Michelle Greiver is a family physician with the North York Family Health Team in Toronto
As a family doctor, I sometimes wonder if I provide too much care for some patients in my practice. Do my elderly patients with diabetes need very low A1Cs? What about the risk of falls and fractured hips due to hypoglycemia associated with enthusiastic use of diabetic medications? Should patients over the age of 90 really be on a statin? Should they be on anything that does not improve their quality of life? Perhaps I should be asking them what they would like? ...continue reading →
Nobody could have predicted the desperate state in Syria when the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) Europe Conference for 2015 was awarded to the Turkish Family Medicine Organisation (TAHUD) a few years ago. Few could also have predicted that Turkey would be at the very centre of a mass exodus of people not seen in Europe since the Second World War. According to the UNHCR as of September 2015 the country now finds itself providing refuge to an estimated 2 million Syrians fleeing conflict and destitution. I have heard the current situation being described as a ‘stress test’ of the European values of solidarity and collegiality, ...continue reading →
Recently, members of the health care community and the public at large mourned the loss of neurologist Dr. Oliver Sacks. My grandfather, also a neurologist, sent me one of Dr. Sacks’s books when I first expressed an interest in applying to medical school. I have since enjoyed many of his other written works.
Earlier this summer, the health care community also lost another tremendous leader, Dr. David Sackett, the father of evidence-based medicine. On my first day of medical school, I remember receiving one of his books too, and to this day it remains a fixture on my bookshelf as a resource.
It may seem odd to bring these two doctors together, because they held such divergent views of the clinical world. ...continue reading →
Robyn Thom is a PGY 1 psychiatry resident at Harvard Longwood
It was a winter afternoon when I came to the shocking realization that although I was only months away from becoming a doctor, there was a significant subset of the Canadian population that I lacked the medical knowledge to care for. I was working at the Gender Identity Clinic at the Centre for Addiction and Mental Health (CAMH), where patients undergo psychiatric assessment to qualify for provincially-funded gender reassignment surgery. There, not only did I find myself listening to my patients rattle off multiple behavioural, hormonal, and surgical options for gender transition that I had never heard of before, but I also gained an appreciation for the degree to which skilled healthcare for transpeople in Ontario is lacking. ...continue reading →
Multimorbidity is usually defined as present when people have two or more chronic conditions. It’s an idea that appeals to medical generalists because it makes clear that specialist care that only focuses on one of those conditions may sometimes be too narrow, particularly when someone has very many conditions or when the conditions they have are very different. Physical and mental health conditions are the exemplar of the latter, with many countries having separate services ...continue reading →
The practice of evidence based diagnosis is what we are taught we should all do, but, in practice, this is quite difficult. EBM diagnosis relies on likelihood ratios, but it’s impossible to remember the diagnostic accuracies of the thousands of tests that exist.
This is why I made a simple tool to help with the scientific diagnosis of diseases spanning most specialties. It is a database of over 700 likelihood ratios of tests (history, radiology, physical exam etc.). The likelihood ratios are completely free for all to access ...continue reading →
Dubrovnik, Croatia, was the setting for this year's WONCA rural practice conference. This is an amazing small city, the so-called 'Pearl of the Adriatic' and a tourist attraction since the late 1800s.
We are two nurses and a physician from rural PEI who took on the job of resurrecting an old medical practice, starting on a very part-time basis in the fall of 2013 and going full-time a year later. The “why” of it is far too long a story for this blog but I have blogged about it before.
We were trying to find some good multi-disciplinary CME in Canada for us three to attend last year. We failed, of course. And then one of us suggested the 13th WONCA world rural health conference as a place where we would likely meet like-minded professionals who were concerned about the systems aspect of rural health care as well as the individual encounters. ...continue reading →
Yesterday, after a long public consultation by the Human Fertility and Embryology Authority and a heated debate and vote in the English House of Commons, it began to seem likely that the UK will be the first country to allow the practice of mitochondrial transfer (albeit with safeguards). If the House of Lords approves it, this will result in an amendment to the UK’s 2008 law regulating IVF, embryological manipulation and pre-implantation genetic therapies. We’re effectively seeing glimmerings of a green light for the creation of ‘three-parent babies’ in the UK.
I've been following this process closely. Once I understood the reason WHY mitochondrial transfer is important in the prevention of certain serious diseases of mitochondrial DNA, I felt convinced that legalising it was the right thing to do. ...continue reading →
Michael Hamilton is a Consultant Physician and Medication Safety Specialist for ISMP Canada
The deaths of 15 children who received measles vaccination in Syria were initially suspected to have been caused by tainted vaccine or sabotage, but now appear to have been the result of a tragic error. In a statement on the interim findings of an investigation released on September 28, 2014, the World Health Organization (WHO) reported that medical personnel most likely mixed the vaccine with the neuromuscular blocking agent atracurium, instead of the intended diluent. The atracurium had apparently been incorrectly added to vaccination packs in a district distribution centre. Like other neuromuscular blocking agents, atracurium paralyzes the muscles that are necessary for breathing and can only be used safely when mechanical ventilation is available to support breathing.
The fact that the potential for this type of tragedy had already been well-recognized makes the deaths of these innocent children all the more heartbreaking. Hundreds of errors with neuromuscular blocking agents have been reported around the world ...continue reading →
Abdullah Nasser is a medical student at the Schulich School of Medicine and Dentistry, Western University, in London, Ontario
The lecture hall slowly came to life. Notebooks in hand, the students filed in to take the front rows. They spoke in hushed tones, ready to put those notebooks to use at any minute. I have not seen a crowd of students so eager to start. But this was not your average university lecture. In fact, it was not a lecture at all. It was a premedical symposium intended to introduce them to medical schools and the application process.
As the symposium got underway, the various steps of the application process were explained in true medical fashion — with an alphabet soup. You write your MCAT, and then start your OMSAS. If you don’t mind being an IMG, you might also consider filling out your AMCAS or UCAS, just in case. Be prepared to do your MMIs if you they call you in for an interview.
The students seemed unfazed. They know medicine is their true calling. “I’ve wanted to be a doctor ever since I was five,” one of them told me with a mixture of pride and determination.