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Medical Assistance In Dying

Canada’s federal legislation outlining the process and eligibility for medical assistance in dying in Canada received royal assent June 17th.

The College’s Professional Standard Regarding Medical Assistance in Dying has been revised to ensure alignment with Bill C-14 .

Eligible patients will be able to access medical assistance in dying through the Nova Scotia Health Authority. Physicians are asked to contact the College if they require further clarification.

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Peer Review Program: Update

The College’s new Peer Review Program has a quality improvement mandate and includes a direct assessment of process, care and documentation in practice.

The new program asks physicians to reflect on their approach to learning and will be challenged to adopt a quality improvement strategy when planning their professional development. All participants will receive a written report and follow-up telephone call from their peer reviewer.

Phase one of the College’s new Peer Review Program launched on April 22nd with an orientation and training workshop for prospective Peer Reviewers.

Peer reviewers learned how the new program would work. Providing useful and meaningful feedback is an essential part of the peer review program. Dr. Joan Sargeant, Head of Dalhousie University’s Division of Medical Education provided peer reviewers with training on how best to provide effective feedback to physicians.

Post-workshop feedback indicated that enthusiasm for the philosophy and methodology of the new program were high.

Over the next few months, participants will conduct reviews of one another’s practices. This is expected to provide College staff with valuable feedback on the program’s new tools.

Lessons learned through Phase One will be used to further refine the review process prior to launching Phase Two, a limited roll out to provincial Family Physicians, currently planned for late 2016.

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College Council Report – Approved Professional Standards

The College’s governing Council consisting of practising physicians and public members met May 27th and approved the following Professional Standards:

The College Council also endorsed the US Centers for Disease Control and Prevention’s (CDC) Guidelines for Prescribing Opioids for Chronic Pain as best practices for physicians in Nova Scotia.

“The existing threshold dose is 200 milligrams per day of morphine. The CDC guidelines urge caution at doses of 50 milligrams and to avoid doses in excess of 90 milligrams. In essence, this represents a dramatic change, a dramatic reduction in acceptable dosages for chronic non-cancer pain,” said Dr. Gus Grant, Registrar and CEO of the College of Physicians and Surgeons of Nova Scotia.

The College recognizes there will be challenges particularly with tapering dosages of long standing patients. Whenever possible, the College encourages physicians to discuss prescribing with their patients to begin to move long standing patient prescribing into alignment with the guideline.

When first initiating opioid prescribing, the College would encourage physicians to follow practices as set out by the CDC guidelines.

Among the CDC’s 12 recommendations is the promotion of non-pharmacologic and non-opioid therapies as preferred treatments of chronic pain. If a risk-benefit analysis indicates that opioid therapy is appropriate, physicians are advised to prescribe the lowest effective dosage with ongoing reassessment of the patient. Physicians are also cautioned to avoid prescribing opioid pain medication and benzodiazepines concurrently.

“The CDC guidelines, however, are built on a firm foundation of evidence that weighs the benefits of these medications as against the risks,” said Dr. Grant.

The College previously endorsed the Canadian guideline developed by the National Pain Centre at McMaster University. This guideline, published in 2006, is now under revision and the College looks forward to reviewing the refreshed version upon its completion.

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PMP’s Improved Password Reset For E-Access

Effective June 28, 2016, physicians will be able to reset their own e-Access passwords online without having to contact the Prescription Monitoring Program. The Prescription Monitoring Program’s eAccess application will be improved allowing registered users improved functionality. More information is available on the NSPMP website.

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New President

The College of Physicians and Surgeons of Nova Scotia is pleased to announce that Dr. William Stanish of Halifax has been appointed College President for the 2016-2018 term.

Dr. Stanish is an internationally recognized orthopaedic surgeon. His distinguished career includes being named chief medical officer for the Canadian Olympic Team, founder and director of the Orthopaedic and Sports Medicine Clinic of Nova Scotia and a member of the Order of Nova Scotia.

He is currently professor emeritus of surgery at Dalhousie University and holds honourary doctor of laws degrees from St. Francis Xavier University and the University of Prince Edward Island.

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Gold-Headed Cane Recipient

The College of Physicians and Surgeons is pleased to announce Dr. Mandi Irwin as the recipient of the College’s 2015 Gold-Headed Cane Award.

The award recognizes an outstanding community-based physician who exemplifies professionalism in service to their patients, profession and community. The award was presented to Dr. Irwin at the Gold-Headed Cane awards ceremony on May 7th, 2016.

Dr. Mandi Irwin is a family physician whose approach to healthcare has touched many lives in the greater-Halifax area. She currently works at the Dalhousie Family Medicine Teaching Clinic and the Methadone Maintenance Clinic both located in Spryfield, the Rockingstone School Clinic and the Dartmouth General Hospital. Dr. Irwin also provides clinical care at the North and East Preston Medical Clinics and the Halifax Transitional Health Clinic for Refugees. She has been involved with both of these organizations since their inception. In addition, she is the lead physician for Halifax Pride.

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Annual Report

The College’s 2015 Annual Report is available along with the 2015 Financial Statements .

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The College has recently redeveloped its physician search tool . This tool provides the public with information about physicians licensed to practice medicine in Nova Scotia. Physicians may wish to visit the site and review their physician search profile .

The Royal College of Physicians and Surgeons of Canada is currently developing the following resources regarding medical assistance in dying:

  • Two new cases within the College’s bio-ethics curriculum (available this Summer)
  • A workshop for residents, and the update of past bioethics cases due to new legislation (available this Fall)

CMA offers Education on end-of-life care and medical assistance in dying

PMP May 2016 Bulletin

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