Domhnall MacAuleyis a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK.
Liveability. What a cool, trendy word that immediately paints a vibrant picture in your mind. We know instinctively what it means as it conjures up an image of a healthy environment, an active lifestyle and personal wellbeing. No surprise, therefore that its used in advertising to sell everything from domestic products to real estate. If, on the other hand, we talk about the social determinants of health, most people don’t really know what we mean and they switch off. But, liveability gives us a common language to explain how there is so much more to health than just medicine.
Serena Arora is a medical student in the Class of 2019 at McMaster University
I love puzzles.
I love looking at the picture on the box, seeing what the completed version will look like and then pouring out all the little pieces — knowing that, somehow, they all come together to create something.
In some ways, practicing medicine is like doing a puzzle. It’s complex, intersecting, and incredibly rewarding when done right. At the same time, medicine is fractured into a thousand different components. As physicians, we look at our patients and we piece them apart into organs and body systems and tissues. We rip the details we think are important from the fabric of their narrative to focus on specific complaints. We take their words and distill them into our jargon, often so much so that their original story would be unrecognizable. Medicine is often an act of reductionism.
Yosef Ellenbogen is a medical student in the Class of 2020 at McMaster University
Canada recently entered a trade agreement with the USA and Mexico: the USMCA. The new agreement has been pitched to Canadians as a progressive way forward that will grow our economy and strengthen the middle class. Eclipsed by discussions on preserving dairy supply chain management and automobile manufacturing was the subtle extension of patent protections for biologic drugs. Chapter 20, Article 20.F.14 of the USMCA allows for the extension of patents for registered biologics by 2 years, a total of 10 years of patent protection (2). The subject of patent exclusivity has historically been a sensitive topic in diplomacy, and was a contentious negotiating point between the US and Australia in the development of the original Trans-Pacific Partnership (TPP) in 2015. This seemingly benign change has serious implications for the future of Canada’s health system. ...continue reading →
Once an elastic band is stretched beyond its limits, it is difficult for it to return it to its unstretched state. Burnout represents a similar phenomenon: an erosion of one’s sense of self and a reflection of emotional over-exhaustion, leading to disinvestment and depersonalization. Years of intensive training, long working hours, increased managerial responsibilities, resource limitations, emotionally-involved patient and family encounters, fear of limited job prospects and litigation, and mounting clinical and non-clinical responsibilities, among other demands: physicians and other health care professionals represent a highly vulnerable group susceptible to burnout, with some estimates suggesting close to 50% of physicians being affected. Evidence suggests that physicians experiencing burnout are more likely to make poor medical decisions, share more tenuous relationships with co-workers, experience more individual and personal relationship challenges, and suffer higher risks of anxiety, depression, and suicidality. Physician burnout has also been associated with differences in overall quality of care, system-level costs, and rates of staff turnover and absenteeism.
This piece focuses on the compromise some residents and physicians make in placing themselves second while dedicating themselves to the care of others, and the silence that some encounter while struggling with burnout. It is encouraging to observe that dialogue around burnout and mental health is growing at individual, institutional, and systemic levels over time. This piece is part of that conversation....continue reading →
Nicolas Senn is professor and director of the Institute of family medicine at the University of Lausanne in Switzerland
In Lausanne, Switzerland, we are in the process of transforming our medical curriculum with new learning objectives (PROFILES), with the perspective of finally having a stronger focus on family medicine and primary care (PC). Before embarking in these important changes, we thought that it would be good to visit another University renowned for its strong PC teaching and research tradition.
Matthew Lee is a medical student in the Class of 2019 at Dalhousie University
I was totally unsure. Meeting a patient who knows they are going to die... wouldn’t it be intrusive, at the end? A student coming into your life: asking questions, getting signatures, asking you to share your precious time. In the same position, I don’t know if I would say yes. That thought makes me feel a bit uncomfortable. Checking in on the floor, with information hurriedly scribbled into the margins of a notebook. A brief run-in with her mother in the crowded room, then twenty minutes spent in the hallway — trying not to be obtrusive while staff hurry by. There are visitors every day, and I doubt I looked out of place.
In some ways, I chose to take on this project in order to become more comfortable with death. It’s something I have faced before, and it took years to move past my friend dying from lymphoma. He quickly stepped away to take a phone call at our convocation. It was a biopsy result. Nearly six months to the day and it was all over. It took nearly everything I had. ...continue reading →
Welcome to this week's edition of Dear Dr. Horton! Send the anonymous questions that keep you up at night to a real former Dean of Medical Student Affairs, Dr. Jillian Horton, and get the perspective you need with no fear of judgment. Submit your questions anonymously through this form, and if your question is appropriate for the column, expect an answer within a few weeks!
Dear Dr. Horton,
It seems everyone is always talking about the importance of having a strong support system around you. While I’ve managed to make casual acquaintances among the pool of colleagues and co-learners I see from time to time, these relationships feel fairly superficial. Yet no one seems to have the time to forge deeper connections...
How do you build your "tribe" in medicine, given how busy everyone is?
Shubham Shan is a medical student in the Class of 2019 at the University of Toronto
She arrived on an inclined stretcher, grasping her Venturi mask like a child holding on to her favourite toy. Flanked on both sides by paramedics, her eyes were splinted wide open by shock and her chest heaved up and down rapidly. She was a queer shade of purple — like spoilt red wine diluted with water — and her gaze flitted around the emergency department as if looking for someone familiar. The paramedics passed her off to the doctor then left, shaking their heads. I remember watching the doctor take the patient’s puffers. The patient swore loudly and snatched them from his hands; first the orange, then the blue. She cocked the puffers like guns, inserted them into her mouth, shot the mist deep, and inhaled. She coughed for what seemed like an eternity. She was what we called a “blue bloater.”
When I saw her again, she was lying on a tattered mattress with bright blue sheets in a freshly bleached acute care room in the emergency department. Her condition had gotten much worse. Her abdomen caved in paradoxically whenever she breathed in. Her eyes were bloodshot. Every time she exhaled, it sounded like an infant's rattle. ...continue reading →
Hilary Drake is a medical student in the Class of 2021 at the University of British Columbia
On my first day in a new family practice, my preceptor asked me to take a history from a patient who had listed their “reason for visit” as a sore throat. I stood in the hallway and made a mental checklist of questions to ask and observations to make. Have they had any sick contacts? Does their voice sound hoarse?
When I opened the door and asked them if they could tell me what brought them in today, they responded as expected: “My throat is sore.” When I asked what they thought might be causing the pain, they unwrapped a scarf from their neck and stated, “I think it’s because the noose didn’t work.” At that point they started crying.
They had tried to come in before. They had recognized their pain and wanted to reach out for help, but they were unable to out of fear that their physician would not believe the pain if they could not see it.
Mitchell Elliott is a medical student in the Class of 2019 at the University of Toronto
Doctors are amongst the intellectual elite of society. In many cases, with decades of training and continuing education in clinical practice, our expertise grants us the opportunity to do things that would be deemed invasive and inhumane if performed outside of the context of medicine. Selectively poisoning people with chemotherapy; carefully dissecting fascial planes and removing organs; asking invasive and personal questions... all in the name of symptom management, remission of disease, and prolonging the inevitable: death. For physicians, these daily rituals become almost routine. In many cases, we have spent the majority of our lives training for the uncertainty of each day, rigorously memorizing each disease presentation and management principle, habituating to these processes and procedures. With the heavy clinical demands on physicians, it may be difficult to fully realize the impact of our actions on each patient. ...continue reading →