Author Archives: CMAJ

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

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Ally Fleming is a writer and publicist at Anstruther Press

 

Illness doesn’t end when you leave the doctor’s office. Affliction is carried, and pain is, as Shane Neilson writes, “a concerto in your back pocket.” As a writer with bipolar disorder and chronic pain, I’ve often felt utterly lost, blinded by what Rita Charon calls the “glare of sickness” . For many, the fundamental question of medicine is not how to be fixed (for it’s often not possible), but how to live one’s life, broken. Physician and pain researcher Shane Neilson’s trilogy of poetry collections from Porcupine’s Quill leads by example.

“Practitioners, be they health care professionals to begin with or not, must be prepared to offer the self as a therapeutic instrument," (p. 215) writes Charon in Narrative Medicine: Honoring the Stories of Illness. Neilson, with one foot perpetually planted in medical practice and the other in love, unflinchingly offers himself to his readers ...continue reading

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

 

Have we lost something in the success of academic family medicine? We produce quality research, have created successful interdisciplinary academic teams, demonstrate competitive publication outcomes and generate significant grant income. But, academic primary care may have drifted away from, and perhaps even alienated, some family medicine colleagues. There are thoughtful and reflective family doctors who read, write, discuss and debate many aspects of general practice but feel undervalued as they do not fit the university based academic profile. ...continue reading

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Wendell Block is a family physician at the East End Community Health Centre and the Canadian Centre for Victims of Torture

 

In the thirty-odd years I have worked with torture survivors, I have heard countless versions of the following story. When Azad* was a 22- year-old university student in his home country, he participated in a public demonstration, criticizing the government’s financial cuts to social programs important to his minority group. He and many other demonstrators were apprehended and brought to a crowded holding centre. They slept on the floor, had limited access to a dirty toilet, and were given a cup of water with a small amount of non-nutritious food twice a day. Azad was taken for interrogation on three occasions. He was accused of having links to terrorist organizations outside the country, and of spreading seditious ideas (his interrogators had found political leaflets in his backpack). They demanded the names of organizers. While being questioned he was struck repeatedly on his back and thighs with police batons, and on the third occasion they beat the soles of his feet. Afterwards he could not ...continue reading

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