Author Archives: CMAJ

Cal Robinson is a PGY2 Pediatrics resident at McMaster University interested in how social determinants of health impact Canadian children.

 

On November 22nd, 2018, Ontario’s Progressive Conservative government unveiled their planned reforms of provincial social assistance programs, including changing the definition of disability for the Ontario Disability Support Program (ODSP). These announcements have been met with criticism from political and advocacy groups who argue that these represent further cuts to social assistance. Further policy announcements last year included a reduction of the planned 3% increase in social assistance to 1.5% and cancellation of the Ontario Basic Income Pilot, one of the largest minimum income studies ever developed. The Ontario Basic Income Pilot had already enrolled 4,000 low-income individuals across the province. These intended cuts to Ontario’s social assistance programs will have a substantial negative impact on the health of Ontarians, and will particularly threaten the physical, psychological and social wellbeing of Canadian children and their families. ...continue reading

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Marcy White is a writer and special needs advocate.

 

In just one year, my son, Jacob, was put on Bi-Pap in the PICU on four separate occasions. Only a respiratory therapist was allowed to put the device on him or make adjustments when he was in the hospital. On the first occasion, he was not allowed on any other hospital unit while dependent on Bi-Pap. On subsequent occasions, he could transfer to the General Pediatrics unit as long as his Bi-Pap needs remained stable but, should his Bi-Pap needs increase, he would be transferred back to the PICU. ...continue reading

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Courtney Bercan is community health nurse at a clinic in the Downtown Eastside of Vancouver

 

Years later, I still don’t want to think about it, let alone type it out. Three children, babies practically, dead before me. Their parents, dead beside them.

It has now been two years since I was on a Doctors Without Borders search and rescue vessel in the Mediterranean and it’s been a slow path, at times, to finding healing and peace for the things I saw and experienced there. As my life settled into a predictable rhythm, the memories started coming out of the blue and with intensity. They demanded attention. Normally, in Canada, the process of finding closure for a patient’s death, while not always easy, is not usually this difficult. There are mitigating thoughts and phrases to help you along the way:

“They were elderly and had had a good life.”

“We did everything we could.”

“At least now they are out of pain.”

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Sarah Tulk is a family physician in Hamilton, Ontario

 

Despite earnestly advocating for physician mental health, my own story has remained cloaked in secrecy. As a medical student, I felt far too junior to risk such a revelation. I watched as stigma, perpetuated by the hidden curriculum, kept my peers from seeking mental health care. Still, I kept my head tucked safely in the sand, and swore to break my silence in residency. However, as a resident the fear of jeopardizing job prospects maintained my mutism. I vowed to speak up when I was staff. Unfortunately, early in my staff career my advocacy efforts were smothered by fierce judgment and harsh consequences. I wholeheartedly renewed my vows with the ostrich approach and reconciled to start talking about mental health when I was protected by more seniority. I hated the secrecy and hypocrisy, but at least I was safe. Then I heard of another resident suicide. Then a medical student. Another resident. A staff physician. ...continue reading

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Pat Rich is an Ottawa based medical writer and editor.

 

Cometh the hour, cometh the man.

It would be the very height of pretentiousness to apply this phrase to Dr. Liam Farrell, an author and former family physician from Rostrevor, Co. Down, Ireland and I am sure he would be the last person to do so.

But at a time when family medicine seems to be at its lowest ebb, if not globally then very much here in Canada, there is much to be said for having a physician who can so eloquently write about both the rigors and the ...continue reading

Hillel M. Finestone is a Physiatrist at the Elisabeth Bruyere Hospital and Professor, Division of Physical Medicine and Rehabilitation, University of Ottawa.

 

My 52-year-old patient took his BP at a pharmacy on 6 separate occasions.  Systolic BP values were high, ranging from 150-177. When I take his BP in the office it’s 168/98.  Yup, he has high BP.  He’s 10 pounds overweight, doesn’t have diabetes, doesn’t smoke and thinks that he was told that his BP was “probably high” 5 years ago, but he didn’t feel that medications would make a difference.

We talk about weight loss, healthy eating and reducing high sodium foods, that we don’t know why BP elevates but that medications really work and help stop strokes and heart attacks from occurring.  He agrees to my prescription of one medication and we discuss its side effects.  A drug information sheet is provided. ...continue reading

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Keegan Guidolin is a General Surgery resident at the University of Toronto

Han Yan is a Neurosurgery resident at the University of Toronto

 

 

Much attention has been paid of late to the phenomenon of social echo chambers - situations in which people’s beliefs are amplified and repeated in a closed system as no dissenting opinion originates from within the group. Echo chambers on social networking platforms such as Facebook and Twitter were identified as a factor contributing to the outcome of the 2017 US Presidential Election. We believe that social echo chambers exist in the real (non-digital) world as well, within social groups whose members may interact outside the group in general, but who discuss particular subjects only within the group. ...continue reading

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Dr. Dhruvin Hirpara is a General Surgery resident at the University of Toronto

Dr. Nancy Baxter is a colorectal surgeon at St. Michael's Hospital

Dr. Fayez Quereshy  a surgical oncologist at the University Health Network.

 

Colorectal Cancer (CRC) is the second leading cause of cancer-related death amongst men, and the third leading cause of cancer-related death in women in Canada. Although screening has contributed to declining incidence in the elderly, recent epidemiological data reflect a rise in CRC among young adults. Data from the Canadian Cancer Registry suggest a steady increase in young-onset (15-49y) CRC, from 745 cases in 1969 to 1475 cases in 2010. In Ontario, the incidence of CRC has been increasing in young adults (30-49y) since 2005, from 6.17 per 100,000 to 9.08 per 100,000 for colon cancer, and 4.31 per 100,000 to 6.29 per 100,000 for rectal cancer. Evidence from other jurisdictions, including France, Australia, and the United States reflects similar trends in the rise of young-onset CRC. Why this apparent increase in CRC among younger people? We don’t yet know the cause but theories point to an interplay of several potential factors.

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Domhnall MacAuley is 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.

This was a recurring theme at the conference on Creating Active and Liveable Societies hosted by the Centre of Excellence for Public Health in Belfast with a host of international experts. ...continue reading