By Trent Wilkie, Local Journalism Initiative Reporter St. Albert Gazette

With confusion over COVID-19 vaccinations, the rise in measles cases, and the privatization of some MRI services, there is a lot of medical information floating around out there. Dr. Brian Wirzba, president of the Alberta Medical Association, believes communication between patients and health professionals is key.

"We feel very strongly that patient autonomy is important and that patients should be able to make decisions, but we want those decisions to be informed," said Wirzba. "If you're diagnosed with cancer and you know you're being presented with all of these potential options, it's a little overwhelming. Patients need that ability to talk to their doctor about that and feel confident that the information they're getting is true."

Wirzba acknowledges there may be some mistrust of the health care system and science in general, but said the government needs to work with the Alberta Medical Association and other groups trying to combat misinformation -- especially when it comes to COVID-19 vaccinations and the current measles outbreak.

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"It is the time of year where respiratory cases spike and systems should be in place to deal with that," Wirzba said, pointing out the AMA has raised concerns with the government about how vaccination and immunization programs in Alberta will roll out this year.

"The point of a public health immunization program really is to prevent disease," Wirzba said. "Lots of people, myself included, had measles with no major complications, but we have otherwise healthy children who can get measles and then have hospitalizations for pneumonia, or end up having neurologic conditions later, or even death."

Public health experts say the rise of measles is linked to declining vaccination rates. These rates are fuelled by misinformation, which begets vaccine hesitancy and distrust of science -- something Wirzba calls a sad reflection of our times.

"The World Health Organization definition for a country having its measles elimination status revoked means that we have to go a full year without further cases transmitting within the country," Wirzba said. "But we are still seeing spread even this week. So we're going to be losing that status, and that relates to our overall vaccination rates. We were seeing vaccination rates that are not at the 95 per cent that we need for our measles elimination."

When it comes to the government planning legislative changes to allow Albertans to privately pay for diagnostic or screening services, Wirzba is worried about how the patient is educated on the findings of the screenings. This is where Wirzba referenced something called an incidentaloma. An incidentaloma in medical or research imaging is an incidental imaging finding that is not related to the original reason for the diagnostic.

As an example, one could go in for a colon cancer scan and there might be a little cyst on their kidney or a lump in their liver or a slight lymph node, or some calcification in their arteries. That's not what the patient was looking for.

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"What we're worried about is with direct access and the way it was described in the video, is that patients would be able to have access to almost any kind of tests," Wirzba said. "And we know that depending on the patient population, 20 to 80 per cent of those scans are going to have an abnormality."

Wirzba says most of these incidentalomas are benign but can cause anxiety for the patient or even excessive spending. Health professionals can educate the patient on what they should or shouldn't worry about.

"But if you've paid $1,000 to have that scan and you don't talk to your doctor about it and you get this result, someone might think the worst," Wirzba said. "That is why it is important not to over-test, because we know that the outcomes aren't better, so patients don't benefit."

Wirzba said without the patient being educated by the proper professional, it could lead to them needlessly spending more money, which costs the system money and time, and delays other people's access.

"Now, if you put appropriate guardrails on it, then we could avoid those issues," Wirzba said. "And that's really where we need to be talking to the government and working with them to sort of see exactly, 'How do you envision this rolling out, how does the government envision this? Once you start with the private system, do you stay in that system or do you flip over to the public system, and could that potentially increase costs?' So again, lots of unknowns that we need to discuss and clarify with government."

Again, Wirzba circles back to the overall theme of clarity and communication -- between patient and their family, between patient and doctor, and between the AMA and the government.

"What we're trying to do is just open the opportunity for conversation," Wirzba said. "And I certainly want to make sure that we're having open and honest conversations with the government. We're not trying to be antagonistic in any shape or form. We need appropriate screening tests and screening tests that follow evidence-based guidelines. These are recommended. These reduce the likelihood of bad outcomes."

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