Author Archives: CMAJ

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

 

Was I wrong!

Pioneering Professional Practice doesn’t sound like the most stimulating title of a Plenary Address but Helen Stokes-Lampard, Chair of the UK's Royal College of General Practitioners (RCGP) Council, gave an uplifting, encouraging and inspiring address on the topic on day 2 of the SAPC ASM 2017. Helen encouraged us all to rediscover the joy and sparkle of general practice despite poor morale, a constant feeling of being under siege, and increasing resource limitations in the profession. I liked her analogy that primary care, secondary care and social care were interdependent and need to be together- a three legged stool that depended on all three components to remain stable. ...continue reading

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

 

Shakespeare’s Warwickshire was the background to last week's 46th Annual Scientific Meeting of the Society of Academic Primary Care (SAPC) where Professor Christine Ennew, Provost of the University of Warwick, introduced the meeting by emphasising the importance of primary care in the development of their young medical school. She also underlined her belief in the transformational power of universities and how their contribution to academic medicine can alter clinical practice.

It saddened me that her optimism and enthusiasm contrasted with the stark reality of general practice as outlined by Candace Imison, Director of Policy at the Nuffield Trust ...continue reading

Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy

 

This is not going to make me popular with my beer-drinking Morris-dancing friends, or with a lot of other people I imagine, but we need to put higher taxes on alcohol and implement other proven policies that make it less accessible and less glamorous. This is the conclusion one must come to on reading the report on Alcohol Harm in Canada just released by the Canadian Institute for Health Information (CIHI) and a 2015 report by Canada’s Chief Public Health Officer (CPHO). ...continue reading

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Sophie Soklaridis is an Independent Scientist and the Interim Director of Research in Education at The Centre for Addiction and Mental Health (CAMH)  in Toronto, Canada

 

Almost 23 years ago, I wrote a Master’s thesis that emerged from my experience with breastfeeding my son. After writing the cathartic 260-page thesis, I thought I was done with thinking about breastfeeding. Then I read about a woman with postpartum depression who died by suicide, with one of the main explanations she wrote in a note being that she was unable to exclusively breastfeed her baby. I also read Chaput and colleagues’ enlightening article in CMAJ Open on the link between breastfeeding difficulties and postpartum depression. When I recently started talking to new and expecting mothers, I realized that very little seems to have changed in the discourse around breastfeeding and the experience of being a “good” mother since I went through that lonely and painful time in my life. ...continue reading

Barbara Sibbald is editor of News and Humanities at CMAJ, and author of the recently published collection of short stories, "The Museum of Possibilities"

 

Health policy pundits should look to André Picard’s new book for a dose of common sense on some of Canada’s most urgent health issues. Picard, as most Canadians know, is the long-time health columnist for The Globe and Mail. The book, Matters of Life and Death: Public Health Issues in Canada (Douglas & McIntyre), is the best-of those columns over the past 15 years, updated and conveniently packaged under 14 topic headings like opioid use, medical assistance in dying, cancer, marijuana, indigenous health and infectious disease. Most importantly Picard delves into medicare itself.  Canadians spent $228-billion in 2016 on health care: Do we get value for our money? Is it sustainable? Picard not only asks the right questions, he provides some very credible answers. ...continue reading

Bill Jeffery is the Executive Director of the Centre for Health Science and Law (CHSL), and  publisher of Food for Life Report magazine

 

The new Director General (DG) of the World Health Organization (WHO) will soon be elected. If the upcoming election does not effectively hold to account all candidates, especially the successful one, the WHO risks losing its influence as the leading global public health authority.

On May 23, 2017, for the first time in WHO’s history, all 194 Member States of its governing body, the World Health Assembly, will cast a vote for the new WHO DG at its annual meeting in Geneva. (Previously, the DG was selected by the WHO's 34-member Executive Board.)

But, public health challenges are too great to allow the vote to descend into geo-political horse-trading and unchallenged controversy-dodging in an environment where opportunities for public vetting are few.

The WHO DG is head of a global staff of 7,000 and chief global ambassador to national health ministries world-wide. The WHO’s prominence and the need for its leadership in global public health have long been greatest in low- and middle-income countries where national health systems suffer a relative lack of financial resources and specialized technical expertise.  But high-income countries draw on the WHO’s work, ranging from graded distillations of nutrition and alcohol research to annual advice about the best flu vaccine to administer globally.

The three candidates shortlisted for the position of DG have been persistently ambiguous about their stances on important governance issues. ...continue reading

Matt Eagles is soon to graduate from Memorial University's medical school, and is headed to a Neurosurgery Residency program at the University of Calgary; he is a former Major Junior and University hockey player and a founding member of Concussion-U

 

On Monday May 1, 2017, the Pittsburgh Penguins entered their second-round playoff game against the Washington Capitals with a tight 2-0 grip on their best-of-7 playoff series. An important reason for this was the play of their star captain: Sidney Crosby.

Through 2 games in the series, Crosby had scored 2 goals and added 2 assists. He was, as he had been for much of the preceding year, playing at a level higher than anyone else in the sport of hockey. However, in the first period of game three, the fortunes of the Pengiuns and their superstar appeared to change when he was cross-checked in the face by the Washington Capitals’ Matt Niskanen.

Crosby lay on the ice for several minutes, and was eventually helped up by his teammates before skating off the ice under his own power. ...continue reading

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Ijaz Rauf is President at Eminent Tech Corporation and an Adjunct Professor of Physics, School of Graduate Studies at York University

 

Growing evidence of problems in the level of quality and safety of care across healthcare organizations, along with public awareness, has made the quality of health care the talk of town. This has drawn significant government and regulatory attention to healthcare systems across the country. Health Quality Ontario (HQO) was established with the mandate to monitor and report on healthcare performance in Ontario and the mission to bring about meaningful improvement in health care. Besides reporting on the key performance indicators, HQO holds quality rounds to share knowledge and best practices. Recently, I attended one of HQO’s quality rounds,  and I left with the impression that quality in health care is not considering the right measures, using the right experts or measuring the right data. ...continue reading

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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