Regional Prix d’excellence — Specialist of the Year: Recipients
2018 Award Winners
Region 1 Dr. Savvakis Nicolaou, FRCPC, Vancouver
As a young radiologist, Dr. Savvas Nicolaou didn’t think it was fair that a patient coming to the emergency department in the middle of the night often waited longer to get a diagnosis, simply because there wasn’t a radiologist available to interpret a scan. Further, he was concerned that radiology had not evolved to deal with the growing and complex demands of emergency medicine. He made it his life’s mission to improve emergency trauma radiology – both in the time it takes to get results, as well as in the safety and quality of imaging.
Dr. Nicolaou recognized early on that there was a need for radiologists to be trained specifically to identify acute emergency issues under a high-pressure timeline. In 2002, within the emergency department at Vancouver General Hospital (VGH) where he works, Dr. Nicolaou developed the first emergency trauma radiology fellowship in Canada, which has trained dozens of specialists who have gone on to practice in emergency departments around the world.
“Under his leadership, the emergency radiology fellowship program at VGH has become the largest in the world and attracts the brightest radiologists from across the globe,” says Dr. Luck Louis, a clinical associate professor in the departments of radiology and surgery at VGH and UBC hospitals. Similar programs have since been created across Canada, including in Ottawa and Toronto.
In 2013, Dr. Nicolaou was instrumental in implementing a 24/7 radiology service at VGH. A radiologist is now on site within the emergency department 24 hours a day. Emergency radiologists can call up physicians to explain what they’re seeing on the screen as the patient is getting a CT or ultrasound scan. This means physicians don’t have to wait until the report is delivered to them to diagnose and treat their patient.
“He started the first 24/7 radiology service in Canada,” says Dr. Nicolas Murray, a radiologist at VGH. “Before his era, radiology was still perceived as a boutique 8 a.m. to 5 p.m. practice, where referring physicians were battling to get examinations done after hours.”
What Dr. Nicolaou’s efforts mean for patients is they can be diagnosed with a blood clot in the brain, or stomach bleeding or appendicitis, in minutes instead of hours. Studies have shown that the protocol he developed has significantly reduced the morbidity and mortality of severely injured patients.
Through his ability to rally and inspire others, Dr. Nicolaou has led a number of important safety protocols in radiology. At VGH, women of childbearing age now have MRI scans in the acute setting, where possible, to avoid the potential of reproductive organ-damaging radiation from CT scans. Radiation levels are also customized for each patient’s weight and medical indications.
As Dr. Murray says, “he literally revolutionized the practice of radiology in Canada.”
Region 2 Dr. Michael Helewa, FRCSC, Winnipeg
As a professor and the head of obstetrics at St. Boniface Hospital in Winnipeg, Dr. Michael Helewa takes his frontline experiences caring for women with pregnancy and birth complications to boardrooms and conferences. He’s advocated to improve maternal care in hospitals and in rural and remote communities, not just in Manitoba, but across the country.
In the 1980s, Dr. Helewa remembers seeing sadness and anxiety on the faces of expectant mothers as their husbands and children left them in the hospital for yet another night. He saw how being separated from their families and support networks was leading to anxiety and depression in women who were about to give birth.
Around 1985, Dr. Helewa and his colleagues launched and promoted the Antenatal Home Care Program, training nurses to treat pregnant women in Winnipeg and rural Manitoba. The success of the program proved that in many cases, complications like preeclampsia and ruptured membranes could be managed at home. Research conducted by Dr. Helewa and his colleagues showed that at-home care led to better health outcomes for women and their babies, and the hub-and-spokes program was subsequently adopted by several other Canadian centres.
In 2005, as president of the Society of Obstetricians and Gynaecologists of Canada, Dr. Helewa oversaw another program to better utilize health care workers in frontline maternal care. The Multidisciplinary Collaborative Primary Maternity Care Project (MCP2) defined roles and improved collaboration and communication among maternal health providers, including rural family physicians, midwives, nurses and social workers.
Dr. Helewa was instrumental to a number of important policy and educational activities, among them management of hypertensive disorders of pregnancy, universal group B strep screening, the National Birthing Strategy and the MOREOB program. The latter is now used at centres across North America to improve patient safety in obstetrics.
The moms meeting him at the hospital in the middle of the night may not know about these contributions. To them, he’s just a great doctor. “He is seemingly indefatigable in his efforts over the years to provide continuity of care and personal attention to his patients,” wrote Dr. Carol Schneider of the Department of Obstetrics at the University of Manitoba. Dr. Shaundra Popowich, a gynecologic oncologist and palliative medicine specialist trained by Dr. Helewa, added, “I am always impressed by the unwavering thoughtfulness of his evaluations.”
Dr. Helewa struggles to explain what motivated him to champion women’s health, especially for those living in socioeconomically disadvantaged and geographically remote areas. He cites, “the love of the specialty, amazement with what teamwork can do” and “the health of women everywhere,” and then he says simply: “You also want to leave something behind for the new generation to build on.”
Region 3 Dr. Jocelyn Garland, FRCPC, Kingston
As her physician-parents tell it, Claire Barber would have died if not for Dr. Jocelyn Garland. The teenager was critically ill, with multiple organ failure, when she was admitted to the ICU in Kingston. Dr. Garland, on vacation at the time, started instructing her care over the phone. She diagnosed her with a rare condition that resulted in acute kidney failure.
Dr. Garland collaborated with experts around the world and lobbied for Claire to obtain access to a $30,000-a-dose drug. At a time when Claire was feeling as some doctors saw her primarily as “an interesting medical case,” Dr. Garland spoke to her “as a person and not a patient,” Claire remembers.
“It became apparent from the start that Claire’s stalwart team of physicians were deferring to Dr. Garland’s expertise,” wrote Dr. Karen Barber, a family physician in Kingston and Claire’s mother. “Under Jocelyn’s stewardship, Claire had the most incredible, compassionate care that her father (also a family physician) and I have ever seen.” Claire’s kidney disease resolved completely with treatment and she is now studying at Queen’s University.
As the medical director of the specialized kidney disease clinic at Kingston Health Sciences Centre (KHSC) and an associate professor at Queen’s University, Dr. Garland provides care for patients with rare and serious kidney diseases. Thanks in no small part to her leadership, in 2018, the Ontario Renal Network designated KHSC as one of the province’s six specialty clinics for glomerulonephritis and pregnancy care for chronic kidney disease patients. As a result, dozens of patients can now receive specialized care in their home region.
“Her care and attention to detail with these patients, as well as the relationships she establishes with them, is like no other I have witnessed in my career,” says Dr. Stephen Archer, head of the Department of Medicine at Queen’s.
Dr. Garland’s commitment to patients is evident in the time she spends after clinic hours to answer her colleagues’ queries and to provide emotional support to her patients. Susanne Jeffrey, a nurse practitioner at the clinic, says Dr. Garland takes great effort to explain the possible treatments so patients can fully comprehend the options.
Dr. Garland’s motivation to go the extra mile – which can mean securing patient coverage for costly drugs – stems from her determination. “I often do say to medical learners, if you identify something, it’s really up to you to see it through,” she says. “I often think about how I would want to be treated and try to treat each patient that way.”
Region 4 Dr. David Fortin, FRCSC, Sherbrooke
When asked about his greatest accomplishment, Dr. David Fortin, chief medical officer of neuro-oncology at Sherbrooke University Hospital Centre, points to the fact that the research laboratory he established is still running after 15 years.
Dr. Fortin’s research lab has led to one of the most successful brain tumour treatments in the world, yet its operation was threatened by a funding shortfall a few years ago. It’s difficult to convince granting agencies to fund the research since brain tumours are extremely rare; major treatment breakthroughs extend lives by months, not years.
Dr. Fortin knows how precious those months are for patients. “There’s all the knowledge and experience this individual has acquired, and a whole network of people,” he says. “When you realize all the ripples left by a single loss, it’s enormous.”
In the last decade, Dr. Fortin has pioneered and perfected a novel treatment called inter-arterial chemotherapy, in which medications are delivered directly into one or more arteries in the brain. This method has opened up a wide range of pharmaceutical options, many of which are limited in efficacy when injected into the body due to the blood-brain barrier. While data shows that median survival is around 15 months for malignant glial tumours, Dr. Fortin and his team have brought average survival rates up to 25 months.
“This is the reason why his team receives referrals from all regions in Quebec, and sometimes from other provinces,” says Dr. Robert Sabbagh, director of research at Sherbrooke University’s Department of Surgery. Dr. Fortin is currently training specialists in Europe to perform the unique treatment method.
Always innovating, Dr. Fortin is also experimenting in animal models with a promising slow-release chemotherapy gel that is applied to the brain after a tumour is removed.
But Dr. Fortin also wants to ensure that longer survival doesn’t come at the cost of quality of life. In 2009, he and his team developed a questionnaire to better measure a patient’s psychological and physical well-being. Data from the questionnaires help his team choose treatment options that lead to greater benefits and reduced harms.
As the only specialist who performs inter-arterial chemotherapy that disrupts the blood-brain barrier, Dr. Fortin follows his patients through the entire course of their disease. As Dr. Dominique Dorion, dean of medicine at the University of Sherbrooke explains, this allows him to “establish very different and, honestly, unexpected professional relationships with his patients” that are “built on support and empathy.”
Dr. Fortin deeply values the relationships he develops and the gratitude he sees in his patients. “They have taught me that life is so precious,” he says. “They drive me to continue the mission.”
Region 5 Dr. Philip Tibbo, FRCPC, Halifax
When Dr. Phil Tibbo was in training, the prevailing wisdom was that schizophrenia was a disease that not only didn’t improve over time, but almost always worsened. Dr. Tibbo has been instrumental in changing that misconception and in giving young people hope at the most frightening time of their lives. Through both his treatment of the patients in his clinic and the national research he coordinates, he has shown that, as he puts it, “sustained remission is definitely possible.”
As director of the Nova Scotia Early Psychosis Program and president of the Canadian Consortium for Early Intervention in Psychosis, Dr. Tibbo treats young adults in their first episode of psychosis and also researches and advocates for better supports. The care he both provides and promotes across Canada is full circle, involving cognitive behavioural therapy, medication, family therapy, physical activity and community programs.
The intervention involves a multidisciplinary team of therapists, nurses and social workers, and it requires the education of community members to reduce stigma. Dr. Pippa Moss, president of the Nova Scotia Psychiatric Association, explains that Dr. Tibbo has “travelled to meet with staff from churches, schools and other community agencies across Nova Scotia, increasing their understanding of early stages of psychosis and the need for support within the community.”
The model is expensive, which is why Dr. Tibbo presents to policy-makers and health care administrators to show them that the investment is worth it. “The longer that schizophrenia goes untreated, the tougher it is to treat,” Dr. Tibbo says, providing the analogy of cancer and diabetes. “Our brain is pretty plastic and it can adapt especially in young adults, but it has a limit.” By investing aggressively in holistic care for young people, Dr. Tibbo and his team have shown that they not only treat psychosis in the short term, but they can prevent future episodes and hospitalizations.
In addition, Dr. Tibbo has led focus groups with young people and launched several online campaigns to reduce the stigma of mental health disorders, and to increase awareness of the link between the use of cannabis and other drugs in the development of psychosis.
Many of his patients have dropped out of school because of their symptoms and because of the interventions they’re able to re-enroll in university. “It’s such a rewarding experience. This is a person who really was suffering and, over time, you can see they’re back to where they should be and they’ve got their whole lives to lead,” he says.
His passion and commitment have inspired not only young people and their families, but a generation of young psychiatrists. As Dr. Sabina Abidi, head of the IWK Youth Psychosis Program, says, “His warm and thoughtful nature with patients is exemplary and a pleasure to see.”
- Dr. Donald Giovanetto, FRCSC, CCFP, DABO - Yellowknife
- Dr. Diana Elizabeth Tullis, FRCPC - Toronto
- Dr. Devinder Paul Cheema, FRCSC, CM - Montreal
- Dr. Ward D. Patrick, FRCPC - Halifax
- Dr. Ernest P. Janzen, MD, FRCPC - Calgary
- Dr. John M. Embil, MD, FRCPC, FACP - Winnipeg
- Dr. Dilkhush D. Panjwani, MBBS, DPM, MD, MRCPsych, FRCPC - Toronto
- Dr. Jacques E. Leclerc, MD, FRCSC - Quebec City
- Dr. Ian R. Morris, BEng, MD, FRCPC, DABA, FACEP - Halifax
- Dr. Vince Bain, MD, FRCPC – Edmonton
- Dr. K. Alok Pathak, MBBS, MS, FRCSC – Winnipeg
- Dr. Rosemary G. Moodie, MBBS, FRCPC – Ottawa
- Dr. Jacques L. Michaud, MD, FRCPC - Montreal
- Dr. Michael J. Mitchell MD, FRCPC - Halifax