Tag Archives: physicians

DMacA_3Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK


Throwing surgical instruments across a theatre, idiosyncratic single handed practice, refusing to see patients in clinic without notes. I didn’t think physicians could get away with this sort of practice anymore. While these were hypothetical examples explored in a recent seminar discussing doctors’ disruptive and unprofessional behaviour, the audience clearly recognised that it still happens. Dr Kevin Stewart, Clinical Director of the Clinical Effectiveness and Evaluation Unit at the Royal College of Physicians in London and a geriatrician in Winchester, England, facilitated discussions on how to manage doctors who display difficult behaviour. His approach was to focus more on patients than doctors and to recognise how such behaviour affects patient safety. ...continue reading


N_JoshiNikhil Joshi is a Fellow in Clinical Immunology at the University of Manitoba. He wrote a blog for CBC about his experience with cancer

I was reading about Allergic Bronchopulmonary aspergillosis (ABPA) when it hit me.

Modern Medicine is taking a beating.

A day goes by in clinic. I’ve told three people today that the medications they are taking are keeping them from having uncontrolled asthma or an attack of angioedema and please not to stop them. I’m explaining that the disease is worse than the medications, which we give to children as young as 2. I sigh. I hate this. I scan the news headlines after my dictations are finished. I read about the NDP and Liberal party stances on physician corporations, which will probably lead to financial hardship on new physicians starting practice with entirely crippling levels of debt amid a background of rising overhead and reduced fee schedules. I’m further disheartened.

When did the world care so little about medicine? When did being a physician become so difficult and unrewarding? ...continue reading

Diane_photoDiane Kelsall is Deputy Editor, clinical, at CMAJ, and Editor of CMAJ Open


As clinicians, we are taught about patient-centred care, where the needs and desires of the patient are foremost. For those of us who work as medical teachers, we are told to focus on the goals of our students in a learner-centred curriculum. We work in multi-disciplinary teams in hospitals and clinics, where it seems, at the very least, paternalistic for the leader to be a physician.

Some of our traditional roles have been taken over by other health professionals—and we are often told that they provide the same or better service at a lower cost. Administrators and other health professionals run the hospitals and clinics we work in. Few doctors are in leadership at the government level, even for decision-making related to health care.

We are frequently blamed for rising health costs, and some of us are not welcome at the bargaining table where our own remuneration is discussed. People may view us as greedy or, increasingly, as lazy and not willing to sacrifice for the greater good.

Somehow over the years, things changed from the physician as “god” to the physician as No Good.

Why did this change happen? Could it have been a reaction to our casual assumption of money, control and entitlement? Or maybe our failure to play well with others? Did we destroy the mystique around our profession when we abandoned our white coats in favour of casual clothes? Perhaps it was when women entered the profession in large numbers? Or was it simply that health costs began to spiral out of control and a scapegoat was needed?

Few of us would wish to go back to the times when a patient may have been kept ignorant of a cancer diagnosis for “his good”, a nurse had to step back to allow a doctor to go ahead through a door, or throwing surgical instruments across the operating room was condoned.

But surely there must be room for us—a physician-centred place—in the health care system.

There is such a place. That place is Medicine. And we are the experts, the only experts, in this millennia-old discipline. From its early days in ancient Egypt to the heady promise of gene and molecular therapy, the medical profession has advanced—and society has benefited.

Because of the life’s work of physicians over the centuries, we have a greater understanding of the human body and mind; what can go wrong and how to fix it. We now know that that cancer or diabetes or an infection does not have to be a death sentence. Indeed, the blind may see and the lame walk; some may even be raised from the dead.

To be able to do this work, we study for years (in some specialties for more than a decade)—and then we keep on studying to maintain our skills in the discipline where we are the experts, the only experts. There is no one else.

Because when patients are sick - really sick - they need a doctor. Yes, the doctor needs to be part of a health care team that works together. And yes, the doctor needs to respect the contributions of others and recognize the importance of involving the patient in his or her own health care. But a health care team without a doctor is missing expertise, expertise that can literally mean the difference between life and death, between illness and health.

But even when patients are not at death’s door, we bring our expertise to bear in addressing their current health concerns—major and minor—and work with them, in conjunction with our colleagues, towards a healthier future. We can listen, we can examine, we can diagnose, we can treat—and perhaps even heal.

Sure, we have made mistakes (big ones, on occasion) but, for the most part, we have tried to make the lives of our many, many patients better. People live better for longer, and are healthier.

And as such, we have earned the right to be key players in our health care system. At all levels.

We need to be included at decision-making tables—to participate as essential contributors. From the individual clinic to the hospital to government. Locally, provincially and nationally.

If health is the issue, we have the right to be there. To speak, to share our expertise—and to have our contribution respected. We need to be heard, along with the voices of our patients, our fellow health professionals and others.

To improve the health care of all Canadians, we, as doctors, need to be in our rightful place.


By Ilona Hale, MD, David Hale, MSc, Env. Mgmt, Courtney Howard, MD, Warren Bell, MD

As physicians we are trained to respond to emergencies – the more serious the diagnosis, the more quickly we respond. The dangers of global warming were recognized by scientists over twenty years ago and there is no longer any serious scientific debate about the existence or cause of anthropogenic climate change. The recently released report from the United Nations Intergovernmental Panel on Climate Change (IPCC) confirmed the many present and future health effects of global warming and climate instability. Increasing drought, food insecurity, extreme weather events, vector-borne disease and wildfires may soon represent some of the most serious threats to human health. Physicians, as guardians of human health, should be actively engaged in addressing this issue. Yet we, as a society and as a profession, are still failing to act in a meaningful and substantive way. Fortunately there are many tools to help us act, one of the most recent being the idea of fossil fuel divestment, similar to the divestment campaign of the 1980s which helped to topple South African apartheid.

The idea of fossil fuel divestment is based on what is referred to as “Terrifying New Math”: Climate experts and governments from around the world have accepted the scientific consensus that an increase in global temperature must be held below 2 degrees Celsius. To remain below this 2-degree target, scientists estimate that we can produce no more than 565 Gt of carbon dioxide. The “terrifying” part is that current known fuel reserves, if burned, represent 2,795 Gt of carbon dioxide. Doing the math, it is evident that this second number is a lot bigger than the first, which means that, if our planet is to survive, most of our current fuel reserves need to stay in the ground - a radical concept challenging our traditional resource-extraction-based approach to economic growth. Clearly, something needs to change.

Despite pledges from governments around the world to cut greenhouse gas emissions, most nations have consistently failed to meet their targets, Canada being among the worst of the offenders.

Expecting that fossil fuel companies themselves will voluntarily move in this direction, leaving their reserves untouched, is unjustified and naive. Corporations simply do what shareholders demand. And therein lies the key to the new divestment campaigns aimed at fossil fuel companies. Proponents are encouraging concerned investors to make their voices heard by withdrawing investments from coal, oil and gas companies, starting with a list of the 200 companies with the largest reserves, and re-directing their investments to other industries that support a healthy climate future. This pressure will provide the stimulus for fossil fuel companies to gradually transition to producing more sustainable forms of energy; it allows them to become part of the solution, building the healthy future that we all want.

Divestment campaigns have been launched at hundreds of colleges and universities, pension funds and religious institutions in a movement that is rapidly gaining momentum. Significantly, members of the British Medical Association have also recently voted to “ transfer their investments from energy companies whose primary business relies upon fossil fuels to those providing renewable energy sources”, the first health organization to do so.

Some investors might fear that divestment could negatively affect their portfolios. On the contrary, many leading economists are predicting an imminent “carbon bubble” based on artificially inflated values of fossil fuel company stocks. This arises from the inclusion of all the reserves which companies hold, without considering that these reserves can never be burned. This “carbon bubble” will leave companies with trillions in “stranded assets” according to the Carbon Tracker Institute, which has links to the London School of Economics. The concept of the carbon bubble has since been supported by the International Energy Agency and the IPCC. Even now, studies looking at divested portfolios found them to provide similar or better returns than their conventional counterparts.

There might also be concerns that abandoning fossil fuel resources in Canada could lead to economic collapse. In fact, the oil and gas industry accounts for only 5% of the Canadian economy. The latest IPCC report concluded that shifting hundreds of billions of dollars into renewable energy from fossil fuels and cutting energy waste would take only 0.06% off of our usual 1.3-3% annual global economic growth. “Waiting to take action will inevitably increase costs, escalate risk, and foreclose options to address the risk.” It has also been estimated that non-fossil fuel industries create 6-8 times as many jobs per dollar invested as fossil fuel companies.

Divestment for physicians is particularly important since we cannot, in good conscience, be strong advocates for addressing climate change while continuing to profit from fossil fuel companies. Physicians, through MD Management, have already made a commitment to divest from other unhealthy industries such as tobacco. Every Canadian physician can start by raising the issue with their investment adviser and encouraging their own university, hospital and medical society to divest from fossil fuels and reinvest in renewable energy sources.

As physicians dedicated to promoting health, we can no longer sit at the bedside while our patient deteriorates. We have more than enough information to start treatment now. Divestment, one of many tools available, is an important first step.

Ilona Hale is a family physician in Kimberly, BC; David Hale is a professional forester with a masters in environmental management; Courtney Howard is an emergency physician in Yellowknife, NT and a board member of the Canadian Association of Physicians for the Environment; Warren Bell is a family physician in Salmon Arm, BC and a board member of the Canadian Association of Physicians for the Environment.