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 →
Dr. Sarita Verma, Vice President of Education at the Association of Faculties of Medicine of Canada (AFMC), notes that this ideal — providing compassionate care that is sensitive to patients’ values, as well as the integrity and nature of the physician-patient relationship — resonates quite strongly with Canadian medical students as well. ...continue reading →
Yes I did wake up at 3 am today and think, "I'll just check the U.S. election results..." and boy do I regret not going to bed earlier because there was no sleeping after that. Since 3am I’ve read at least a hundred articles analyzing the election’s outcome. I’ve been openly “with her” throughout the campaign. I’m a UK citizen living in Canada so nobody cares, but I'm a woman and the misogyny that the campaign has brought into sharp focus has upset me greatly, so I care. It means I’ve been zipping back and forth through the stages of loss for the past few hours. ...continue reading →
In this week of the Paris climate change summit, it is worth considering the health care system’s contribution to climate change and how it can be reduced.
Health care, not surprisingly, is a bit of an energy pig. After all, health care comprises a large part of our economy – about 11% of GDP – and with around 2 million workers, it's the third largest employment sector in Canada after retail and manufacturing. Moreover, our hospitals run 24/7, use a lot of energy-intensive equipment and maintain an even temperature no matter the temperature. That's why hospitals are among the most energy-intensive facilities in our communities. ...continue reading →
The federal election seems to be focusing largely on issues such as the economy and security. If health is mentioned at all, it is in the context of health care.
But health care is a determinant of our health; it is not the main one. While our genetic inheritance also plays an important part, much of our health comes from the environmental, social, economic, cultural and political conditions we create as communities and as a society.
In our system, the federal government does not provide health care or manage a health-care system, aside from special situations such as for aboriginal people and the armed forces. But many other areas of policy for which the federal government does have full or at least partial jurisdiction do influence the health of Canadians. ...continue reading →
Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK
French general practitioners went on strike today. It’s part of an extended period of industrial action that includes refusing to process paperwork and a number of planned medical centre closures. Not every GP could participate today, however, due to a flu epidemic sweeping across France. Doctors had already closed their offices during December but there was little response from Marisol Touraine, the Minister for Health, and this was part of their planned efforts to maintain pressure.
The aim is to highlight the need to improve the effectiveness and accessibility of heath care worldwide. Why? As this (slightly UK-focused) video from the London School of Hygiene and Tropical Medicine elegantly illustrates ...continue reading →
If you look at an old map of Canadian healthcare policy, just near Privatization Island is a big warning: “Here be dragons.” So it proved for Alberta Health Services recently when a seemingly innocuous decision -- to swap the tender for laboratory services from a United States-based transnational corporation to an Australian one -- provoked a furore fueled by discontent.
Part of the problem is that ‘privatization’ has two meanings. One refers to an increase in the private funding of healthcare. In the Canadian context that is unequivocally bad. It breaks the compact between Canadians that they are all in the same boat in terms of access to healthcare and strikes at one of the key differences between the U.S. and Canada. On one side of the border, people can sleep easy knowing they are protected against the costs of healthcare if something goes wrong for them or their family. On the southern side, the spectre of bankruptcy or no care looms, even in the post-Obamacare world.
But Alberta’s controversy over lab contracts is about a different sort of privatization. It is about who delivers care within the publically funded system. ...continue reading →
Victor Montori is a physician specializing in diabetes care at the Mayo Clinic in Rochester, Minnesota. He conducts research in the Knowledge and Evaluation Research Unit at Mayo Clinic, and is a member of both the National Advisory Council for Healthcare Research and Quality to the U.S. Department of Health and Human Services and the steering committee of the International Patient Decision Aids Standards Collaboration. Dr Montori is a keynote speaker at the forthcoming NAPCRG Annual Meeting 2014
On Saturday November 22 2014, I will have the privilege to speak with the North American Primary Care Research Group plenary gathered in New York City, on Minimally Disruptive Medicine.
What will I try to accomplish? Beyond the stated objectives, I am hoping to promote among participants a new lens of looking at how we might organize and deliver care for patients with multiple chronic conditions. At the heart of my presentation will be the need to be careful and kind when caring for and about our patients, particularly those likely to be overwhelmed by multiple chronic conditions.
Careful care reminds us of our commitment to patients in terms of technically correct and safe care. For patients with multimorbidity, this means that we must understand how multimorbidity affects the efficacy and safety of routine interventions. Major uncertainty exists in this exercise, uncertainty that should lead us to only conditional recommendations, the kind that require us to engage patients in collaborative deliberation. This uncertainty gives clinicians permission to to care for each patient, rather than to attain targets.