Julian Nguyen is a medical student in the Class of 2019 at McGill University
Monday morning; flu season. The attending respirologist has spent the whole weekend on call battling the symptoms of influenza, likely caught from one of our many afflicted patients. Swallowing a Tamiflu pill, he tells me how—despite a hectic shift in the emergency room—he managed to complete a major grant application for his next research project. His voice is hoarse from coughing and exhaustion lies around the corner, yet his determination to carry on is unshaken. I admire his fortitude while hating myself for lacking his sense of sacrifice.
Michel Foucault, in his seminal Naissance de la clinique (The Birth of the Clinic), highlights the primordial role physicians occupy in a society predicated on science. He sees in physicians (and priests) “les héritiers naturels des deux plus visibles missions de l’Église — la consolation des âmes et l’allègement des souffrances” (the natural heirs of the two most visible missions of the Church — the consolation of souls and the lessening of suffering). Western society’s obsession with youth and health has elevated physicians beyond mere technicians to all-encompassing healers, increasing the burden placed on aspiring doctors. ...continue reading →
Dr. James Maskalyk describes emergencies “as a sign of life taking care of itself” in his most recent memoir, Life on the Ground Floor. Throughout his book, the reader is left to wonder what exactly Maskalyk means by this. It is an ominous phrase that, at first glance, reads more like a repackaged “survival of the fittest” for emergency departments. However, through deft and emotional storytelling, Maskalyk urges us to look beyond this stark message of Darwinism and see that emergencies are the purest form of life helping life, or “life taking care of itself”. ...continue reading →
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 →
Often when we talk about improving health care, we turn to the Triple Aim. Developed in 2007 by the Institute for Healthcare Improvement (IHI) in the United States, the Triple Aim captures three objectives for a better quality health system: Improving a patient’s experience of care, improving population health and doing this at a reasonable cost. It has become a way of thinking embraced by many health care systems around the world.
The Triple Aim takes a big-picture, system-wide approach that can be applied to any part of the health care system, as well as across all levels of an organization. The ultimate endgame is a sustainable health care system that patients trust and that contributes to healthier populations.
Interview with Dr. Christopher Parshuram, critical care specialist with the Hospital for Sick Children in Toronto. He is the lead author of a randomized trial published in CMAJ looking at patient safety, resident well-being and continuity of care for three resident duty schedules in the ICU. Work schedules incorporating shorter periods of continuous duty affected neither doctors' daytime sleepiness nor adverse outcomes in patients.
Interview with Dr. Thomas Maniatis, internal medicine training program director and clinical ethicist at McGill. Dr. Maniatis is the author of a commentary published in CMAJ. He argues that resident duty-hour reform must be further evaluated in order to design systems that provide maximal benefit and minimal harms for all involved.
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Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK
“It was the loneliest I’ve ever felt,” said my consultant surgeon colleague as he described lying in his hospital bed the night before cardiac surgery. Even with all his surgical experience, familiarity of the surroundings, knowledge of his own hospital, and utmost confidence in his cardiac surgical colleagues and anaesthetist, he was scared. Despite what our patients might think, being a doctor is no defence against illness and doesn’t make coping with illness any easier.
But, we are our own worst enemies. We put immense pressure on ourselves and don’t want to let our medical colleagues or patients down. I once listened to a single-handed rural GP who had recent chest pain and was awaiting an angiogram. His greatest worry was that he could not get a locum to cover his patients ...continue reading →