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The article focuses on the policy paper "Looking Beyond the Numbers: Planning British Columbia's Physician's Workforce," released by the British Columbia Medical Association (BCMA). It emphasizes the need for better coordination in physician workforce planning. It cites the stakeholders influencing physician resource planning, including the provincial government, health authorities and universities. The recommendations given by the paper include the establishment of a provincial committee.

The article deals with the policy paper submitted by the British Columbia Medical Association (BCMA) to the government which includes recommendations for addressing the challenges facing the British Columbia health care system.

Background: Family physicians with enhanced surgical skills/obstetric surgical skills contribute significantly to surgical care delivery in rural British Columbia. This environmental scan documents their practice locations and procedural scope. Methods: Practice locations of enhanced surgical skills physicians/obstetric surgical skills physicians were identified using public data and professional networks. These data were collected between January 2022 and April 2023. Numbers of surgical procedures performed were determined using MSP billing data for fiscal year 2021-2022. Results: Overall, 11 enhanced surgical skills physicians and 21 obstetric surgical skills physicians were practising in 17 of the 45 rural communities. Five communities had enhanced surgical skills physicians/obstetric surgical skills physicians as the sole surgical providers. Common procedures billed by these physicians included colonoscopies (n = 559), C-sections (n = 404), and inguinal/femoral hernia repairs (n = 52). Conclusions: A number of family physicians provide core surgical services in rural BC, sometimes as the only surgical providers at their hospital. Despite the limitations of the data collected, due mostly to a high turnover of surgical providers in rural sites, our study shows that enhanced surgical skills physicians and obstetric surgical skills physicians are integral to the well-being of rural patients and the health care systems they access. Concerted efforts should be made to recruit and retain these key surgical providers in our province. [ABSTRACT FROM AUTHOR]

The author reflects on the challenges and accomplishments in the medical sector in British Columbia in 2011 and offers an outlook for 2012. He mentions the negotiation in 2011 to renew the Physician Master Agreement. He cites the release of the policy papers "Enhancing Surgical Care in BC: Improving Perioperative Quality, Efficiency, and Access" and "Planning British Columbia's Physician Workforce." He anticipates new programs for physicians, patients and the health care system.

The article focuses on the policy paper "Enhancing Surgical Care in BC: Improving Perioperative Quality, Efficiency and Access," released by the Council on Health and Economic Policy (CHEP) of the British Columbia Medical Association (BCMA). It cites the topics covered by the paper such as preoperative preparation of the patient, operating room scheduling and start time. It explains the importance of the association between quality and efficiency.

Background: In British Columbia, a significant proportion of children with neurodevelopmental disorders are unable to access recommended medical investigations/assessments due to behavioral complexity such as aggression and self-injury; consequently, examinations/investigations under anesthesia are often required. However, difficulties in coordination result in fragmented and traumatic service provision. Methods: Within a larger quality improvement project, an initial chart review of patients aged 2 to 18 years who underwent anesthesia at BC Children's Hospital was conducted to describe the current state of sedation in children with behavioral complexity. Patients were identified from the operating room slate for a randomly selected week in January 2021. Results: Seventeen percent of patients (31/185) who accessed the operating room during the review period met the criteria for behavioral complexity. Of these, 16% received an add-on procedure in the operating room. Fifty-two percent of patients had not had any blood work done for at least 1 year before the date of their procedure. Conclusions: It was impossible to efficiently characterize all missed opportunities to conduct physical examinations and medical assessments of children with behavioral complexity who are seen at BC Children's Hospital for sedated procedures, which highlights significant gaps in care optimization for these patients. [ABSTRACT FROM AUTHOR]

The author discusses the consultation paper under the medical association Doctors of BC focusing on governance structure and processes. He encourages members to provide feedback on the alternatives presented in the board structure focusing on a single governing body , or a dual formation with a board and a representative group. He also explains an overview of the current management composed of elected medical practitioners representing geography and practices.

The author provides his views on physician-assisted death in British Columbia. Issues raised include the promotion of advance care planning by the Doctors of BC, the organization's policy paper "It's Time to Talk: Advance Care Planning in British Columbia," and the advantages of having an end-of-life plan.

Background: Publicly funded telephone interpretation for family physicians in British Columbia has been available since 2017 through Provincial Language Services. However, there has been no published literature on its usage. Methods: We performed a quantitative and descriptive analysis of data from Provincial Language Services for all users who accessed telephone interpretation through the Primary Care Telephone Interpreting Service Pilot Project from 2017 to 2020. These data were then compared with publicly available data on populations and physicians in BC. Results: Of 23 484 interpreted telephone calls between November 2017 and December 2020, most (86%) were made in Vancouver. Arabic and Farsi represented 58% of all calls. There were 15.1 calls per 100 people with limited English proficiency during the study period. Average call duration was 21 minutes (range 1 to 266). Monthly usage increased from 164 calls in November 2017 to 927 calls in December 2020. In 2020, an estimated 1.9% of primary care visits involving language barriers used telephone interpretation. Conclusions: Uptake of interpretation services has increased but remains low among BC family physicians; barriers to this should be explored. [ABSTRACT FROM AUTHOR]

Background: Inhaler therapy is a cornerstone treatment for asthma and chronic obstructive pulmonary disease. Propellants used in pressurized metered-dose inhalers contain potent greenhouse gases that contribute to climate change. Dry powder inhalers and soft mist inhalers do not use propellants and have a lower carbon footprint. Methods: We conducted a retrospective longitudinal analysis of community-dispensed inhaler prescriptions in the Fraser Health region in British Columbia from 2016 to 2021 and calculated the resulting carbon footprint. We modeled three scenarios for switching inhalers to lower-carbon alternatives. Results: The average annual carbon footprint of inhalers was 8478 tonnes of CO2 equivalent (tCO2e), which was 21.8% of the reported total emissions from Fraser Health facilities. Different prescribing scenarios for inhalers can eliminate 1217 to 6607 tCO2e annually. Conclusions: Encouraging switches to lowcarbon inhalers offers an opportunity to reduce health care-associated carbon emissions and potentially improve respiratory care. [ABSTRACT FROM AUTHOR]

The article discusses WorkSafeBC's policy on inguinal hernia claims. The policy limits the postoperative wage loss to 42 calendar days unless there are complications. In 2004, a paper issued by WorkSafeBC's Evidence Based Practice Group claims postoperative convalescence and return to work usually occurred in less than 42 says. WorkSafeBC is working with the British Columbia Medical Association on addressing the discrepancy between expected and actual convalescence period for injured workers.

The article discusses partnership between physicians and family caregivers in the delivery of quality health care to patients in British Columbia.

The article discusses the effect that the electronic medical record (EMR) has on the patient care, finances, professional satisfaction and retirement planning of several general physicians (GP) in British Columbia. As stated, Geoff Edwards achieved his goals of increased efficiency and improved patient care quality at his Vancouver office with EMR. Some benefits of the EMR to Doctors Walter Chow and Anthony Yue are better patient care, increased income and efficiency.

Background: Sustainable Childhood Obesity Prevention Through Community Engagement is an initiative that engages stakeholders across multiple sectors to promote the Live-5-2-1-0 message (5 vegetables and fruits, 2 hours at most of recreational screen time, 1 hour of physical activity, 0 sugar-sweetened beverages each day) and implement action to support healthy behaviors. As part of this initiative, an intervention using the Live 5-2- 1-0 Toolkit for family physicians (FPs) was piloted in two communities. This study aimed to identify barriers and aids to toolkit implementation, and to determine whether the toolkit improves physicians' capacity to promote healthy childhood behaviors. Methods: FPs completed preintervention and postintervention surveys and participated in semistructured interviews after implementation of the Live 5-2-1-0 Toolkit intervention. Implementation occurred sequentially in two communities and involved a total of 21 FPs in six primary care clinics. Descriptive statistics were used for quantitative data, and content analysis was used for qualitative data. Results: Of the 21 participating FPs, 14 completed the preintervention and the postintervention surveys (67%) and 7 completed the preintervention survey only (33%). FPs reported increased knowledge of medical evaluation of pediatric patients with obesity (from 14% preintervention to 36% postintervention), behavioral goal setting (from 36% to 93%), and motivational interviewing (from 57% to 79%). FPs' perceived efficacy in addressing the subject of weight improved (from 43% preintervention to 93% postintervention). Increases were also observed in routinely addressing nutrition (from 43% preintervention to 79% postintervention), physical activity (from 50% to 79%), screen time (from 14% to 64%), and sugar-sweetened beverage consumption (from 29% to 71%). As a result of toolkit implementation, 71% of FPs felt their patients were more aware of long-term complications related to lifestyle, 64% felt patients were more willing to set behavioral goals with providers, and 50% felt patients were more able to selfmanage issues related to lifestyle. The predominant barrier to implementation was lack of staff/clinic capacity to measure BMI; the most noted aid to implementation was access to ready-to-use Live 5-2-1-0 resources. Conclusions: The Live 5-2-1-0 Toolkit facilitated health promotion to pediatric patients in the primary care setting. Increasing routine BMI measurement in primary care remains challenging due to clinical capacity issues. Results of this pilot study will be used to refine the toolkit prior to wider dissemination across British Columbia. [ABSTRACT FROM AUTHOR]

Mr Ronnie Grigg has been a longtime harm reduction worker in the Vancouver Downtown Eastside and is currently general manager of the Vancouver Overdose Prevention Society. Located at 58 East Hastings St. in Vancouver, British Columbia. The Vancouver Overdose Prevention Society is a not-for-profit organization that oversees hundreds of consumptions daily. The society began as a tent designated for safe consumption and overdose prevention, and was one of the initial communityled responses to the opioid crisis in British Columbia. In 2017, its peer workers--all individuals from the Downtown Eastside community--oversaw more than 100 000 visits to the site, responded to 417 overdoses, and recorded zero deaths. In mid- September 2018, I interviewed Mr Grigg about his experiences in harm reduction and innovations such as the society that arose in response to the opioid crisis. In this interview Mr Grigg describes his experiences as a front-line harm reduction worker during the crisis, his perspectives on the role of overdose prevention sites as an integral component of the health care system, and the need for increased support of the peer workers who staff these sites. [ABSTRACT FROM AUTHOR]

British Columbia's primary care landscape is increasingly focused on using blended virtual teams to coordinate and integrate patient journeys. Simply bringing multidisciplinary colleagues together does not guarantee effective team communication. With potentially depersonalized remote working environments, physicians need tools to support collaboration and enable staff to achieve a shared vision. Adapting daily huddle practices by using visual management tools during the CoVID-19 pandemic has the potential to unite primary care staff. Reflecting on practice changes in my local clinical context, huddling has improved patient safety behaviors, job satisfaction, and leadership perception. Contextually targeted huddles are vital because there is no single approach that best suits all disciplines, rosters, and teams. Ideal huddle length, timing, and content must be adaptive and are of increasing importance due to the accelerated pace of health care change. [ABSTRACT FROM AUTHOR]

The article discusses the accomplishments by the Doctors of BC' Council on Health Promotion (COHP) in British Columbia's (BC) for 2014. Topics covered include the group's creation of the website OpenMindBC.ca, the fifth annual Walk With Your Doc event, and a number of resolutions developed by the Environmental Health Committee that are now both Doctors of BC and Canadian Medical Association (CMA) policy.

The article discusses highlights of the Doctors of BC Annual Meeting held at Pan Pacific Hotel in Vancouver, British Columbia on June 4, 2016.

Simulation-based training has had positive impacts on safety and efficiency in a number of industries, including aviation, and is now being applied to education for health care professionals. Simulation can involve a person, a device, or set of conditions, and permits repetitive practice of skills to a prescribed level of proficiency in a riskfree environment. The debriefing step at the conclusion of any simulation activity allows trainees to clarify and consolidate the insights and lessons learned from the experience. As well as task training, skills training, and procedure training, simulation can be used to provide errorresponse and group training for the high-reliability teams working in the operating room, emergency room, and intensive care unit. Globally, simulation is fast being incorporated into professional assessment and programs for maintenance of certification. Such programs may become more efficient with the use of crowdsourcing to evaluate video-recorded performance of procedures. Next steps may be to link assessments from performance evaluation systems that rely on crowdsourcing to clinical outcomes, and to use these systems to evaluate nontechnical skills such as communication for health care professionals and teams. In BC the Provincial Simulation Coordination Committee works with health authorities and postsecondary institutions to advance the development of simulation education through an integrated approach that improves access to facilities, technologies, and resources. [ABSTRACT FROM AUTHOR]

An interview with Dr. Charles Webb, president of the medical association Doctors of BC, is presented. When asked about memories in South Africa, he mentions creating electronic equipment with his grandfather, and spending holidays in St. Francis Bay. He explains his experience with multi-disciplinary care focusing on the province-wide initiative A GP For Me. He shares his accomplishments which include being Head of Anesthesia at the Creston Valley Hospital, and chair of the General Assembly.

A calendar of events for the medical sector in British Columbia is presented including the Colorectal Cancer Community Workshops, Prison Health Sessions and the Ovarian Cancer Workshops.

This article announces that the British Columbia Medical Association received the 2012 Dr. Nancy Hall Public Policy Leadership Award of Merit from the Canadian Mental Health Association British Columbia Division.

A calendar of events related to the medical sector in British Columbia (BC) in Canada is presented, including the continuing medical education (CME) cruise destinations from Sea Courses Cruises, the General Practitioner in Oncology training program from the BC Cancer Agency's Family Practice Oncology Network and the Forensic Psychiatry Conference.

Background: Between 2004 and 2007 the number of CT and MRI examinations per 1000 people in BC increased by approximately 50%, a finding that raised concerns about the appropriateness of the examinations. To address these concerns, the BC Ministry of Health commissioned a study of requests for CT and MRI in all health regions. Methods: An independent company considered expert in analyzing medical imaging data was contracted to assess 2000 randomly selected CT and MRI requisitions issued across BC between 2010 and 2011. The requisitions were analyzed using a five-point rating scale for appropriateness that was based on the Canadian Association of Radiologists guidelines and a meta-analysis of other guidelines. A computer program rated each requisition according to the appropriateness scale. Subsequently, a subset of the requisitions was reanalyzed by two independent reviewers. Results: In the computer analysis, 2% of the requisitions were rated "inappropriate," while 46% were rated "indeterminate" because the computer program was not able to interpret the written portion of a significant number of requisitions. However, the two independent reviewers encountered no difficulties in assessing the appropriateness of each requisition in the data subset and found that only a small number of examinations were "indeterminate" and none were "inappropriate." Conclusions: The results suggest that physicians in all regions of BC are requesting CT and MRI in compliance with established guidelines. In the computer analysis, CT and MRI orders rated "inappropriate" amounted to only 2% of all examinations, a figure considerably lower than an often quoted but poorly substantiated 30%. While the level of appropriateness found in BC orders for CT and MRI is acceptable, continued monitoring is needed and would be facilitated by the use of computerized physician order entry. [ABSTRACT FROM AUTHOR]

Several recent collaborations between correctional facilities and community health organizations and community education organizations have enabled incarcerated women to access health and education programs that are also available in the community. In addition, health educational programs initiated by incarcerated women themselves illustrate that incarceration provides opportunities to engage hard-to-reach women in health and educational community-based programs with potential long-term healing benefits. [ABSTRACT FROM AUTHOR]

When looking for ways to improve the health of incarcerated women in BC, lessons can be learned from Nova Scotia, where the provincial Ministry of Health is responsible for delivering health care to provincial inmates, and from research undertaken through the WHO Health in Prisons Programme. These lessons include recognizing that incarcerated women have different needs than male inmates and that more needs to be done to address gender inequalities in prison services. [ABSTRACT FROM AUTHOR]

The article urges physicians across British Columbia to participate in the British Columbia Patient Safety and Quality Council's National Surgical Quality Improvement Program.

The article deals with the survey of general practitioners and specialists across British Columbia initiated by the British Columbia Medical Association's Specialist Services Committee in fall 2011.

A calendar of events of interest to medical personnel in British Columbia is presented, including the free HIV testing workshops in Vancouver, the 6th Annual Pacific Psychopharmacology conference and the 13th Annual WorkSafeBC Physician Education Conference.

An interview with Shelley Ross, president of the British Columbia Medical Association (BCMA) for 2012-2013, is presented. She shares that she wants female physicians to get involve in leaderships and she hopes to be a role model for them. She explains why she decided to close her practice after taking on the presidency role at the BCMA. She relates one of the highlights of her career as a physician.

This section offers news briefs from the medical sector of Canada. It outlines the average clinical payments of Canadian physicians in 2010-2011. It reports that the people of British Columbia are facing a 415 billion Canadian dollar tax bill due to increased care costs over the next 50 years to provide care for aging baby boomers. It discusses a study by the University of British Columbia which revealed that body language can indicate whether an alcoholic will relapse.

The article presents new guidelines for monitoring blood lead levels in British Columbia.

The authors respond to a commentary to their article on the privileging project in the health care system in British Columbia. They argue that implementing the privileging project will allow physicians to voice-out the support they need in clinical practice. They also explain the difference between currency and competency.

The article offers ideas on how to make the provincial Privileging Standards Project in British Columbia relevant and effective. It explains the association between privileging and competency, as well as the possible consequences of using volume thresholds as currency and competency markers. The author argues that a privileging project for diagnostic imaging problem will not be effective to generalist rural medicine.

The article deals with the progress in the use of electronic medical records (EMR) in British Columbia (BC). It was noted that almost 65% eligible physicians have adopted an EMR in their practice in BC. The reasons for the variation in the level of effective EMR use are cited including an individual's basic computer and typing skills and quality of training. Also noted is the support of the Physician Information Technology Office (PITO) for EMR use.

The article reports on cases of agranulocytosis or neutropenia arising from the use of cocaine containing levamisole in British Columbia (BC). It reveals the investigations by the BC Centre for Disease Control (BCCDC) on genetic markers and behavioral risk factors for the development of levamisole-associated neutropenia from patients who fill up questionnaires and provide saliva samples for genetic-marker analysis. It enjoins physicians who suspect agranulocytosis caused by cocaine with levamisole in their patients to report to the BCCDC.

The article discuses the on-site billing audit process of the Billing Integrity Program (BIP) in British Columbia, which includes examining the clinical records and Medical Services Plan (MSP) billings, and discussing preliminary findings with the auditee.

The article reports on the use of electronic medical records (EMR) in British Columbia (BC). 80% of target family physicians and medical specialists in BC is now utilizing EMR and 85% of medical practices is now in the implementation process. EMR produce better patient data and make physicians perform efficiently.

The author comments on the Statement of Expectations (SOE) sent by a health authority to physicians in British Columbia. According to the cover letter that accompanies the document, the SOE will help develop true partnership between physicians and the health authority. The author criticizes the document for advising physicians to send response to the credential office.

The author reflects on Christmas traditions in her family and her practice of family medicine in British Columbia. For more than 30 years, the author partake in the tradition of checking on the newborn babies in the nursery during Christmas morning. The author describes how her family traditionally spend Christmas day. She concludes that Christmas traditions are an important element of the family fabric.