1999 2000

Cardiac Surgery B B B B CGeneral Surgery A A B B ANeurosurgery B B B B COrthopedic Surgery B B B B BOtolaryngology B B B B BPlastic Surgery D D C C CUrology C C C C B

~ Specialties are grouped by order of priority, A (thegreatest need) to D (lesser need). Rules concerning transferfrom one specialty to another exist, which the faculties mustrespect in order not to contravene the decree (see figure).

As you can see Neurosurgery and Cardiac Surgery weredeemed to have lower priority ratings in 2000 (C category),and General Surgery has gone from A to B and back to A. Ac-cording to recent decrees, transfers can freely occur betweenA and B specialties.

Surgical disciplines are always very popular amongst students.At McGill, we have always tried to accommodate residentswho wish to switch between specialties, as it is important thatresidents achieve their career aspirations. When the numberof residency positions will increase in a few years, it is antici-pated that the decree at that time will give priority to thosesurgical disciplines with insufficient number of specialists forthe population needs.

A frequently asked question is "why has the number of spe-cialty residents entering a given program decreased?" The an-swer is that the number of students allowed into medicalschools in Quebec has been gradually cut over the past years.This translates into a proportionate decrease in residency po-sitions four years later. Unfortunately, for residency numbers,we are now in the nadir for the next three years. The good

THE SQUARE...z~5

news is that the Quebec Government has been the firstprovincial government to recognize that it was time to in-crease medical school enrollment. We have witnessed an in-crease of 65 students in 1999, distributed between the fourfaculties, which will translate in an increase in resident num-bers starting in July 2003. The Faculties of Medicine arepresently awaiting Quebec Treasury Board approval for a fur-ther increase of 55 students.

The decree also allows the Faculties of Medicine to train clin-ical fellows from other provinces or countries. Clinical fellowsare residents or fellows funded by other sources than by theMinistry of Health (RAMQ). McGill continues to attract manyhigh caliber students, residents and fellows to its 57 RCPSac-credited specialty programs and three (CFPC)Family Medicineprograms (Family Medicine, Care of the Elderly, EmergencyMedicine), and Palliative Care, a joint RCPS/CFPCprogram.

The Associate Deans for Postgraduate Medical Education inQuebec work with the Ministry of Health, the Ministry of Ed-ucation and with CREPUQ,to help in the annual reformulationof the decree. Hopefully, now that there is such an acuteshortage of physicians there will be increased flexibility in theformulation and the application of the annual decree. •

Anne-Marie Maclel/an, MD CM, FRCPCAssociate Dean, Postgraduate Medical Education

and Professional Affairs

..............................................................................................................................

Royal College Visits McGill

Department of Surgery

On April 11, 12 and 13,SurveyTeams from the RCPSCand fromthe Quebec College of Physicians carried out the AccreditationVisit of the McGill Post-Graduate Training Programs in our De-partment of Surgery. The "Inspectors" visited the hospitals andthey met with the Faculty, Residents and Fellows.

The following programs will be recommended for APPROVALto the Accreditation Committee in October in Ottawa:

Program Program Director

Cardiac Surgery Dr. Ray ChiuGeneral Surgery Dr. Judith TrudelOrthopedic Surgery Dr. Michael TanzerPediatric General Surgery Dr. Jean-Martin LabergeVascular Surgery Dr. Oren SteinmetzGeneral Surgical Oncology Dr. Sarkis Meterissian

Congratulations! The next visits are to be in 2006.EDM

Upcoming

Events

The following Surgical Societies will meet at the same time asthat of the Royal College 6th Annual Con~erence on ResidencyEducation in Edmonton, September 21-24, 2000.

• Canadian Cardiovascular Society

• Canadian Society of Colon and Rectal Surgeons

• Canadian Association of General Surgeons

REMINDER

September 22, 2000 - 13:30 hoursGallie LectureDr. Jonathan L. Meakins

~ Fli '"c c:: >0'\10NlI~

~ in 1999, with an extensivelist of research activities, publica-tions, and abstracts accepted forpublication. On graduation, he planson a one year fellowship in Hand andCraniofacial Surgery. Paul is marriedto Zobeida, who has a Ph.D. in An-thropology.

Dr. Antoine Hal/ok is a native of Lebanon and grad-uate of the Lebanese University Medical School in1992. He came to McGill in 1999 as an R-4 havingcompleted five years of General Surgery in StatenIsland University Hospital in New York, and beingBoard certified. He has multiple publications on la-parscopic surgery. He is married to Marie, and ongraduation will go to practice in New York.

Dr. Ali Hussain came to us as an R-1 from Bahrain, having graduatedfrom the Arabian Gulf University in1991. On completion of PlasticSurgery training in June 2001, heplans a one year fellowship in Handand Microsurgery, after which he willreturn to Bahrain to practice. Ali issingle and available.

DIVISION OF PEDIATRIC GENERAL SURGERYDr. Sherif Emil is an Egyptian-born U.S.citizen whograduated from McGill University in 1991 and pursuedhis training in General Surgery at Loma Linda Univer-sity Medical Center. He participated in research pro-jects in Pediatric General Surgery at The Children'sHospital of Los Angeles, University of South California.He started his 2-year Pediatric Surgery Residency atthe Montreal Children's Hospital in July 1999 and will

be Chief Resident effective July 1st 2000. He is very interestedin medical ethics and health care policy. Sherif is very activewith the human rights movement around the world and hasa strong interest in church history. In the fall of 1998, he wenton a 1a-day medical mission to Egypt visiting hospitals in thepoorer areas of Cairo. In the spring of 1999, he spent onemonth in a mission hospital in Nairobi. All this in preparationof future annual trips. He enjoys the outdoors, hiking, joggingand has a great passion for travelling.

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DIVISION OF GENERAL SURGICAL ONCOLOGYDr. Ayman Linjawi will be the fifthsurgical oncology fellow in ourrecently fully approved Royal CollgeGeneral Surgical Oncology FellowshipProgram. He completed his generalsurgical residency at McGill andduring his residency did researchwith Dr. Meterissian on prognosticmarkers in breast carcinoma. As a result of his research year,he will only need to do one clinical year to qualify for his cer-tificate. We wish Dr. Linjawi well and hope that after his stintwith us he will have a productive career as a surgical oncolo-gist in Saudi Arabia.

DIVISION OF ORTHOPEDIC SURGERYDr. Benoit Bessette completed hisundergraduate and medical degree atthe University of Ottawa where he wasalso born and raised. Prior to startingresidency, he travelled to South Amer-ica and Europe on a few occasionsandplans to travel some more prior to set-t~ing in his career. He will start offpractising general orthopaedics in a community in Ontario andthen plans to complete a fellowship in sports medicine. Mean-while, Ben also plans to fine tune his new snowboarding skillsand avoid any serious orthopaedic injuries!

Dr. Robert Stephen James Burnett is originally from WestVancouver, completed his BSc at UBC,followed by MD at theUniversity of Western Ontario in London. Returned to BC tocomplete the UBCRural Family Medicine Programme in 1996.Hobbies include cycling, shoulder-deep powder, water-skiing,and windsurfing. Future plans include fellowship training anda family with his wife Susan.

Dr. Ian D. Dickey was born and raised inVancouver. He graduated from St. George'sSchool and then completed his B.Se. andM.D. at U.B.C.before moving to Montreal tostart residency as a Shriner's Hospital Clin-ical Fellow in Orthopaedics. While havingvaried interests, rugby and playing guitar ina band have been the most consuming and

rewarding. He can be spotted around town sitting in with var-ious bands. After completion of training, Ian has been ac-cepted to a fellowship in Musculoskeletal Oncology and AdultReconstruction at Mayo Clinie.

............................................................................................................................. ..

DIVISION OF UROLOGY

Or. Nasser AI-Said was born in JahraCity, Kuwait in 1967. He is married andhas one child, a daughter named Noorwho will be a year old in July. He willcomplete his urology residency June2001, and at that time he will returnto Kuwait. Nasser's special interest isin pediatric urology and his favoritehobby is fishing.

Or. Avrum Jacobson was born and raised in Mon-treal. He graduated from McGill University, Faculty ofMedicine in 1996. Upon completion of his residencyin 2001, he plans to pursue a fellowship in endurol-ogy and laparoscopic urology. Avi is engaged to RonitAmsel, who works as a financial consultant. The wed-ding is set for September 24th.

Or. Marc Savoie originates from New Brunswick. He gradu-ated from'Sherbrooke Medicine in 1996 after completing hisundergraduate studies from Moncton University. Marc is hap-pily married and has a passion for motorcycles which he

Quebec Creates New Specialty forCardiac Surgery

Le College des Medecins du Quebec has announced that, effec-tive March 9,2000, it will no longer issue specialty certificates inCardiovascular and Thoracic Surgery. A new regulation has beenapproved for the recognition of Cardiac Surgery as a specialty.

Of course, specialists who already have their CVT certificateswill continue to be recognized.

The requirements are 72 months of approved residencytraining of which:

THE SQUARE...z~8

shares with his wife. After completing his residency, he plansto practice urology in New Brunswick serving the communitywhere he originated.

Or. Andrew Steinberg was born andraised in Montreal. He completed anundergraduate degree in chemical en-gineer in 1992 and went on to com-plete his M.D. in 1996, both at McGill.During his urology training, Andrew hascarried out research projects in renaland testicular cancers. Upon comple-tion of his residency, he is going to the Cleveland Clinic to pursuea fellowship in laparoscopic urology. He plans to return to an aca-demic career at McGill. Andrew looks forward to spending moretime with his wife Mandy and daughter Emily.

DIVISION OF VASCULAR SURGERY

Marie France Guimond is a native of Quebec City. She ob-tained her Medical Doctorate at the Universite de Montrealand went on to the Universite Laval for her residency in Gen-eral Surgery. She will be joining the Division of VascularSurgery for a two year fellowship starting July 1st, 2000 .•

a) 24 months of Core Surgeryb) 24 months of rotations in Cardiac Surgery including 6 months

in Pediatric Cardiac Surgeryc) 12 months of rotations with 6 months in General Surgery

and 6 months in Thoracic Surgeryd) 12 months of electives as determined by the University Post

graduate program

For more information please contact before October 9,2000 •Secnltaire du (omite d'admission a I'exercice

Direction des etudes medicales(ollege des medecins du Quebec2170, boul. Rene-Levesque Ouest

Montreal, Qc H3H 2T8ou en communiquant au (514) 933-4441 poste: 273

ou par courriel il: nchampagne@cmq.org

...............................................................................................................................EDM

Quebec SpecialistsGet Pay Increases

On May 24th, Health MinisterPauline Marois announcedthat the province's 7,500medical specialists would get

a 9% pay increase over the next four years.

This means that the average annual payment to specialists inQuebec will rise from $185,000. to $200,000.

The agreement also proposes a 40% bonus for specialistsworking in outlying regions.

Surgeons are part of this agreement reached between theMinistry of Social Affairs and the Federation of MedicalSpecialists of Quebec. •

EOM

REPORT ON CURRENTACTIVITIESOF THEFEDERATION DES MEDECINS RESIDENTS DU QUEBEC

These are the issues on which our Federation's members havebeen focussing.

Report on CurrentActivities

Applications for recogni-

tion of Areas of Added

Competence (AAC) - Royal

College of Physicians and

Surgeons of Canada (RCPSC)

While we are aware that medical knowledge is constantly ex-panding, we nonetheless believe that before venturing to adda further year in any area whatsoever, the curriculum of the pro-gram for which recognition of added competence is requestedshould first and foremost be reviewed, in order to ensure therelevance of each rotation, and to make the learning experienceeven more effective and profitable within existing rotations.This, in our view, will be the challenge for the next decade.

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Comprehensive accreditation visit of training programs

and sites, Faculty of Medicine, McGill University

We took an active part in the comprehensive accreditationvisit of training programs and sites at the McGill University Fac-ulty of Medicine, which took place April 9 to 14,2000. Four res-idents (two in specialties and two in family medicine)representing Quebec's medical residents attended. While thevisit went well, we unfortunately observed that there are in-timidation and harassment problems in some programs. Finally,we would point out that hospital mergers and the fact thatsome hospitals have wings at a number of different locationshave brought their share of problems with regard to residents'work. We believe it is extremely important to resolve theseproblems so that residents' health is not jeopardized. Thesecomments are equally valid for the entire Quebec system.

Stress and psychological distress among residents project

to measure the scope of distress among medical residents

In view of the high level of psychological distress observed inthe population of residents as a whole, the FMRQ's Board ofDirectors has decided to take the necessary steps to identifypossible solutions for prevention, early detection and intro-duction of management and follow-up mechanisms for resi-dents currently experiencing psychological distress.

Nurse practitioners, nurse clinicians and physician

assistants

Early in the year, the FMRQ put out a special issue of its quar-

9terly Bulletin, on the changing role of nurses. This report por-trays the situation in the U.S., Canada (rapid change in On-tario) and Quebec (a fast-growing trend) in terms of thepresence of these new players in the health care system. Itbriefly describes the specific medical acts performed by nursepractitioners, nurse clinicians and physician assistants, a groupof professionals not to be found in Canada, but forming a con-stantly expanding profession south of the border. Since weanticipate a substantial increase in medical services in thefuture, in a medical system which has undergone and is stillundergoing major changes and suffers from a shortage ofphysicians across the country, the introduction of nurse prac-titioners into the system, particularly in university hospitals, islikely to have an impact on postdoctoral training. In somecases, its impact is already being felt. We believe this will bea hot topic in the coming months and even years. We havewritten to various organizations for copies of any referencematerial, positions and information on this issue in order toinform medical residents adequately of the scope of therepercussions that multidisciplinary practice will have in theyears to come.

ATLS/ACLS/ANLS/ALSO,Enhancing access and reducing

or even removing costs

We are currently in the process of completing a comparativetable of resuscitation courses given in each of Quebec's fourmedical schools. We are continuing our analysis in order tocheck whether it would not be timely to enhance access tothese certificates so that adequate training and clinical ex-posure can be offered to ensure the residents' competency inthe context of residency and as future practising physicians.

FMRQ policy on adding a third year in family

medicine, reintroducing rotation internships, and the

rural family medicine program

The FMRQis opposed to adding a third year to the family med-icine program and to bringing back rotating internships. TheFederation also believes it would be premature to institution-alize a rural family medicine program distinct from the exist-ing family medicine program. The FMRQsuggests instead thatthe current program be revised. This position (d.FMRQ'spo-sition attached) was tabled at the last (FPC Board of Direc-tors meeting in December 1999.

Medical manpower

The standing committee (round table) on medical manpowerplanning in Quebec, on which the FMRQ sits, tabled a sum-mary report in December 1999 concerning medical training,the organization of medical services and medical manpowerprojections in Quebec. The round table forwarded variousrecommendations to Pauline Marois, Minister of ~

THE SQUAREl:!51

~ Health and Social Services, and these were recentlymade public.

Working group on communicable diseases (College desmedecins du Quebec, CMQ)The FMRQwas asked by CMQ management to join a workinggroup whose mandate is to examine the issue of candidateseligible to study medicine, medical students and residents,clinical fellows and practising physicians who are carriers ofa communicable disease, and to review the ethical and legalaspects of this question. The goal is to be able to offer theauthorities concerned (faculties and colleges) a mechanismfor managing the files of individuals carrying a communica-ble disease when they apply for admission to a medical schoolin Quebec or pursue postdoctoral medical studies (with regardto the impact on eligibility for specialty or licensing exams)and to propose means of ensuring implementation of andcompliance with preventive measures.

The Federation is, however, most concerned at the short-ages of doctors throughout Quebec, in both specialties andfamily medicine. The FMRQ anxiously awaits the creationof regional departments of general medicine (DRMG), whichare supposed largely to solve the problem of the distribu-tion of family physicians within and among the regionsacross Quebec. The Federation will shortly be meeting withthe President of the FMOQ to find out more about the SECORreport on using private offices as the base for delivering pri-mary services in Quebec.

On another front, the Federation also wonders about the inten-tion of the College des medecins du Quebec (CMQ) to issuerestrictive licences to practise to graduates from outside Canadaand the u.S. following three months of evaluation-oriented ro-tations in order to offset the shortage of manpower in certainregions. We do not believe it to be sound to set up a fast trackand bypass the evaluation and learning criteria normally re-quired of Quebec medical residents and graduates from outsideCanada and the U.s. who apply for a regular licence.

Emergency ForumFollowing the Emergency Forum held last October 4 and 5, aworking group on Emergency Forum follow-up was set up toanalyse the training needs of family medicine residentswithin their regular two-year programs and during their ad-ditional training year. The FMRQwas asked to join this com-mittee, whose report is to be submitted this coming June.

We are confident, however, that the CMQand its different part-ners will grant these restrictive licences with great caution.Finally, it is our view that the granting of restrictive licencesto practise must remain at the sole discretion of the CMQ, theguarantor of the quality of medicine.

Youth SummitIn February 2000, FMRQPresident, Dr Jean-Fran\ois Cailhier, hadthe privilege of representing his resident colleagues at theQuebec Youth Summit. At this event, young people from everysector of activity across Quebec expressed their views on vari-ous issues and on young people's place in Quebec society .•

Stephane Montminy-Metivier, President

Academic Affairs Committee - Specialties, FMRQ

"The Doctor isn't available right now.

Would you like to speak to Mr. Hyde1"- TheNew Yorker

10

ROYAL (OllEGEREVIEWSITS POLICY

REGARDING RECOGNITION OF INTERNATIONAL TRAINING

-7997 Ruling Reversed on Recognition of Interna-

tional Specialty Education

In September of 1996, the RoyalCollege ruled that "Henceforthonly residents seek training un-dertaken in an accredited pro-gram in Canada or a program

accredited by the Accreditation Council on Graduate MedicalEducation in the United States would be acceptable to meetthe prerequisite requirements as defined for each of the cer-tifications offered by the College".

News Fromthe Royal College

Since 1997, recognition of the credentials of internationalmedical graduates has been restricted to graduates of accred-ited residency programs in Canada and the United States. In1999, in collaboration with the Federation of Medical licens-ing Authorities of Canada (FMLAC) and the Medical Council ofCanada, the College established a crisis management process,the "FMLAC process" (see April 2000 Annals RCPSCfor details)to assist licensing authorities with the assessment of interna-tional medical specialists and with a new pathway to RCPSCcertification. Also during 1999, President Richard Baltzanlaunched an international initiative focussed upon postgradu-ate education in specialty medicine in some countries wherethere exists a comparable organization and accreditation ofspecialty residency programs.

Ever since 1991 when the Barer Stoddart report recommendeda decrease in medical school enrolment by 10%, there hasbeen a decreased physicians supply from a high of 2,640 in1974 to a low of 1,822 by 1997. During this interval, Canada'spopulation grew from 22 million to 30.5 million.

A well prepared document by the TaskForce on Physician Sup-

ply in Canada prepared by Dr. Lorne Tyrell, President of theAssociation of Canadian Medical Colleges and Dr.Dale Dauphi-nee, Executive Director of the Medical Council of Canada in No-vember 1999 on behalf of the Canadian Medical Forum TaskForce, co-chaired by Dr. Hugh Scully, President of the CMAmade the following recommendations:

o Increase medical school enrolment from 1,577 to 2,000 bythe year 2000. This increase in medical school enrolmentneeds to be appropriately funded and free of coercion.

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!11

@ Increase efforts to retain and repatriate Canadian physicians.

@} Increase provincially-funded residency positions from100/100 to 120/100 medical school graduates. This willprovide short- and long-term relief and enhance our abil-ity to integrate IMGs into the physician supply in Canada.

o Develop a formal and continuing process involving theCanadian Medical Forum, other health care providers,federal and provincial governments to monitor and makerecommendations on the number of entry positions forCanada's medical schools and postgraduate training pro-grams on a regular (2-3 year) basis.

o Address the issues of distribution and new models ofdelivery through co-operation of governments, health au-thorities, and educators.

This year, Council passed a new resolution - THATthe RCPSC

consider applications from International Medical Graduate

physicians for assessment leading to certification examination

if they fulfill the criteria of having been trained in acceptable

accredited programs and satisfy specialty training require-

ments in Canada.

Accordingly, a joint meeting of the Accreditation and Creden-tials Committees was held in Ottawa on the 11th and 12th ofMay in order to review the recognition of training for Inter-national Medical Graduates.

The Accreditation Committee prepared a document entitledCriteria for an Acceptable Accreditation System and the Cre-dentials Committee prepared a draft document entitledCredentialing Process for Establishing RCPSCExam Eligibility.

These will be submitted to Council for further deliberations .•

The twin sirens

of bias and selection

await the most

excellent physician

as he voyages

on the sea of

clinical epidemiology.

-Keen, 1978

~ waiting list. Most of the trans-plants were being done at Ste-Justine,with only 1 to 3 per year being done atthe MCH between 1990 and 1997. Nev-

ertheless, the availability oftwo sites allowed a contin-ued collaboration and a few"tour-de-force': In 1991 atthe MCH, after returning

from a trip to Chicago to watch Dr.Broelsch perform his 20th living- relateddonor liver transplant, we performed thefirst segmental transplant using a 72-Kgdonor liver (segments 2 and 3) for a 3-month-old child with neonatal he-mochromatosis who weighed 5 Kg. Untilthen we had been using left lobe graftsand were limited to a donor weight 4 or5 times the recipient weight. After thisand subsequent successful experiences,the team of Drs. Laberge, Guttman andBlanchard was the first in Canada to per-form a split-liver transplantation, i.e. usea single adult donor liver to transplanttwo children; the recipient operationswere carried out simultaneously at theMCH and Ste-Justine.

Letters(continued from pg. 2)

Dr. Jean Tchervenkov was a welcome ad-dition to the team of pediatric surgeons,having had experience with pediatric livertransplantation in Cincinnati. He helpedwith several procedures both at the MCHand Ste-Justine, and participated in several

more split-liver transplantations amongwhich the first one in 1996, where both re-cipients (a 1-year-old child at the MCHandan adult at the RVH) are long-term sur-vivors with their liver segments (previouslyat least one of the split-liver recipients haddied or required re-transplantation).

Because of the lack of pediatric gastroen-terologists/hepatologists and an extremeshortage of anesthetists, no liver trans-plants have been done at the MCH sinceOctober 1997. The undersigned remainsinvolved in the procedure at Ste-Justineand continues to follow the patients pre-viously transplanted at the MCH with thehelp of pediatricians form the IntensiveAmbulatory Care Service and counselingfrom the MUHC "adult" transplant sur-geons and the hepatologists from Ste-Justine .. Despite having done only 18transplants (in 17 patients) since 1983,we can be proud of our 14 long-term sur-vivors and our many "Firsts': Looking for-ward to a single site for the MUHC, thiswill have many advantages, but will notsolve our shortage of pediatric hepatolo-gists and anesthetists. Ideally, we shouldinvite Ste- Justine to move to our newsite. With only 12 to 15 pediatric livertransplants per year in Quebec, it wouldmake sense to perform them on a singlesite while being just a corridor away froman adult facility performing 40-50 trans-

······...................................................................

Submitted by: AN ELEmON YEARLESSONFOR THE U.S.:Stephen F. McCartney THE CANADIAN MODEL FOR GOVERNMENT•••••• •• •• •••• •••• •• •• HEALTH CAREIS FALLING APART

You may have noticed that the strategy to complete the na-tionalization of the U.S.health care system has changed. Bill,Hillary, AI, Ted and Henry (Waxman) no longer talk of sweep-ing changes as they did in 1993 with the Hillary Healthcareplan. Instead, they have publicly stated that they will do it in-crementally in small steps. Top down by expanding Medicareeligibility to age 55 and Medicare disability to such things asalcoholism and drug abuse. Bottom up by expanding theCHIPSProgram for kids and young families. Sooner or laterall of us in-between will be eligible for some government runhealth care scheme.

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plants/year. This would also allow us todo living-related transplants in the safestpossible manner.

Like the Internet and the e-mail, we at theMCHare "case-sensitive': Future articles inTheSquare Knot should use terms such as"Adult McGill Liver Transplant Program"(Winter 2000), "The first successful adultliver transplant at McGill" (Winter 2000Addendum p. 24), and "Adult MUHCSurgi-cal Transplant Team" (Autumn 1999), ifthey totally ignore the "smaller story':

J-M. Laberge, MO, FRCS(C),FACSDirector, Division of Pediatric Surgery

...................Dear Editor:Between HMO's and university encroach-ment, many associations have Doctorswho still pride themselves by remainingin pure private practice. The AmericanAssociation of Private Physicians is onehere in Santa Monica of about 160 MD's.I thought you might find the article in theNewsletter of the APPA of interest. It isentitled PROGRESS and is about Cana-dian Health Care. It's veracity is up toyour opinion (article follows).

Thanks for keeping me on the mailing listof The Square Knot .•

Stephen F.McCartney,Santa Monica, California

You may also have noticed that none of the proponents ofnationalized (AKA: single pay, universal coverage, socalized)medicine are touting the successes of the Canadian Medicaresystem as they did in 1993. Medicare is the Canadian termfor their national health insurance plan covering cradle tograve care. As of the year 2000 it is falling apart and is thesubject of much public and press discussion in Canada.

What follows is information readily available from sourcessuch as the following: Canada's Fraser Institute(www.fraserinstitute.ca). David Gratzer's new book Code Blueabout the present Canadian crisis, Canadian public opinionpolls by Toronto based Polara, the Organization for EconomicCooperation and Development (DECD)and articles in the ()o

12

~ tawa Citizen, Toronto Sun, New York Times, WashingtonPost and Wall Street Journal.

• Government deficits in the 1990's led to spending cuts clos-ing 7 hospitals in Montreal, 44 in Ontario, early retirementfor 1200 doctors and 3600 RN's in Quebec.

• Over the last decade 6,000 RN's and 1,000 doctors havemoved to the United States from Canada.

• The Canadian health care crisis was inevitable because theirpopulation is graying rapidly on a par with the U.s. such that25% of the citizenry will be over age 65 within 30 years.

• In marked contrast to increasing longevity in the free world,the disability free life expectancy of Canadian women hasfallen to 63.8 years as of 1991 from 66.7 years in 1978.

• Canada ranks fifth in overall spending for health care worldwide but is 21st in availability of CTscanners, 19th for MRI's.

• Canadian physicians judge median waiting times to be 70%longer than medically reasonable overall, 145% longer forcardiac surgery.

• The median wait for an MRI is 11 weeks, for a CT5 weeks.

• The median wait for cardiac surgery is 13-60 weeks depend-ing on the province, 4-11.5 weeks for radiation therapy.

• Montreal physicians are now referring chemotherapy to U.s.hospitals in New York.

• Hospitals in Washington State market chemotherapy ser-vices in British Columbia and are doing a booming cashbusiness.

• Canadian hospitals spend 80% of their budget on unionizedhospital labor versus 55% for labor in a typical U.S.facility.

• The Quebec government keeps a catalog of deaths from lackof availability of life saving drugs.

• One January day this year, 23 of 25 Toronto hospitals hadto turn away ambulances all day because of overcrowding.

• During the first week in January, Toronto police shot todeath a distraught father who had taken an ER physicianhostage to speed treatment of his sick baby.

• An official at VancouverGeneral Hospital estimates that 20% ofheart attack patients wait more than an hour for attention intheir emergency room when they should be seen immediately.

• The New YorkTimes interviewed a grandmother in a Canadianhospital who had waited for open heart surgery for 5 yearsand spent the night pre-op in a drafty hallway near the emer-gency room door along with 66 other such hallway patients.

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• Winnipeg "hallway medicine" patients lie in fixed hallwaystretchers with permanent location numbers because ofbed shortages.

• 80% of Canadians believe their "health care system is in crisis':

• Quebec Premier Lucien Bouchard has told his constituents tofix the health care system before worrying about sovereignty.

• Alberta Premier Ralph Klein has now proposed using privatefacilities to provide some surgical services in short supply.

• Michael Bliss, Canadian Medical Historian in the NationalPost: "So we have the absurdity in Canada that you getfaster care for your gum disease than your cancer, andprobably more attentive care for your dog than yourgrandmother':

• Canadian journalists are now writing about a hopeful newalternative to the government mess: MEDICAL SAVINGSACCOUNTS!

When you hear politicians describing a wonderful new ex-pansion of government run health care, or journalists, punditsor "experts" expounding on the virtues of "universal access" orsingle payer systems, refer them to the items above and thevoluminous editorials in every Canadian newspaper describingthe health care disaster that country is experiencing. For ascholarly and detailed discussion of Canada's health care issuesgo to www.fraserinstitute.ca and their summary treatise"Canadian Health Care - A System in Collapse': •

The brainis a wonderful organ.

It starts working

the moment you get up

in the morning

and it doesn't stop until

you get to the office.

-Robert Frost

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RECRUITMENT ANDRETENTIONCOMMITTEE

OF THE DEPARTMENT OF SURGERYRecruiting young surgeons is a priority for the Department ofSurgery. Once this is achieved, we have to provide the ideal

environment for academic and clinical sat-isfaction that should facilitate retention ofthese surgeons once they are established.Recruitment

The department realized that several components are neces-sary to achieve this goal. The most important is a clear un-derstanding between the recruit and all the parties involvedonce he/she is on site. In the old days, a handshake and a paton the back was enough. This is obviously outdated and con-sequently had to be replaced by a clear transparent memo-randum of agreement which covers all pertinent componentssuch as expectations; including institutional, clinical care,teaching and other academic achievements (research whenapplicable). The other aspects include the promised divisional,departmental and institutional resources necessary to achievethese goals which are spelled out in detail and signed off bythe responsible authorities. Since January 2000, 6 such Mem-oranda of Agreements have been signed and two are in theprocess. All the involved players have been cooperating tomake this system work .

THE SQUARE...~15

The other major challenge facing thedepartment was the very difficult com-petitive nature of recruiting surgeons indifferent disciplines. Obviously theMcGill reputation, the academicstrength, the role models, the beauty ofour city and the friendly environmentare important factors. We still neededmajor funding to be able to put to-

Dr.Mostafa Elhi/ali gether competitive recruitment pack-ages. Toward this end we were veryfortunate to have the support of a ma-

jor donor "Dr. Richard Tomlinson". Through a major donationto McGill, a very significant sum was put into a "Young Sur-geons Endowment Fund". The revenue generated by this fundwill be used by the committee to compliment existing re-sources and help facilitate these recruitments. This realizationcompliments the acceptance of the department missionstatement and the department priorities list which when allis said and done is an excellent outcome for the year.

U.S. The 2000 Medicare Fee ScheduleCombined Impact of 2000 Fee Schedule Changes on Key Surgical Services

Editor's Note:This donation of 64 million dollars to McGill by the 76 year oldscientist and businessman is a philanthropic record - thelargest single donation ever made to a Canadian university .•

1999 Average 2000 Average % ChangeProcedure Payment Payment

Remove breast $948. $995. 5

Total knee replacement $1,684. $1,631. -3

(ABG, three-vein $2,341. $2,273. -3

Rechannel artery $1,220. $1)36. 1

(olonoscopy with lesion removal $384. $357. -7

Laparoscopiccholecystectomy $705. $696. -1

TURP $859. $850. -1

Hysterectomy $919. $923. 0.5

Laminectomy $1,177. $1,136. -3

Removecataract, insert lens $773. $748. -3

.............................................................................................................................. .The 2000 Medicare Fee Schedule

Reference: Bulletin of the American College of Surgeons, Vol.85 (1J.

D.Hele•• Flag.ol. andDr. Jean-Martin Laberge in collabora-tion with Dr. Bruno Piedboeuf from

Universite Laval in

KUDOS II Quebec City have.. been awarded a grant

--~ sw ~ ~ of $14,550.00 by theAPQ (Association pul-

monaire du Quebec) to pursue their mul-ticentre research in the treatment ofCongenital Diaphragmatic Hernia. Theirproject is entitled: Postnatal Pul-

monary Distension in the Treatment

of Pulmonary Hypoplasia: A Pilot

Project. Dr. Helene Flageole and Dr.Jean-Martin Laberge are also co-in-vestigators in a multicenter study inQuebec to evaluate prognostic criteriaprospectively for fetuses with congenitaldiaphragmatic hernia. Funding from theFRSQwas just obtained.

Dr. Joseph Froncioni who graduatedfrom McGill in 1980 and who is an ortho-pedic surgeon at the King Edward Memo-rial Hospital in Hamilton, Bermuda, is amember of the Road Safety Council wherehe has made tremendous contributions toroad safety initiatives. Recently he hasmade a plea for safer helmets to be wornby cyclists in Bermuda.

Dr. Philip H. Gordon of the JGH hasbeen elected President of the AmericanBoard of Colon and Rectal Surgeons. Hehas also been appointed reviewer for theBritish Journal of Surgery. Philip alongwith Dr. Santhat Nivatvongs of the MayoClinic have just authored a textbook enti-tled Neoplasms of the Colon, Rectum and

Anus, Quality Medical Publishing, St.Louis, 2000. Not surprisingly, Philip wascited in Whos Who in Medicine and Health

Care in the Millennium Edition of MarquisWho's Who, 3rd edition 1000-2001.

Dr. Karen M. Johnston was awarded

the Franklin H. Martin Faculty ResearchFellowship by the Board of Regents of theAmerican College of Surgeons in Febru-ary. This two year fellowship is named tohonor Dr. Martin, founder of the Collegeand is funded by the Scholarship Endow-ment Fund of the College. Her researchproject is entitled A Comprehensive Ap-

proach to the Diagnosis and Investigation

of ConcussiveHead Injury.

Dr. Jean-Martin Laberge was invited toattend the "6' Journee deMedecine Foetale" in Morzine,France in March. The title of his

address was La Malformation

AdenomatoTde du Poumon: Faut-il

operer si elle est asymptomatique

(Congenital Adenomatoid Lung Malfor-

mation: Is resection warranted when the

patient is asymptomatic). Martin wasalso irivited to attend the first AdvancedPed iatric Lapa roscopy IThoracoscopycourse given at the Center for Minimal Ac-cess Surgery in Hamilton, Ontario. Dr.Laberge is part of the "National Faculty"of the CMAS and he presented a paperentitled Laparoscopic approach to the

recto-urethral fistula in high imperforate

anus. He also became a member of theSociety of University Surgeons this year.

Dr. Richard G. Margolese of the JGHhas been presented with the R.M. Taylormedal and award. This award is given bythe Canadian Cancer Society (CCS) andthe National Cancer Insti-tute of Canada (NCIC) torecognize a person's con-tribution to cancer control.Dr. Margolese is recognized asa leader in cancer control andresearch in Canada.

Dr. Jonathan L. Meakins has beennamed President of the International Fed-eration of Surgical Colleges. He was in-augurated in this position in Berlin at ameeting of the German Surgical Societyon May 4th.

THE SQUARE...z

!::16

Dr. Peter Metrakos has been awarded aresearch grant from The KidneyFoundation of Canada enti-tled Expanding the Kidney

Donor Pool: Use of Pulsatile

Perfusion for the Evaluation of

Extended Criteria Cadaveric Kid-

ney Donors.

Dr. A. Robin Poole, Director of the JointDiseases Laboratory at the Shriner's Hos-pital for Children, happily has had his re-search grants from the National Institutesof Health and the Medical ResearchCoun-cil renewed, each for periods of five years.Since last summer, Dr. Poole has been in-vited to speak at a number of confer-ences: At the British Connective TissueSociety Conference in Aberdeen, Scotlandin September on Cartilage Turnover; theEuropean Respiratory Society Congress inMadrid in October on Mechanisms of

Lung Damage; Southeastern Inflamma-tion Research Association Conference inHot Springs, Virginia in November on Bio-markers for Arthritis; the Novartis Sympo-sium on Skeletogenesis in November onCartilage Resorption in Skeletogenesis;

and on Cartilage Ageing and the Develop-

ment of Arthritis. He also co-chaired aSymposium on Gene Therapy at theAmerican College of Rheumatology inBoston in November. Robin was a speakerat a Symposium on Pathophysiology ofOsteoarthritis and at the InternationalRheumatology Symposium in Kobe,Japanin March on Collagenase and Cartilage

Erosion in Arthritis. He co-chaired a spe-cial session on Cartilage Degradation atthe Orthopaedic Research Society inMarch in Orlando, Florida. Dr. Poole hasre-joined the Dental Sciences ResearchGrants Review Committee of the MedicalResearch Council of Canada. Further, hehad two papers published in March whichidentify the principle protease that de-grades cartilage collagen in articular car-tilage in health and arthritis ascollagenase-3. This is the protease usedto remodel cartilage in endochondral os-sification in growth and frac- ~

~ ture repair. It is also used bysome tumors to invade tissues. This dis-covery provides a therapeutic target forthe treatment of cartilage damage inarthritis. These studies represent a col-laboration with Drs. Michael Tanzerand David Zukor in Orthopaedics.

Dr. Lawrence Rosenberg is the recipi-ent of research grants from the Canadian

Diabetes Association and the Juve-nile Diabetes Foundation Inter-national. He was a visitingprofessor at the University ofPittsburgh. At the annual meet-

ing of the American Society ofTransplant Surgeons, he presented twopapers with Dr. Steve Paraskevas andDr. Rennian Wang entitled TacrolimusMediates Islet Cell Survival In Vitro: A Rolefor Calcineurin Inhibition During Isolationand Insulin-like Growth Factors PromoteIslet Cell Survival In Vitro Through MAP Ki-nase Mediated Signaling. He also pre-sented a paper with Dr. ArchanaRamaswamy and Dr. Rea Brown enti-tled Outcome of Acute Pancreatitis: 47

Yearsof Management at a University Hos-pital at the annual meeting of the Soci-ety for Surgery of the Alimentary Tract.At the Sixth World Biomaterials Congress,he presented a paper entitled Develop-ment of Artificially Vascularized TissueScaffolds for Islet Cell Transplantation.

Dr. Gaston Schwarz was theguest speaker of the Mexican So-

ciety of Plastic Surgery at their an-nual meeting in Mazatlan, Mexico

in February.

Dr. Dominique Shum- Tim wasawarded an operating grant for threeyears from the Heart and Stroke Founda-tion of Quebec for his research project en-titled Cardiopulmonary BypassManagement and Brain Protection in Pedi-atric Cardiac Surgery. Dominique is alsoone of the winners of the Jonathan BailonAward. This prize is given to the researcherwho has obtained the highest rate for afirst grand-in-aid application at the Heart

and Stroke Foundation of Quebec.

Dr. Judith Trudel, General Surgery Pro-gram Director, has been awarded a$13,000. education researchgrant from the Royal BankTeaching and LearningImprovement Fund to de-velop and interactive (D-

ROM based curriculum toteach surgical skills to surgical residents.Co-investigators are Drs. KevinLachapelle (Cardiothoracic Surgery) andPierre Guy (Orthopedics).

AchievementsResidents andFellows. /J./'J,Dr. Majeed AHaqi (R·2 - (.;j'Plastics) and Nourah AI-Sulaili ~(R-2- Dermatology) ae pleased to announcethe birth of their baby girl named Farahweighing 3 kg on June 5that 4:20 A.M.

Dr. loana Bratu presented an article atThe Society of University Surgeons in Feb-ruary. Her abstract was entitled Surfac-tant Levels After Reversible Fetal TrachealOcclusion And Prenatal Steroids In Congen-ital Diaphragmatic Hernia. In Toronto inMay at a meeting of the American ThoracicSociety International Conference, she helda poster presentation entitled PulmonaryArtery Remodeling After Reversible TrachealOcclusion and Prenatal Steroids In Di-aphragmatic Hernia.

Dr. Edgar Chedrawy was awarded theBigelow prize at the Terrence Donnelly Car-diac Residents' Research Day held on May26th and 27th in Toronto. The topic of histalk was entitled Myocardial Tissue-Engi-neering: Mesenchymal Stem Cell Transplan-tation for Myocardial Regeneration.

Dr. Stephen Korkola held a poster pre-sentation at the Society of Thoracic Sur-

THE SQUARE:i~17

geons meeting in February in Fort Laud-erdale, Florida on Mechanical (Needle)Transmyocardial Revascularization Im-proves Blood Flow to Ischemic My-ocardium Following Angiogenic Stimulus.

Congratulations to Dr. Laurie Morrisonon her wedding to Vincent Cochran onApril 25th in New Orleanswhere they met five years ago. ~Laurie is just finishing her Vas- •cular Surgery Fellowship. ~

On December 27th, £~~j1999, Dr. Andreas .~.Nikolis (R-4 in GeneralSurgery) and Dr. Stavroula Christopou-los (R-1 in Internal Medicine) were en-gaged to be married. Andreas surprisedStavroula by proposing on an electronicbillboard in downtown Montreal. Specta-tors described the event as a very quietand personal engagement. The televisioncrews agreed.

Congratulations to Dr. Marc Pelletierand his wife Missy who are the proudparents of a son, Robert, born in April, abrother for Will.

Dr. Pascale Prasil is completing her2-year training in Pediatric GeneralSurgery at the Montreal Children's Hospi-tal in June 2000. Upon graduating, shehas a position on staff at the CHUL,whichis part of the Centre Hospitalier Universi-taire de Quebec, where she had done herGeneral Surgery training. Pascale enjoysplaying the piano, travelling, movies,horseback riding and scuba diving.

Dr. Patrick Robinson and his wifer:. Marie-Josee Larue are the proud

U<J) ~ parents of Philippe Charles, bornIJ V May 1st at the RVH. Baby weighedJJ 6 Ibs 13 oz.

(Dr. Abdulrahman J. Sabbagh

(R1-NS) and his wife,Alaa M.Arafah meritour best wishes on the birth of theirdaughter, Leen Sabbagh on March 4th.•

fOM

THE SQUARE

;!

!:l

0"again, we come to the end of another aca-demic year, capped by a very successful Fraser Gurd Scientific

Day. I would like to take this opportunity to congratulate the

prize winners for a job well

done. First prize was

awarded to Dr. AndrewSeely (Supervisor - Dr. NickChristou) for his paper Dif-

ferential Alteration of Neutrophil Chemoattractant Receptors InVivo Regulates Human Neutrophil Chemotaxis. Second place

prizes were awarded to Dr. Jose L. Pascual (Supervisor - Dr.Nick Christou) for his paper entitled Hypertonic Saline-Resus-citation from Hemorrhagic Shock Results in Diminished Interac-tions Between PMNs and Endothelium In-Vivo; and to S. Nguyen(Supervisor - Dr. Denise Arsenault) for a paper entitled Se-lective Incorporation of Osteopontin into Calcium Oxalate CrystalsPrecipitated from Human Urine. It was the feeling of those in

attendance that the quality of the scientific work continues to

increase from year to year. This is borne out by the fact that

much of this work will be presented at prestigious national and

international meetings in the year to come.

With respect to the Graduate Program in Experimental Surgery,

The Division of Surgical Research has received University ap-

proval to offer a novel 6 month Diploma Program in Health

Technology Assessment in Surgery. This program, co-ordinated

by Dr. John Sampalis, commences this summer and is de-

signed especially for residents in General Surgery. However,

anyone interested in this program is encouraged to apply. Fur-

ther information can be obtained from myself or Dr.Sampalis.

Division of SurgicalResearch

Finally, I would like to inform you that the Division of Surgical

Research web site is up at: www.surgery-research.mcgill.ca.

Although the site is still under some construction, I would still

encourage you to check it out. We are presently soliciting bi-

ographical material from all scientists and clinician-scientists

in the Department for posting to this site. Each scientist will

be given their own web page within the site to highlight their

research and accomplishments. Material may be sent to me

by mail, fax or e-mail. •

............................................................................................................................. ..

Were You There? - 1962

Eleven former Chairmen of the Post-Graduate Board attend lunch in honour of Mrs. Winifred Rock,Secretary of the Board,on the occasion of her retirement in 7962.

Lt. to Rt.: Drs. Gibson Craig,A.D.Macdonald, John Howlett, Vincent Young,UU. Tidmarsh, J.S.L.Browne, Walter Scriver,J.~. Brabander, F.J.Tweedie,D.O.Munro, R.A.Cleghorn

18

THE SQUARE..z

~

Once againthisyear,it ismypleasu~to re-

port to you the events which transpired on Hingston Day - our

Founder's Day - on May 10th, 2000 at the St. James Club in

Montreal.

the guest speaker. He showed a number of videos in which

he and other doctors were featured performing medical tasks

in different war-torn zones around the world.

Awards were also given to the current physicians who have

arrived at 25 years service to the hospital.

It was my pleasure to perform the duties of Master of

Ceremony .•

Founder's Day at

St. Mary's Hospital

James D. Sullivan, MD, FRCSCOrthopedic Surgeon

The Hingston Award this

year given to the most

deserving physician since

last year's award was be-

stowed upon Dr. George

Fraser, Cardiologist. It was a popular choice judging by the

reaction by the large number of attendees. George was equal

to the task using his born wit to his advantage in his thank

you speech.

i

I

Dr. Fred Wiegand, now retired from our staff and a member

of Les Medecins sans Frontieres, recent Nobel Laureates, was

Dr. Fred Wiegand

Dr. George Fraser

19

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THE SQUARE;21

McGill University Department of Surgery

2000 Graduates

General SurgeryOrthopedic Surgery Cardiothoracic Surgery

Dr. Husain AI-Mutairi Dr. Marc Pelletier Dr. Aayed AI-QahtaniDr. John Borkowski Dr. Abdollah Behzadi

Plastic SurgeryDr. Phillip Downer Dr. Margaret ChenDr. Graham Elder Dr. Zubin Panthaki Dr. Jonathan Fridell

Dr. Kayvan Taghipour-Khiabani Dr. Saundra KayOrthopedic Sports Medicine Dr. Andrea Pusic Dr. Eric KeyserDr. Rashid AI-Shaeel Dr. Eric Labelle

Laparoscopic Surgery Dr. Ayman LinjawiUrology Dr. Liane Feldman Dr. Jose PiresDr. Khalid AI-Othman Dr. Archana Ramaswamy

Paediatric General SurgeryDr. Sylvain Lapierre Dr. Alison RossDr. Daniel Rosenstein Dr. Pascale Prasil Dr. Daniel SwartzDr. Carson Wong

Surgical Oncology Vascular Surgery

Dr. Francine Tremblay Dr. Laurie Morrison

............................•..•...••..•...•..••..•..•..•..................•....•....................•...••....................

Dr. Rea A. Brown Day

In honour of his retirementThursday, November 9,2000We would love to hear what you have been up to!If you would like to be present please RSVPaccordingly.

THE DAYS'S EVENTS INCLUDE

07:45 ......... Grand RoundsVisiting ProfessorOsler Amphitheatre, Montreal General Hospital

08:45 Presentations from Alumni11:30 .Lunch13:30 Presentations from Alumni18:00 Cocktails & Dinner

Hotel Omni Mont-Royal1050 Sherbrooke St. WestMontreal, Quebec H3A 2R6(Cost $100.00 per person)

For further information please contact:Maria Cortese

e-mail: maria.cortese@muhc.mcgill.caTel.: (514) 934-8044Fax: (514) 934-8438

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THE SQUARE..z!a25

Thanks to OurContributors!How often have I heard the phrase in the title

above except with my name rather than Germain's? Over thelast 35 years whenever Germain said something controversial

at a meeting or rounds he began bysaying "My buddy Fox and I" etc. Attimes I was his accomplice, albeitunwillingly, and often cringed inside

at his most outrageous statements. I will admit it has been aprivilege and fun to work in the same department and, forsome time, to share an office with Dr. Germain Houle.

In response to our letter of solicitation, the McGill SurgeryAlumni & Friends has received more than $11 000. The fol-lowing Surgeons have donated $100 or more. The SquareKnot is most grateful!

EOM

My Buddy HouleDr. Shyam N. AgrawalDr. Basil RS Baeta

Dr. Jonathan L. MeakinsDr. Jose Mijangos-Palaez

Dr. John R. MooreDr. Jeffrey BarkunDr. Daniel Benatar Dr. Joel Steven Morris

Dr. David S. MulderGermain came to the Royal Victoria Hospital as a Clinical Fel-low in the Department of Anaesthesia. He is a medical grad-uate of the University of Ottawa who did his residency inDetroit, Michigan. Germain is from Alfred, Ontario, not exactlya metropolis, between Montreal and Ottawa. However, hisachievements have made him widely known throughoutNorth America. To name but a few of his accompiishments,Germain has served in executive positions in the Associationdes Anesthesistes du Quebec and the Canadian Anaesthetists'Society. He was President of the latter organization during1978-1979. He has been Director of Continuing Medical Edu-cation at McGill University and an Examiner for the Royal Col-lege of Physicians and Surgeons. Germain served with theCanadian Medical Protective Association on Advisory and Ed-ucation Committees. He was President of the Academy ofAnesthesiology during 1990-1991.

Dr. Alex BrzezinskiDr. Harvey C. BrownDr. Nicolas Christou

Dr. Jemi OlakDr. Richard O'ConnorDr. Dimitri PetsikasDr. David Clas

Dr.T. Coutsoftides Dr. Neville G. PoyDr. John H. Duff Dr. Lisa Marie Ronback

Dr. lawrence RosenbergDr.Warren SchubertDr. Jorge Schwarz

Dr. Peter M. FeldmanDr. Eric D. FosterDr. Michel GagnerDr. Fivos Gahhos Dr. R. ShortDr. Jacob Garzon Dr. Joseph Stratford

Dr. James F. SymesDr. Andrew B. HillDr. Harry S. Himal Dr. L. Tin

Dr. Abdel-Raouf IsmailDr. M. Ray James

Dr. Ivan M. TomekDr. G.Tremblay

Germain's exuberance and gregariousness have made him the"fun guy" to sit with at parties or , as I learned years ago, an

excellent person withwhom to share an office,and play squash with atthe end of the day. So tomy buddy Houle and hiswife Rose-Marie bestwishes for health andhappiness from the entireDepartment.

Dr. Ahmed JamjoomDr. Howard W. KleinDr. Robert M. levineDr.Walter Lloyd-SmithDr. G.V.A.MacDonaldDr. Lloyd D. MacleanDr. Peter H. Mclean

Dr. Benjamin M. TrippDr. A. Turnbull

Dr.William W. WatsonDr. Marvin J.Wexler

Dr. Frederick M. WiegandDr. Ihor A. Zakaluzny

Editor's Note: Gordy Fox

also has retired. More

about him in a future is-

sue ofTSK. •

j

Dr.Germain Houle & Dr.BruceSmith

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cGILL PARTICIPATES IN THE 18TH

EDITION OF QUEBEC "ENTRETIENS VASCULAIRES"(VASCULAR TOPICS)Held at the Ramada Plaza Hotel in Hull on the 5th and 6

thof May

The Presidents of the

Congress were Dr.

Claude Beaulieu, alecturer in the Depart-

ment of Surgery at

McGill and Dr. Patrice Nault, also a lecturer in our Department

of Surgery, and the Site Director for Vascular Surgery in Hull.

Quebec's

"Entretien vasculaires"

The invited faculty were Dr. Jean Panneton of the Mayo

Clinic, Dr. J. Dennis Baker of UCLA, and Dr. Michele

Casaubon from Paris.

Dr. A. Ramaswamy, R-5 from McGill, along with Dr. Patrice

Nault presented a paper on Duplex per-operatoire [Peroper-ative Duplex Studies}.

Exclusion d'un AAT descendante par endo-prosthee avec repa-ration simultanee d'un anevrisme de I'aorte abdominale par

THE SQUARE

!:l!a27

approche retroperitoneale [Exclusion of Thrombosis of the Ab-dominal Aorta by Retroperitoneal Endo-prosthesis with Simul-taneous Repair of an AAA} was presented by Dr. Laurie

Morrison, Vascular Fellow, Dr. 0.1. Obrand, Dr. O.K. Stein-

metz, Division of Vascular Surgery, McGill.

Outcomes of Ruptured AAA in the Elderly was presented by

Dr. Archana Ramaswamy, PGY-5, General Surgery, McGill.

Risk Factors in the Development of Thromboembolism in Criti-cally Injured Patient was submitted by Dr. A. Nikolis, PGY-5,

General Surgery, McGill, Dr. M. Zerey, PGY-l, General Surgery,

McGill, Dr. J. Sampalis, Ph.D., Dr. R.A. Brown, A.

Christopoulos, Dr. D.S. Mulder. The paper was presented by

Dr. M. Zerey.

In the session entitled "New Technologies in Vascular Surgery';

the following report was well appreciated: Traitement des AAet iliaques par endo-prosthese: resultant de 2 ans d'experience[Treatment of Aortic and Iliac Aneurysms by Endo-prostheses:Result of 2 Years Experience} by Dr. O.K. Steinmetz,

Dr. B. Aljabri, R-2, General Surgery, Dr. L. Morrison, Vascu-

lar Fellow, Dr. B. Montreuil, Dr. 0.1. Obrand, Division of Vas-

cular Surgery, McGill.

Congratulations go to Dr. Marc Zerey who won the Paul

Cartier prize for his presentation as mentioned above. •

...............................................................................................................................

The 25'ers

Four secretaries associated with

the Department of Surgery at

the RVH recently celebrated their

25 years (or more) of service at

the Royal Victoria Hospital. This

photograph was taken at the

RVH secretaries' Annual Get-To-

gether on March 24 organized by

Madeleine Beaulne. All the sec-

retaries had a jolly good time at

a Murder-Mystery Dinner and, as

the hats in the photo attest, got

into the spirit of the mock wed-

ding reception .•

From It. to rt: Rita Mete (SurgicalNursing), LucieFrancoeur (Cardiothoraci( Surgery),Una Musso (PlasticSurgery) and EnniaMulfati (GeneralSurgery)

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LUCIE FRANCOEUR: 25 YEARS WITHTHE CAROIOTHORACIC TEAMThe Division of Cardothoracic Surgery at the RVH held asurprise reception on March 22 in honour of their sec-

retary Lucie Fran-coeur. Not only wasit to celebrate Lucie'sbirthday, but alsoher 25 years withthe Division. Lucie

joined the Division straight out of high school, at thetender age of 17. She has seen many come and go overthe years, but Dr. Jean-E. Morin has benefitted fromLucie's efficient and faithful service from day one... andthey continue their collaboration to this day.•

25 Years With theCardiothoracic Team

THE SQUARE::5':29

From It. to rt.: Dr. TonyDobell, Dr. Kevin Lachapelle, Lucie Francoeur,Dr.Jean-E. Morin .

............................................................................................................................. .

The 10th AnnualMcGill UrologyResearch Day

The 10th Annual McGill Urology Re-search Day was held on April 19,2000 at the Mcintyre Medical build-ing. Our invited guest speaker, Dr.Laurence Klotz, Chief of the Urol-ogy Division at the Sunnybrook &Women's College Health Science

Centre of the University of Toronto gave an excellent talk en-titled Cell Cycle Regulation in Prostate Cancer Progression. Thiswas followed by oral presentations from both residents andgraduate students fromour Division. The winnersof this year's research daywere Mr. Sero Andonian

(supervised by Drs. Armen Aprikian and Simone Cheva-lier); Ms. Linda Lefievre (supervised by Dr. ClaudeGagnon) and Ms. Sandra Nguyen (supervised byDr. Denise Arsenault). Both Ms. Lefii~vre and Nguyen wereselected to present at this year's Fraser Gurd Day.•

Lt. to Rt. Back Row: Dr.Aprikian, Dr. Simon Tanguay (co-organizer of the Research Day) and Mr. Andonian.Front Row: Dr. Gagnon, Dr. Chevalier, Ms. Nguyen, Ms. Lefievre, Dr.Serge Carrier and Dr.Mario Chevrette,

(co-organizer of the Research Day)

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StikemanVisiting Professor

Dr.William A. Baumgartner

JUNE 7-2,2000Or. William A. Baumgartner,Professor of Surgery & CardiacSurgeon-in-Charge at Johns

Hopkins University in Baltimore, was thisyear's Stikeman Visiting Professor for Car-diovascular and Thoracic Surgery at McGillUniversity.

At the MGH Surgical Grand Rounds on Thurs-day morning, Dr. Baumgartner's topic wasRe- tooling Thoradc Surgery Education. Fol-lowing Grand Rounds, laboratory and clinicalresearch presentations were given by resi-dents, staff and alumni. A special session[New Millennium Addresses: A NewBeginning] moderated by Or. Garrett

THE SQUARE..z!:l31

Walsh was given by Or. A.R.C. Oobell on Cardiovascular andThoradc Surgery at McGill: The First Quarter Century, andOr. Ray c.-J. Chiu on The 'Vision' Thing: Past and Future.

In the afternoon at the RVH Rounds, Dr. Baumgartner spokeon Assessing the Impact of Cerebral Injury Following CardiacSurgery: Will Determining the Injury Reduce this Injury.

A banquet was held on Thursday evening in honour of the Vis-iting Professor and the graduating resident at the MountStephen's Club. Drs. Dobell, Walsh and Marc Pelletier, on behalfof the residents, paid homage to the highlights in Dr.Chiu's ca-reer. On Friday morning, more presentations by alumni and res-idents took place at the RVH, followed by a luncheon .•

EKL

...............................................................................................................................

Surgical Theatre at the MGH, late 1800's

~KNOT

"'-I

«(Y")

=>aV>

THE SQUARE KNOT strives very hard to keep its Address Listof Surgical Alumni, current Attending Staff, Residents and Fel-lows up-to-date. But after the mailing of every issue, some

~

~ are returned to us "Address Unknown - Return to Sender".L!' When we look at the Canadian Medical Directory or the List

~ of Fellows of the American Col-Return to Sender lege, the addresses given are

Add U k the same as the ones we used.ress n nownIf you are going to move or if

you have already moved, please send us your new address.We are missing the addresses of some alumni who have ac-tually written to us to tell us how much they enjoy readingThe Square Knot. Please help us find the following:

Emma Lis;

Dr. Z. Arekat (General Surgery)Dr. Ram Aribindi (Orthopedics)Dr. Michel Bazinet (Urology)Dr. R. Bend-Jabal

Dr. Richard Berkowitz (Orthopedics)Dr. L. Bueno & Dr. M.Bueno (Plastic)Dr. Shayne Burwell (Plastic)Dr.W.E. Collins

Dr. D.Deforno

Dr. Irwin Paul Enker (Orthopedics)Dr.Jose Espinosa-Sedda (Neurosurgery)Dr. J. Fleming (General Surgery)Dr. Bryant Joseph Gilot

Dr. Jonathan D.Glassman (Orthopedics)Dr.Mark Healey (General Surgery)Dr. CT. Ho

DI·. Tom Konowalchuk (Urology)Dr. Robert S. Kurtz (Pediatric Surgery)Dr. Marc Lanser (General Surgery)Dr. Ronald R. Lett (General Surgery)Dr. Shaun MacDonald (Vascular)Dr. Paul Manner (Orthopedics)Dr. Michael 'Munz (Neurosurgery)Dr. Ian Richard Neilson (Pediatric Surgery)Dr.Vincent A. Piccione, Jr.

Dr. Mark Preul (Neurosurgery)Dr.Wadi Bin Saddiq (General Surgery)Dr. S.M. Strasberg

Dr. J. Tarbet

Dr. D.C.Wood (General Surgery)

THE SQUARE..z2

33

~

Even the Medical~ ~ Record Room

1) Can be Funny!

1& The lab test indicated abnormal lover function.

1& The baby was delivered, the cord clamped and cut, and handedto the pediatrician, who breathed and cried immediately.

1& Exam of genitalia reveals that he is circus sized.

1& The skin was moist and dry.

1& Rectal exam revealed a normal size thyroid,

1& The patient had waffles for breakfast and anorexia for lunch.

1& She stated that she had been constipated for most of herlife until 1989 when she got a divorce.

1& Between you and me, we ought to be able to get this ladypregnant.

1& The patient was in his usual state of good health until hisairplane ran out of gas and crashed.

1& I saw your patient today, who is still under our car for phys-ical therapy.

1& The patient was prepped and raped in the usual manner.

1& Examination reveals a well-developed male laying in bedwith his family in no distress.

1& Patient was alert and unresponsive.

1& When she fainted, her eyes rolled around the room.

1& The patient lives at home with his mother, father, and pet tur-tle, who is presently enrolled in day care three times a week.

1& Bleeding started in the rectal area and continued all theway to Los Angeles.

1& Both breasts are equal and reactive to light and accommo-dation.

1& She is numb from her toes down.

1& Exam of genitalia was completely negative except for theright foot.

1& While in the emergency room, she was examined, x-ratedand sent home.

1& The patient was to have a bowel resection. However, hetook a job as a stockbroker instead.

1& The patient suffers from occasional, constant, infrequentheadaches.

1& Coming from Detroit, this man has no children.

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