Reflections

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Sarah Tulk is a family physician in Hamilton, Ontario

 

Despite earnestly advocating for physician mental health, my own story has remained cloaked in secrecy. As a medical student, I felt far too junior to risk such a revelation. I watched as stigma, perpetuated by the hidden curriculum, kept my peers from seeking mental health care. Still, I kept my head tucked safely in the sand, and swore to break my silence in residency. However, as a resident the fear of jeopardizing job prospects maintained my mutism. I vowed to speak up when I was staff. Unfortunately, early in my staff career my advocacy efforts were smothered by fierce judgment and harsh consequences. I wholeheartedly renewed my vows with the ostrich approach and reconciled to start talking about mental health when I was protected by more seniority. I hated the secrecy and hypocrisy, but at least I was safe. Then I heard of another resident suicide. Then a medical student. Another resident. A staff physician. ...continue reading →

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Pat Rich is an Ottawa based medical writer and editor.

 

Cometh the hour, cometh the man.

It would be the very height of pretentiousness to apply this phrase to Dr. Liam Farrell, an author and former family physician from Rostrevor, Co. Down, Ireland and I am sure he would be the last person to do so.

But at a time when family medicine seems to be at its lowest ebb, if not globally then very much here in Canada, there is much to be said for having a physician who can so eloquently write about both the rigors and the ...continue reading →

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Hillel M. Finestone is a Physiatrist at the Elisabeth Bruyere Hospital and Professor, Division of Physical Medicine and Rehabilitation, University of Ottawa.

 

My 52-year-old patient took his BP at a pharmacy on 6 separate occasions.  Systolic BP values were high, ranging from 150-177. When I take his BP in the office it’s 168/98.  Yup, he has high BP.  He’s 10 pounds overweight, doesn’t have diabetes, doesn’t smoke and thinks that he was told that his BP was “probably high” 5 years ago, but he didn’t feel that medications would make a difference.

We talk about weight loss, healthy eating and reducing high sodium foods, that we don’t know why BP elevates but that medications really work and help stop strokes and heart attacks from occurring.  He agrees to my prescription of one medication and we discuss its side effects.  A drug information sheet is provided. ...continue reading →

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Keegan Guidolin is a General Surgery resident at the University of Toronto

Han Yan is a Neurosurgery resident at the University of Toronto

 

 

Much attention has been paid of late to the phenomenon of social echo chambers - situations in which people’s beliefs are amplified and repeated in a closed system as no dissenting opinion originates from within the group. Echo chambers on social networking platforms such as Facebook and Twitter were identified as a factor contributing to the outcome of the 2017 US Presidential Election. We believe that social echo chambers exist in the real (non-digital) world as well, within social groups whose members may interact outside the group in general, but who discuss particular subjects only within the group. ...continue reading →

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Dr. Dhruvin Hirpara is a General Surgery resident at the University of Toronto

Dr. Nancy Baxter is a colorectal surgeon at St. Michael's Hospital

Dr. Fayez Quereshy  a surgical oncologist at the University Health Network.

 

Colorectal Cancer (CRC) is the second leading cause of cancer-related death amongst men, and the third leading cause of cancer-related death in women in Canada. Although screening has contributed to declining incidence in the elderly, recent epidemiological data reflect a rise in CRC among young adults. Data from the Canadian Cancer Registry suggest a steady increase in young-onset (15-49y) CRC, from 745 cases in 1969 to 1475 cases in 2010. In Ontario, the incidence of CRC has been increasing in young adults (30-49y) since 2005, from 6.17 per 100,000 to 9.08 per 100,000 for colon cancer, and 4.31 per 100,000 to 6.29 per 100,000 for rectal cancer. Evidence from other jurisdictions, including France, Australia, and the United States reflects similar trends in the rise of young-onset CRC. Why this apparent increase in CRC among younger people? We don’t yet know the cause but theories point to an interplay of several potential factors.

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Alastair McAlpine is a fellow in paediatric infectious diseases at BC Children's Hospital in Vancouver

 

People sometimes ask me, "What’s the difference between medicine in Vancouver and medicine in Cape Town?" The answer is, quite simply, Everything.

But let’s rewind a bit. In July of this year, I flew the 20 or so hours it takes to get from South Africa to Vancouver. I arrived in the city by myself with 2 suitcases, knowing hardly a soul, and feeling completely overwhelmed. A few months earlier, I had been accepted into a 2 year paediatric (even the spelling is different) infectious diseases program at BC Children’s Hospital. Before coming I had filled out endless paperwork, done a million online courses ...continue reading →

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Dr Margaret Rundle is a Family Physician practicing in Scarborough, Ontario

 

There is little dispute among care providers that a person’s dietary habits influence preventative and treatment outcomes. Every year, there is more research validating the role of food and therapeutic diets for chronic disease management and prevention. However, basic education around the role of nutrition and lifestyle for a long time has been a blind spot in the Canadian medical school system. ...continue reading →

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Kevin Lam is a third-year medical student at McMaster University

Lawrence Loh is Associate Medical Officer of Health at Peel Region, Ontario, and Adjunct Professor at the University of Toronto Dalla Lana School of Public Health

 

Suburbs, and later exurbs, became central to the Canadian lifestyle during the automobile boom in the 1960s and 1970s. Cars were sold as the future and urban planners created suburban neighbourhoods that quickly became the primary venue where people lived and learned. Suburbs were touted to be cleaner and safer spaces, far away from “derelict” urban cores, where people went only to go to work. From this idyllic image, suburban built environments have since developed various distinct characteristics, typically defined by "commercial strips, low density, separated land uses, automobile dominance, and a minimum of public open space."

Having reshaped many cities in North America, the suburban model has gone global. Around the world, the suburban forms of major cities such as Mississauga (Toronto), Surrey (Vancouver), Limert Park (Los Angeles), Footscray (Melbourne), and Prospect Park South (New York) share these similar characteristics. But it’s becoming clear that suburban living doesn’t necessarily promote wellbeing. In fact, urban sprawl is not healthy. ...continue reading →

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Denis Daneman is Professor and Chair Emeritus in the Department of Paediatrics at the University of Toronto, and Paediatrician-in-Chief Emeritus at the Hospital for Sick Children in Toronto

 

Here’s a strong recommendation for all paediatricians and paediatricians-in-training: if you are going to read only one book in 2018, seriously consider Ghost Boy: The miraculous escape of a misdiagnosed boy trapped inside his own body, the autobiography of Martin Pistorius, co-written with Megan Lloyd Davies. The book was given to me by a colleague aware of my bibliophilia, my South African roots and my advocacy for child health: “Read this!” she said, simply and forcefully. I obeyed, picking it up a couple of days later. I could not put it down until I’d read it cover to cover.

The story is pretty simple: a 12 year old, previously well boy in South Africa, develops an undiagnosed neurological illness, which leaves him mute and quadriplegic ...continue reading →

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Kirsten Patrick is Deputy Editor at CMAJ

 

A week ago, André Picard published a column in the Globe and Mail entitled “How many people actually suffer from mental illness?” and later he tweeted his thanks to readers for making that column the publication’s most-read story of the day. The column may have been well-read - it certainly sparked controversy on social media - but it wasn't because Picard had anything very profound to say. In fact the piece was based on an epidemiological faux pas, which is why I called it a nothingburger.

Commenting on the findings of a poll commissioned by Sun Life Financial Canada, which found that 49% of Canadians have “experienced a mental health issue” at some point in their lives, ...continue reading →