Neil Chanchlani is a CMAJ Associate Editor and clinical research fellow at the University of Exeter, UK. He recently attended the 8thEBMLive conference in Oxford, England.
All healthcare practitioners are encouraged to make decisions that are based on strong evidence. But often we don’t – sometimes because the evidence is poor and conflicting, other times because we are ignorant and unaware and, rarely, because we aren’t comfortable with updating our practice. So we need to keep Evidence-Based Medicine (EBM) on the frontline and not on the (academic) shelves - we need to remind clinicians, researchers, and patients that decisions should be based on the best possible data. ...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 →
Nigel Rawson is President at Eastlake Research Group
The 2019 federal budget announced that the federal government will take initial steps towards implementing national pharmacare to improve the affordability and accessibility of prescription drugs across Canada. The government's plan includes the development of "three foundational" elements - a national Canadian Drug Agency (CDA), a comprehensive national drug formulary, and a national strategy for high-cost rare-disorder medicines. ...continue reading →
Mark Speechley is a Professor of Epidemiology at Western University
The age-old debate over who should be addressed as ‘doctor’ lives again in recent letters to CMAJ. Of course, it is important not to confuse the public. Since more people get sick than get university educated, members of the public are more likely to have met a physician-doctor than a professor-doctor. As a PhD epidemiologist, ‘the population is my patient’. Consequently, when I meet my medical colleagues in the hospital, I do not expect to be addressed as ‘Doctor’, but should the whole population be in the hospital, and the crowding in the corridors be so acute that I would have the statistical power to practice my profession by expertly assembling the massed throngs of gurneys into long rows of cases and controls, or exposed and unexposed, as appropriate, I would most certainly expect to be addressed as such. ...continue reading →
Iris Gorfinkel is a General Practitioner, and Founder and Principal Investigator at PrimeHealth Clinical Research in Toronto, Ontario.
On July 10, 2018 Health Canada issued a recall of several products containing the blood pressure lowering drug, valsartan. This came in response to a disclosure from its Chinese manufacturer that the drug had been contaminated with a known carcinogen. A massive effort to contact patients to stop the affected drug lots, and to replace it with an alternative, ensued. Few clinicians had been even remotely aware that ...continue reading →
Emily Harris is the Business Manager for the Heart and Vascular Program at Unity Health Toronto – St. Michael's Hospital
Healthcare is a varied and multidisciplinary world. From clinical medicine to social work to data collection, expertise from many diverse specialties is required to ensure that hospitals run successfully and that patients receive the very best care.
In just one year, my son, Jacob, was put on Bi-Pap in the PICU on four separate occasions. Only a respiratory therapist was allowed to put the device on him or make adjustments when he was in the hospital. On the first occasion, he was not allowed on any other hospital unit while dependent on Bi-Pap. On subsequent occasions, he could transfer to the General Pediatrics unit as long as his Bi-Pap needs remained stable but, should his Bi-Pap needs increase, he would be transferred back to the PICU. ...continue reading →
Courtney Bercan is community health nurse at a clinic in the Downtown Eastside of Vancouver
Years later, I still don’t want to think about it, let alone type it out. Three children, babies practically, dead before me. Their parents, dead beside them.
It has now been two years since I was on a Doctors Without Borders search and rescue vessel in the Mediterranean and it’s been a slow path, at times, to finding healing and peace for the things I saw and experienced there. As my life settled into a predictable rhythm, the memories started coming out of the blue and with intensity. They demanded attention. Normally, in Canada, the process of finding closure for a patient’s death, while not always easy, is not usually this difficult. There are mitigating thoughts and phrases to help you along the way:
Shaun Mehta is an Emergency Medicine Resident (R4) at the University of Toronto
In elementary school, I always dreaded bringing my report card home. My grades were good, but the teachers’ comments that followed could go either way — and were unfortunately of much more interest to my parents. I was often described as “disruptive,” and it seemed that relinquishing this quality was the key to making something of myself.
Two decades later, I’m finding out that being disruptive is one of my most valuable assets.
To clarify, we probably shouldn’t praise students for being disruptive in the classroom. But outside of the classroom... now, that’s an entirely different story. The health care industry is ripe for disruption; strapped for cash and bursting at the seams, we need better ways to manage today’s volume and complexity of patients. Forward-looking individuals and organizations have heeded the call and are making huge strides in health care innovation, yet patients continue to suffer as a result of systems-level issues.
By shifting our paradigm of innovation, creating an environment to foster disruption, and educating future leaders to drive change, we stand a chance at driving maleficent creatures (like hallway medicine and eternal wait times) to extinction. ...continue reading →
Sarina Lalla is a medical student in the Class of 2020 at McMaster University
When McMaster medical students learn about medical conditions in a problem-based setting, we frequently use the mnemonic “DEEPICT” (Definition, Epidemiology, Etiology, Prognosis, Investigations, Clinical presentations, Treatment) to approach them. Medical schools focus on teaching students about these important aspects of diseases; with time and practice, this information can be retained and applied by students to make them better clinicians.
However, there is also value in understanding a disease through the eyes of patients. More specifically, it is critical to recognize how facing an illness and navigating the healthcare system impacts their lives. Patients are the experts on their own experiences, and the knowledge they can present in the form of stories can teach us a lot. While we learn how to interpret information in the form of bloodwork and imaging, patients present first and foremost with a story. ...continue reading →