Iris Gorfinkel is a General Practitioner, and Founder and Principal Investigator at PrimeHealth Clinical Research in Toronto, Ontario.
Medical documentation in primary care is a balancing act between promoting timely connection with patients and reducing clerical demands placed on physicians. Clinical notes contain increasingly less by way of narrative. They are often made up of time-saving digitized checklists of symptoms, physical findings, and treatments. Or the progress note may be a copy-and-pasted template. Both checklists and templates lessen the need for clinician typing and offer detailed notes within a few clicks.
Prior to the electronic medical record (EMR), hand-written or dictated notes would often relate a patient’s experience by quoting patients' descriptions of their symptoms. With the arrival of the EMR, doctors, most of whom had little typing experience, were abruptly confronted with having to type detailed patient encounters. The degree to which a clinician must type has since been correlated with physician burnout, which has risen sharply in conjunction with EMR utilization. ...continue reading →
Puneet Sethis a practicing family physician in Toronto, part-time Assistant Clinical Professor (Adjunct) in the Department of Family Medicine at McMaster University and Chief Medical Officer of InputHealth Systems
As someone whose life is deeply entrenched in health care technology, both as a physician tinkering with a variety of digital health tools in my own practice and as an entrepreneur helping to build these tools, I've become acutely aware of the growing trend among health professionals in viewing "virtual care" as some kind of magical endpoint that will solve all of the woes of health care. ...continue reading →
Welcome to this week's edition of Dear Dr. Horton. 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. Submit your questions anonymously through this form, and if your question is appropriate for the column, expect an answer within a few weeks!
Dear Dr. Horton,
I've experienced the death of patients before — but this one feels different. I can’t help but think of small things we spoke about, like their dogs and their season tickets to the theatre. How do you navigate the intersection of professionalism and mourning another human you felt connected to?
Sahil Sharma is a medical student in the Class of 2020 at Western University
It was my first week on service for internal medicine as a third-year clerk. I had finally begun to figure out the labyrinth of charts, forms, and computer apps that went into my interactions with patients. I still had four of the eight pens I’d started with and had managed to misplace my sacred “pocket guide” only twice — so, all in all, I was off to a good start.
I was told by my senior to go see a patient who was in ICU step-down and had recently been transferred to our care. I hurriedly went to the computers and started reading up on the patient’s history.
Mr. C had a long and complicated history. He had initially presented to the hospital with signs of cholecystitis but later developed multiple complications landing him in the ICU. After a flurry of resuscitative measures and close monitoring, Mr. C was finally deemed stable enough to be transferred to the ward. ...continue reading →
Giuliana Guarna is a medical student in the Class of 2019 at McMaster University
I pulled back the large door and stepped into the room. It was early in the morning — just after 6 am. She was lying in bed, awake, with a smile on her face despite the fact that she was post-op. The evidence of surviving rounds of chemo were borne out in front of me. Her hair was peach fuzz, peeking through a silk turban wrapped around her head. Her cheeks were like little Timbits, but her frame was swallowed by her hospital gown.
“Oh, hi. Come in. Let me turn on the light.”
I walk to the foot of the bed. The sun had not yet peeked out from under the shades. The room was illuminated by a yellowish-white hospital glow as she pressed the switch.
Mitchell Elliott is a medical student in the Class of 2019 at the University of Toronto
Doctors are amongst the intellectual elite of society. In many cases, with decades of training and continuing education in clinical practice, our expertise grants us the opportunity to do things that would be deemed invasive and inhumane if performed outside of the context of medicine. Selectively poisoning people with chemotherapy; carefully dissecting fascial planes and removing organs; asking invasive and personal questions... all in the name of symptom management, remission of disease, and prolonging the inevitable: death. For physicians, these daily rituals become almost routine. In many cases, we have spent the majority of our lives training for the uncertainty of each day, rigorously memorizing each disease presentation and management principle, habituating to these processes and procedures. With the heavy clinical demands on physicians, it may be difficult to fully realize the impact of our actions on each patient. ...continue reading →
Sarah Hanafi is a Psychiatry Resident (R1) at McGill University
I started my Geriatrics rotation on the Restorative Care unit. Having trained mostly in acute care, I found myself perplexed by this care model. On the surface, many patients seemed to suffer from maladaptive personality traits that hindered their graduation to primary care. It felt like a bizarre blend between an internal medicine ward and a long-term care facility; this mirrored the disorientation I felt in managing patients who had few medical problems, per se, but lacked the means — whether intrinsic or extrinsic — to cope. ...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 →
Zeenat Junaid is a medical student in the Class of 2020 at Bahria University in Pakistan
I checked his file again and looked up to see the patient with a tube hanging off his shaved head. Mr. Taj Saboor, 48 years old, had brain cancer —glioblastoma multiforme. It had been removed twice in the last six months, and each time it had returned with pugnacious insistence. If cancers were little shoots and plants, or even weeds or bushes, then glioblastoma multiform would surely be Jack's colossal beanstalk of lore spurting straight up to the sky. It is fast; it is monstrous. Even when meticulously removed, one never knows where else in the brain the beans have been strewn and where hell may again break loose. It surely is the grand master of all stealthy and lethal cancers. ...continue reading →