D.Ri(hard L (ruess 00 May31, 1995 ended his ex,,"entteou~ of 14 yea"as Dean of the Faculty of Medicine at McGill since 1981. He and his wife, Sylvia, who hasbeen Director of Professional Services at the RVHfor 17 years, leave after a summer hol-iday for Princeton, New Jersey and next spring for Oxford, on a sabbatical to study the im-

pact of budgetary restrictions on health care, medicalresearch, education and manpower planning. A number ofreceptions have been given to thank both Sylvia and Dickand to wish them well in their ongoing work.

McGillChanges Deans

Dr. Abraham Fuks, B.Se. '68, M.D. '70, wasappointed as the new Dean as of June 1,1995. He completed his internship andmedical residency at the RVH. He hasbeen on staff since 1978 and holds therank of Full Professor in the Departmentsof Medicine and Pathology and at theMcGill Cancer Centre. He is a specialist inImmunology and Allergy. He is a widelyrespected scientist a nd teacher, an effec-tive negotiator, and a skilled admininstra-tor who is well qualified to deal with thechallenges that lie ahead for the medical faculty. Dr.Fuks has served on innumerable com-mittees including the Institutional Review Board of the Faculty of Medicine dealing withethical issues, and the Advisory Committee on Research of the National Cancer Instituteof Canada. He was also a key member of the Faculty's Curriculum ~

Richard L. Cruess Abraham Fuks

-:::I McGill ChangesDean 1 FraserGurd DayBanquet~. Surgery During Last Decadeand a Half 2 Ad~i~i;t;ati~~'S~;;p~;tSt~ffHHHH'HQ. 'HHHHHHHH.HHHHHHHHID ~e~er~.tot~~E~itorHHHHHHH'H 2 Kudos

Communications Skills 3 Achievements Residents and Fellows... . .

Upcoming Events 3 Obituary..................................................................................................................Graduating Residents 4 Resignation of Dr.Mount

. . . . . . . .. .... . .. . . . . . . .. . . . . .Decreasesin Residents and Med Students 4 NewWomen's Scarf

8

10

11

13

14

14

14

15

15

16

18

Hospital Closures.. . . . . . . . .. . . . . . .. .... . .. . . . . . . . . . . . . .

Visiting ProfessorsNew CoreSurgical Residents....................Doctor's Age by Specialty

5 Heward Visiting Scientist. . . . .. . .. . . .. . ...........................•

6 Dr.McArdle's Retirement7 Canada'sHealth CareDelivery System7 USCResearchDirectors and Fellows

DEPARTMENT OF SURGERY

NEWSLETTER

McGILL UNIVERSITY

VOl. 5, NO.5, SUMMER 1995

~ Implementation Committee. He has played a leadershiprole in Martinex R&D Corporation in promoting technologytransfer from McGill, and was instrumental in bringing sub-stantial research support to McGill. •

....................................•........................EDM

T,last fourte,n y,m have Sl'<'n a great evolutionin surgery. This evolution has included many technical detailsrelevant to the practice of surgery and it has certainly beenaccompanied by a change in the vision for the university

department.

Surgery During the Last

Decade and a HalfWhen I becameDean, the majorityof surgical proce-

dures were carried out on in-patients using a very traditional ap-proach. Most hospitals had made admission and dischargeprocedure more efficient, but even minor procedures were doneusing the hospital bed as the base. The effect of budget pressuresand newer techniques have made an enormous difference in thesurgeon's approach to an operation. The McGill network is ap-proaching a situation where 60% of operations are carried out asout-patients. There are enormous advantages to the populationand to society from an approach such as this, but it is the impres-sion in the Dean's office that we are only beginning to address theeducational implication of the changes. As has been emphasizedby two successive chairs, residents at the present time are receiv-ing less exposure to both pre- and post-operative management ofrelatively straightforward cases. Aswe begin to look into the fu-ture, undergraduate and postgraduate education must be mod-ified in order to provide some educational continuity so that astudent or a resident can follow the same patient from the timethe diagnosis is made until the surgeon's role is finished.

The technical innovations in surgery have included both an in-creasing complexity to the procedures carried out and an increas-ing emphasis on minimally interventional surgical procedures.Virtually every discipline is now using some form of modifiedscope in order to carry out its procedures. The series of gallblad-ders which were recorded using the entire McGillnetwork was alandmark achievement and shows what can be done when wework together. However, the impact on general surgery, orthope-dics, urology, gynecology, and other disciplines has been enormous.At the other end of the scale, procedures of increasing complexityare carried out and this has certainly suggested that a greater cen-tralization and rationalization of our resources will lead to betterpatient care, better education, and better research.

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2The final major factor has, of course, been the budgetary picturefacing our institutions. It is probable that the other factors whichhave been operative during the last decade would have also forcedus to allocate tasks to different institutions because of the neces-sity of sub-specialization, but the lack of resources has forced us tohave a university wide vision of our role. This is just beginning,but if we are to remain competitive on the world scene, we mustcome together to a much greater degree and we must supporteach other's efforts to concentrate sub-specialized and expensiveactivities in a single institution.

As we look into the future, these trends will certainly continue.What will also become more important will be the ability of theDepartment of Surgery and its various divisions to add to their re-source base from a variety of sources, including industrial contracts,private support, and perhaps a privatized sector as our legal frame-work evolves.

The Department of Surgery has a distinguished past and present.It appears to have the capacity to continue to evolve and Iam con-fident that it will retain its status and its stature .•

Letter from Dr.Susan SkanesSusan is now in a busy active Plastic Surgerypractice in Moncton New Brunswick. She received her Royal Col-lege Certification in General Surgery in 1989 following her resi-

dency training program at McGill,and that inPlastic Surgery in 1991 after residency pro-grams both at McGilland at the Lahey Clinicin Massachusetts. In March 1994, she mar-ried an Acadian, Dr.Victor Robichaud, and

they have a baby boy,Mathew EricSkanes Robichaud bom on Jan-uary 24, 1995. She remembers fondly her training at McGill andappreciates receiving the Square Knot.

Letters to

the Editor

We received letters from Dr. Clarence James of Hamilton,Bermuda and from Dr. Breen Marien (McGill 1949) of Montrealwith generous donations to the McGillSurgery Alumni Association.

Letter from Dr. Lancelot K. TinLancelot is in Oregon, Ohio where he is having to cope with ex-tensive changes such as all kinds of managed care organizations -HMO;PPO;HPO,etc. He has passed the examinations of the RoyalCollege in General Surgery, and also those of the American Boardof Surgical Critical Care. He also has obtained his F.A.C.S.•

COMMUNICATION SKlUSThere is an ART in talking to and aboutpatients. Not everyone is a natural borncommunicator. Perhaps we have not paid

enough attention to thisskill in our Surgical TrainingPrograms. Have you ever

been a witness to any of these scenarios?

Editorial'"'<"'~~ Scenario I~ Surgeon taking a history, "You mean youu::a

~ have been taking that little white pill every:::II, day for twenty-five years and you don't

know its name?" This is scolding the pa-tient - bad communication skills.

Scenario IIX-ray technician to patient, "Your x-rays areOK,you may leave now." The technician isreally referring to the quality of the films,but the patient misinterprets this an-nouncement so as to mean that the X-raysare normal and leaves for home rather thatreturning to the Emergency Department -bad communications skills.

Scenario 11/Some Residents doing Rounds enter theroom of a patient who had an appendec-tomy last night. The family is there. How-ever, the Residents are still talking aboutthe patient in the previous room who had"a carcinoma of the colon with metastasisto the liver." The appendectomy patientand her family misinterpret this as involv-ing them - bad communications skills.

Scenario IVService Rounds are being done in a four-bedded room. The clinical clerk presents thehistory of the patient in bed 2 and affirmsthat the patient is in for "radiation therapyto the spine because of a remote CAof thebreast with metastasis to the spine." Thisis said in front of both the patient and infront of the other three patients in the room- bad communications skills.

Scenario VIn the clinic, a Resident brings you into a cu-bicle to see a patient who is lying on the ex-amining table in the Sim's position to showyou an anal fissure. Without knocking on thedoor and without introduction to the patient,immediate attention is focused on the per-ineum - bad communications skills.

Scenario VIA patient's case history is presented atM&M Rounds and the presenter lists somany negative findings that you lose thegist - bad communications skills.

Scenario VIIYou are taking a history on a patient whohas been operated upon elsewhere. "TheDoctor only told me that he removed a tu-mour from my stomach." - bad communi-cations skills.

Many more examples could be cited. Thereis much emphasis nowadays in MedicalSchools and Hospitals across Canada in or-der to improve these skills in their broad-est sense from the dialogue betweenSurgeons and their patients to publicationsin peer review journals. The Royal Collegein its blue booklet entitled General Stan-

dards of Accreditation Section B.Vlc

stipulates the following: - Communicationsskills should be assessed by direct observa-tion of Resident interactions of patients andcolleagues and by scrutiny of written com-munications to patients and colleagues in-cluding clinical and scientific reports,particularly consultation letters to referringphysicians where appropriate.

But good communication skills are difficultto teach. Basically, the core principle is justthat of having good manners. One shouldtalk to and treat a patient just exactly asthe Surgeon himself of herself would liketo be talked to and treated. At McGill, im-provement in these interactions are taughtboth at the undergraduate level and at thepostgraduate level. _

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UpcomingEvents

Dr. Gerald Moss will be the FirstA.H. McArdle lecturer for SurgicalNutrition on Sept. 7, 1995. He willtalk on Immediate Post-operativeEnteral Feeding at the MGH GrandRounds. Dr. Moss comes from Troy,New York. He is the inventor of theMoss tubes.

The 64th Annual Meeting of the

Royal College of Physicians and

Surgeons of Canada in collabora-tion with The Canadian Society

for Clinical Investigation willtake place in Montreal, Sept. 13-17,1995. The Canadian Association

of General Surgeons will alsomeet at the same time and place.

The McGill University Department

of Surgery Residents and AlumniReunion will take place on Tuesday,October 24th, 1995 at 6:30 P.M.dur-ing the 81st Annual Clinical Con-gress of the American College of

Surgeons in the Sheraton NewOrleans on Canal Street.

The L.D. Maclean Visiting Professorwill be Dr. William Pierce fromHershey Medical Center in Pennsyl-vania on Nov. 16th, 1995. He is aworld expert in cardiac assist de-vices and artificial heart.

The H. Rocke Robertson Visiting Pro-fessor in Trauma will take place sometime in January 1996. Dr. Kim

Maull is scheduled to be the VisitingProfessor. He comes from Loyola Uni-versity Medical Center in Illinois. _

SEROLOGY:Q Studyof

.-Jot Knighthood

""" »

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Congratulations

to OurGraduating Residents 1995

General Surgery

Renzo CecereDavid GreentreeAhmed JamjoomJose Mijangos-PalaezGary SalasidisJohn Vee

Neurosurgery

Karen JohnstonMark Preul

Vascular

Lisa AlfordPatrice Nault

Orthopaedics

Richard BerkowitzRonald CastonguayCarl FarmerCyril RebelLisa Ronback

Cardiothoracic

Kevin LachapelleDominique Shum-Tim

Pediatric General

Surgery

Helene Flageole

Plastic Surgery

Hashim BalkhyPhillip DahanArthur Rideout

4

Urology

David EileyDaniel KhouriSandeep SawhneyBenjamin Tripp

...............................................................................................................................

Decreases in the Number of Residents

and Medical Students at McGill 1995-1996

TFor McGill, this translates into 83 Entries into Specialtiesas follows:

Surgery GeneralSurgery 10 In addition, there will be 49 new resi-he government of the ~.~~~~surgery ~ l 21 dents in Family Medicine (this includes 3

province of Quebec in its "Decret" has Orthopaedics 4 J in Emergency Medicine). Further, one ofpromulgated the following distribution Plastic Surgery 1 the 8 Canadian Transfer Positions will goof Residents for the 95-96 academic Urology 2 to Pediatric Surgery and five of the new

Th b . I Medicine 22 9 I d h A . Q '11year. ere are to e 330 new speCla ty .. sots un er t e mencan uota WI goPj3(k~t~~t:~ 7

It is noteworthy that the 1st year medical class will have adecrease in admissions. Dr. Nelson Mitchell, ~

~ Associate Dean of Admissions, informs us that there willbe 94 Quebec Students, a decrease of 7 from the previous 101.In addition, there will be between 22 and 28 U.S. and Foreignstudents. It is established that the class will now numberaround at least 116 students compared to 164,5 years ago.While this is mandated by the Ministries of Education andHealth, to control medical manpower in the Province of Que-bec, a smaller class size is more appropriate for our commit-ment to small group teaching in the New Curriculum .•

EDM

.................................................................

Te MinistryofHealthand locialle~iceshasan-nounced some important budget cutbacks that will be spreadover the 16 Regie Regionales throughout the province of Que-bec. The object is to reduce overall expenditures by $1.4 bil-

lion over three years starting in1995. The 1995 budget was setat $12.5 billion before the cut-backs were announced. In 1995,there will be a $550 million cut

~ of which $340 million will come from the acute care sectorband $133 mil!ion from payments to physicians. It is expected~ that between 9,000 and 10,000 health care jobs will be lostoSl in 1995. It is anticipated that, by 1997, there will be 2.5 acuteloCIf" care beds per thousand, with 5 beds per thousand in the long-::II

3: term care sector.?

Montreal Faces

Hospital Closures

In May, the Regional Council for Health and Social Services forMontreal Center issued a proclamation that it intended toclose seven hospitals and to cease sponsoring two others.These measures would permit economies of $178 million dol-lars. Almost a thousand Doctors, that is, more than 20% ofmedical personnel from Montreal would be affected by thisimportant restructuration. In June, the Montreal RegionalHealth Board gave its final approval to close the Queen Eliza-beth Hospital, The Lachine General Hospital, The 51. LaurentHospital, The Reddy Memorial and the 51.Jeanne D'Arc Hospi-tal. It will also cease to sponsor the Bellechasse Hospital andthe Guy Laporte Private Clinic. Further, the Centre HospitalierGouin Rosemont and the Centre Hospitalier 51. Michel wouldbecome centers for Long-Term Care.

The Catherine Booth Hospital in Notre Dame de Grace and theVilla Medica Rehabilitation Hospital on Sherbrooke S1. Eastwere spared after review.

THESllUARE..z::

5Health Minister, Dr. Jean Rochon, defended these measures asbeing necessary not only for economic reasons, but also because"there are too many acute beds in Montreal". The Board's planis to cut 1,224 beds and with the savings set up a new systemin which hospitals, 30 CLSC'sand 5,422 doctors in private clin-ics would work together to coordinate patient care.

The Regional Health Board based its conclusions on a credit ordemerit system utilizing five criteria viz., proportion of bedsfilled, number of patients admitted, average length of stay,level of outpatient care, and the number of beds used by pa-tients who did not need to be hospitalized .

There has been immediate negative reaction not only from thehospitals, but from many sectors of the Montreal area. Onecounter proposal has even been offered in which the Royal Vic-toria and Hotel Dieu Hospitals would close which would save$270 million compared with the $178 million the Board ex-pects to save by shutting the aforementioned community hos-pitals. This was not accepted.

In Quebec City, the Centre Hospitalier de I'Universite de Laval,the Hotel Dieu and Hopital 51. Fran~ois d' Assise have a unifiedmedico-administrative structure. The Enfant-Jesus as well asS1. Sacrament Hospitals have also requested to be "fused" toform a Centre Hospitalier Universitaire de Quebec (CHUQ).There is much anger particularly by the 15,000 anglophonesbecause the Quebec Regional Health Board intends to closethe Jeffrey Hale Hospital. The "Jeff" which is 130 years old has138 acute care beds and 20 long-term beds.

In Quebec City,there are 7.5 acute treatment hospital beds per1000 population, whereas in Montreal there are 4.2 beds per1000 population.

On June 20, Bill83, the health reform bill,was passed by the gov-ernment. It is expected that hospital closures will be as follows:

April 1, 1996 - St. Laurent and Lachine General Hospitals.Sept. 1, 1996 - Queen Elizabeth and St. Jeanne d'Arc HospitalsFeb. 1, 1997 - Reddy Memorial and Bellechasse Hospitals.

St-Michel Hospital will convert to long-term care.April 1, 1997 - The last closings will be Gouin-Rosemont

and Guy Laporte Hospitals.

The main elements of the health reform in Quebec, so far, arethe horizontal mergers of facilities, facility shut downs and theexpansion of the ambulatory care sector. However, given thetime frame for the implementation of the reform, certain Re-gies Regionales are having difficulty funding the ongoing ser-vices during the transition period .•

D.Aile. Va. Beek from Minneapolis, Min-nesota was a Visiting Professor to the Plastic Surgery Programat McGill, April 12-13 1995.

Dr. Jean Deslauriers, Professor ofSurgery at Laval University andChief of the Division of Thoracic

Surgery at Hopital Laval in Sainte-Foy, Quebec, was this year'sStikeman Visiting Professor for Cardiovascular and ThoracicSurgery at McGill. Dr. Deslauriers lectures widely on an inter-national level, and has trained many young thoracic surgeonsfrom Quebec and from many other countries. He has developedan international reputation for his expertise in general thoracicsurgery, particularly lung cancer, esophageal surgery and

surgery for emphysema.

Visiting Professors

At the MGH Surgical Grand Rounds onThursday morning, June 1, his topic wasThe History of Surgical Approach to Emphy-sema. In the afternoon at the RVHRounds, Dr. Deslaurier's topic was Princi-ples of Tracheobronchial Reconstruction.

During the morning session, residents pre-sented their research work and on Thurs-day evening during the annual dinnerheld at the Mount Stephen's Club, Dr.BrianMott was the recipient of the 1995 Ed-ward Charette Research Prize.

Dr.Jean Deslauriers

The Stikeman Endowment Fund for Surgical Advancement wasestablished in memory of Richard Alan Stikeman in 1965 bythe Stikeman family. The fund was mandated to be "peopleoriented", with the main objective to "sharpen people" whoare engaged in the practice, training and research in cardio-vascular and thoracic surgery. It is also a reunion of previousresidents in CVTSurgery at McGill, providing a forum for pro-fessional, scientific and personal interactions among alumni,current staff and trainees. Thus, the Stikeman Visiting Profes-sorship has become an outstanding occasion both for scholar-ship and friendship, significantly contributing to thedevelopment and vitality of Cardiovascular and ThoracicSurgery at McGill University.

Dr. C.W. Elston is Consultant Histopathologist at City Hospital inNottingham, England. At the MGHon March 10, his talk was en-titled Making the most of histology - the value of traditional patho-

THE SQUARE..:z

~

6logical fadors in breast cancer. On March 9th at the RVH,he spokeon the following topic, Assessment of Prognosis in Breast Cancer;Experience in the Nottingham TenovusPrimary Breast CancerStudy.

Dr. LaSalle D. Leffall, Jr. was the seventh Fraser Gurd Visit-ing Professor on May 25, 1995. He is Professor and Chairmanof the Department of Surgery at Howard University in Wash-ington, D.C. His professional life has been devoted to the studyof cancer, especially as it relates to African-Americans. He is

President-Elect of theAmerican College of Sur-geons.

On May 25th, 1995, hegave Surgical GrandRounds at the MGH dis-cussing The Evolutionand Changing Status ofSurgical Oncology. In theafternoon at SurgicalGrand Rounds at theRVH, his topic was TheDiagnosis and Manage-ment of Soft Tissue Sarco-mas. That evening he

was the guest speaker at the Fraser Gurd banquet held atLe Westin Mont-Royal.

Dr. LaSalle D. Leftall,)r.

Dr. Robert K. Finley, Jr., Professor, Department of Surgery,Wright State University, School of Medicine, Dayton, Ohio vis-ited McGill on June 8th. His topic at Surgical Grand Rounds atthe RVHwas Practicing Surgery in Undeveloped Countries. Hespoke of doing Surgery in northwest Kenya and in Rwanda.

Professor Henrik Kehlet visited the Department of Anes-thesia and Surgery at McGill during the week of March 20th.Professor Kehlet is a Surgeon at Hvidovre University Hospitalin Copenhagen and a pioneer in the study of the effect of mul-timodal pain management on stress and surgical outcome. Hegave the Surgeon's perspective on various types of peri-oper-ative analgesia. His visit was sponsored by ASTRACanada .•

EKL

......................................................

AVERAGE DOCTOR'S AGE BY SPECIALTY - PROVINCE OF QUEBEC

The numbers following the specialty indicate the percentage of doctors over the age of 60 in that specialty.

Average AverageSpecialty PercentAge Specialty Percent Age

42 Geriatrics 13 49 Plastic Surgery 20Allergy and Immunology 2145 Nuclear Medicine 20 Internal Medicine 29

46 Dermatology 10 50 Orthopedic Surgery 23Medical Microbiology Endocrinology 21and Infectious Diseases 19 Opthalmology 24Radiation Oncology 19 Diagnostic Radiology 2747 Neurology 13 51 CVT 29Rheumatology 17 oBSIGYN 27

O.T.l. 2748 Gastroenterology 17Community Medicine 29Hematology 17 Urology 22Nephrology 17

Pediatrics 20 52 Anatomo-Pathology 35Pneumology 22 Neurosurgery 33Psychiatry 22 Physiatry 3249 Anesthesia 29 53 General Surgery 38Medical Biochemistry 17

Cardiology 23 SOURCE: College of Physicians of Quebec.

THESQUARE""z:c...7

..................................•...........................................................................................

Welcome Aboard to Our·New

CoreSurgical Residents 1995-1996

RIKhaled AI-Albdulhadi

(Ear,Nose and Throat)Salem AI-Amri (Neurosurgery)Hussain AI-Mutairi (Orthopaedics)Khalid AI-Othman (Urology)A'Ayeed AI-Qahtani (General Surgery)Craig Baldry (General Surgery)Abdollah Behzadi (General Surgery)

John Borkowski (Orthopaedics)Margaret Chen (General Surgery)Victor Chu (Cardio- Thoracic)Philip Downer (Orthopaedics)Graham Elder (Orthopaedics)Paola Fata (General Surgery)Chantal Giguere (Ear, Nose and Throat)Felicia Huang (General Surgery)Emma Husain (Orthopaedics)Sandra Kay (General Surgery)Eric Labelle (General Surgery)Ayman Linjawi (General Surgery)

CONGENITAL:

~

~~~ Friendly~ r~ i>

~

Nancy Morin (General Surgery)Zubin Panthaki (Plastics)Jose Pires (General Surgery)Jose Adrian Prudencio (Neurosurgery)Archana Ramaswamy (General Surgery)Daniel Rosenstein (Urology)Jean-Pierre Souaid

(Ear,Nose and Throat)Adel Taha (General Surgery)Carson Wong (Urology)Steven Zielinski (Neurosurgery)

THE SQUARE'":z!:l

~RASER ~URD :;!JAY ~ANQUET

Dr.Rea Brown, Dr. Baird Smithand Dr. David Mulder

Dr. David Latter and Dr.Jonathan Meakins

Dr. Gerry Fried, Dr. Lucie Lessardand Dr.Jeffrey Barkun

~ARDSea.

Dr.David Mulder and Dr. LaSalle Leffall, Jr.

Dr. Taguchi and Dr. Benjamin Tripp

Dr. William Fisher,Dr.and Mrs. Ronald Castonguay,Dr.and Mrs. Richard Berkowitz

Madeleine Beaulne with Sarkis Meterissianand Marcelle Lavoie

Dr. Peter Richardson and Dr. Harvey Brown

Dr. Sandeep Sawhney, Dr. Benjamin Tripp,Dr.David Eiley and Carol Shear, Dr. David Greentree

Dr.Jose and Olga Mijangoswith Dr.Renzo Cecereand Natalie

TEACHING EXCELLENCE

AWARD (STAFF)

DR. OREN STEINMETZ

TEACHING EXCELLENCE

AWARD (RESIDENT)

DR. AHMED JAMJOOM

BEST TEACHER

(UNDERGRADUATE)

DR. DAVID LATTER

Dr. and Mrs. Hashim Balkhy

Dr. Lawrence and Donna Rosenbergwith Dr. Nick Chrostou

8

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(§lUAY 25, 91995

~ARDSe&>

BEST CLINICAL SCIENCE

RESEARCH AWARDDr.David Mulder, Mrs. Ruth Leffall,

Mrs. Norma Mulder and Dr. LaSalle Leffall, Jr.Mrs. Blundell, Dr. Peter Blundell

with Dr. Lisa Alford

DR. JOSEPH TECTOR

"Ex-vIVO XENOGENEIC

LIVER PERFUSION

AS A BRIDGE TO TRANSPLANT"

BEST BASIC SCIENCE

RESEARCH AWARD

Dr.Owen Steinmetz and Dr. Joe HelouDR. JULIO FARIA

"ANALYSIS OF PHENOTYPIC

EXPRESSION IN

AN IN VITRO MODEL

OF ENTEROCYTE DIFFERENTIATION

BY DIFFERENTIAL DISPLAY

OF M.R.N.A."

Dr.Julio Faria and Dr. LaSalle Leffall,Jr.

Dr.Joseph Tector and Dr. LaSalle Leffall, Jr. Dr.Ahmed Jamjoom and Dr. Andrew Selly

Dr. Carl Farmer and Dr. Eric Lenaner Dr. Lisa Ronback, Dr. Najma Ahmedand Dr. Delphine Glorieux

Dr.Jean Tchervenkov, Dr. Vinay Badwharand Dr. Jonathan Fridell

Dr. Arthur Rideout and Dr. Bruce Williams Dr. Helene Flageo/e and Dr.J.M. Laberge Dr. Ronald Zeit, Dr.Andrew Hilland Dr. David Owen

General Surgery Residents

THE SQUARE,..zo...

BACK ROW (L to R)

FRONT ROW (L to R)

Louis-Phillipe Palerme, Marc Pelletier, Vinay Badhwar, Kent Mackenzie, Talat Chughtai, Danny Enepekides.

Jody Bothwell, Marian Blumenkrantz, Andrew Seely,Jonathan Fridell, Liane Feldman, Eric Keyser-Gauvin,

Daniel Swartz.

Administrative Support Staff

Te fucultyisgenuinelyapp'"

ciative of the fine work and dedication of

these hard workers shown here at the

Fraser Gurd Dinner.

Sitting at the table are Gloria Morgan,

Emma Lisi, Rita Piccioni, Maria Bikas

and Maria Betancourt. Standing are

Suzanne Dupont, Madeleine Beaulne

and Cathy Torchia .•

URINE:OPPo5iteof~~~~

"yourout" ~ -- ~

~~

EDM

10

\1I

D.Jeffrey Bark •• of theRVH presented a lecture entitled BiliaryTract - Laparoscopic Cholecystectomy - Out-comes and Costs: The Montreal Experience

at the meeting of theSociety of American

.. --~ Gastrointestinal Endo-scopic Surgeons (SAGES) which was heldin March at Walt Disney World in LakeBuena Vista, Orlando, Florida. SAGESis anorganization of more than 2,800 surgeonswhich fosters academic, clinical and re-search excellence in endoscopic surgery.

KUDOS !!

Dr. Paul Belliveau was Visiting Professorat the University of British Columbia fromMay 24th to May 26th. On July 1st, Paulbecomes the Chief of the Blue Generaland Oncological Surgery Service of theRVH. He replaces Dr. E.D. Monaghanwho has held that position since 1984.

Dr. Ray Chiu was the Invited Speaker atthe International Symposium on Myocar-dial Protection in Chicago, and at the In-ternational Circulatory Support meetingof the Society of Thoracic Surgeons inPittsburgh, both in October of 1994. Healso presented a paper at the Society ofThoracic Surgeons in Palm Springs in Jan-uary 1995 on Myocardial Regeneration. Hewas an Invited Faculty at a Symposium onBiomechanical Support for Heart Failureat the American College of Cardiologymeeting in New Orleans in "~I,March 1995,and a Visiting Pro- ~~/.:

. /~~),fessor at the Shanghai Chest I

Hospital in Shanghai, China inApril 1995. He was in China as aguest speaker to the Chinese Na-tional Conference for Medical Resi-dencies sponsored by the Ministry ofHealth of the People's Republic of China.This conference was to develop a na-tional system of graduate educationin medicine, and Dr.Chiu was asked to in-troduce the North American System of

Graduate Education to them both formedical specialists and family physicians.The new system being developed in Chinacould eventually affect the quality ofhealth care affecting a population of 1.2billion in that country. Twodelegates from each of the28 provinces attended thispolicy conference. The mag-nitude of its implication canbe glanced that a singleprovince of Chiang-Su, where this con-ference took place, has a population of70 million, more than twice that of all ofCanada. Dr.Chiu was the Invited Speakerat a Symposium on Impact of MolecularBiology on Cardiovascular and MuscleDisease held in May 1995 at the StateUniversity of New York Health ScienceCenter in Brooklyn, New York. Dr. Chiuwas awarded the "Membre a I'Honneur"at the annual meeting of the Associationof Cardiovascular and Thoracic Surgery ofQuebec held at the Manoir Richelieu inJune 1995.

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mathematics among high school stu-dents. Dr. Entin· has been re-elected Pres-ident of the Canadian AuthorsAssociation, Montreal Branch for 1995.

With the collaboration of medical schools

~

» °00 across Canada, Dr. DavidI{f< Fleiszer of the MGH has}i ••••. started a consortium to put to-j "L gethera i;brary of .i.<lron;c mod;«i ;m~

ages for teaching purposes. There isstrong business support from Kodak,Canadian Aviation Electronics and MerckFrosst. The ACMC, the Royal College andthe Medical Council of Canada have allagreed to participate in this endeavor.

Dr. Nicolas Christou of the RVHhas beenappointed President-Elect of the SurgicalInfection Society (SIS). Along with Dr.Jonathan Meakins, Dr. Julius Gordon,Dr. John Vee and Dr. Lloyd Maclean, heco-authored a paper presented at theAmerican Surgical Association entitled TheDelayed Hypersensitivity Response and HostResistance in Surgical Patients: 20 YearsLater. This gave a 20 year follow-up of re-search on anergy done at the RVHto a veryprestigious society.

Dr. Martin Entin, McGill M.5c'42and MD'45 received a Distin-guished Service Award in Novem-ber of 1994 from the RVH. Thisaward is given yearly in recogni-tion of achieving a high degree ofprofessional competence. It is

noteworthy that Dr.Martin Entin hasserved the Royal Victoria Hospitalfor 40 years. He is also Vice-

President of the McGill Sigma Xi ResearchSociety which promotes science and

Dr. Daved Forbes, orthopaedic sur-geon for over 30 years at St-Mary's Hos-pital, retired in June. A farewell dinnerwas held for him at the Royal MontrealGolf Club by his colleagues, Drs. JimSullivan, Jack Sutton, PaulStephenson and Ron Dimentberg.His wife Patricia, who is a pediatricianat the MCH, will strive to accompanyhim in his travels.

Dr. Michel Gagner who graduated fromthe McGill Postgraduate Training Programin General Surgery in 1988 has left the Ho-tel Dieu de Montreal for the ClevelandClinic where he has been named Directorof the Section on Minimal Invasive Surgery.

Dr. Philip H. Gordon as President of theAmerican Society of Colon and Rectal Sur-geons hosted the annual meeting here inMontreal May 7th to the 12th, 1995. On}Monday, May 8th, he gave the presiden-tial address to a large appreciative audi-ence. It is noteworthy that at the samemeeting Dr. Phil Gold, Physician-in-Chiefof the MGH gave a presentation entitledThe Study of CEA 7965-7995: My Life in a''Mi!limorgan ".

Congratulations to Drs. Andrew Hill andMargaret Fraser on the birth of their son,Fraser on March 4th, 1995, weighing 7pounds 3 ounces at St. Mary's Hospital. ~

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THE SQUARE

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Dr. Julio Faria has received a fellowshipaward from the FRSQ (Fonds deRecherche en Sante). Julio is registered inthe Ph.D. program in ExperimentalSurgery under the co-supervision of GaryE. Wild, MD, PhD, FRCP. His research fo-cuses on Differential Gene Expression in

Colon Carcinoma. Working with Dr. Ju-

dith L. Trudel, Julio presented ",1 I'~/a paper at the 1994 Surgical -=:- ~.~ ~I 'Forum of the ACS and has had

two posters accepted for presen-tation at the 1995 American Gas-troenterological Associationmeeting in San Diego, and at the1995 American Society of Colon and Rec-tal Surgeons meeting in Montreal re-spectively.

D.,brahim AI-Sh.n.berpresented a paper at the April meeting inToronto of the Canadian Society of Surgi-cal Oncology entitled Small Bowel Resec-

tion for Metastatic

Melanoma.

vival in Isolated Human Islets.

Dr. Paraskevas is working under the su-pervision of Dr. Lawrence Rosenberg.

Dr. Baird Smith is an Assistant Professorof Pediatric Surgery at Stanford Universityeffective July 1st, 1995.

Dr. Mitchell Stotland won firstI prize (basic science) at the Canadian

Society of Plastic Surgeons 49th an-nual meeting in Saskatoon, June 9,1995 for a paper entitled E- and

L-Selectin Adhesion Molecules in

Reperfusion Injury. The co-authoron this paper was Dr. Carolyn Ker-

rigan. Mitchell also co-authored apaper The Effects of TNF in Is-

chemia-Reperfusion Injury of

Myocutaneous Flaps and Skin Flaps and a

poster E-Selectin Expression in Flaps Sub-

jected to Different Types of Ischemia pre-sented at the 40th annual Plastic SurgeryResearch Council in New York City in Mayof 1995. The latter papers were co-au-thored by Dr. Changzheng Wang andDr. Carolyn Kerrigan.

Achievementsof Residentsand Fellows

Dr. Najma Ahmed

presented a pa per tothe Surgical Infec-

tion Society entitled Modulation of Human

Neutrophil L-Selectin During the Systemic

Inflammatory ResponseSyndrome is Partly

Mediated by Tumor NecrosisFactor-a. Thiswill be published in the Archives of Surgerynext spring. Najma will be the recipient ofthe Glaxo Canada Fellowship Award whichis given through the Canadian InfectionDisease Society for residents who carry re-search on surgical infections. She was pre-sented this award which is for one year'ssalary at the meeting of the 19th Interna-tional Congress of Chemotherapy in Mon-treal, July 16-21, 1995.

Dr. Helene Flageole is going to do pe-diatric surgery in Belgium on a McLaugh-lin scholarship for one year.

Dr. Frank Fleming, a graduate of our Plas-tic Surgery Program, has taken up practicein Seattle, Washington, July 1st, 1995.

Dr. Ezat Hashim and his wife Carole Picardare the proud parents of a sonJulien Albert weighing 9 pounds1 ou nce born on May 20, 1995.

Dr. Audrius Zibaitis, Dr. Chiu's ResearchFellow, presented an abstract entitled Dif-

ferentiation of Satellite Cells Implanted In-

tracardially: Confluence-Effect Hypothesis

at the 17th Annual Meeting of the NorthAmerican Section of the International So-ciety of Heart Research on May 21 st,1995, Orange Beach, Alabama.

Dr. John Antoniou, fourthyear orthopaedic surgeryresident and a McGill Ph.D.candidate, received the Canadian Or-thopaedic Association's COR/ACORawardfor 1995. This was for a project entitledQuantitative Magnetic Resonance: Diag-

nostic Tool of Intervertebral Disc Matrix In-

tegrity and Turnover. This award is givento the best research by a young Canadianorthopaedic resident.

Dr. Teanoosh Hossein-

zadeh started a Hand Fellowshipin Plastic Surgery at the Medical Collegeof Wisconsin in July 1995.

Dr. Brian Mott presented a poster at theModerated Poster Session on TachycardiaInduced Cardiomyoplasty of the 17th An-nual Meeting of the North American Sec-tion of the International Society of HeartResearch on Effects of Adynamic Car-

diomyoplasty on Ventricular Function in a

Rapid Pacing Heart Failure Model on May20th, 1995, Orange Beach, Alabama.

Dr. John Vee is the recipient of the MilesPharmaceutical Infection Disease Fellow-ship Award starting July 1996. John alsoreceived the New Resident ResearchAward co-sponsored by the CSCIand theMRC. John is shown here with Dr. Gerry

Fried at the Fraser Gurd banquet. Also,John and his wife Cindy are the proudparents of a son, Justin Timothy, born atthe RVH on June 29th, 1995, weighing 6pounds 14 ounces. ~

Dr. Frank Campanile, a graduate of ourprogram in Plastic Surgery, started a HandFellowship at Ohio State University in Au-gust of 1995.

Dr. David Clas has been named an As-sistant Professor in the Division of GeneralSurgery and Critical Care at the Maison-neuve-Rosemont Hospital.

Dr. Steve Paraskevas was awarded aCanadian Diabetes Association ResearchFellowship to conduct work on his M.Sc.project entitled Factors Mediating CellSur-

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D.A. Hope McArdle, Associate Professor of

Surgery, retires this year following over thirty years of servicein the research laboratories ofthe University Surgical Clinic atThe Montreal General Hospital. Dr.McArdle received her Ph.D.

in Biochemistry fromMcGill University, and wasappointed by Dr. FraserGurd as a basic scientist tocollaborate with surgeons

during their research year. She was the first woman and Ph.D.to be appointed to the Department of Surgery at McGill Uni-versity. She has been Assistant Director of the University Sur-gical Clinic, and over the years trained a number of Ph.D. and

Dr.A. Hope McArdle's

Retirement

Dr. Ernest W. Richards presenting a plaque

to Dr.A. Hope McArdle

M.Sc. students. She has taught generations of surgical resi-dents passing through the University Surgical Clinic. One ofher major contributions was the development of an elemen-tal diet for which she collaborated closely with Dr. GustavoBounous. Dr. McArdle participated in the animal and clinicaltrial phases of this diet, actively participated in the nutritionalmanagement of critically ill patients, and was primarily in-strumental in the establishment of the Nutritional SupportService at The Montreal General Hospital.

A retirement party was held at the Faculty Club of McGill Uni-versity on May 26th, 1995. Her associates, residents and lab-oratory personnel, many from decades ago, returned to paytribute to her. Dr. Ernest W. Richards, Clinical Research Asso-ciate, Cancer and AIDS Support of Medical Nutrition of RossLaboratories presented a plaque to her acknowledging her re-search excellence and in recognition of over four decades ofdistinguished research, outstanding contributions to the field

THE SQUARE,..zo...15

of clinical nutrition, and the lives she has helped throughthese accomplishments.

The entire McGill Department of Surgery wish her a veryhappy retirement. •

EKL.........................................................

A generous business leader and an imagi-

native surgeon combine to offer the Surgical Research Lab-oratories in the University Surgical Clinic of The MontrealGeneral Hospital a unique approach to enhance research

productivity inthese labs. Mr.U.G. Heward,Chil to friends, isthe Chairmanand Chief Execu-

tive Officer of C.F.G. Heward Investment Management Lim-ited, a company founded in 1981 to provide globalinvestment strategy to its clients. When approached by Dr.Peter E. Blundell, senior cardiovascular and thoracic sur-

geon at The Montreal GeneralHospital, to contribute supportfor the surgical lab, he respondedrapidly with a sizeable chequeand promises of more to come.Designated as the "Heward Visit-ing Scientist Fund", it allows ourinvestigators to identify and in-vite a specific scientist who cancontribute directly to an ongoingproject in our lab to come for ashort visit. Unlike visiting pro-

fessors, these scientists get down to discuss and work inthe lab directly with the investigators and research fellows,in order to transfer their specific knowledge and skills.During the working dinner, the exchange of ideas continue.No ceremonial lectures or banquets here! The benefits toour researchers are concrete and immense. Mr. Heward'ssupport, like his investments, reflects his global vision, en-hances our research and ultimately our patient care .•

R.C.-J.Chiu

(.F.6. Heward

Visiting Scientist for

Surgical Research

Dr. D.F.G.Heward

.........................................................

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~ Up until approximately one year ago, hospital budgetsdid not actually drop, but did not keep up with inflation. Thesebudgets are now being absolutely diminished. There are anumber of activities within the hospital which could be pro-vided outside the hospital which diminishes the global bud-get for activities that cannot be performed anywhere else.Incentives which reward excellent care and large patient loaddetract from other activities and create interprofessional ten-sion. For example, a very effective cardiac team can be ex-pensive for the hospital even though the service provided issuperb. Fees are low in this country, especially in Quebecwhich has the lowest fee schedule in Canada, and lower thanin the United States. The scheme encourages a single level ofcare which need not be of high quality. There are disincen-tives to recent graduates in that trained Surgeons with per-haps a very narrow specialty interest, which prevents themfrom working in rural areas, receive only 70% of the stipendfor their activities if they rema in in cities in the province. Newtechnology is in very short supply compared to the UnitedStates. For example, there are only 50 CT scanners in all ofQuebec which has 140 acute care hospitals.

Table III: Fee Schedule, Quebec

Colonoscopy $100Right hemicolectomy $380left hemicolectomy $460Total proctocolectomy and pouch $840Abdominoperineal resection $620Mean Gross IncomeGeneral Surgeon $195,801 in 1994Procedures per Surgeon $4,332 in 1994

04('

Table III will be of interest to those of you doing colorectalsurgery. Despite the low fee schedule, the mean gross incomeof General Surgeons last year was $195,801. This income,while gross, is not subject to major expenses for collecting feeswhich is truly minimal nor deductions for practice insurancewhich for a General Surgeon is approximately $5,000 per year.This table does emphasize the large amount of activity of theGeneral Surgeon. The number includes all codes submitted bythe 435 General Surgeons in the province of Quebec, office vis-its, as well as operative activity. If a total colectomy pluscholecystectomy is done, this would count as two bills to thegovernment. This is a level of activity that far exceeds thatcommon in the United States. If a General Surgeon in Quebecworks 5 days a week and 11 months a year, he or she will billfor 18 procedures/day.

We have recently seen a change in health care delivery espe-

THE SQUARE..z

~

17cially in the province of Quebec. We refer to the early 70's asthe"good old days"when the number of trainees and their ac-tivities in the teaching hospitals were determined by theneeds of those institutions not the needs of the community.The government recognized this in the 80's and proceeded tolimit the numbers who could be taken into various specialtiesand increase the number of people to be trained as FamilyPhysicians, but did not solve the problem of getting special-ists to rural areas. We call the 90's the "not-so-bad period" orthe managed market which is now prevalent in which thegovernment does consult with all hospitals, universities, theFederation of Medical Specialists, the Federation of FamilyPhysicians, the Federation of Residents and other interestedgroups. There has been much more agreement on appropri-ate goals which include the following: the production of theright number, mix and type of physician to look after the pop-ulation; to maintain the 1986 population to MD ratio which isapproximately 450:1; and to maintain a 50:50 ratio of FamilyPhysicians to Specialists.

There is one position in a training program for each persongraduating in Medicine in the province. This number hasdropped over the last decade from 650 to less than 500, andin the next five years the graduates of the four medical schoolswill be down to approximately 450. The number of peopletrained in each specialty is determined more at the practicelevel rather than at the training level programs, and every at-tempt has been made to have only three types of hospitals inthe province. Firstly, a local hospital which has available Anes-thesia, General Surgery, Internal Medicine, Diagnostic Radiol-ogy, Pathology, Ob/Gyn, Pediatrics, Orthopedics and Psychiatry.A Regional Hospital has the Medical and Pediatric subspecial-ties, the Surgery specialties, laboratory specialties and Com-munity Health. Tertiary Care Hospitals provide in addition tosome of the other activities, CVTSurgery, Transplant, Neuro-surgery and Radio-Oncology. There is extensive data availableon Physicians' and Surgeons' activities within the province sothat one could predict on the basis of work week, waiting lists,and age how many in each specialty should be trained. Forexample, there are 7.39 General Surgeons per 100,000 of thepopulation in Quebec, 58% are over 50, and 30% are over 60.The weekly work hours are 44 which is higher than Ontarioand it has been concluded on this basis that more General Sur-geons should be trained and more have been recruited intothe training programs within the province. The opposite ex-ists for pediatricians where there is a lesser need, and so fewertraining spots have been provided.

The increased number of residents going into Family Practice,because it was the only residency available for many gradu-ates during the period when the government ran things ~

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