Tag Archives: patient care

Domhnall_MacDomhnall 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.

“You must be kidding!” was his reaction, when telephoned with the news.

But, his findings did change the world. ...continue reading

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

doanRichard Doan is a Psychiatrist with Inner City Health Associates and Assistant Professor of Psychiatry at the University of Toronto in Toronto, Ontario

 

In Toronto’s first week of true winter weather, two homeless men died on the street, one in a bus shelter in the city’s most public square. He was wearing only jeans, a t-shirt and a hospital identification bracelet.

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

Israel in RockiesIsrael Amirav is a Program Director and Associate Professor at the Faculty of Medicine, University of Alberta, Edmonton, Alberta

 

 

As a program director at the Faculty of Medicine, University of Alberta, I attended a recent seminar concerning residents coming from other countries to train in our program. People here are trying to design a training program to address the “culture shock” that these residents may face on arrival.

Even if not explicitly stated, the premise of the seminar was that these residents come from an “inferior” culture and thus should learn about and adjust to our “superior” culture. Although this may be true for some aspects of our host culture, particularly those related to scientifically based and clinical medicine, I find this approach too all-encompassing and dogmatic.

Recently, I faced my own “culture shock” associated with a major personal health issue. ...continue reading

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Peggy Cumming, is a wife, mother, grandmother of 6, sister, niece, cousin and friend, as well as a teacher - retired after 34 years in the classroom - and an athlete.
 

In 1985, when I was diagnosed with breast cancer, the disease was private and hushed. Other than a campaign for SBE (Self Breast Exam) there was no publicity or awareness. Feeling ashamed and embarrassed, and thinking that I had somehow caused this, I kept my diagnosis secret and silent from all but a very few close friends. After my treatment, my fears and feelings were repressed and locked, and I got on with my life, my family, my career and my health.

Twelve years later, I was one of the founding members of the Busting Out dragon boat program, and suddenly I was surrounded by other survivors and the steadily growing ‘Pink Ribbon Culture’! I found kindred sisters in these women, and my deeply secreted feelings found an outlet and an expression. My silence was broken, and relief came flooding in.

This year, when I finally accepted the ‘highly suspicious for Lung Cancer' report, I realized that I would not, and could not, be secret and silent about my disease. Learning from experience, I was concerned for my mental health as much as for my physical health ...continue reading

Guest blogger, Peggy Cumming, is a wife, mother, grandmother of 6, sister, niece, cousin and friend, as well as a teacher - retired after 34 years in the classroom - and an athlete.
 

So, the CT report found nodules that are ‘highly suspicious for lung cancer”. Now what am I supposed to do with that news? How am I supposed to react? How am I supposed to feel? There is no rehearsal for this, I thought. No class to take, no website to consult. I realized that I was alone in figuring out how to deal with this.

I needed several days to digest this information, to accept it, to find the courage to make it real by saying it out loud. Eventually, I was able to speak the dreaded words, to tell my two adult children. Because we are a very pragmatic family, and not given to drama, they were very calm, and declared their support. I also think, because they had been through Breast Cancer with me 29 years ago as children, there was a certain familiarity for them, and they had faith in a positive outcome.

I realized that I had to learn from them, and that the best way to handle this was to carry on with my normal life and my daily routine. In my daily life, I am a Swimmer. ...continue reading

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Guest blogger, Peggy Cumming, is a wife, mother, grandmother of 6, sister, niece, cousin and friend, as well as a teacher - retired after 34 years in the classroom - and an athlete.
 

I enjoy a healthy, active life style and activities with my family and friends. In my fourteen years of retirement, I have climbed Kilimanjaro, hiked the Inca Trail and the West Coast Trail, cycled in many countries, and won medals at Provincial and National Masters’ swimming championships.

I have survived Breast Cancer, (age 41), a broken leg (age 49) and Melanoma (age 52).

On June 8, 2014, I celebrated my 70th birthday with a swim across Meech Lake in Gatineau Park, Quebec, with my daughter and friends. Five days later, June 13, I woke up with a sore throat and laryngitis. My third cancer story begins there. ...continue reading

Gordon Giddings. Editorial Fellow, CMAJ.by Gordon Giddings, Editorial Fellow (2013-14), CMAJ

One of the benefits of attending conferences is in getting to share knowledge and in meeting colleagues—seeing how things are done in other places and settings. It is, however, less frequent that we have the benefit of direct patient experience at these conferences. It should not be underestimated how powerful that is.

I had the distinct pleasure of meeting Canadian classical guitar legend and multiple Juno Award winner Liona Boyd at the General Practitioner in Psychotherapy Association Annual Conference in Toronto on May 24. Liona was one of the keynote speakers and opened the morning session with a talk on focal dystonia. This was a very personal story for her as someone who had reached the heights of an internationally celebrated career, having played for England’s royal family and American presidents, and living a jet-set lifestyle in Beverly Hills. She began to notice several years back that she was having increasing difficulty in playing some of the more difficult passages on her guitar, specifically a technique called ‘tremolo’, a way to produce a sound likened to 2 or 3 guitars playing at the same time. Her fingers were not painful, but stiff, and wouldn’t seem to want to do the tasks that she had so effortlessly done over the years before.

She was subsequently diagnosed with focal dystonia, a diagnosis that she resisted for several years, as she was told that it was incurable. The implications of this for her were immense, as the guitar had defined her career, livelihood, aspects of her marriage, and in a very broad sense, her life as a whole. After struggling through several performances, she stepped down from the professional guitar stage at the level she had been performing. She moved to Miami, and after a period that she refers to as ‘la vida loca’, began looking at potential treatment options, for other ways to further her career, and ultimately to re-engage with her life.

To a large extent she has done that, by launching a singing career with multiple vocal recordings to her credit, moving back to Canada (yay!) and picking up the guitar again and giving concerts, albeit with a different technique and the assistance of a guitar partner who often accompanies her during live performances.

Liona stated during her 90-minute talk that this was the first talk (and PowerPoint presentation) that she had ever done. It was indeed a very admirable and inspirational presentation. However, her presence did bring something else—a reminder of the reasons why we travel to conferences and spend endless hours on continuing education, read numerous journal articles and immerse ourselves in rigorous research and scholarship.

The experience reminds me to immerse more fully with patients in their experience. Physicians often control what transpires during a patient visit. This may have the effect of rendering them more passive in their health care experience. It is important to remember to see patients as more than just their disease, but placing their experience in the context of their lives. Specifically looking at:

How is this illness affecting your life?

What do you think is causing it?

Why do you think that is happening?

What are you concerned that it might be?

What were you hoping we might be able to do for this?

Liona spoke of the difference for her in being seen by medical professionals who truly wanted to understand her illness experience and see how they could improve her condition. What proved most successful for her was a transdisciplinary approach that acknowledged the limitations and losses that she had experienced, but that also gave her a sense of hope and purpose. Though she still suffers from focal dystonia, she is optimistic about her diagnosis and her future. As well, myself and 100 other physicians who heard her speak that morning were enriched for it. Thank you Liona!