Kirsten Patrick is Deputy Editor at CMAJ

 

This post really needs no introduction. First came #WomenBoycottTwitter when Twitter straightjacketed Rose McGowan and women reacted angrily to what they felt was unfair ‘victim silencing’. But many pointed out the irony and probable ineffectiveness of self-imposed silence to protest enforced silence. Then yesterday my social media feeds were full of the hashtag #MeToo along with story after story after story from women friends, of sexual harassment, abuse and unwanted physical attention. Women I look up to; tough women…the sort about whom you might think, “It would never happen to them.” Lawyers, a chemistry professor, a neuroscientist, respected colleagues in medical research.

Last week, writer Anne Donahue tweeted, “When did you meet YOUR Harvey Weinstein? I’ll go first…,” which has tens of thousands of replies and ‘quote’ retweets and prompted Trevor Noah to tweet "The number of replies to this tweet is insane. As men we have to do better to stop this."

One reply came through my Twitter feed,

Regularly in the Operating Room when surgeons would approach from behind while I was 'scrubbing' at the sink, hence unable to move.

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Doctor Mom is a physician who lives in Ontario

 

Earlier this year I took my 13 year old son out to lunch to talk about mental health. It just happened that Son #2 and my husband were out for the day and I had a rare opportunity to be alone with Son #1. I didn’t say ‘I’m going to take you out to lunch so that we can talk about mental health.’ I just reckoned that the odds of him listening to me would be higher if a) we were somewhere removed from the all-consuming ‘call of the PS4’, and b) there was a favorite food to both fill his mouth and free his hands from electronic device. So out to eat we went.

I had no idea how to have the conversation I wanted to have. I can tell you that figuring out how to talk him through the gaps left by school sex ed was easy by comparison.

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In this interview, Dr. Thara Kumar and Dr. Hans Rosenberg tell us about take-home naloxone kits used for opioid overdose. They discuss how to use them, where to get them, how they work, and more. They offer practical guidance to physicians in Canada and also include tips for the general public.

Dr. Thara Kumar is an emergency medicine resident in her fifth and final year of training at the University of Ottawa, with a Global Health Certificate from Johns Hopkins University. Dr. Hans Rosenberg an emergency physician at the Ottawa Hospital and an assistant professor in the Faculty of Medicine at the University of Ottawa. Together, they co-authored a practice article published in CMAJ called "Five things to know about...Take-home naloxone."

Listen to the author interview:

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Max Deschner is a medical student at the University of Ottawa

Maaike de Vries is an epidemiologist & PhD candidate at the University of Toronto

Jonathan Gravel is an epidemiologist & resident physician at the University of Toronto

 

 

Pain is one of the most common reasons patients present to emergency departments and primary care clinics, as well as a common complaint among patients treated by subspecialty services. Physicians will agree that treating pain is vital. Yet despite grossly inadequate training in pain management – physicians are expected to offer multimodal pain management (including pharmacological, non-pharmacological and behavioural therapies). All too often, patients with acute or chronic pain also do not have a complete understanding of what options should be available to them and how to access them. Needless to say, an informed and bidirectional discussion between providers and patients about pain management before an opioid prescription is written is an all too rare occurrence. ...continue reading

Kirsten Patrick is Deputy Editor at CMAJ

 

In the last two weeks I’ve attended three very different scientific conferences on behalf of the CMAJ Group. In fact you couldn’t get more different than the 33rd International Conference on Pharmacoepidemiology and Therapeutic Risk Management (ICPE - all Big Data and massive record linkage aimed at finding out more about the benefits and harms of medicines and devices) and the 5th Canadian Conference on Physician Health (mainly focusing on the major problem of physician burnout and what we should do about it). And yet the same study was mentioned by plenary speakers at both conferences to support the same message: that physicians are overburdened by administrative and data-capture demands. Across four medical specialties, “for every hour physicians provide direct clinical face time to patients, nearly 2 additional hours is spent on EHR and desk work within the clinic day,” ...continue reading

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Ray Schachter is a lawyer in Vancouver. He is on the Executive Committee of the Global Sepsis Alliance and Canadian Sepsis Foundation

 

In March 1996, I was a healthy, fit 50-year-old man enjoying life with a young family.  A month later, I was in an induced coma fighting for my life against acute septic shock accompanied by severe adult respiratory distress syndrome (ARDS) and multi-joint and -organ dysfunction which frequently accompanies sepsis.  My sepsis was brought on by Group A Streptococcus (Strep A) in my bloodstream which compromised almost all my joints.

My trajectory which led to acute sepsis is not unusual.  On Day 1, I had a very severe, but short-lived, bout of extremely high fever (40.5 degrees Celsius), followed by excruciating hip pain the following day.

By Day 3, the hip pain had become unbearable.  That evening, we called my family doctor’s on-call service and a doctor came to the house at midnight.  The physician felt my condition was osteoarthritis and prescribed anti-inflammatories.

On Day 4, my wife became so concerned that she called a doctor who was a family friend.  ...continue reading

Justin Lam graduated from University of Toronto Medical School in 2017 and is now a first year resident in Paediatrics at UofT and SickKids

 

Denis Daneman is Chair Emeritus, UofT Dept of Paediatrics, and Paediatrician-in-Chief Emeritus, SickKids

 

The Mentee: JL

I sat in front of my laptop, staring at an email draft to a potential mentor. I knew it was pointless trying to perfect it, but I felt I needed to read it just one more time. He was, after all, a legend in my medical world, a well-respected clinician and expert in the field, with a prolific academic career and an illustrious research career. Also, I had only interacted with him a handful of times before. I was reaching out to him because of what I perceived to be his ability to balance his career with a family. How had he done it? I hit send. His reply came not 10 minutes later. Our first meeting was set.

Before I knew it, we were meeting for the third time. It was during this meeting that I was given an article written by a psychiatrist about how he had chosen not only his specialty, but also between a “quiet life” and a “calling” , a process that I myself was going through at the time and had begun to explore with the help of this mentor. ...continue reading

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Ally Fleming is a writer and publicist at Anstruther Press

 

Illness doesn’t end when you leave the doctor’s office. Affliction is carried, and pain is, as Shane Neilson writes, “a concerto in your back pocket.” As a writer with bipolar disorder and chronic pain, I’ve often felt utterly lost, blinded by what Rita Charon calls the “glare of sickness” . For many, the fundamental question of medicine is not how to be fixed (for it’s often not possible), but how to live one’s life, broken. Physician and pain researcher Shane Neilson’s trilogy of poetry collections from Porcupine’s Quill leads by example.

“Practitioners, be they health care professionals to begin with or not, must be prepared to offer the self as a therapeutic instrument," (p. 215) writes Charon in Narrative Medicine: Honoring the Stories of Illness. Neilson, with one foot perpetually planted in medical practice and the other in love, unflinchingly offers himself to his readers ...continue reading

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Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK

 

Have we lost something in the success of academic family medicine? We produce quality research, have created successful interdisciplinary academic teams, demonstrate competitive publication outcomes and generate significant grant income. But, academic primary care may have drifted away from, and perhaps even alienated, some family medicine colleagues. There are thoughtful and reflective family doctors who read, write, discuss and debate many aspects of general practice but feel undervalued as they do not fit the university based academic profile. ...continue reading

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Wendell Block is a family physician at the East End Community Health Centre and the Canadian Centre for Victims of Torture

 

In the thirty-odd years I have worked with torture survivors, I have heard countless versions of the following story. When Azad* was a 22- year-old university student in his home country, he participated in a public demonstration, criticizing the government’s financial cuts to social programs important to his minority group. He and many other demonstrators were apprehended and brought to a crowded holding centre. They slept on the floor, had limited access to a dirty toilet, and were given a cup of water with a small amount of non-nutritious food twice a day. Azad was taken for interrogation on three occasions. He was accused of having links to terrorist organizations outside the country, and of spreading seditious ideas (his interrogators had found political leaflets in his backpack). They demanded the names of organizers. While being questioned he was struck repeatedly on his back and thighs with police batons, and on the third occasion they beat the soles of his feet. Afterwards he could not ...continue reading