Class of 2016
“I have stage 4 lung cancer. I’m dying and this is where I will spend my last days.”
I listened as a vulnerable, palliative, homeless man told our team about his life in a homeless shelter in Toronto. I watched him and thought of my great aunt who passed away from cancer, surrounded by her loved ones, housed, safe and comfortable. I was left feeling ashamed - how could we allow people to pass in such circumstances? ...continue reading
Dr. Harpreet Sood and Dr. Mahiben Maruthappu
Harpreet Sood and Mahiben Maruthappu are Senior Fellows in the office of the Chief Executive for NHS England.
Over the last decade, the NHS has achieved a lot. It has been ranked the number 1 healthcare system in the world, public satisfaction has almost doubled, cancer survival is at its highest, and early deaths from heart disease down by 40%. Central to this achievement has been general practice as it continues to be the cornerstone of the health system, with 99% of the population registered with a general practice today.
There are an estimated 340 million consultations that occur in general practice today but the demand across the health system is rising. An estimated 70% of the NHS budget is spent on long term conditions but the number of people of choosing to become a GP is not keeping pace with the growth in funded training posts.
Therefore as a health system we need to look for innovative ways to keep up with the demand and ensure primary care remains a key component of the NHS.
Models of care
Primary care of the future will build on the traditional strengths of ‘expert generalists’, proactively targeting services at registered patients with complex ongoing needs such as the frail elderly or those with chronic conditions, and working much more intensively with these patients. Future models will expand the leadership of primary care to include ...continue reading
Class of 2017
Patient M. presents to clinic,
Melanoma of the Heel.
Radial forearm free flap,
Doing well post-op.
Day 1 - How is the flap?
It's looking well-perfused, Dr.
Day 2 - Is it congested? Should we revise?
Graeme Rocker is a professor at Dalhousie University in Halifax
Editor’s note: Part I of this series appeared as a Humanities article in CMAJ; part II appeared on CMAJ Blogs.
Early days at home, with no major events until day 3. I simply could not get warm. It was the same on day 4. My extremities felt like blocks of ice coupled with which I had persistent cramps in hands and feet that wouldn’t shift. It finally dawned on me that this might be carpo-pedal spasm in a setting of some subconscious hyperventilation caused by overall discomfort. Whatever the cause, it was a lousy way to spend a day.
Day 5 Intense bladder spasms coupled with colonic gas distension pain made for, if not the worst pain, certainly the most discomfort yet. I don’t know if there’s such a thing as a horrible orgasm, but a bladder spasm in the early stages must come close to it. It’s a foul experience and for 5, 10, 15 seconds you pray for relief from an internal surge of gargantuan proportions and thank some deity when it passes. ...continue reading
Ashley Miller is a child psychiatrist and family therapist at BC Children's Hospital. She lives with her husband and two children in Vancouver.
I entered medical school in much the same way I later entered parenthood: without any real clue. In Quebec, we had the option to apply to medical school at the age of 18, straight from CEGEP. In the blur that would follow from age 19 (the start of medical school) to age 29 (graduation from a child psychiatry fellowship), I moved across the country, got married and had my first child. There is nothing remotely spectacular in these events, except for the lack of time I had to notice them. Now that my children (mostly) sleep through the night, I’ve developed the time and capacity to remember and reflect on the first of my 10 years of motherhood. ...continue reading