on small things to stay healthy.
Visit morethanmedication.ca 6 tips for patient codes
Patient codes of conduct allow you to establish what
is acceptable behaviour in your clinic—and what the
patient can expect from you and your staff 24
New cruise contest
The Medical Post’s latest CME Cruise Contest
will send lucky readers on a fabulous adventure
on the Mediterranean! Enter today 35
VOLUME 47 NO. 3 | $82 year THE ROGERS NEWSPAPER FOR CANADA’S DOCTORS | CANADIANHEALTHCARENETWORK.CA FEBRUARY 22, 2011
Colorectal Follow the
screening Dr. Doug Angus
guideline should look abroad
for examples of
slammed successful health systems 32
But authors say issue C. diff with
is more complex than
merely sigmoidoscopy that meatloaf?
versus colonoscopy Hospital food may
by David Hodges
Mark Hamon/St. Joseph’s Health Care London
TORONTO | Critics of the Canadian
Association of Gastroenterology’s
(CAG) recently updated position state- U.S. researchers
ment on colorectal cancer screening
are slamming the new recommenda-
tion that flexible sigmoidoscopy—and
not colonoscopy—be offered to all
“To call this colorectal cancer screen-
ing is dishonest,” Dr. Patricia Johans-
son, a family physician in Sherbrooke,
Que., wrote in a letter to the Medical
Post. “The name of the program must
be changed to ‘sigmoidrectal cancer Saskatchewan project shows
screening,’ and it must be made crystal physicians and pharmacists can work
well together on health teams 48
clear to patients that they are being
offered a partial see Response | page 6
See story page 17.
Snapshot 60% Que. eye Golf in Guatemala
Public responding yes (%) to 40% Curvaceous courses that hug the slopes
“Would you call 911 or EMS 30%
of mountainsides make for interesting rounds
if you or someone you know 20%
of golf in Guatemala, while active volcanoes
experienced a sign of stroke?”
0% provide a dramatic backdrop 20
Source: Heart and Stroke Foundation, 2007
PM 40070230. Canada Post: Please return undeliverable Canadian addresses to: The Medical Post, Circulation Department, One Mount Pleasant Road, 8th Floor, Toronto, Ont. M4Y 2Y5. E-mail firstname.lastname@example.org
THE MEDICAL POST CanadianHealthcareNetwork.ca FEBRUARY 22, 2011 17
nected to the NICU and one of
its most important physicians,
Dr. Graham Chance.
“It’s a funny story,” says
Dr. Sottosanti. “When I was
in undergrad my father was
working at the hospital, and
he had run into a nurse who
remembered him from when I
was a baby, and she asked how
I was doing. He told her I was
applying to medical school. She
actually hooked him up with
Dr. Chance’s phone number.
“Dr. Chance ended up tele-
phoning my father and later
telephoning me and giving me
advice about applying to med-
ical school. It was wonderful
talking to him because I had
Mark Hamon/St. Joseph’s Health Care London
heard about this man growing
up and vaguely remembered
him from NICU Easter parties.
“Later on, when I started my
fellowship here (in July 2010),
the NICU, which has always
been very supportive, surprised
me with Dr. Chance as a guest
speaker. So I was able to meet
Dr. Maria Sottosanti tends to an infant in the neonatal intensive care unit at St. Joseph’s Hospital in London, where she started life 30 years ago. him and chat with him, and
he gave a lovely talk about the
From preemie to pediatrician
time when I was in the NICU.
So he’s always been a big part
of my becoming a pediatrician
and physician, because my par-
ents always talked of him with
the utmost respect, not just in
Dr. Maria Sottosanti began life receiving care at an Ontario NICU. terms of his medical knowledge
She went back 30 years later to return the favour but (also) his support. He’s a
very spiritual person who was
by Joe McAllister always respectful of my parents’
spirituality as well. . . . He could
Staff of the neonatal do no wrong in their eyes.”
intensive care unit (NICU) at
St. Joseph’s Hospital in London, Special reunion
Ont., always remember mem- Dr. Chance is a Canadian
bers of their “family,” the fragile pioneer in the care of very low-
newborns and frightened par- birthweight babies and was St.
ents who depend on the 42-bed Joseph’s director of nurseries
unit. during Dr. Sottosanti’s shaky
So it’s not surprising that 30 beginning in the NICU. At the
Courtesy of St. Joseph’s Health Care London
years on there was a delighted homecoming event last sum-
welcome from staff when Dr. mer, Dr. Chance, who retired
Maria Sottosanti came back last in 1997, reminisced about the
year. She wasn’t there to visit, evolution of neonatology as a
but rather returned as a newly specialty, and noted there were
minted pediatrician for a one- no neonatology fellows at St.
year fellowship to learn how Joe’s 30 years ago. Dr. Sotto-
to serve the next generation of santi’s case was evidence that
preemies. When Dr. Sottosanti returned to St. Joseph’s for her residency, she was reunited with nurse Sharon babies born at 26 weeks gesta-
There were even a few staff Pullman (left), nurse Lynn Whitty and Dr. Graham Chance, who were all involved in her care as a newborn. tion weighing as little as 800
members still working on the grams can do well with special-
unit who remembered when “Her family was very dedicated. says. “My parents were always and sister all went to university ized perinatal care, he recalled
Dr. Sottosanti first arrived on They travelled from Sarnia very grateful and spoke with in London, so whenever we in a St. Joseph’s newsletter.
the unit as a newborn with a every day. . . . They had a good high regard about the medical came to London my parents “This is why Maria’s presence
perilous future. Veteran NICU hour’s drive. Often it was her staff in London. Being a doctor would take me by the hospital here is not only miraculous but
nurse Lynn Whitty recalls that dad who brought the milk that was always in the back of my and say, ‘This is where you were a great joy for all of us,” he said.
Dr. Sottosanti was remarkable her mom had expressed.” mind. I loved science, I love the born.’ It was something that So, with good reason, Dr.
not only because she weighed Once released from the unit, human body, I love interacting seemed so unknown and yet Sottosanti felt special when she
just one pound 15 ounces, but Dr. Sottosanti had a healthy with people and I really love fascinating to me.” arrived on the NICU last year.
because of Dr. Sottosanti’s par- childhood, but her father Peter children. So, if I was to go into Growing up, Dr. Sottosanti “For me it was, for a minute,
ents’ dedication. and mother Rosa never let her medicine, pediatrics was what I attended a few of the neo- very overwhelming,” she says.
“Certainly at that time a baby forget their connection with was going to pursue.” natal followup parties that St. “I definitely thought I belonged
born at 26 weeks who would the NICU. “I grew up hearing Her history of being in the Joe’s held for members of its there. I felt like I had come
survive was rare; 28 weeks was all the stories about what hap- NICU is part of the Sottosanti “family,” but her entry into home. It was right to train
pushing viability,” says Whitty. pened to me as a child,” she family folklore. “My brothers medical school was also con- see Preemies | page 18
18 life FEBRUARY 22, 2011 CanadianHealthcareNetwork.ca THE MEDICAL POST
Fending off depression
immediately work an insane calendar as you would a class
amount of hours. I was frugal or a meeting—and don’t com-
during med school. I didn’t promise on performing those
as a young physician
have a car, cellphone, cable TV activities. Of course, this is
or Internet (although I used almost impossible to maintain
about 30 free trials of AOL). I with a call schedule, but it can
did, however, live very close to be done during early training.
the hospitals. My apartment During medical school, I
Consider these simple ways to lessen the emotional toll was a bit more expensive than took up beginner synchron-
that medical training and the profession take average, but I saved on ized swimming. Every Tuesday
transportation costs because of night, I had a team of women
MUCH Has been written we’re wrapped up in the midst the location and was able to expecting me to show up. I
about depression and anxiety of it, and talking to someone sleep 15 minutes longer—and only missed synchro when
in medical students, residents who has “been there and done trust me, that extra time added I had a call shift that I was
and practising doctors. You’ll that” helps. up over four years! unable to trade. The workout
have to excuse me if I don’t I was very fortunate to One of the best moves was good for my body and
do a complete review of the choose an amazing mentor young doctors can make is to socializing with people outside
literature here. Maybe you can by sarah Giles through my medical school’s resist the temptation to live like of medicine was good for my
just take my word and accept mentoring program. Dr. Sarah attending physicians. Yes, we’re brain. Getting away from the
that depression and anxiety organizations. Medical school Shea kept me out of trouble, surrounded by people making pressure cooker of medicine
wreak havoc on our profession beat that out of me in the first offered sage advice and helped a lot of money as we train, but was priceless.
and that the problem is largely month. Now I’m PG-6, I haven’t me to keep things in perspec- we need to resist the urge to
ignored. touched a piano in years and tive. To this day, we communi- buy crazy consumer goods— Get real
People who tend to get into I can’t remember who I used cate frequently and I consult the five-foot-wide television We young doctors need to
medical school spend the first to be or why I ever thought I her prior to making any life- can wait! When you start pay- have realistic expectations of
20-odd years of their lives wanted to be a doctor.” altering decisions. ing back your loans, you’ll get ourselves. We cannot be every-
excelling at school and taking The good news: I think there I honestly don’t know how ahead faster and eventually be thing to everyone. We are not
part in a ridiculous number are ways to avoid depression, I could have ever survived my able to afford to take chunks of individually responsible for fix-
of extra-curricular activities. but it does require some plan- medical training and early time off work. ing an understaffed and broken
Once they get in, time for all of ning and guidance. career without Dr. Shea. Every Trust me: I paid of my debt medical system.
that “balance” disappears, and medical school and residency in 18 months and only worked And even if that extra night
some of them become desper- Develop a support system program should offer a formal 26 weeks last year! of call will pay you a ridiculous
ately unhappy, depressed and It strikes me that everybody mentoring program. amount of money, if taking it
even suicidal. should have a mentor, espe- Have activities outside puts you over the edge, it just
As my friend put it: “Prior cially stressed out medical Curb financial stress medicine isn’t worth it.
to medical school, I spoke four students and residents. Perhaps Minimize the debt you incur Everyone should identify a
languages, was a concert level the greatest role of a mentor is during medical school. That couple of activities that are Sarah Giles is a locum family
pianist, ran for fitness and to provide perspective. It’s easy way, when you start your important to them and sched- physician in Ontario and
volunteered for about a million to sweat the small stuff when career, you won’t be pressed to ule these activities into their Western Australia.
just as much my teachers as my “Before we had care to who suffered no developmental school. It’s a place where the
physician mentors are.” deliver and we delivered it, delays herself, is interested in children can play while NICU
NICU nurse Whitty, who (but) didn’t really look at how how her fellow NICU graduates doctors and nurses get together
from | page 17 says she has never wanted to the babies react in the same develop, particularly in endo- and reconnect with family
where I had, essentially, been work anywhere else over her way we do now. We are learn- crinology and in how nutrition members they remember from
born and where all of these decades-long career, is thank- ing,” says Witty. plays a role in development. the NICU.
stories had come from. The ful for the praise and quick to Now, expressing breast milk While she wants to set up a This year the party will be a
thought didn’t enter my mind note the quality of care being for feeding is encouraged, pediatric practice in southwest- big gala celebrating the move of
to go anywhere else.” delivered at St. Joe’s has come babies are wrapped in swad- ern Ontario, she says she hopes the NICU into a new, expanded
Dr. Sottosanti has had no a long way, and not only in dlers, and staff try to minimize to continue working with the facility. “I’ll be there,” a proud
regrets so far. She loves work- a technological sense. Thirty noise and bright lights. Parents, neonatologists and academics and happy Dr. Sottosanti
ing with the team of neonatal years ago, nurses would care for meanwhile, are encouraged who have made St. Joe’s special. promises. It will be a family
specialists and nurses in the the little babies in isolettes with to interact with their children Every two years, St. Joe’s celebration.
NICU. “It’s like a family there. little understanding about the and are taught some of the cues holds a party at a London
I feel like I can go to them for mental well-being of either the the babies exhibit about their theme park for NICU gradu- Joe McAllister is a senior editor
help or advice, and they are babies or their families. comfort level. Dr. Sottosanti, ates who are about to enter at the Medical Post.
Because you know
the importance of a regular checkup.
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