From preemie to pediatrician

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Visit                      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
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  VOLUME 47 NO. 3 | $82 year                              THE ROGERS NEWSPAPER FOR CANADA’S DOCTORS | CANADIANHEALTHCARENETWORK.CA                                                                                                       FEBRUARY 22, 2011

Colorectal                                                                                                                                                                                    Follow the
cancer                                                                                                                                                                                        Europeans!
                                                                                                                                                                                              Health economist

screening                                                                                                                                                                                     Dr. Doug Angus
                                                                                                                                                                                              says Canada

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
                                                                                                                                                                                              harbour harmful
                                                            Mark Hamon/St. Joseph’s Health Care London

                                                                                                                                                                                              pathogen even
TORONTO | Critics of the Canadian
Association of Gastroenterology’s
                                                                                                                                                                                              after cooking,
(CAG) recently updated position state-                                                                                                                                                        U.S. researchers
ment on colorectal cancer screening
are slamming the new recommenda-
                                                                                                                                                                                              report 52
tion that flexible sigmoidoscopy—and

not colonoscopy—be offered to all
average-risk individuals.

                                                                                                                 From preemie
   “To call this colorectal cancer screen-

                                                                                                                                                                                              for teamwork
ing is dishonest,” Dr. Patricia Johans-
son, a family physician in Sherbrooke,
Que., wrote in a letter to the Medical

                                                                                                                to pediatrician
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

                                                                                                                                              fight for
    “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?”

                                                                                                                                                fees 29





                                                        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
                                             THE MEDICAL POST    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                      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

                                                  young md
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.

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