March 10, 2022
- COVID Update
- Updating on Masking in Clinics
- Support for Ukraine
- Surgery and Diagnostic Backlog Update
- Physician, Learner and Patient Supports
- Vaccine Updates
- Fantastic Physicians
- Upcoming Events
- Physician Well-Being Research
- Stone Soup Week
Since our update on Tuesday, March 1…
- Hospital occupancy continues to decrease: There are 424 people in hospitals with COVID-19, down from 463 on March 1.
- Hospital admissions continue to decline: There were 8 people admitted to hospital yesterday with COVID-19. The average over the last seven days has been 15 admissions per day, down from 19 per day the previous seven days.
- ICU occupancy steady: Of the hospitalizations reported above, 22 patients are in ICU, down from 29 on March 1. There are 93 patients total in ICUs right now.
- COVID-related ICU admissions have averaged 2.1 per day over the last seven days, with just one admitted each of the last four days. This is down slightly from 2.6 admissions per day on average during the previous seven day period.
- 28 more people have died from COVID-19 since March 1 with the total now at 1,708.
According to the COVID-19 Tracker Canada Project, Manitoba has an average of 31 hospitalizations per 100,000, down from 34 on March 1. This continues to lead the nation.
*Comparing hospitalizations by jurisdictions continues to be challenging as some provinces may use slightly different standards (e.g. only reporting patients with active COVID-19 infections and not recovered, or only reporting patients admitted because of COVID-19 and not with — Manitoba still reports both using a broader strategy).
Government Restrictions Easing on March 15
A reminder that pandemic restrictions will be loosened on March 15 as restrictions are replaced with recommendations. The changes include no longer requiring masks in public places, including in schools and child care facilities, as well as no longer requiring isolation for individuals who have tested positive for COVID-19.
Isolation will still be recommended for people who have symptoms and individuals who have tested positive (even without symptoms). Isolation should continue for at least five days from the onset of symptoms or positive test result, until individuals who no fever and other symptoms are mild and improving. Individuals are still advised to avoid non-essential visits with higher risk people or to higher risk settings for 10 days after symptom onset or positive test, and should wear a good quality, well-fitted mask when around others during this period as well.
Doctors Manitoba continues our New COVID Normal campaign to encourage Manitobans to take precautions as COVID is still widely circulating, especially considering that many have risk factors that make them more vulnerable to severe illness or death. The NewCOVIDNormal.ca resource was created based on public health advice and with the input of physicians with a wide variety of expertise, including in infectious diseases, public health, family medicine, critical care, geriatrics, pediatrics.
Masks Still Required in Clinics
We have heard from many physicians concerned about guidance from CPSM last week about not denying care to patients who refuse to wear a mask. We know their message was seen by many of our members as abrupt, surprising and even hurtful after two years carefully following public health and infection control COVID-19 guidance. Many of you interpreted CPSM’s message to mean that physicians must not turn away patients who refuse to wear a mask, even if they have COVID-19 and could spread the virus to other patients in your clinic. And while we don’t believe it was their intention, we even heard from some who felt CPSM was placating convoy mandate protesters.
Our team has been aggressively pursuing this issue on behalf of physicians and today we hope the following guidance offers the clarity and comfort physicians need at this critical phase of the pandemic.
We also issued a public advisory today reminding the public to wear a mask in doctors’ offices, medical clinics and other health care facilities after pandemic restrictions are eased next week, a message we will be repeating on social media. This coincided with a similar public notice from Shared Health. We also see that Manitoba Public Health included a prominent reminder in their weekly bulletin today indicating that “masks will continue to be required for all individuals attending a health-care facility, including visitors.”
You will see that CPSM updated its guidance earlier this week. While their new direction may not be worded as warmly as it could have been, we believe it offers the needed clarity and flexibility for physicians and their staff to respond to patients who refuse to wear a mask, as we outline below. This guidance is consistent with the approach already in place in Shared Health/RHA facilities, reflected in new guidance they updated today for primary care and outpatient settings.
Our Mask Guidance for Medical Practices
After provincial mask requirements for public places are lifted on March 15, Clinics can and should continue to have a mask policy in place for both staff and patients/visitors. Staff should continue to wear appropriate PPE and patients/visits should continue to wear a non-medical or medical mask. The following steps, which are consistent with a variety of local, national and international sources we reviewed, are important to support a mask requirement in your practice.
First, you should take steps to ensure patients and visitors are aware of the expectation and come prepared to wear a mask:
- Advise them of mask expectations when making an in-person appointment on the phone, online and in any email confirmation messages.
- Post a notice on your website
- Post signage at the entrance of your clinic (download our low-ink mask poster or full colour mask poster. You should also consider posting our respect and safety sign as well).
As has always been the case, including through the pandemic, physicians have a professional obligation to ensure patients receive care, but this obligation does not mean you must provide immediate in-person care to an unmasked patient. Unless there is an urgent medical issue, patients who refuse to wear a mask may be asked to leave, but alternatives should be considered to meet your professional obligation while minimizing the risks. Consider the following steps should a patient refuse to wear a mask:
- Offer them a mask.
- Explain why masks are required, to protect the other patients who could be at increased risk of severe illness and death from COVID-19.
- Offer a virtual visit if medically appropriate
- Reschedule them to a quieter period, such as an end-of-day appointment, and have them wait in the car until they can go direct to a treatment room.
Exceptions to the mask requirement have not changed and include children under the age of five and anyone who is medically unable to safely wear a mask. Clinical judgment will continue to guide decisions related to individuals who cannot wear a mask.
We believe the guidance above satisfies the direction to physicians from CPSM. It is also consistent with guidance from CMPA along with other regulators we reviewed in other jurisdictions. The approach above is also consistent with Shared Health/RHA facilities where patients and visitors will still be required to wear a mask, but similar measures are in place to ensure care is still provided in some way to patients who refuse.
What if the situation escalates?
If a patient is steadfast in their refusal to wear a mask and is not accepting of your attempts to safely accommodate them, the situation could escalate. If the situation escalates, you may have grounds to terminate a professional relationship if the patient:
- Poses a safety risk to you, your staff, or other patients;
- Is abusive to you, your staff or other patients; or
- Does not respect professional boundaries or acts in an inappropriate manner.
You should carefully and factually chart the behavior, and in all but the most extreme cases you may wish to consult the CPSM to discuss the reasons why you wish to terminate the relationship. Even if you have reason to terminate the relationship, you may still have some ongoing duties to the patient (for example, in relaying the results of diagnostic tests) and we encourage you to review the CPSM Standards.
Resources and Further Reading
Please see the following for further information:
- CPSM Guidance on Virtual Care and Masks (February 28 with important March 8 update).
- Shared Health guidance for primary care and outpatient clinics (updated today, March 10)
- CMPA FAQ on Face Masks for Patients (Updated March 2, with guidance on requiring masks in your practice and managing patients who refuse to wear a mask)
- Doctors Manitoba Guide to Physician Safety
If you have concerns or need advice about mask requirements in your practice, please contact us at email@example.com. Our teams is here to assist you, every step of the way.
Doctors Manitoba Support for Ukraine
Yesterday, our Board of Directors unanimously supported a motion to demonstrate our support for the Ukrainian people, and for our physician and health care colleagues who must be protected during the Russian invasion. The Board held a moment of silence and Doctors Manitoba is making a donation to the Red Cross to support its response to the humanitarian crisis. You can read a full statement here from Dr. Kristjan Thompson.
Surgery and Diagnostic Backlog Update
Last week, the Diagnostic and Surgical Recovery Task Force offered a public update… well sort of.
The Minister of Health had announced last Thursday they would offer their monthly public briefing the following day. But that briefing didn’t end up happening due to a communication blackout in effect during the Fort Whyte by-election. Instead an update was posted on the Task Force’s website.
Luckily, Doctors Manitoba held a Town Hall with the Task Force last week and participating physicians received a complete update about the progress made and next steps.
Key take-aways from the update include:
- Surgical staff are being returned to hospitals across the province throughout the month of March, allowing many facilities to return to pre-pandemic surgery and endoscopy volumes.
- The waitlists for CT, Ultrasound and MRI all decreased by 12% — 16% in January from the previous month.
- The first spine surgery patients are finally going to North Dakota for their procedures.
- Gynecological surgeries at Maples will start soon, as the initiative waits on key equipment to support these procedures
The Task Force also discussed the Request For Service Agreements approach, or RFSAs. This competitive process will be opened again to accept proposals for additional surgical capacity, including outside of hospitals. Doctors Manitoba will be meeting with the Task Force staff to better understand this process and we will notify members when the next RFSA is posted.
If you missed the Town Hall and want to watch a recording, please contact us for access. We hope to update our Backlog Dashboard later this month, to help track the size of the massive pandemic backlog. The Task Force is pursuing central wait list software for the province that should help the health system to more accurately measure and monitor wait lists going forward.
Physician, Learner and Patient Supports
The last few months have been difficult and it is having an impact on everyone. Whether it’s the ongoing uncertainty with COVID and prolonged isolation from family and friends, to the bitterly cold and snowy winter or the unprovoked invasion of Ukraine, there is a lot for our minds and hearts to process.
As the Omicron wave passes and the snow melts, our tightly wound stress and feelings may begin to thaw as well and many of us may begin to feel the true impact of the last two years. Doctors Manitoba would like to remind you of resources available for your patients and specific supports for medical learners and physicians.
Mental Health and Addiction Supports for Patients
Care for All in Education is a new resource to support teachers and other school staff with the stress and burnout from the pandemic. Local research suggests 46% of Manitoba’s education sector staff are approaching exhaustion and burnout. You can support patients who work in education by suggesting the Care For All portal and you can support and resources from a Wellness Specialist by calling 1−877−602−1660 or emailing firstname.lastname@example.org.
AbilitiCBT is cognitive behavioral therapy (CBT) guided by a therapist through a digital platform, which is accessible through your smartphone or tablet. CBT is proven to be one of the most effective and efficient therapy methods. MATC has a number of services for youth including the Rural and Northern Telehealth service (accepts referrals from community professionals Monday to Friday 8:30am to 4:30 pm by phone: 1-855-413-7855 or fax: (204) 958-6260)
The Catalogue of Specialized Services (CSS) is a secure, searchable online directory of the specialized services provided by physicians and psychologists throughout Manitoba. It can also include information on specialized services provided by primary care providers.
Manitoba Addictions Helpline is the central source for adult and youth addiction services.
The Mental Health and Wellness Resource Finder provides a number of mental health, wellness and addictions supports and resources for adults and youth.
For Medical Learners and Physicians
We have created a simple overview of Doctors Manitoba supported physician health programs (get the interactive digital version HERE and the printable version HERE). Please print off this resource sheet and place it in your staff room or any place physicians may gather.
The CMA Wellness Connection is a virtual, safe space where physicians and medical learners can gather to discuss shared experiences, get support, seek advice and help each other.
Al-Anon groups are non-professional, self-supporting and spiritually based. Anonymity is very important in each meeting, so that confidentiality can be maintained. There is a specific magazine for health professionals.
Physicians Wrap Up Support and Super Sites
For nearly a year, physicians have played a vital role at the Winnipeg COVID-19 vaccine super sites, assisting patients who have detailed questions or health concerns with informed consent.
Over 120 physicians covered over 1,400 shifts at the RBC and Leila super sites. We estimate they provided individual counselling and advice to well over 100,000 Manitobans.
Dr. Ewoma Avanoma worked many shifts supporting hundreds, if not thousands of patients on their vaccine journey. “I found it very rewarding to support thousands of Manitobans in making an informed decision to get their COVID-19 vaccine. One invaluable aspect of our role I found was support of allied health staff in navigating difficult and unfamiliar medical complexities to safely approve patients seeking to protect themselves, their loved ones and their communities”
Doctors Manitoba played a unique role, recruiting, scheduling and managing the remuneration for the participating physicians. On behalf of our team, thank you to the many physicians who contributed to this important part of Manitoba’s immunization effort.
Motivational Interviewing Skills for Vaccine Conversations
The Manitoba Government, in partnership with the Crisis & Trauma Resource Institute, has created a vaccine hesitancy course to help medical professionals engage in difficult conversations with vaccine hesitant patients. This three-hour workshop focuses on delivering the Motivational Interviewing skills needed to break down barriers and address uncertainty and resistance around immunization. Specifically designed for doctors and other healthcare practitioners, the 20-person training sessions are facilitated by accredited professionals and are available virtually weekdays, evenings and weekends in March 2022.
What is Motivational Interviewing?
Motivational Interviewing is a collaborative, non-confrontational communication style that emphasizes people’s decision-making autonomy. The focus is to gain a better understanding of someone’s knowledge and beliefs to help make them more receptive to other points of view.
For further information on this course, or to register, please contact Troy Popadynetz at email@example.com for details and remaining time slots available.
March 21 – 6:00 pm CST to 9:00 pm CST
March 22 – 8:30 am CST to 11:30 am CST
March 24 – 12:30 pm CST to 3:30 pm CST
March 26 – 9:30 am CST to 12:30 pm CST
March 29 — 12:30 pm CST to 3:30pm CST
March 30 — 6:00 pm CST to 9:00 pm CST
March 31 — 8:30 am CST to 11:30 am CST
Dr. Marcia Anderson was named appointed Vice-Dean Indigenous Health, Social Justice and Anti-Racism of the Rady Faculty of Health Sciences last week. In this new role she will ” explore how the Rady Faculty can accelerate and expand anti-racism and equity-focused work by firmly grounding in social justice principles, including human rights, participation, access and equity.”
Distinguished former and current members of the UM faculty and administration were honoured this week as the University of Manitoba Board of Governors officially conferred their annual Emeritus appointments. Congratulations to our members Dr. Allan Becker, Dr. Robert Lotocki, Dr. Michael Moffatt, Dr. Richard Warrington, and Dr. Michael West on your Emeritus appointment.
Congratulations to Dr. Jennifer Chan, who was recently recognized as one of Scheif’s Healthcare Heroes. After a breast cancer diagnosis and treatment in the fall of 2020, Dr. Chan used her time to recover to work from home to call each of her patients to check in on them and to discuss the importance of vaccination against COVID-19 she worked with Child and Family Services social to ensure her patients in care had access to vaccinations. It was her mission to make sure that none of her patients at the Aikins Street Community Health Centre would be missed. Congratulations and THANK YOU, Dr. Chan.
We want to share physician accomplishments with our members! Do you know of a colleague who has received an award or recognition for the work they do? We’d like to hear about it. If you know of a physician or medical learner who has been recognized with an award or honour, please let us know by emailing firstname.lastname@example.org! Let’s get more Manitoba physicians recognized:
- Nominations are open for the Canadian Medical Hall of Fame, due June 13. Read nomination FAQs about nomination here and tips on creating a compelling nomination package here.
- The WXN Top 100 Most Powerful Women Awards are open for nominations, due May 17. The awards celebrate Canada’s women leaders who lead selflessly with humility and authenticity, lift others up around them and who face adversity with bravery and strength. Nominate a colleague or yourself today!
- Do you know a UM graduate who has achieved outstanding accomplishments in their professional and personal lives? Nominate them for a Distinguished Alumni Award. Find out more here and nominate someone here.
A few recent updates, in case you missed them:
- See our recent President’s Letter about how the 1% increase in physician remuneration for 2022/23 is being allocated
- Physicians can how order rapid tests to distribute to patients. Find out how here.
- March is Kidney Health Month. You can help your patients with prevention and care. Read more.
- The war in Ukraine is affecting people across the globe. We’ve got some resources to help you cope with the conflict. Find out more.
- Claim your vaccine expenses. Learn more here.
- Our *NEW* Bannatyne office is open! Learn more about location and hours here.
- Our Wordle challenge has been extended to March 15. Get your submission in by Tuesday!
Bookmark our Events Calendar to be sure you don’t miss any events or learning opportunities that interest you.
IHI Leaders in Safety Course (on-demand) — Register here. In this free IHI Open School online course, you’ll explore the foundational role of leaders in keeping the health care workforce safe and strategies that have succeeded in reducing physical harm and improving psychological safety across organizations.
MCFP Annual Scientific Assembly April 28 – 29 — Register here. Register for Manitoba’s premier family medicine conference in live streaming webinar format April 28 & 29. The MCFP Annual Scientific Assembly (ASA) provides the highest quality, expertly vetted, evidence-based education specific to the practice of Family Medicine. Since its inception, the MCFP has recognized the importance of providing members with continuing professional development opportunities and this year’s program will not disappoint.Certified for 1 credit per hour.
The Continuing Professional Development (CPD) Medicine Program recently launched its new online learning platform. The program provides evidence-informed educational opportunities for lifelong learning, competence and sustained practice change, in a culturally safe and responsive manner. You can learn about upcoming courses and learning modules here and here
Early Career Learning Series
CMA Joule recognizes the challenges new physicians face and is offering a Early Career Learning Series to help early career physicians increase awareness and competency in key areas crucial to success. Learn more about the four sessions being offered here.
Physician Well-Being Research
A research team from The Ottawa Hospital is conducting a study to examine physician wellness. Findings from this study will inform and implement strategies that may be used by organizations to cultivate wellness among healthcare professionals during times of increased
work demand and stress. Researchers are looking for practicing physicians and medical learners from both community and academic hospitals who are actively working in both primary and acute care settings in Canada to share their experiences regarding physician wellness by completing an online survey.
Click here to complete the implied consent form and the 15-minute survey. You can choose to be entered into a draw for a $250 (CAD) Amazon gift card. You will receive a total of THREE reminder emails, two weeks apart, to complete this survey. Your participation in this survey and your individual responses will remain confidential. By completing this survey, your consent to participate in this study is implied.
Stone Soup Week — March 14-20, 2022
Participating restaurants across the province have created signature soups to be sold the week of March 14 – 20, 2022 and will donate $1 from the sale of every bowl of soup to the Child Nutrition Council of Manitoba. All of the funds raised will go directly to support Manitoba school meal and snack programs. Participating Restaurants & Signature Soups
How can you participate?
Purchase soup from one of the participating restaurants during the week of March 14 – 20th. Or, plan a Stone Soup staff or group lunch! Download a poster here.
Vote for your favourite soup.
Encourage your friends, family and colleagues to support participating restaurants during Stone Soup Week.
Share the event on social media using the hashtag #stonesoup2022