The new Canadian guideline presents evidence-based recommendations for prescribing of opioids for chronic non-cancer pain, including maximum dose recommendations, avoiding opioids in high-risk populations, and guidance for tapering.
Jason Busse, Associate Professor in the Department of Anesthesia at McMaster University and researcher with the Michael G. DeGroote National Pain Centre in Hamilton, Ontario, co-authored the guideline (open access). In this podcast, he speaks with Dr. Diane Kelsall, interim editor-in-chief, CMAJ, and explains the recommendations.
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 →
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 →
Kim Perrotta is Executive Director of the Canadian Association of Physicians for the Environment (CAPE)
A month ago the Financial Post published a commentary entitled “They keep saying shutting down coal will make us healthier, so how come there’s no evidence of it?” written by Warren Kindzierski of the School of Public Health at the University of Alberta. It seems a sad statement of our times that this article, which muddies the waters with incomplete facts and misleading information about coal plants, air pollution and human health, was published in the middle of an important debate about policies aimed at supporting the phase-out coal plants Canada-wide by 2030. The Canadian Association of Physicians for the Environment feels strongly that publication of the article was irresponsible. ...continue reading →
I changed jobs this week. On Monday, my first day, when I should have been primarily concerned with learning the office microwave-cleaning rota and orienting myself to a new Xerox print centre, I was a little preoccupied. At 8 pm on Sunday, I found out that my father had fallen, broken his hip, undergone emergency surgery, and was in isolation in a hospital in southwestern Ontario. Details were fuzzy. Hospital staff would not share much with my aunt, my father’s sister. He had managed to call her on Sunday morning, 24 hours after his fall, once he had come round after anaesthesia. He needed her to go to his house to make sure my mom was okay. My mom wasn’t answering the phone.
Unanswered phone calls are not uncommon at my parents’ house. My father is quite hard of hearing, after spending 37 years as an infantry officer. My mother tends not to answer the phone because she is self-conscious. She has a severe cognitive disability ...continue reading →
It’s March Break, which means last chance to do winter activities for some families in Canada. Unfortunately, I’m not Winter Fun Mom so I booked Son #2 - the only person in our family who is interested in winter sports - on a bus-in snowboarding camp. On day 1 I warned him to be careful and to try not to injure himself. On day 2 I forgot to warn him. So at 2pm on day 2 I got a call from the snowboard instructor to tell me that my son had fallen and would soon be on his way to hospital in an ambulance.
I know I should be more encouraging of adventure and more accepting of risk-taking in my boys. ...continue reading →
Interview with Dr. Andrea Boggild, clinical director in the Tropical Disease Unit at the Toronto General Hospital, and assistant professor in the Department of Medicine at the University of Toronto.
In this podcast Dr. Boggild gives practical advice about preventing and diagnosing Zika virus in Canada. She also shares the findings of the research article she co-authored that analyzed data coming from Canadian Travel Medicine Network sites, or CanTravNet, in Canada.
Interview with Dr. Brett Thombs, professor in the Faculty of Medicine at McGill University and senior investigator of the Lady Davis Institute, Jewish General Hospital in Montreal. He is also chair-elect of the Canadian Task Force on Preventive Health Care and chair of the tobacco guideline working group.
In their clinical guideline published in the CMAJ (open access), Dr. Thombs and the Task Force reviewed the evidence supporting behavioural interventions for prevention and treatment of smoking in children and youth. He explains their findings in this podcast.
Did you hear about Chris’s mint condition 1963 Shelby Cobra? Mechanics say he didn’t check the oil for decades, and the engine just seized one day on the way to work. When they opened it up, they say there wasn’t much left. Such a shame really.
Said Nobody. EVER.
Jazlin Mayhue is a researcher in Victoria, BC
Peter Hobza is a family physician in Victoria, BC
Robert O'Connor is a family physician in Victoria, BC
Introducing a new concept...
We all know folks who are not vigilant with preventive health for their body. However, a subset of them wouldn’t drive an irreplaceable million-dollar car until it was destroyed from lack of maintenance. A human’s life and body are irreplaceable, and worth at least a million dollars, when considering the price of an injury causing death. Therefore, it’s logical to help some people think of treating their body as well as a valuable car. ...continue reading →