It is my honour and privilege to assume the Presidency of the
SOGC.
Je suis à la fois heureux et fier de jouir de cette incroyable
opportunité.
I want to thank all of the past presidents for their enthusiastic
escort to the stage. Have I really given informed consent for this?
And, as one of my first official duties I would like to honour our
retiring President, Dr. Margaret Burnett.
You have brought passion, clear thinking and commitment and
advanced our Society. And all the while kept up prodigious other
activities, including being a Royal College Mentor of the year.
It is my great pleasure to present you with a past president’s pin
as a token of appreciation for your efforts and achievements on
behalf of the Society.
Thank you
I am also honoured to acccept my new role here, in
Vancouver…..on the territory of the Coast Salish people or the
Tsleil-Waututh First Nation.
One of their well-known chiefs in the 1960s was Dan George who
became an actor later in life. He was also a poet.
He wrote:
The beauty of the trees,
the softness of the air,
the fragrance of the grass,
speaks to me.
And my heart soars.
I use these words today as I launch my Presidency to celebrate all
that that which, as health providers, we have the privilege of
doing every day in our profession.
And, as I will get to a little later, that poem paints a powerful,
elegant and minimalist image, using few words. It is a concept I
want you to hold in your mind this morning and ultimately into
your practice.
So why me ? How did I get this opportunity ?
The simple and precise answer is that my colleagues on our
Board elected me.
This is not the traditional way that we have chosen our
presidents.
In Saskatchewan provincial politics when there’s a problem what
we say is “Blame the feds.”
In this case it is federal legislation known as the Non-Profit
Corporations Act. This act changed the rules for us and about
30,000 other non-profit organizations in Canada.
Consequently, we have had to change our governance.
You, the members, elect members of the Board from among
yourselves, preserving regional representation.
It is then the Board which chooses the Officers of the Society. I
have therefore been given this opportunity.
I would like to express my sincere thanks to the SOGC Board for
entrusting me with this position and I look forward to
representing you during the exciting year that lies ahead.
I also know it is not possible to do this job without enormous
ongoing support. I appreciate the time, commitment, passion and
talents of my colleagues on the Board and in our membership, as
well as the devoted staff in our national office who work
tirelessly on behalf of all of us.
Ils sont tous dévoués à notre société et à sa mission d’améliorer
la santé et la vie des femmes et des familles au Canada et dans le
monde.
I will rely upon all of you heavily and I know you will rise to the
occasion.
One of the proudest highlights of the SOGC year is this annual
conference.
Notre réunion clinique et scientifique est l’une des principales
réalisations de notre société en vue d’aider nos membres, qui
essaient tous de mieux faire leur travail.
We have had another superb learning opportunity over the past
few days and I thank Doctors Nancy Kent, Amanda Skoll,
Margaret Burnett and all members of the planning committee
and all those who produced and provided this program.
Nous partirons tous d’ici mieux équipés pour mener à bien le
travail que nous avons le privilège de faire.
Let us thank them again.
Time spent serving the SOGC must come from somewhere during
the next year. I would like to thank my colleagues in our
Department in Regina in advance for their support --- in particular
Doctors Cardoso and Adanlawo in Maternal Fetal Medicine. I
somehow think that women will continue to get pregnant, some
of them with difficult pregnancies, during my presidency.
And, I come to the most important support of all, which is family.
Our son and his wife are nearly as excited as I am, and are
strongly supportive. When I had the unexpected honour to be
asked to consider this position my first step was to check with
Senior Management – Sheila. She is my best friend and unfailing
supporter, whom I have loved since we met on a pediatric ward
in the Ottawa Civic Hospital 44 years ago. Whatever I achieve will
be owed to her.
The SOGC continues to strive to meet its mission “to promote
excellence in the practice of obstetrics and gynecology and
advance the health of women through leadership, advocacy,
collaboration and education.” That is where we are going. Our
Strategic Priorities are how we will do it.
As you have all been hearing, we have developed and brought
forward a new Strategic Plan for our Society which is the broad
general direction we will be heading in over the next four years.
Vision 2020, as ratified this morning at the AGM, includes clear
priority placed on Quality of Care, Education, Advocacy and our
sustainability as we are Growing Stronger.
The Quality of Care is, of course, what all of us do and can
substantially control ourselves. This includes following best
practices, participating in research and developing and
supporting the highest standard of clinical guidelines—something
about which the SOGC should be very proud.
The SOGC will continue to play a huge role in Education to help
physicians, health care workers and the public keep up-to-date
with and implement new research and advances in medicine.
We will continue to Advocate for the care of women - with a
strong voice –and with particular attention to those with
increased chance of adverse outcome and disadvantageous
circumstances both in Canada and internationally. We will be
visible and credible as the voice for the care of women and
reproductive health care in Canada.
Nous nous efforcerons d’être visibles et crédibles et nous nous
ferons le porte-parole du milieu des soins aux femmes et des
soins de santé génésique au Canada.
For those of you who may wonder where specific mention of
Indigenous health or global health has gone, have no fear. These
important constituents are no longer labelled separately; they
are integral in everything we do.
And, of course, we can do none of this without Growing Stronger
as an organization. We will continuously make choices we believe
are in the best interest of the Society, and look realistically at the
cost-effectiveness of what we do.
Another way we can grow stronger is to forge closer
partnerships.
One partnership I feel strongly about is with the Association of
Professionals in Obstetrics and Gynecology, or APOG who have
been leaders in education and research in academic programs of
obstetrics and gynaecology in Canada for the past 35 years.
And there others where many of our professional colleagues are
leading experts in subspecialty groups such as gynecologic
oncology, endocrinology and infertility, maternal fetal medicine
and others.
The SOGC feels like it should be the natural home for all of us.
There is a simple equation that 1 + 1 is much greater than 2. We
have complementary strengths.
Therefore, as a first step, I can tell you that discussions are
underway and will be pursued for an alliance with APOG.
I strongly believe we can achieve more together than separately.
We will each preserve our individuality but will take advantage of
the fact that we are substantially together in practice anyway.
This alliance will make the SOGC stronger by strengthening the
relationship between the Society and our colleagues in teaching
and research.
This brings me to a theme of mine that I believe we need to
explore as a profession. This is the appropriateness of what we
do. More is not necessarily helpful; more is not necessarily
innocuous. I will explain.
I go back to Chief Dan George’s poem and the exquisite simplicity
of taking time to appreciate the beauty and life around us.
There is a saying “don’t just do something, stand there.” I wish I
had invented it but I am fully prepared to steal it.
We all go to work with good intentions but incontrovertible
evidence reveals that about 30% of what we do confers no
benefit. Yet we face incessant pressure from ourselves and
patients to do more.
The Choosing Wisely initiative, which the SOGC will join and
wholly support, suggests there is a balance eluding us.
Sometimes by doing less, not more, we will spare patients harm
and can free up resources for what is really helpful.
More is not necessarily better. More is not necessarily innocuous.
What do I mean by this?
Choosing Wisely - Choisir avec soin is designed to advance a
national dialogue to avoid wastefulness, unnecessary medical
tests, treatment and procedures.
An example.
In neonatology the outcome for critically ill babies improves
moving from the lowest quintile of resource expenditure and
number of neonatologists to the next lowest quintile. But further
increases beyond that do not improve the outcome and consume
more resources.
Another example.
Ovarian cancer is a horrible disease and too often it is found at
advanced stages. So we have pursued screening. But it has been
proven through large randomized trials, that the women
subjected to the screening did not have a reduction in ovarian
cancer mortality or all-cause mortality.
More was not helpful.
The women with the extensive screening instead had many more
interventions for non-malignant masses and, associated with the
interventions, of course, complications.
More is not necessarily innocuous.
And, a last example.
In trying to prevent potential damages such as cerebral palsy to a
babies from lack of oxygen during labour intervention, the
instances of electronic fetal monitoring have increased
dramatically.
Only after the proliferation were actual trials conducted to
determine if benefits were achieved and, if so, at what cost.
Data shows there has been no reduction of intrapartum death or
survival with cerebral palsy in the women with EFM compared to
IA. However, quite reliably, there is been an increase in both
operative vaginal delivery and caesarean section – interventions
which have their own increased risk of complications.
More has not been helpful; more has not been innocuous.
These sorts of findings are, of course, not restricted to obstetrics
and gynecology. The American Board of Internal Medicine
adopted the Choosing Wisely initiative in the United States in
2012. Choosing Wisely Canada has been mobilizing ever since
and held its first National Meeting in Toronto earlier this spring.
In practical terms Choosing Wisely began by asking physician
groups to identify unnecessary procedures in their area, and for
each specialty group to come up with five things physicians and
patients should question. These must, and for us will, be
meaningful things- things we do enough that not necessarily
doing them will make a difference.
The SOGC is ahead of the curve. We have the benefit of a
substantial body of information arising from our own clinical
guidelines in which there are strong, evidence-based reasons not
to do some things.
We can, and in my opinion we should, publicize these.
Some of this work is already underway and many of you will hear
more about it in a workshop to be held a little later this morning.
I believe this is a vital dialogue about the fundamentals behind
delivering the best in health care in Canada.
As President, I want the SOGC to be a strong and vibrant part of
the Choosing Wisely movement.
To be clear, the Choosing Wisely movement it is not just about
saving money. But I think it is actually not a dirty word to talk
about that.
There are a finite number of resources available for health care
and if we do not spend it on things that do not confer a benefit
then we can redirect resources to things that do provide benefit.
It is our duty as responsible stewards of resources to Choose
Wisely or, in other words, sometimes to “Don’t just do
something, but stand there.”
Just recently - I like to pretend - I was a medical student and one
of my more inspiring teachers espoused, what he referred to at
the time, as the “Elegant Minimum.”
J’espère que nous saurons tous accomplir cet élégant minimum.
This is an approach to patient care which involves doing
everything that matters - and nothing else!
To achieve this requires rigorous analysis of a problem to create a
strategy that includes everything necessary to solve the problem
and then doing only what works or can reasonably be expected
to work.
Cela signifie qu’il faut faire la bonne chose de la bonne façon du
premier coup.
The essential prerequisite for this is critical thinking – clearly,
accurately, consistently and fairly.
What appeals most to me is that it recognizes, and puts first, the
needs of the individual patient. By so doing, it conserves
resources so that the whole population of patients benefit.
The elegant minimum flows from clear thinking.
You and I, and our colleagues who are back at home working in
their practices, have enormous opportunities.
There are sorrows, of course, which must be borne by our
patients and their families – and those of us who care for them in
during unfortunate circumstances. But we also get to share the
joy. The joy of a new baby; the joy of successfully treated disease.
And we can take legitimate self-satisfaction in believing that our
work makes a difference.
We will continue to have good intentions and work hard.
As we pursue our Strategic Priorities I hope I can help drive a
movement towards the elegant minimum as we consider “more
is not always helpful.”
This is where I hope we will go together.
And with that, as we go forth from here, may our hearts soar.