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Breast Cancer Screening Update

Yesterday (May 30, 2024), the Canadian Task Force for Preventive Health Care (CTFPHC) released draft guidelines on breast cancer screening for public review. We emphasize these are a draft and part of the CTFPHC’s standard process. Interested parties have a six-week window to comment and suggest amendments. The final guidelines will be released sometime in the future. As such, there is no change to the existing screening program, BreastCheck, in Manitoba.

The CTFPHC undertakes a careful, systematic review to synthesize available research, including a review of over 165 studies, including randomized trials and observational studies, as a basis for their recommendations. You can review the guidelines and supporting material here: Breast Cancer (Update) – Draft Recommendations – Canadian Task Force on Preventive Health Care.

Breast cancer screening has been in the news a lot lately. Advocacy groups have been increasing their pressure for guidelines to expand to include people in their 40s, including the Canadian Cancer Society. The Task Force stopped short in their draft of expanding recommendations to include routine screening for people in their 40s, but did introduce new language saying mammograms should be available to those who have been informed about the benefits and harms of screening.

Some provinces have already introduced self-referral options for this age group or have signaled an intention to work towards a lower age limit in the future. Yesterday, local advocacy groups joined the opposition PC caucus in calling on the NDP government to lower the screening age to 40. Health Minister Uzoma Asagwara responded by reassuring the public that Manitoba is looking seriously at the issue, but also said capacity is a concern. ​“What we don’t want to happen, which we’ve seen in other places, is to expand access to this care and then have the people who are most impacted with not being able to access this care,” they explained.

What should you tell your patients today?

With heightened media coverage, physicians should expect an increase in questions and requests from women in their 40s. It is important to reinforce that guidelines are always being updated based on the latest scientific data and research, and what was in the news was proposed, not final, guidelines. The current guidance from CancerCare Manitoba for physicians is available here. This includes information about risks, and how to request a mammogram depending on where the patient lives. 

As always, if a patient has symptoms, they need to be referred for diagnostic workup. This is a separate issue from screening, which is directed at asymptomatic, average risk women.

What do you think?

The Task Force is requesting feedback on the draft guidelines. You can review the guidelines on their site and take a survey to offer your feedback. 

You can also send your feedback and concerns to us at practiceadvice@​doctorsmanitoba.​ca.

Medical instructors needed

Teaching is more than relaying knowledge; it is inspiring change.

The Max Rady College of Medicine is looking for physicians, particularly generalists in the community, to become Clinical Educators to instruct and inspire medical learners during their first and second years.

No prior teaching experience is required and all materials are provided. The role offers recurring half-day blocks of four hours. Varying schedules or the opportunity to pair up with a colleague are also options to consider. Your role as a Clinical Educator also qualifies for Mainpro+ or MoCOMP credits, and compensation is based on an hourly salary of $170 per hour plus $30 per hour preparation time. 

Becoming a Clinical Educator also offers something more, said UGME’s Associate Dean Jim Butler. ​“It’s the opportunity to try something new, reduce your burnout, give back to others, and improve the quality of education for our new learners.”

While not new to teaching medical learners, Dr. Teresa Wawrykow is an emergency room doctor looking forward to taking on a role as a Clinical Educator.

​“Preparation for each unique encounter, and discussion with learners during the sessions always give me a deeper understanding of the material; I appreciate that this benefits my practice as an emergency physician. The greatest joy for me in teaching is watching learners deepen their comprehension of medicine and witnessing their growth as physicians. Teaching is a fun change from the chaos of the emergency room, and it garners a high level of gratitude from the students.”

Clinical Educators provide students with instruction on the management of patient problems in a variety of care settings. The emphasis will be on interviewing skills, clinical skills and assessment, clinical reasoning, and patient-focused care. Educators facilitate small group sessions and participate in the Clinical Skills Evaluation for OSCE (Objective Structured Clinical Exam) and CCE (Comprehensive Clinical Examination).

Qualifications include having a Doctor of Medicine Degree. A current license with the College of Physicians and Surgeons of Manitoba is preferred.

Apply by June 30 for a September start at bit​.ly/​U​M​C​l​i​n​i​c​a​l​E​d​u​c​ators.

Need more information? Contact Dr. Donna Sutherland at donna.​sutherland@​umanitoba.​ca or Casie Fracz at casie.​fracz@​umanitoba.​ca or call 204−789−3766.

Prescribing Requirement Update

The College of Physicians and Surgeons of Manitoba PSM has updated its Standard of Practice for Prescribing Requirements and the Practice Direction for Electronic Transmission of Prescriptions effective June 1, 2024.

Most notably, CPSM and the College of Pharmacists of Manitoba (CPhM) have authorized operational changes related to the M3P Program. (See Must-Have Information for M3P Prescriptions here.)

1. M3P Prescription Booklets (duplicate pads) will be phased out. 

2. CPSM strongly recommends physicians use M3P Prescription Templates in their practice.

Another notable change is that the practice directions for Facsimile and Electronic Transmission of Prescriptions have been consolidated into one document. This has caused some confusion with members on the impacts on electronically generated signatures. 

We want to emphasize that electronically generated or handwritten prescriptions are acceptable when transmitted:

  • From the prescriber directly to a specific pharmacy via fax,

  • From the prescriber sent via a closed e‑prescribing system to a specific pharmacy, or

  • When handed to a patient to take to a pharmacy of their choice.

All prescriptions handed to patients must be signed in ink. For prescriptions transmitted by fax or by an E‑prescribing system, an electronic signature is sufficient.

Prescriptions will not be accepted via e‑mail, nor may images of prescriptions be sent via text message or emailed to a patient or a pharmacy.

For more information please see the CPSM notice from May 30. An FAQ will be available shortly with further clarification on the impacts of this change. 

Questions or concerns? Contact practiceadvice@​doctorsmanitoba.​ca.

Pride parade on Sunday

Be a part of the action with Doctors Manitoba at the Winnipeg Pride Parade and Rally on Sunday, June 2. 

We invite you, your friends and family to walk the parade route to celebrate and support the 2SLGBTQ+ community. Our group will be assembling at 10 a.m. in Memorial Park, in aisle: G, And our entry number is 74.

Look for the Pride windsock flying above us to find us. Be sure to wear sunscreen and bring a water bottle!

What to expect at Pride?

We are participating in the Pride Parade, however there are many other activities that are part of the Pride Festival, including a vigil and rally. 

Pride parades started as protests decades ago to advocate for 2SLGBTQ+ rights and equality. Today, the parades often have a more celebratory tone, though advocacy and allyship continues to be a foundational reason for the event. You can learn more about the roots and history at a series of lunch and learns through Rainbow Resource Centre. It is common at Pride events to have adjacent protests and rallies about intersecting or unrelated issues. For those who may not have attended Pride, in past years here and across North American this has included rallies or protests about international conflicts, such as Black Lives Matter, and protesting gender identity ideology. The Winnipeg parade is often not directly impacted by these adjacent or counter protests, but it is important to know what to expect.

Pride Lunch & Learn Events

The Rainbow Resource Centre is offering Lunch & Learn virtual events throughout June. Subjects include Allyship 101, Queer History in Manitoba, The Stonewall Uprising & Modern-Day Pride Movements, and Dispelling & Challenging Anti-2SLGBTQ+ Stereotypes. Learn more here. 

Pride Winnipegosis

Winnipegosis has several opportunities to participate, including:

  • Friday, June 7: Educational session and public forum at the WDRS Day Program Building beginning at 7 p.m. titled An Introduction to Sexuality and Gender: Exploring Hormones and Puberty Blockers.

  • Saturday, June 8: Winnipegosis Boulevard 11 a.m. to 4 p.m. drag storytimes and performances, food, games, vendors and speakers.

  • Saturday, June 8: Pride Parade, line up at 3:30 p.m.at the old bus garage.

Congratulations Dr. Reimer 

“It is critical physician voices are heard by decision makers.”

New CMA President Dr. Joss Reimer is profiled on CMA’s website, in an interview that outlines her priorities as president as well as her own journey recovering from burnout and how that has influenced her advocacy now both for helping doctors find the joy in medicine and improving patients’ access to care. 

“Doctors are overwhelmed and frustrated; they aren’t able to give care to patients the way they want to, especially in primary care and emergency care,” she says. ​“We need to create work environments where physicians can thrive.”

You can read the full profile here.

Dr. Reimer received the Doctors Manitoba 2022 Humanitarian Award for her work as medical lead for the COVID-19 immunization initiative. 

The latest from the CMA annual general meeting is also available in a special May 30 edition of The Brief, including an update from co-presidents Dr. Reimer and Dr. Kathleen Ross.

CMA’s Journey of Reconciliation virtual sessions

The Canadian Medical Association (CMA) is hosting an upcoming virtual session for physicians and medical learners, hosted by Dr. Alika Lafontaine and featuring a panel discussion with Dr. Evan Adams, Dr. Michael Kirlew and Dr. Onye Nnorom. Learn more about the CMA’s journey of reconciliation and its upcoming apology to Indigenous Peoples for continued harms done, and discuss the actions needed to move towards reconciliation in learning and practice environments.

Please consider attending one of two virtual sessions:

  • Mon., June 17, 2024 – 12 to 2 p.m. ET (English session)

  • Wed., June 19, 2024 – 6:30 to 8:30 p.m. ET (English session with simultaneous French interpretation)

The sessions are an opportunity for physicians and medical learners to:

  • learn about the CMA’s journey of reconciliation;

  • understand the significance of the CMA’s commitment to an apology;

  • discuss strategies to foster cultural safety and humility in the delivery of healthcare; and

  • identify steps that physicians and health organizations can take to cultivate inclusive and culturally responsive learning and practice environments.

Spaces are limited. Registration closes on June 14.

Learn more about the CMA’s upcoming apology to Indigenous Peoples at cma​.ca/​a​p​ology

Providing gender-affirming care

Take part in a full day of interactive sessions Saturday, June 15 at 167 Sherbrook St.. 

Transgender and Gender Diversity Awareness & Inclusion — 9 a.m. to noon

Facilitated by Trans Health Klinic staff including peer supporters with lived experience, this training explores impacts of systemic anti-Trans discrimination and explores strategies to create positive space and inclusive practices.

Gender-affirming Hormone Therapy- 1 to 4 p.m.

This interactive workshop will encourage participants to explore patients/​clients’ gender journey and goals, partake in informed consent discussions with clients/​patients requesting hormone therapy, assess readiness for hormone therapy, prescribe and monitor hormone therapy, manage side effects and common concerns about hormone therapy, and seek ongoing clinical support.

Participants will gain a thorough understanding of providing holistic care for folks seeking gender affirming care and receive certification for completing both sessions.

Registration is $100 and lunch is provided. For more information and to register, go to book​when​.com/​k​linic.

Navigating Incorporation for Canadian Physicians

Join MD Financial Management and MNP for a live educational webinar titled Navigating Incorporation for Canadian Physicians on June 12 at 6 p.m CDT. This webinar is ideal for residents approaching their transition to practice or new in practice physicians who want to understand the benefits and challenges of incorporation, learning how to incorporate your medical practice, exploring accounting implications, and finding out how to leverage your medical corporation for financial planning. Register here.

Golf with Doctors Manitoba

Register today for the 2nd Annual Doctors Manitoba Getting Healthy Golf Tournament planned for Tuesday, September 3 at Southwood Golf & Country Club. The format is friendly for less-experienced golfers, with a shotgun start and best-ball scramble, while more experienced golfers will enjoy the challenge of a premier championship course. Presented by MD Financial and Scotiabank with support from Bokhaut CPA.

Find out more and register at doc​tors​man​i​to​ba​.ca/​g​olf24

Health System Updates

Newborn screening expands to include sickle cell disease and hemoglobinopathy

Manitoba’s universal newborn screening program is expanding its list of rare diseases to include sickle cell disease and hemoglobinopathy starting tomorrow, June 1. In addition to being reported to the ordering practitioner, any screen positive newborns will be automatically referred to the Pediatric Hematology program at CancerCare Manitoba to arrange for confirmatory diagnostics and early intervention. Screening results will be available in eChart, along with other newborn screening results. 

Sickle cell disease is an autosomal recessive condition of hemoglobin, and is considered the most common single-gene disease worldwide. Sickle cell disease is more frequent among those whose ancestors are from Africa, the Caribbean, Central and South America, the Middle East and South Asia. An increasing proportion of individuals affected by this and related conditions of hemoglobin reside in Manitoba and Canada. There are many strategies to be used in the prevention of morbidity and mortality associated with hemoglobinopathies; newborn screening is considered an additional cornerstone population strategy for early identification of individuals affected by these conditions. 

Read the full memo from Cadham Provincial Lab here.

CPSM CEO and Registrar Retires

The College of Physicians and Surgeons of Manitoba announced the retirement of Dr. Anna Ziomek, CPSM Registrar and CEO, effective June 30, 2024 after 22 years of service to CPSM. An announcement from President Dr. Nader Shenouda thanked Dr. Ziomek for her vision, leadership and dedication, adding that she will focus on practicing medicine. 

Dr. Ainslie Mihalchuk, Deputy Registrar, will assume the CPSM Registrar/​CEO role effective July 1, 2024. 

New Hepatology Intake Form

The new Central Intake Form is for all outpatient consults for adult Hepatology at HSC (viral and general), except liver transplant. Consults for adult liver transplant assessment and consults to the Mount Carmel Clinic Hepatology Clinic should continue to use existing forms. Download the new form.

Manitoba HIV Medications Program Update

Manitoba is expanding coverage for HIV medications. The Manitoba HIV Medications Program (MHMP) ensures that all Manitobans with active Manitoba Health coverage who meet established criteria and who do not already have full coverage through a federal drug coverage program or another provincial drug coverage program will be able to access HIV medications free of charge. Clients enrolled in the Manitoba Pharmacare program are eligible for the MHMP.

You can read the full update letter here.

Additional information for health professionals will be posted here.

ICYMI

Upcoming Events

You can always review upcoming events on our events calendar page.

Doctors Manitoba Book Club

Join us for our Doctors Manitoba Book Club on June 4 at 7 p.m. We’re reading Study for Obedience by Sarah Bernstein, winner of the Scotiabank Giller Prize. Register Here.

CANPAD CME Conference and Family Event
The annual CANPAD Annual Continuing Medical Education Conference and Family event August 1 – 5 at the Fort Garry Hotel Spa And Conference Centre goes beyond the education sessions, including activities and programs tailored to all ages. Youth activities include movie nights, speakers, and volunteer opportunities. Events also include a ladies night, financial talks, family day at the zoo, picnic and gala night. Established in 2001, CANPAD has been at the forefront of advocating for the interests of Nigerian physicians and dentists across Canada. Register now.

IPAC Mentorship Gathering 

Registration is open for the Indigenous Physicians Association of Canada’s Annual Mentorship Gathering and AGM July 12 – 14 in Halifax. The gathering is an opportunity for Indigenous medical students, residents, and physicians, both members and potential members, to come together to share stories of their academic journeys, grow their networks, and enjoy cultural activities.

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