Pieces of a puzzle inherit meaning not by their individual qualities, but by being pieced together into context. Good medicine — and good healthcare — are similar: they rely on understanding patients as people, and clinical presentations as brush-strokes forming part of a bigger picture....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 →
Arjun Sharma is a medical student in the Class of 2019 at the University of Toronto
Picture a physician on a hospital ward at the day’s peak.
He jumps from one task to the next: patients being careened off for tests, colleagues who wish to discuss care plans, progress notes that need documenting, and piles of orders that need filling. Add to that the tune of beeping pagers, ringing telephones, and clattering keyboards, and not a single minute is spared of its full economy.
I’m watching all this during my first stint on a hospital ward. As a newly minted clinical clerk caught in the professional purgatory between classroom-cocooned medical student and ward-flying physician, I’m asked to do much of the work of the latter. But having only two years of study under my belt means much of medicine still remains beyond my intellectual reach. ...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 →
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 →
Cathy Li is a medical student in the Class of 2020 at the University of Toronto
"Doctor, what do you recommend for my grandmother's pancreatic tumour?" My heart was fluttering nervously as I scribbled down his suggestions. This was the third meeting I had arranged.
Growing up, I had a very close relationship with my grandmother and lived with my grandparents until I was six years old. I received the news of her diagnosis during my third year of university. The words “intraductal papillary mucinous neoplasm” haunted me and echoed incessantly in my head for days; I could neither think nor focus. The feelings of powerlessness grappled to hold me down. Yet deep down, I was aware that simply being a passive bystander would be the greatest personal defeat. With that, a new wave of resilience inundated my thoughts. ...continue reading →
Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK
We expect Nobel Prize winners to be high profile researchers of almost celebrity status, pioneering cutting edge science that changes the world at a stroke. And, then I heard that one of this year’s winners was William C Campbell, a fellow Irish man. I didn’t recognise the name, was unfamiliar with his work, and knew nothing of his background. But, as the media story broke, I learned more about him. He came from Ramelton, a small village in County Donegal, far from the bright lights and, like many Irish doctors, undertook his graduate work in the US. His research was in worms - not the type of glamorous cutting edge clinical science that features in glossy magazines but, from the messy world of vials and dishes and parasitic roundworms kept in the freezer.
CMAJ deputy editors Dr. Matthew Stanbrook and Dr. Kirsten Patrick discuss an editorial written by Dr. Stanbrook. Too often, at election time, Canadians ignore pressing health care concerns and let economic fears dominate how we vote. This needs to change. A plan for strong federal leadership in health should be front and centre in this year’s election.
Also, a research article by McAlister et. al., published in CMAJ, looks at level of physician experience and its effect on important patient outcomes that proxy for quality of care. Physician groups were stratified according to years since graduation. Dr. Matthew Stanbrook, deputy editor, provides an editor's summary of the article and its findings.
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Graeme Rocker is a professor at Dalhousie University in Halifax
Editor’s note: Part I of this series appeared as a Humanities article in CMAJ.
I woke from the anesthetic with the worst dry mouth ever and the agonizing sensation of a massive overfilled bladder being ripped apart from the inside. I let loose some very repetitive Anglo-Saxon expletives not generally expected of a health care professional. When asked to rate the degree of agony on the usual scale of 0 to 10, I spluttered 15! Finally, a hydromorphone bolus kicked in, and I then settled into a few hours of patient-controlled analgesia. At some point that first night I felt the most sublime sense of calm, as if my place in the universe was just as it should be and that all would be well for all time. I can only presume it was an opioid haze. It still felt as if a mule had kicked me in the pelvis, but for a while it just it didn’t matter. That remarkable feeling never came again, but I was awed by the powers that these drugs have when used in the right amount, time and place. ...continue reading →
My street outreach teammates and I saw a slight, older woman who had literally been living in a box for months.* The box was about 6 feet long, 4 feet wide and 3 feet high and was covered by a blue plastic tarp. Her furnishings consisted of a few blankets. The “dwelling” was in an alleyway just behind some shops. The lady was disinterested in any form of housing or treatment and never accessed shelters: she always slept in her box. She repeatedly said that she would soon be moving to a Caribbean island. During a particularly bitter cold spell, we became concerned with her safety, and I completed a form for involuntary psychiatric assessment. The emergency department psychiatrist agreed with me that she likely had chronic schizophrenia, but the client was calm and would not take any medication. She promised the emergency department staff that she would go to a shelter if she was discharged. We made it clear that she was unlikely to do so, but after one night in emergency she was given a subway token to go to a shelter. She disappeared and was lost to follow-up. ...continue reading →