Pulmonary Function Testing Symposium

Back in 2016, I was working as the Lead Respiratory Therapist, or Chief Technologist, at a Toronto based respirology clinic.  I was responsible for diagnostic testing, training and supervision of staff, quality assurance and technical operation of the clinic (PFTs, MCTs, 6 MWTs, CPETs and Cap. Gas and ABGs).  One of our suppliers, Novus Medical Inc, informed me of an upcoming conference that focused on pulmonary function testing by Canadian Association of Cardio-Pulmonary Technologists (CACPT).  The 2016 Pulmonary Function Testing Symposium was a two-day event of talks, workshops and networking opportunities by experienced technologists, respiratory therapists, respirologists and other healthcare professionals.  Attendees were like minded individuals who were driven and dedicated to the field.  This conference allowed me to expand my knowledge, to learn from the wisdom of technologists, and to connect with individuals from across Canada (some whom I am still in touch with).

This year’s Symposium is on September 22nd and 23rd.  I am looking forward to talks by Laura Seed RCPT, Dr. Gottschalk, Lori Davis RCPT, Dr. Stanbrook, Angela Thomas RN, Dr. Allan Coates, Andrea White-Markham RRT, Dr. Myrna Dolovich, Tony Kajnar RRT, and workshops by Ontario Lung Association, Susan Blonshine RRT, Jane Schneiderman PhD, Susan Lori RKin and Tony Kajnar RRT!

This conference is organized by Laura Seed, Murray Beaton and Tony Kajnar.  To find out more about the conference I got in touch with CACPT.   I was lucky enough to have a conversation with Ms. Laura Seed, the VP of CACPT.   This is what she had to share.

The Canadian Association of Cardio-Pulmonary Technologists (CACPT) has always provided an education forum for its members.  For years the Pulmonary and Cardiovascular members of the CACPT across Canada came together at the annual Canadian Cardiovascular Conference (CCC).  Respiratory Sessions were included at this cardiovascular venue.  Attendance to the CCC unfortunately decreased dramatically in the last 5-7 years.  The Canadian Respiratory Conference (CRC) was then considered by the CACPT to provide an alternative education forum for the Pulmonary members.  The Pulmonary members did not attend this conference due high registration fees and not enough content on Pulmonary Function topics. 

In 2015, I as Education Chair, organized a 1 day PFT Symposium in Toronto at the Hospital for Sick Children.  This was very successful.  With feedback from the delegates pointing to the need of this type of symposium it was expanded to 2 days, to include not just lectures but also workshops.   At this time Murray Beaton of Novus Medical expressed interest in promoting this education forum.  This partnership has resulted in workshops that provide hands on experience in PFT testing. 

The PFT Symposium is unique as all topics for lectures and workshops pertain directly to aspects of a Pulmonary Function Lab.  It allows CACPT members, Respiratory Therapists and anyone else who work in the PFT lab to come together and learn from each other’s experiences.  What is particularly challenging is providing topics for the “diverse” experienced technologists that attend.  Basic topics such as learning to perform quality Spirometry to the more challenging topic of Methacholine Challenges are included in the program.  All employers of Pulmonary Function Labs, independent or hospital based, would greatly benefit in supporting their PFT technologists to attend the Symposium.  It speaks to the quality of care and patient safety that is provided when diagnosing, treating, and monitoring  patients with respiratory disease

The 2017 PFT Symposium will be on September 22 and 23 in Toronto at the International Living Learning  Center, Ryerson University.  Registration Link is available on the CACPT website (www.cacpt.ca).  The program can be viewed on the link as well.  There are plans underway to organize the 2018 PFT Symposium in Alberta (Edmonton or Calgary).

I also got in touch with Mr. Bernard Ho.  He was my PFT clinical preceptor at Women’s College.  I consider him as my mentor and, to this day, I seek his opinion, advice and suggestions.  I asked Bernie about his thoughts on this symposium, and this is what he had to share:

PFT Symposium by the CACPT (Canadian Association of Cardiopulmonary Technologists) is the only comprehensive annual educational seminar in Pulmonary Function Testing in Canada.  It provides up-to-date standards and recommendations of the American Thoracic and European Respiratory Societies.  More importantly, there is opportunity of networking among the colleagues and discussing test procedures and policies from various PF Laboratories.  PFT Symposium is accredited for 13 hours of continuing education (CE) /professional development (PD) credits by the CSRT and CACPT.    It is a great opportunity for PF Lab from the Independent Health Facility in Ontario to earn the required PFT professional development credits.


I am really excited to attend this year’s conference.  Hope to see you there!

Farzad ‘Raffi’ Refahi HBSc RRT CRE
September 01, 2017

-Image : http://www.cacpt.ca/PFT-Symposium-Programme-2017.pdf
-Thank you to Laura Seed, Murray Beaton, Tony Kajnar and Bernard Ho.



Merci Christiane

Ms. Christiane Menard is retiring from her position as the Executive Director of Canadian Society of Respiratory Therapists, after almost a decade of service (9 years).  As a thank you for her contributions to the respiratory therapy field, this blog post is dedicated to her.

The first time I met Christiane was at the 2016 Ottawa Conference.  Even as a relatively new respiratory therapist and a novice blogger, I was greeted with a big smile and a hug.  She is full of energy, passionate and is very driven.

From a quick glance at her career accomplishments you can see that Christiane’s dedication to excellence is evident.  Besides the position of Executive Director of CSRT, she held other positions such as the Communications Coordinator for Merck, Director with Society of Obstetricians and Gynecologists of Canada (overseeing Communications, Government Relations and Partnerships), and Director of Communications for the Canadian Association of Medical Radiation Technologists.

In 2017, she was the Honorary Lifetime Membership Recipient from CSRT.

I reached out to CSRT’s president, Mr. Jeff Dionne.  This is what he had to share about her:

When I think of Christiane, I think of a true visionary.  She took on the role as Executive Director for the Canadian Society of Respiratory Therapists during a time when things were quite unstable.  Our profession was going through an identity transformation; our membership numbers were steadily dropping, our impact within the RT community was dwindling, and our image as a national organization was blurry at best.  During her time as ED, we have witnessed numerous success stories emerge; from the Blueprint for Action for our profession in 2014, to our role in private practice, to the Anesthesia Assistant certification process, the CSRT is now a nationally recognized leader in the realm of professional association.  Not only have we seen our student memberships double, but we are also proud to say that we have well over 4,000 members in our association.  It has been through her tireless commitment and dedication for our profession that has placed us in such a positive situation for the years to come.  Thank you, Christiane.


I will share with you the brief conversation I had with Chriastiane.

  1. Looking back over the years as the Executive Director, what are some of the memorable moments that come to your mind that you can share with us?I have so many memorable moments and in each of these moments, it is the passion of the RT profession that was front and center.  Whenever I went to provincial meetings, I always tried to find out about RTs and to learn more about what they did and the projects in their region.  The most memorable moment was in 2014, I was in Vancouver for several meetings and on my way to the airport I accepted an invitation to visit the PROP program in Vancouver.  A young and most passionate RT named Esther Khor gave me the grand tour of her organization and it was the most amazing set up I have ever seen.  It was the first time, after working 40 years in the health care sector, that I saw an organization actually put in place a truly effective “patient centered approach” to care.  I immediately invited her and her patients to speak at the 2015 conference and I feel this was one of the most memorable presentation at a CSRT conference. 
  2. How has the RT field changed from your point of view?I see a profession that has gained a lot of confidence in their knowledge and clinical skills.  More and more RTs are working in less traditional roles like research, quality assurance, patient transport.  I am very proud of all the RTs who continue their education and keep building on their RT skills and knowledge.  Nine years ago, critical care was the most important area of practice.  Now we see more and more RTs working in community and home care.  Many RTs have entered a growing area of the health care that is most important – patient safety.  The profession constantly shows its versatility and ability to adapt to the changes required in the health care sector.  I have no doubt that RTs will continue to look for new applications of their skills and knowledge than any other profession. 
  3. What is next for you?I am retiring from being an Executive Director, but I love working.  I just feel I am no longer able to work at the Executive Director level and knew it was time to take a step back.  I plan to stay at CSRT in a lesser capacity for a number of months to support the transition of the new CEO.  I will then find some part-time work where I can still use my knowledge and skills.  As I will no longer travel for meetings, I look forward to attending more cultural events in Ottawa and going to the pool and gym more often. 
  4. What were some of the goals you set for yourself when you began as Executive Director and do you think you accomplished them?I had many objectives when I started – increase the CSRT membership, increase the number of participants at the CSRT conference, increase the income from sponsorship – and then I soon realized that none of these objectives could be achieved if we were not able to show the value of CSRT to our members and to our industry partners.  So I think we have achieved those objectives by showing value.  The most difficult objective to achieve had to do with the financial viability of the CSRT.  When I started in August 2009 we had absolutely no money in the bank … no money for rent, no money for payroll.  That was so overwhelming and I struggled with this for many years.  It took nine years, and inch by inch, we increased our financial stability.  This year is the first year that I feel we are on solid financial ground and that we do not have to borrow on the line of credit or on next year`s income to meet our financial commitments. 
  5. What are some words of advice for people in the industry who want to get more involved?Find something that is missing, something where you can make a difference, something that can be done better, and just do it!   If I look back at who has done just that I think of Jason Nickerson, who got involved in international health, not because of the money, but because there was a need and he knew he could make a difference.  Tom Piraino is another RT who saw a void in RT education with regards to the clinical applications of ventilation and he got involved in increasing knowledge and understanding in his institution, at the provincial level, at the national level and at the international level.  It just takes effort, constant effort, and you can achieve everything by doing an inch at a time, one step at a time.  The secret is to not get discouraged by hurdles … anyone can build a mountain one spoonful at a time! 
  6. What are some of the challenges you see in the future for RT’s and how can we as practicing RT’s prepare for those challenges?
    The biggest challenge for the RT profession is keeping up with the complexity of the health care sector.  As the health care sector always seems to be in transition, the RT profession will also continue to be in a transition and there is no way to go but forward and learn more complex clinical applications.  I do feel that the RT profession has been very quick to adapt to changes that have occurred in the past and I have no doubt that RTs will continue to increase their knowledge and clinical skills. RTs will surpass any challenge and will move forward where they are most needed and where they can make the most difference in the respiratory care of their patients.
  7.  Any final thoughts?
    My final thoughts ….I am so grateful that my last full time job was with the CSRT and that I had the privilege to have the trust and support of the RT profession who so generously shared their passion with me.   I can brag that my last job, after working in the health care sector for over 45 years, was the best ever!  Not many people brag about their job when they retire, but I do !

I want to thank Christiane for her dedication to our industry and for taking the time to speak with me.


-Image: https://www.linkedin.com/in/christiane-menard-3946a140/detail/photo/

-Thank you to Carolyn McCoy and Jeff Dionne for taking the time to help me  with this article.

Farzad ‘Raffi’ Refahi HBSc RRT



The Journey Back To Acute Care

Perhaps you are a new Graduate RT or you have been practicing in the Pulmonary Function Testing lab, Homecare or Patient Education side of respiratory therapy for some time and are looking to get back to the acute care setting.   The last acute care experience dates to when you were a student.  The process carries a sense of excitement and anxiety. You keep your certificates up to date, and try to attend networking sessions.   Despite submitting multiple applications, you have not received a single call for an interview. There is a sense of frustration and doubt that we all have experienced at some point.  Major Canadian cities are saturated with recent graduates and new RTs compete for casual positions which tend to offer limited shifts per week but expected an open availability.  More part-time and full-time positions are available in rural hospitals but fewer postings show up.  Should you move to a rural hospital to get the experience?  Should you change provinces? Is this the right career for me?  Before you head into a downward spiral or make any serious decisions, take a moment, step back and breathe.  Just like any career or job, there is a high level of competition.  The journey back to acute care is not easy but it is possible. Recently, I sat down with a colleague who successfully made this transition.

Viral Patel Image Mr. Viral Patel is an RRT in the Greater Toronto Area.  His experience includes acute care, pulmonary function testing at various laboratories, and sleep apnea education.  Over the past few months he has found his way back to acute care.   I asked him few questions to find out more about his experience, challenges and thoughts.


Question 1.  What were your challenges applying for an acute care position without a prior/recent acute care experience?

Acute care is field that requires constant practice to maintain skills that are learned overtime. As you move away from acute care practise these skills begin to fade and our mind loses the “routine-ness” of working in a hospital. That in its self presents a very massive challenge in applying for acute care position.  Furthermore as you move away from acute care the more knowledge you tend to lose. Acronyms that you were so used to in clinical such as “TVR, ECMO or CHF” you have to think about what they are and how they affect our practise. As such, most places prefer someone who has had recent acute care experience. Can you blame them? Absolutely not, their first priority is to get the best possible candidate for the job and patients.


Question 2a. What were some areas that you had to improve to increase your chances of getting an interview (i.e. skills/knowledge/networking etc.)?

If you don’t work in acute care for an extended period time you begin to lose the clinical skills that are required to be an effective part any respiratory team.  Maintaining certifications such as BCLS, NRP and ACLS are very important to keep your mind asking the right questions when presented with real scenarios.  I had to sharpen up on mechanical ventilation (paeds vs. neo vs. adults), ABG interpretations (what is realistic when dealing normal values comparing to what is taught at school vs. real practise).  Review different types of procedures which are part of our scope of practise: arterial lines, intubations, extubation and smaller procedures such as sputum indications. Brushing up on how they are done really helped.  Keeping an eye open for positions is also key, establishing good relationship with clinical managers and building a rapport to show commitment to the respective hospital.


Question 2b. What resources/recommendations would you share with RTs who are trying to get back to acute care setting?

Class notes, evidence based journal articles, go to your local hospital and get an outline of policies and procedure of common RT related procedures, ACLS/NRP books and of course practice leaders! Even if you don’t work for a hospital if you are a certified SRT/GRT/RRT what harm is there to approach a practice leader to shadow a regular RT for a day just to feel it out?


Question 3. What are some of your challenges now that you are working? 

Definitely getting back in routine of things, knowing where to find appropriate supplies and organizing myself during procedure so that I am not caught unprepared.  Speeding is also something I am working on as acute care can be highly volatile in terms of work load therefore quick safe and efficient work management is key.  Some procedures/equipment maybe only used under special circumstances so taking the time to understand specialty equipment so in the event that I ever do need use them I am prepared.


Question 4. what resources/recommendations you have for those who are now working in Acute Care (after a hiatus)? 

The key resource is definitely policies and procedure that every hospital implements.  They highlight and guide us in implementing our scope of practice such as ventilation of patient groups, arterial line insertions, intubations, extubation, flolan/Milrinone, bronchoscopy and code blue teams.  Clinical practice leaders are an excellent resource for all kinds of information such how to better yourself at specific skills, odd requests from RN’s or patients that you may not have seen in practice so far, or even when dealing with a really stressful day and you need someone to debrief with.  RN’s are your best friends, they know their patient just about better than anyone! If there are specific test results you need or a clarification on patient history you can bet they know the answer.  Lastly RT’s are truly a team driven department and therefore your fellow RT’s are also an amazing resource.  I have been very lucky to be surrounded by a great team who are willing to help each other out above and beyond the call.


Question 5. Any last thoughts?

Don’t be discouraged if you are just out of school and without a job and don’t be discouraged if you need to go out of the province to practice.  Follow up with HR after applying, build a good rapport and always have a positive attitude.  Always be eager to learn and adapt to changing circumstances.  A few of my colleagues jokingly remind me that I am not a student and I don’t have to do everything everyone says but I tell them all the time I am building experience. The way I see it the more you see and do the more comfortable you become.


Thank you Viral for taking time out of your busy schedule to answer my questions.

To view a list of his qualifications, education and experience, visit his LinkedIn profile at https://www.linkedin.com/in/viral-patel-92598940 .

Farzad ‘Raffi’ Refahi


Influential People In Respiratory Therapy: Dr. Mika Nonoyama

There are many people contributing to the field of respiratory therapy. In my journey to learn more about this field, I have reached out to few individuals to discover more about their experiences and the types of activities there are currently involved in. Today’s post is about Dr. Mika Nonoyama.

Mika Headshot

Dr. Nonoyama is a Respiratory Therapist, Health Clinician Scientist, Associate Professor, Advocate, Scientist and Researcher.  I have read her articles and posts in variety of platforms and mediums. I wanted to learn more about Mika, her ongoing contributions to our field.  She was kind enough to take time from her busy schedule to answer my questions:


Question 1: What attracted you to the research side of respiratory therapy?

A few reasons. I loved the idea of coming up with a question and going through the process of answering it. Especially once all the data has been collected and it sits in front of you – it’s almost like an exciting mystery where the results could go any which way despite the hypotheses. The other main reason is because of my mentors, in particular my PhD supervisor Dina Brooks who is a fantastic leader and doing such amazing research.

Question 2. What does a typical day look like for you?

In theory my job is 40% research, 40% teaching and 20% service (volunteering). But depending on the time of year it will change…every day is different. During the teaching term much of my time is devoted to the preparation and ongoing upkeep of the courses (at UOIT). I spend once a week at SickKids doing research with the front-line RTs and collaboratively with other researchers. I also do other research that brings me into the community setting. I have many students (undergraduate, graduate and RT) who help with the initial parts of the research projects while I oversee the processes. My service involves volunteering at various places like the Lung Association and within my University. I love this aspect of my job also because I am able to network and learn about the work these organizations do. I have to mention my day also involves being a wife and a mother of school aged children!


Question 3. Who do you collaborate with on daily basis?

My three research themes are 1) paediatric respiratory therapy; 2) long-term mechanical ventilation; and 3) rehabilitation and chronic respiratory disease. For each of these themes I have different collaborations. The first are my collaborations with SickKids, but I also have connections with folks at CHEO. I collaborate with a large group across the country of health professionals for long-term mechanical ventilation – we call ourselves CANuVENT. My main mentor there is Louise Rose. For the rehab and chronic lung disease I also have various contacts but much of my collaboration is with Dina Brooks.


Question 4. What are some of the sources of gratification/satisfaction and challenge working in this area?

Gratification – seeing the end result of your research projects – usually publication. Though this can be a challenge because it takes time and patience to write and have a paper accepted. I also love to see the look of recognition and understanding on students’ faces when I teach them. My goal is usually to help them experience so they can apply it when they enter the work force…would be nice to see them once they are in the work force! The main challenge for me is finding the time to do it all…


Question 5. What were some areas/knowledge/skill sets that you had to work on to improve in this role?

There is the usual education but more importantly is the desire to learn and do things outside the box. Trying something that interest you and makes you somewhat uncomfortable can lead to wonderful things. I also believe that volunteering your time is essential. I found my success came once I figured out what interested me and what I wanted to do (seems simplistic I know). Once I had that vision I put things in place to make it happen. Having great mentorship to help along the way is key too.


Question 6. Any interesting projects you are working on right now?

One of the most interesting (and challenging) is trying to streamline various respiratory therapies in the paediatric ICU at SickKids. As you know there are many aspects to RT – intubation, weaning, extubation and everything in between. We are working step-by-step on this, extubation readiness being the first. It’s interesting because the research questions come from patient care, involve the care practitioners and are applied back to patient care. Since I don’t practice anymore it’s wonderful to be a part of the practice side of things.

Question 7. Where do you see the future of Respiratory Therapy?

I do hope RT becomes a degree-entry-to-practice. Since most students have a degree already it seems to make sense. It would also help get RTs more within the University system so they are able to interact with the peers they would practice with e.g. nursing, PT, OT, MDs. It would be great also if many RTs would seek graduate degrees and step into the primary investigator role within their institutions.


Question 8 – Any recommendations/thoughts/suggestions for students and RRT who are interested in getting involved in the research side? What are the steps involved?

Though generic my answer for question 5 really is the advice I would give. Figure out what area you would want to research and find who is involved. Get in touch with them to see if you can start the collaboration. I am always happy to hear from anyone to chat about things also.


Question 9- Any final thoughts?

I do love what I do and feel very lucky I am able to do it.


Thank you Mika for sharing your experience, perspective, and giving us a better understanding of the research side of the respiratory therapy field!

To see a full list of Dr. Nonoyama’s educational background and research collaborations, please visit http://healthsciences.uoit.ca/people/faculty/mika-nonoyama.php#tabresearch-1

Mika Nonoyama image

Image source: Google Scholar https://scholar.google.com/citations?hl=en&user=bW6XMhYAAAAJ&view_op=list_works&sortby=pubdate

-Headshot https://www.linkedin.com/in/mika-nonoyama-rrt/

Farzad ‘Raffi’ Refahi

July 16, 2017

Resources for Bronchiectasis

At the beginning of my career I was more focused on few respiratory conditions and diseases such as Asthma, COPD, Cystic Fibrosis and Acute Respiratory Distress Syndrome.  With more experience, I am more exposed to variety of conditions that directly and indirectly impact the respiratory system.  In my journey I have realized that bronchiectasis is a common condition which I did not pay much attention to as I viewed it a “secondary consequence” or complication.  This condition involves abnormal widening of airways.  In my attempt to better understand this condition, I searched the web; Here is a list of great resources that will help you review this condition:

CHEST: http://hubs.ly/H07C_730

The Lung Association:  https://www.lung.ca/lung-health/lung-disease/bronchiectasis

British Lung Foundation: https://statistics.blf.org.uk/bronchiectasis

European Respiratory Society: http://www.erswhitebook.org/chapters/bronchiectasis/

Duty of Care

On June 14, 2017, CBC’s World News reported that “5 people, including Michigan health chief, charged in Flint water probe”.   The investigation follows the poor quality of water in Flint where more than 100, 000 people were exposed to high levels of lead.

This topic may not be related to respiratory health but does speak to our accountability and actions as individuals with power and influence over other’s health.

Take the time to review:
-CSRT’s Standards of Practice at http://www.csrt.com/standards-of-practice/ and

-CRTO’s Stands of Practice at http://www.crto.on.ca/pdf/Standards_of_Practice.pdf

– CBC World Newshttp://www.cbc.ca/news/world/flint-water-health-chief-charged-1.4159883

-CNN-Flint Water Crisis Facts http://www.cnn.com/2016/03/04/us/flint-water-crisis-fast-facts/index.html


Farzad ‘Raffi’ Refahi

June 14, 2017

Working In A Multi-Generational Workforce


I was given the chance to share my thoughts and views in the Leadership Forum of Canadian Society of Respiratory Therapist in the 2017 annual conference.  I spent few months studying and preparing a list of recommendations to remind managers of ways to improve their workforce (relating to different generations).  In this post however, I will share some advice for employees, staff and students.

As you know, there are several factors that influence the characteristics of individuals such as gender, cultures, politics, race and ethnicity, educational background, age and many other factors.   While individuals are grouped in various categories so they are better understood, each individual is unique.

Check out this quick chart with the list of the recent Generations:

Cohort         Veteran


Baby Boomer Generation X Generation Y


Generation Z
Age* 74-92 57-75 36-56 17-35 7-21
DOB 1925- 1943 1942-1960 1961-1981 1982-2000 1996-2010
*Age in 2017

Veterans grew up during wartime and scarcity.  In order to survive and be successful, they had to be make calculated decisions, and had to work hard at their job.  Change was associated with risks, which they may have not recovered from.   Thus calculated decision making and royalty was the key to success.  There are few existing biases and negative stereotypes out there which include Veterans being out of touch, Baby Boomers being workaholics, Generation Xers being slackers and Generation Y being demanding and disloyal.     I hope that by explaining the experience and mentality of the individuals from different generations, it would lead to better understanding, empathy, and communication between people.   I like to promote a culture of respects for everyone (regardless of their generation).

Baby Boomers are stereotyped as being workaholics.   Just like Veterans, working hard lead to success!  While Baby Boomers also had to work in a hierarchical structured workplace, they may not fully agree with this Top-Down structure.  They enjoy having more options and more influence in the decision making.

Generation Xers are stereotyped as being Slackers.  This generation cohort grew up taking care of themselves as both their parents were working.  Keep in mind that there was an increase in divorce rates.  It is not surprising that Generation Xers grew up being resourceful and independent.  In addition, this generation was introduced to computers and access to information.  They watched as corporations failed and had to laid-off staff.   With a lack of full trust in institution and organizations, Generation Xers are careful in their relationships with organizations or employers.  Generation Xers are resourceful, calculated, and may not be dedicated to a single employer/organization.  This generation values work-life balance.

Millennials (Gen Y) are stereotyped as demanding and disloyal.  Just like Generation Xers, Millennials are cautious about their relationship with organizations and employers.  Grown up with instant access to computers, technology and information, this generations has higher expectations.  Unlike the experience of Generation Xers, the parents of Millennials provided a lot of options to them, and included their children in more decision making.  Thus, for Millennials and Generation Z, sharing their thoughts has been a normal part of their life.

Generation Z receives similar negative stereotype as Millennials.  Just like Millennials, individuals from Gen Z are educated, enjoy instant access to information and opportunities.

To improve communication and to reduce the chance of perceived disrespect between generations, keep the communication style more formal and proper for older generations.  Younger generation is comfortable with less formal communication and in less formal settings.     Older generations value being heard as they like to pass on their knowledge and wisdom.   Younger generation also enjoy sharing their thoughts and ideas despite having less experience than older generations.

Staff, students and employees need to realize that one size does not fit all, and they need to look at things through different lenses.  Everyone is unique.  Each person deserves a chance to work where they feel respected.

This post is meant to be short, simple, and to serve as a reminder.  If you require additional information or have additional questions, feel free to get in touch with me.

Image credit: http://maxpixel.freegreatpicture.com/Models-Old-Communication-Generations-Phone-1662191

Farzad Raffi Refahi  May 18, 2017

Improved. Part 3. ‘Foot Health’

This is the third part to a series of posts, titled ‘Improved’, aimed to assist with development and improvement of Respiratory Therapists and other Healthcare Providers as individuals and as clinicians.

I share recommendations and advice from Mr. Piyush Jadav, a healthcare professional with educational and work experience as a chropodist.  In my conversation with Mr. Jadav, I asked for any recommendations for clinicians who either work 12 hours long day/night shifts/ acute care, and/or to those who work sedentary 9 hours shifts/diagnostic/patient education.

In time for foot health month, this post is released in May.

Footwear Advice for Clinicians/Hospital Workers

First off, when speaking about footwear; the most important thing is comfort. I have told many patients about what footwear is the best or most appropriate for them. The biggest issue with compliance has to deal with the level of comfort.

When speaking about footwear, at the most basic level there are 3 shapes of “lasts”. A last is the structure on which a shoe is built around.


Source: https://sportspodiatryinfo.files.wordpress.com/2011/02/foot-shape-and-shoes.jpg?w=478&h=243
  1. Straight last
    1. most appropriate footwear is motion control (high torsional stability,  stiff heel counter)
    2. Most appropriate for patients with over pronation, low arch profile
  2. Semi Curved Last
    1. most appropriate footwear is cross-trainer (medium torsional stability, EVA midsole (dual or single))
    2. most appropriate for patients with mild over pronation
  3. C- shaped Last
    1. Most appropriate footwear is cushioning/running shoe/minimalist shoe
    2. Most appropriate with patients with high degree of supination, high arch profile


With respect to hospitals, these same examples can be applied. Mesh/net material in shoes is usually not allowed in some departments due to risk of infection and lack of protection. Shoes that are used for long periods of walking in the hospital or clinic setting should not be used to recreational activity. Footwear that is meant for running/exercising are designed to absorb more force due its high demands.

Look for footwear with either Velcro or laces which provide stability to the midfoot as well as the ankles. Slip on shoes provide little to no support and have a shorter lifespan.

The best time to try on shoes is closer to the evening because one’s feet do swell slightly during the day. This will ensure a proper fit.

Also, try to change socks at least once a day. Try to designate a pair of shoes for work only, allowing them to breathe overnight. This will prevent excessive odour and moisture from building into the shoe. Never wear your shoes without socks, this can harbour excessive moisture and may contribute to athlete’s foot.

A typical clinician/hospital worker can be on their feet for 8-12 hours per day. Standing for long periods of time has been linked increased pressure on peripheral blood vessels. In addition, this can lead to varicose veins or “bulging veins”. Some of the first symptoms may include cramping, muscle aches and mild swelling. An inexpensive option to help with this would be to use mild compression (10-15 mmHg) stockings which may help with relieving symptoms, which can be picked up without a prescription from the pharmacy.

Written by:

Piyush Jadav, B.Sc., D.Ch
Registered Chiropodist

Primary site of practice:
Uptown Health Centre
9325 Yonge St Richmond Hill, ON L4C 1V4
(905) 508 -8876