Author Archives: CMAJ

Nicole Le Saux is Associate Professor in the Division of Infectious Diseases at the University of Ottawa *

 

As physicians we should be concerned about the inappropriate use of antibiotics. Have you ever had a patient with an extended spectrum beta-lactamase (ESBL), E. coli or Klebsiella urinary tract infection, a Clostridium difficile infection (CDI) or a drug-resistant N. gonorrhoeae?

Whereas resistant bacteria and CDI were rare a decade ago, these clinical situations are now commonplace in hospitals, long term care facilities and emergency departments. According to the Canadian Antimicrobial Resistance Surveillance System Report 2016 the rate of CDI in hospitalized patients is 3.4 cases per 1000 patient admissions (approximately one in every 300 patients admitted). As of 2014, 18.2% of isolates of Neisseria gonorrhoeae were resistant to penicillin with worrisome decreased susceptibility to cefixime, ceftriaxone and azithromycin. ...continue reading

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Barbara Zelek is Associate Professor and Co-Chair for the Section of Family Medicine at the Northern Ontario School of Medicine

 

Marathon, a rural community on the North shore of Lake Superior, made CMAJ headlines in 1997 because it boasted a stable workforce of seven physicians for the first time in over a decade. 2017 marks the 20th anniversary of that CMAJ article and of the arrival of Dr. Sarah Newbery and Dr. Eliseo Orrantia in Marathon.

The article described “a medical renaissance” taking place in Marathon and an end to “the revolving door that has affected rural medicine across the country”. That door has stopped revolving in Marathon since 1997 thanks, in many ways, to the leadership of Eli and Sarah.

Let me put this important milestone in context. ...continue reading

Larry W. Chambers is Research Director at McMaster University's Niagara Regional Campus, School of Medicine

 

Eric Larson committed his career to researching how to delay and prevent Alzheimer’s disease, other forms of dementia, as well as declining memory and thinking. He led the “Adult Changes in Thought study”, which began following a large general population cohort in 1986. It has one of the largest research populations that included individuals aged 85 years and older.

Larson’s new book, “Enlightened Aging: Building Resilience for a Long, Active Life,” coauthored with professional writer and journalist Joan DeClaire, is based on information from hundreds of research papers Larson has authored and co-authored. The reader benefits from his profound understanding of health and aging research and his clinical experience as a practicing physician. Evidence is presented alongside useful patient stories to aid comprehension, engagement and to pique ...continue reading

Catherine Whicher is a graduate student of Global Health Policy at the London School of Hygiene and Tropical Medicine

Varoon Mathur is a Software Engineering/Data Science student at the University of British Columbia

 

Last week Universities Allied for Essential Medicines (UAEM) published the 2017 University Report Card for Global Equity in Biomedical Research, evaluating fifteen of Canada's universities (U15) for their contributions to neglected health needs including biomedical research, equitable licensing, global health education, and transparency. This is the 5th iteration of the report card, but the first time UAEM focused exclusively on public research schools (and exclusively on Canada, for that matter). While there were some promising highlights of what our universities can do when they set themselves to it, overall it is clear that Canadian schools are failing to use their considerable power to address many neglected aspects of global health. ...continue reading

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Daniel Miller is a Physiatrist (Physical Medicine and Rehabilitation) in Lethbridge, Alberta

 

Income splitting has come under attack by the current Federal Liberal Government as an unfair tax advantage for certain individuals and several proposals put forward to eliminate certain “tax loop holes” may have a further reaching impact that revenue generation and impact our charter rights. We shouldn’t be discussing tax loop holes, but rather the effects of income splitting being a charter right for all Canadians. While I use the term marriage specifically, I would also include civil union and common-law partners to whom the same legal rights apply.

I recently met with my accountant to review the financial details of my medical practice. He told me and my wife that we would no longer be able to income split due to the proposed changes in Federal taxation legislation. ...continue reading

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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.

...continue reading

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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.

...continue reading

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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

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