Ever wish you could ask a wise, kind, approachable Student Affairs Dean something without having to admit the question was yours? Maybe you think it’s cringe-worthy; maybe you feel like you should know the answer already; maybe you think you will be judged; maybe you’re sure you are the only medical trainee on the planet ever to have felt this way, and you need confirmation now.
Enter Dear Dr. Horton, a new feature on the CMAJ Blog. Send the anonymous questions that keep you up at night to a real former Dean of Medical Student Affairs, Dr. Jillian Horton, and get the perspective you need with no fear of judgment (rest assured, though — Student Affairs Deans in Canada are all really great people, and not only have they heard it all, but they take on these decidedly unglamorous, 24-hour call jobs because they really, really care about learners).
Submit your questions anonymously through this form, and if your question is appropriate for the column, expect an answer within a few weeks! ...continue reading →
The HIV/AIDS Care Unit (Unit 371) at Chicago’s Illinois Masonic Medical Centre was founded on a heartbreakingly simple observation. “We are all just people taking turns being sick,” stated Dr. David Blatt, one of the founders of Unit 371, in MK Czerwiec’s newest graphic novel — the aptly named Taking Turns: Stories from the HIV/AIDS Care Unit 371. Czerwiec was a brand-new nursing graduate on 371 during the height of the HIV epidemic, and Taking Turns is in many ways her tribute to the unit’s extraordinary spirit. The intention of the unit was made clear from day one: this would be a place where the most stigmatized and ostracized patients could be cared for with empathy, understanding, and love. ...continue reading →
Imaan Javeed is a medical student at the University of Toronto
On Monday, April 23, while driving on Yonge Street near Finch Avenue in Toronto, it's alleged that Alek Minassian whipped the steering wheel of his rented white Ryder van sideways and killed ten innocent, unsuspecting people; physically injured sixteen more; and emotionally scarred hundreds of others. At the time of my writing, a clear motive for these actions has yet to be publicized. Minassian is alive and certainly under investigation, as much as he may have desired otherwise, but there still isn't much we know about the lead-up to the event.
Indeed, much to the dismay of some members of the media, the 'default' assumption quickly turned out to be untrue — there was not a single known link to "jihadist" terrorist groups or foreign radicalization to be found. ...continue reading →
Robbie Sparrow is a medical student in the Class of 2019 at Western University
For individuals facing deep personal struggles, the path to recovery is often daunting and overwhelming. Support from others who have overcome similar challenges can be extremely beneficial. For example, the best people to help heroin addicts are those who have fought to stay sober for two years, and women facing domestic abuse are best aided by women who have escaped it. Doctors who care for patients living through crises are often disadvantaged when trying to empathize with them because they themselves haven’t faced the same struggle. Difficult experiences throughout a physicians’ life can help them approach this ideal of empathy and improve the care they offer patients. ...continue reading →
Sarah Tulk is an Ontario physician who recently finished her residency training in family medicine at McMaster University
“If only he had chosen a higher floor, we wouldn’t have had to come here!”
These were the words that came out of my preceptor’s mouth. I was a wide-eyed medical student, shadowing in orthopedic surgery. The patient was an older man who had sustained multiple fractures after attempting to end his life by jumping from an apartment building balcony. The trauma ward was full, so he was, inconveniently, located on a distant ward which meant his poor choice of departure level was now encroaching on our operating room time. In medical school, I learned that mental illness was shameful before I learned how to use a stethoscope. ...continue reading →
Kayla Simms is a Psychiatry Resident (R1) at McMaster University who graduated from medical school at the University of Ottawa in 2017
Compartmentalization is to medical knowledge as bread is to butter: patients, divided into sub-types; the body, separated by systems; the physician, detached from the pain.
Or so I once thought.
In medical school, I walked into patients’ rooms and stood idly at the bedside, intimately embedding myself into the darkest spaces of strangers’ lives. The bedside, like a carpenter’s work bench, is where I mastered concepts of sound and touch: the absence of bowel sounds auscultated in an obstructed state. The warmth of inflammation against the back of my hand.
The bedside is where I grew accustomed to asking questions like, “How is your pain today?” and learned to de-humanize the experience with the help of a 10-point scale. ...continue reading →
Domhnall MacAuleyis a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK
Could cancer simply be due to bad luck rather than environmental factors, risky behaviour or bad habits? In recent weeks, media attention focused on a scientific discussion on the risk of cancer based on papers published in Science and Nature. While the discussion itself is fascinating, isn’t it interesting that this debate took place across mainstream scientific publications rather than in established medical journals. Perhaps medicine is already convinced by the epidemiology or, maybe medical journals are less open to such debate. This is the story: ...continue reading →
Today is a momentous day for physicians in Canada. No matter what your opinion about whether or not physician assisted dying is morally right, it will be a human right henceforth under certain circumstances.
James Downar is a Critical Care and Palliative Care physician with a Master’s degree in Bioethics. He is an Assistant Professor in the Department of Medicine at the University of Toronto, and co-chair of the Physicians’ Advisory Council for Dying with Dignity Canada, a group that advocates for the legalization of Physician-Assisted Death.
Physician-Assisted Death (PAD) is a controversial subject in Canada, but it shouldn’t be. The latest polls show that Canadians support PAD almost as much as they support sunlight and clean drinking water. PAD is now legal in many jurisdictions, and we have a large body of evidence to address fears about slippery slopes. When PAD was legalized in Europe, it did not become the default option for dying patients; it generally remained stable while Palliative Care grew dramatically. According to the Economist, the 5 countries that have legalized PAD are world leaders in the “Basic end-of-life healthcare environment”, while Canada sits in the middle of the pack. According to the Center to Advance Palliative Care, all three US states that have legalized PAD by statute rank in the top 8 for availability of palliative care services in hospitals. The vulnerable do not appear to be pressured into accepting PAD - on the contrary, the patients who receive PAD appear to be disproportionately wealthy, educated, and well-supported by family members and health insurance. I would almost call them “privileged”, but then I remember that they were suffering enough that they chose to end their lives.
I don’t support death. I enjoy my life, and I work very hard as a Critical Care physician to keep patients alive when I can. But I accept that there are times when I can’t. And there are times when I can keep people alive, but not in a state that they would value. ...continue reading →