President’s Pen: A Final Word

After decades of administrative service and leadership, Dr. Don Milliken has stepped down as the President of the South Island MSA.  Here are his thoughts, as presented at last week’s AGM:

After three years as the President of the South Island Medical Staff Association, I am even more convinced of its value both to the individual physician and our patients’ clinical care by comparison to when I started. A physician can walk into the hospital, see a patient, do their stuff, and walk out again. For those of us who do it as a profession, this is not entirely satisfying. We are more than widget-makers. We wish to do a good job, but we also want to improve the work that we do. Covid highlighted this: the work could not be done in the same routine as before. Physicians had to self-organize and do things differently for the safety of themselves and the patients.

From time immemorial, every hospital organization has needed input and direction from its medical staff. This requirement is laid out quite specifically in the Bylaws, which exist in similar forms throughout BC. Good clinical care cannot exist if physicians behave as widget makers; we all must contribute to improving care both through departmental and Medical Staff Association activities. Our colleagues in Nanaimo, through their MSA, changed the trajectory of iHealth for the better, and we here in the South Island will benefit. Similarly, the physicians of the Royal Jubilee and Victoria General Hospitals have made contributions to clinical care locally, throughout the island, and indeed throughout the province, as documented in our Storybook distributed with this meeting. I encourage everyone to read it.

Covid-19.

 We are lucky. Epidemics occur regularly throughout the world, and, indeed, without vaccination, many more infectious diseases would be endemic within our society or have much more fatal outcomes.

As a child, I can remember the fear of poliomyelitis. As a medical student, I can vaguely remember the effect influenza introduced to care homes before successful vaccines were available. As an internal medicine resident in 1969, I can remember working on the “iron-lung” unit at the University of Alberta Hospital with patients who had been in their iron lungs since the epidemic of 1953.

Covid-19 has come as both a shock and a wake-up call to our healthcare system, highlighting the lack of attention to public health preparation and the complete lack of surge capacity in our systems. In the first weeks, your MSA repurposed many of the funds available for FEI initiatives to projects to support physicians and fellow healthcare workers in improving safety and care for patients. Physicians not in administrative roles were partly compensated for spending the needed time in clinical planning or simulations of procedures that suddenly would become high-risk in the new Covid environment. Although we allocated $184,000, not everyone got paid for everything they did, even with this amount. Your Executive established a decision-making process, published on our website, that prioritized activities that kept physicians and patients safe, focusing on those departments or subgroups that were more at risk. We emphasized FF and non-contract docs, as some physicians on APP’s could flex their work with less income loss or had “surge” contract changes.

We were very transparent in what we did, giving reasons for each acceptance or refusal. Some understandably were disappointed when we said there were other priorities. Nevertheless, it was very gratifying to experience the level of support that this process engendered amongst our colleagues. Indeed, my concern has been that some people did not put themselves forward as clearly as they should; my personal belief is that a significant amount of the medical staff contribution to our organizational preparedness remains unrecognized, independent of any discussion about compensation.

Some members of the medical staff regularly refuse to pay their annual dues. In this Covid crisis, the Executive decided that every physician – dues-paying or not — would be eligible for these funds. The crisis affected us all, and one person’s skills or training could change the risk for the colleague standing next to him or her. Getting everyone working together was the right thing to do, regardless of whether the individual physician had also fulfilled their responsibilities. (As an aside, it is interesting to note that some colleagues who make the most use of the hospital facilities, and indeed, requested significant support are amongst those who regularly refuse their dues.)

Projects.

Under the auspices of a Working Group chaired by John Galbraith, we have completed over 1XX projects over the past three years, as seen in the attached Storybook.  These have encompassed a wide variety of activities: evaluating waiting times in the ER, same day arthroplasty, multiple care pathways and order sets including those used Island-wide for the admission of patients with Covid, neurological symptoms including spasticity, complex regional pain syndrome, establishing a protocol for MAiD and initial funding for the idea for the Hospital at Home project, to name just a few. Over the years, we have developed a support team to allow physicians to focus on the work’s clinical aspects while our team supports them with the administrative components. Colleagues who participate in these activities find them consistently rewarding and feel that they are making a difference. When I look at the overall picture, we create real suggestions to bend healthcare costs while improving patient care time. We must be enormously proud of our colleagues.

This organization allows us to be nimble in trying to float ideas and initiate funding. This process also means that some proposals are not successful. One of my original ideas — to restore using the Doctors’ Lounges in our two hospitals – was a resounding failure. However, the cost was not high; even though it did not work, it was worthwhile to learn from it. This openness has been the working group’s attitude, and we encourage people to come forward with their ideas, and if we can make it work, we will do so.

Advocacy for Individuals and Groups.

There are two components to the type of advocacy in which the MSA is supposed to engage.

First, the MSA is supposed to be notified if an individual member is subject to any form of disciplinary action. We have to inform that member of the rights under the bylaws. If the matter is serious, we refer to the CMPA. For less severe issues, we have offered support to individual members who are meeting with various administrative staff when they want to have a “friendly face” along.

This has been a growth area of our activities in the last few years. It is likely to increase as medical administration, rightly, requires greater rigor in attending to the processes for review laid out in the Bylaws and Rules.

Having participated in several of these myself, I have seen our role as threefold: providing emotional support to the individual physician, acting as an independent, friendly sounding board for any questions the individual physician may have, and also ensuring that fairness is seen to be done in the process.

Special thanks must go to Fred Voon, Catherine Jenkins, and Daisy Dulay for their support in this. Although infrequent, I suspect it will become more common, and, as a colleague put it to me this year, “ You don’t think about the MSA till you really need them.”

The second type of advocacy that we engage in is to make the appropriate administrative bodies, including HAMAC, aware when there are issues of general concern amongst the medical staff generally or discrete subgroups. Nanaimo’s concerns about iHealth was an obvious example. Here in the South Island, MSA representatives took the concerns of members of the Department of Psychiatry to HAMAC when they felt discounted by their senior administration, which were then echoed by colleagues in the Cowichan Valley Comox Valley, and Nanaimo.

This process of advocacy for the individual and commentary on matters of concern to the medical staff generally are so crucial to the Board, responsible for patient care. How can the Board be accountable if it never hears of the squeaks and groans in the system?

iHealth.

When I was elected President, just after the Nanaimo iHealth crisis, I stated that one of my goals was to stay out of the newspapers. Achieving that goal was much helped by the fact that the iHealth expansion to the South Island was put on hold.

In the last two months, this has changed. Your MSA held its first Zoom meeting earlier this month to get the preliminary information about the new process and consider how we can ensure that the process will be successful. We are focused on success both from the practicing clinician’s perspective and from the organization’s perspective. Catherine Jenkins has consented to coordinate our activities as we work our way through the challenges these changes will bring.

Social and wellness activities.

Under the warm leadership of Daisy Dulay, the South Island MSA Physician Wellness and Social Committee offers a range of activities to support physicians’ hearts and minds.  Covid restrictions have prevented this year’s traditional ‘Welcome and Thank You’ celebration of new and retiring members, as well as the popular South Island Physicians Family BBQ, but wellness-related opportunities and connections remain forefront for this committee.  Physician walking groups, Mindful Mondays, communications workshops, as well as a film viewing and discussion have been bridges among members while also providing thoughtful consideration of the needs of the medical staff in this time of limitations.  Daisy is now the Island rep to address the Memorandum of Agreement on Psychological and Physical Safety between the Ministry of Health, Doctors of BC, and the health authority.

Here let me mention the awards that we will present this evening. Your Executive established these to recognize the contributions that colleagues have made to our common good. But we, as individuals, cannot leave this type of recognition to the Executive, or to the Association. If we want to develop a culture that is friendly and supportive, in a large group of 1,200 docs where we often don’t know each other, we must make an effort to individually do it ourselves. How many times in the last week have you said “thanks” to a clinical colleague – physician or other? How many times has someone said “thanks” to you? We all work with patients who really, if we asked them, would rather not have to be seen by us. Who really wants to go to a doctor? They are often grateful for our kindness and care – but how often do we acknowledge that care to our colleagues? We all work in challenging circumstances; saying thanks to one another is essential if we are to prevent stress and burnout. At the risk of sounding preachy, I hope that our awards will encourage others to just say thanks in their day-to-day activities.

The Executive.

Activities like this always are a group effort. I must thank the executive members who do most of the work and yet let me get the credit. First, I must acknowledge the contribution of Sarah Brabant, who first took on the position of Sec.-Treasurer to allow us to have an executive of two. When she left for her maternity leave, I have to thank Parvinder Birdi, who took on the Vice-Presidency, Pat Slobodian, who helped for a crucial eight months,  Fred Voon, who took on the separated position of Treasurer and Kevin Yee, who took on the role of Secretary as well as our initial computer and communications guru. The four of us were then joined by John Galbraith, who took over the chairmanship of the Working Group supervising the projects, and Catherine Jenkins, who not only gives us a female perspective but, as noted above, will be organizing our responses to iHealth. The Executive was also authorized to co-opt another female member to make a total executive of seven – a significant step up from the original group of two – and we were thrilled to be present a much more balanced slate for election.

I want to give a special call-out to Parvinder Birdi, who is stepping down from the Executive at this time. Parvinder came to me early and said, “Don, what can I do to help? Let me do anything for you.” For several years, he has done yeoman service, attending all the meetings of the Legislative committee, going to meetings up-Island to represent us, contributing in many ways, yet always with a self-effacing and humble approach of service to his colleagues. He has my utmost respect and undying gratitude for being the first to step forward. Your association would have foundered if it were not for him.

In addition to the clinical Board of Directors, I must also acknowledge the other group of people who make this organization work. All help us on a part-time basis, fluctuating their time commitment as the occasion demands. First, we have Lillian Fitterer in the Victoria Medical Society office, who, along with Marg Severs, has provided generous support in organizing meeting locations, catering, dues notices, and communications over the last several years. Julia Porter and Stephanie Poirier have been invaluable in managing and keeping track of what goes on at our meetings, as well as keeping our Doctors’ Lounges stocked with reading materials and mid-afternoon snacks.

The project team of Clara Rubincam, Ph.D., and Rita Webb has helped colleagues take ideas and translate them into projects. They have provided administrative support and follow-up and, equally importantly, assist in the write-up so that other medical staff members and our administration can see and acknowledge the contributions that our physicians are making to the healthcare system’s better functioning.

My final acknowledgment must go to Ms. Erica Kjekstad, who has organized me, the Executive, the social and wellness committee, many activities. She has improved our communications. She has done tasks for us at 7:00 in the morning while driving her children to school, has roped her children into helping, and has also been available until 9:00 at night to make this association work. Without her help and contributions, we would not have achieved the successes that we have.

Working with Erica and the team has, for me, served as a paradigm for how healthcare should be organized. Those with clinical expertise should be saying what needs to happen, and those with the administrative skills should then be making those concepts work. I wish that this was the general rule in healthcare!

Every member of the South Island Medical Staff Association owes all these colleagues and administrators an enormous vote of thanks.

Respectfully submitted,

 

A. Donald Milliken

MB, MSHA, FRCPC

President, South Island MSA.

 

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