Praveen Ganty is a Consultant in Pain Medicine & Anesthesia in Toronto
There is a new fashion in the world of Medicine, and in the world of primary care in particular. It is the reluctance to continue prescribing, or to prescribe, opioids. There are two sides to the situation. As medical professionals, we have realized the potential harm that opioids can cause to potentially any patient, especially if prescribed for chronic non-cancer pain. However, many of us have also decided to stop prescribing opioids to patients who have been on them for many years, which raises some concerns. The first principle in the practice of Medicine is Primum non nocere-first do no harm - (modified to ‘first do no further harm’ by some authors).
Managing chronic pain is not easy and - let’s face it - most of us don’t have enough training in this area. A 2011 survey revealed that only an average of 19.5 hours are devoted to the management of pain in an average medical school curriculum. ...continue reading →
Charlie Tan is a medical student at McMaster University
Lawrence Loh is Associate Medical Officer of Health at Peel Public Health
Too often, physicians forget that they might be just one of many sources of health advice that patients access. Behind every physician-patient encounter is a difference in how health and wellness are perceived and pursued. For many physicians, their views and advice are shaped by formal education and training, the Hippocratic Oath, and the insights of colleagues, researchers, and experts. Their patients, by contrast, have a different and often wider range of influences, be it personal beliefs, social networks, or cultural traditions.
Over the last three decades, physician practice has been transformed by two important movements ...continue reading →
Kim Perrotta is Executive Director of the Canadian Association of Physicians for the Environment (CAPE)
A month ago the Financial Post published a commentary entitled “They keep saying shutting down coal will make us healthier, so how come there’s no evidence of it?” written by Warren Kindzierski of the School of Public Health at the University of Alberta. It seems a sad statement of our times that this article, which muddies the waters with incomplete facts and misleading information about coal plants, air pollution and human health, was published in the middle of an important debate about policies aimed at supporting the phase-out coal plants Canada-wide by 2030. The Canadian Association of Physicians for the Environment feels strongly that publication of the article was irresponsible. ...continue reading →
I changed jobs this week. On Monday, my first day, when I should have been primarily concerned with learning the office microwave-cleaning rota and orienting myself to a new Xerox print centre, I was a little preoccupied. At 8 pm on Sunday, I found out that my father had fallen, broken his hip, undergone emergency surgery, and was in isolation in a hospital in southwestern Ontario. Details were fuzzy. Hospital staff would not share much with my aunt, my father’s sister. He had managed to call her on Sunday morning, 24 hours after his fall, once he had come round after anaesthesia. He needed her to go to his house to make sure my mom was okay. My mom wasn’t answering the phone.
Unanswered phone calls are not uncommon at my parents’ house. My father is quite hard of hearing, after spending 37 years as an infantry officer. My mother tends not to answer the phone because she is self-conscious. She has a severe cognitive disability ...continue reading →
It’s March Break, which means last chance to do winter activities for some families in Canada. Unfortunately, I’m not Winter Fun Mom so I booked Son #2 - the only person in our family who is interested in winter sports - on a bus-in snowboarding camp. On day 1 I warned him to be careful and to try not to injure himself. On day 2 I forgot to warn him. So at 2pm on day 2 I got a call from the snowboard instructor to tell me that my son had fallen and would soon be on his way to hospital in an ambulance.
I know I should be more encouraging of adventure and more accepting of risk-taking in my boys. ...continue reading →
Did you hear about Chris’s mint condition 1963 Shelby Cobra? Mechanics say he didn’t check the oil for decades, and the engine just seized one day on the way to work. When they opened it up, they say there wasn’t much left. Such a shame really.
Said Nobody. EVER.
Jazlin Mayhue is a researcher in Victoria, BC
Peter Hobza is a family physician in Victoria, BC
Robert O'Connor is a family physician in Victoria, BC
Introducing a new concept...
We all know folks who are not vigilant with preventive health for their body. However, a subset of them wouldn’t drive an irreplaceable million-dollar car until it was destroyed from lack of maintenance. A human’s life and body are irreplaceable, and worth at least a million dollars, when considering the price of an injury causing death. Therefore, it’s logical to help some people think of treating their body as well as a valuable car. ...continue reading →
Arlene Bierman is the Director of Center for Evidence and Practice Improvement (CEPI) at the United States Agency for Healthcare Research and Quality (AHRQ)
Rick Glazier is a Family Physician and Senior Scientist and Program Lead of Primary Care and Population Health at the Institute for Clinical Evaluative Sciences (ICES) in Toronto, Canada
Primary care is foundational to optimizing individual and population health. Health systems based upon primary care provide better access to care while improving health equity and outcomes and reducing costs. Effective models of primary care can greatly enhance the value of increasingly constrained health care spending. Despite large investments on primary care transformation in the US and Canada, primary care has yet to achieve its full promise in either country. Sharing successes and failures from attempts at innovation on both sides of the border can help each country accelerate improvement.
Despite very different health systems, primary care practices in both countries encounter remarkably similar challenges in delivering care. At the point of care, patients’ needs are similar and their experiences too often suboptimal. ...continue reading →
Yehuda Berg, an American author and spiritual leader, was probably talking about individual level transformation when he said “We need to realize that our path to transformation is through our mistakes. We're meant to make mistakes, recognize them, and move on to become unlimited.” But the statement has a lot of validity even applied to system level transformation.
Canada and the United States share the dubious honor of ranking near the top of OECD nations for total healthcare costs and near the bottom for health outcomes, whether measured in terms of individual health or health system performance. But it is through the recognition of these mistakes that both countries have embarked on a path toward transformation.
While differences between the two systems of health care delivery are frequently emphasized, we actually face some common challenges to primary care transformation ...continue reading →
Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy
The Iroquois Confederacy’s Great Law is said to include the principle of making decisions taking into account impacts on the seventh generation, which means thinking 140 – 175 years ahead. That is a far cry from our modern politicians, who can barely think past the next election, never mind our businesses and stock markets that are too often focused only on the next quarter’s bottom line.
As Canada celebrates its 150th anniversary, it seems a particularly good time to think about the next 150 years. Of course we can’t predict that far ahead; imagine how much of today’s world we could have predicted in 1867. But there is no doubt that what we do today will have impacts at least 150 years into the future, and probably much further. ...continue reading →
Cory Peel is a GP-Anesthesiologist who locums throughout British Columbia, Alberta and the Yukon
A couple of months ago I read Mike Hager’s article in the Globe and Mail about Dr. Reggler’s tribulations at St. Joseph’s Hospital in Comox, BC, and I was overcome by a realization that, despite having been a practicing Family Physician for 7 years, I had culpably little understanding of the prejudicial impact of faith-based hospitals in determining patient access to care.
The article detailed the refusal of the “Catholic hospital” in Comox to provide medical aid in dying to its patients despite having a staff physician willing and able to do so, thereby forcing them to be transferred elsewhere. That such a policy could exist stunned me. It is the work of “the bishop [a.k.a. the Diocese of Victoria] and the hospital board,” with the board’s CEO maintaining that “minimizing patient discomfort and pain is always the highest priority,” which seems to me to fly in the face of logic.
It is not, however, an isolated example. Canada contains many hospitals whose delivery of healthcare to its patients is directed by Church doctrine. ...continue reading →