Author Archives: CMAJ

Mark Soth is a mid-career academic intensivist in Ontario, Canada. He blogs as the Loonie Doctor about physicians' personal finance

 

We really have come a long way as a society in that "the talk" is not so much of a big thing anymore. We speak more openly about sex - the benefits, the pitfalls, and the repercussions both within our families and in our public institutions. It is no longer a major taboo. That was not always the case.

Historically, the taboo of sex has contributed to much misery. For example, when syphilis ran rampant around the world in the 16th century, many were denied care because it was considered “the wages of sin”. Of course, they treated syphilis with mercury back then, so that may have been worse. The advent of penicillin as an effective cure for syphilis in the 1940s was revolutionary, but it still did not eradicate the disease. With penicillin, education, and condoms - syphilis is much less common now, except on internal medicine exams.

Did all that talk about sex make you uncomfortable? Probably not. In fact, some medical nerds are probably chomping at the bit to correct me on some fact about syphilis.

"Let's talk about money." ...continue reading

Natasha Sarah Crowcroft is Chief of Applied Immunization Research at Public Health Ontario and a Professor at the University of Toronto in Laboratory Medicine and Pathobiology and the Dalla Lana School of Public Health. Her work aims to maximize the public health benefits of immunization.

 

It is good to celebrate anniversaries of major achievements in public health. The bicentenary anniversary of the publication of Dr. Edward Jenner’s paper on vaccination against smallpox, published in 1796, was celebrated on the cover of the 1996 edition of the United Kingdom’s (UK)’s immunization guide, marking one of the greatest achievements of humankind. Recently however we reached the anniversary of a publication that we might all rather forget.  Twenty years ago in February 1998, two years after the celebration of Jenner’s legacy, The Lancet medical journal published a paper describing a small case series of “ileal-lymphoid-nodular hyperplasia, non-specific colitis and pervasive developmental disorder in children”. The story has been described ...continue reading

Magbule Doko is a family physician in Windsor, Ontario, and an adjunct professor at The University of Western Ontario

 

 

Our decision, firm and dedicated
To become doctors: a noble profession
Long years of heads in our books
Clinical years of emotional turmoil
Oh yes you did not know
Their stories touched us, imprinted on our minds
We wept ...continue reading

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Howard Abrams is the Director of Openlab, a design and innovation shop located at the University Health Network (UHN) in Toronto

 

Andre Picard recently proposed in the Globe and Mail: “if we want a healthier Canada, we should spend less on healthcare.” This may, at first, seem counterintuitive, but it has been long recognized that the social determinants of health are at least as, if not more, important in the health of a population. This is where food intersects with public health in a pivotal way. If we look at the evidence, we know that food insecurity and poor housing are two major risk factors for chronic disease and adverse health outcomes. Patients we serve don’t show up out of thin air, but come out of a community environment rich with factors that impact their health ...continue reading

Paul G. Thomas is Professor Emeritus of Political Studies at the University of Manitoba. From 2004 to 2007 he served as the founding board chair for the Manitoba Institute for Patient Safety.

 

My introduction to the complex and emotional world of adverse events in healthcare occurred in 2001 when I chaired a committee to review an inquest report into the tragic deaths of twelve infants in a paediatric surgery program in Manitoba. Justice Murray Sinclair who conducted the inquest had concluded that at least five of the deaths were preventable.

Back then there was no apology law in Manitoba.  Neither the Sinclair report (2000) nor the Thomas report (2001) recommended the adoption of such a law.   ...continue reading

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Lawrence Loh is an Adjunct Professor at the Dalla Lana School of Public Health at the University of Toronto

 

I took up run-commuting following the birth of my first child because leisure time physical activity just wasn’t going to happen. My office had a shower, and what better way to counter the drudgery of the commute? I soon discovered mental calisthenics were also part of the running deal—not only in planning logistics, like ensuring you have enough toiletries, underwear, and the right accessories at the office—but also in the opportunity to sharpen one’s sense of observation.

The routine of run commuting leads one to notice patterns over time. If you leave at the same time most days, ...continue reading

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This article is co-authored** by (top row) Christina M. Nowik , Pamela Lai, Thomas McLaughlin, Simon Moore, (bottom row) Gillian Shiau, Natasha Snelgrove, Nureen Sumar, and Jasmin Yee, all of whom previously served on the Resident Doctors of Canada (RDoC) Resiliency Working Group

 

For Canadian resident doctors, July 1st is more than a national holiday; it represents the day when newly-minted doctors become responsible for decisions in patient care.  While this is an exciting day, it can also be fraught with anxiety and stress. Over the course of residency, acute work-related stressors, including traumas and patient deaths, can negatively impact residents’ wellbeing.  Additionally, residents endure chronic stressors such as large debts, extended work  hours, and isolation from family.  These factors predispose residents to burnout. The prevalence of burnout among resident doctors is up to a staggering 75%. Resiliency interventions have been shown to work, and the time to begin implementing them nationwide is now. ...continue reading

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Kirsten Patrick is Deputy Editor at CMAJ

 

Rising awareness of the toll that physician burnout is taking on our profession and our healthcare services has inspired numerous organizational physician wellness initiatives and resilience courses aimed at individual physicians. Yet, as experts discuss the relative merits of the system-level approach vs. the individual-wellness-training approach to addressing burnout, one key element seems to be all-but ignored: the healing power of the relationship between physicians and the patients they serve.

Dr. Tom Hutchinson, in his book, Whole Person Care: Transforming Healthcare (Springer International Publishing AG, 2017), suggests that we have lost touch with “the interior processes of healing and growth in the individual patient and the practitioner that give meaning to illness and to healthcare,” ...continue reading

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Reza Mirza is a second year Internal Medicine resident at McMaster University

Justin Hall is a third year Emergency Medicine Resident at the University of Toronto.

Odion Kalaci is a PGY-3 in Pediatrics at the University of British Columbia

(All authors are members of the Practice Committee of the Resident Doctors of Canada - RDoC)

 

In Canada, 38 percent of recently graduated specialists are unemployed or underemployed with a further 31 percent having delayed entering the job market altogether according to a Royal College report. Thus, many of us will struggle. As residents and members of Resident Doctors of Canada (RDoC), this report is alarming as it reinforces existing job-security anxieties. And yet Canadian patients face the longest wait times among high income countries. Consider: 29 percent of patients had to wait four or more hours for an emergency room visit, compared to one to four percent in Germany and France according to a Commonwealth Fund report.

Specifically, the report reveals that 16 percent of specialist physicians were unable to secure employment three months from certification. This excludes 22 percent of new physician graduates who piece together an income by combining locum and part-time positions (they wryly self-identify as “locum-ologists”) ...continue reading

Adam Kassam  is the chief resident in the Department of Physical Medicine & Rehabilitation at Western University

Jeremy Wasserlauf is a fellow in cardiovascular disease at Northwestern University Feinberg School of Medicine

 

The meteoric rise of bitcoin has fueled worldwide interest in cryptocurrencies and, more broadly, blockchain technology. The once obscure brainchild of Satoshi Nakamoto has evolved into a speculator’s paradise, rivaling the dot-com bubble of the early 2000s. While bitcoin’s future as a digital currency is a topic of debate, its underlying blockchain software has become the foundation for a technological revolution that began in finance, but is quickly transforming other industries. The application of blockchain to the world of healthcare may prove to be its most humanitarian of functions.

Acclaimed as one of the biggest innovations since the internet itself, blockchain eliminates trusted third parties such as banks from online transactions and replaces them with a decentralized database, or a ledger, of transactions. The ledger is stored across a network of computers that is visible to everybody, and a combination of cryptographic keys is used to create a secure reference of identity. ...continue reading