Primary Care

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Vincent Soh is a 4th year medical student at University of British Columbia.

I was born into the war— a war which has carried on for over fifty years.

But “war” for me was nothing more than a word thrown around by newscasters. Growing up in a small South Korean town only 50 kilometers south of the demilitarized zone, I have never felt unsafe or experienced the anguish of true desperate hunger. Instead, over the years, I have witnessed one of the most rapid economic booms in the century, a remarkable global expansion of both culture and technology, and the evolution of a world-renowned health care system. I could never believe that my country was at war…

In stark contrast are the experiences of my cousins north of the 38th parallel. To them, the effects of the war are devastatingly real and tangible.

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Jovana Milenkovic is a PGY2 in Pediatrics at the University of Calgary.

Ready is what I was.

A week of what should have been pure relaxation on the beaches of the Caribbean, was ruined by the torment of my special sixth sense. You see what I refer to as my sixth sense, is this twist deep in my stomach that always comes before something, usually bad, is going to happen. It came before I lost my first patient during clerkship. It came before my grandfather fell and broke his hip. It continues to come as a subconscious warning to brace myself.

We arrived at the airport, ready to head back home. While checking in, a passenger became unwell and was pulled to the side by the medical team. I watched as they took out a simple blood pressure cuff, “I haven’t had to use one of those since medical school, it’s all electronic now,” I commented to my mother. The twist in my stomach tightened.

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Stephanie Choquette is a medical student in the class of 2020 at the Northern Ontario School of Medicine

 

 

 

Public health is most often understood as “...the science and art of preventing disease, prolonging life, and promoting health through the organized efforts of society”. Its scope is broad and encompasses both physical and mental health. We are often attuned to the ways these efforts are not meeting the needs of our patients, and to the public-health crises that continue to plague us (pun, intended). Fifty-six long-term drinking water advisories remain on public systems on First Nations Reserves in Canada as of September 3rd, 2019.  Although a significant reduction from previous years, this indicates that many Indigenous Canadians still lack access to clean drinking water. In Thunder Bay, an HIV outbreak affecting predominantly the homeless population was declared in June 2019 within the context of an ongoing tuberculosis outbreak. News coverage regularly includes threats to public-health programs and funding, and concerns from within the field about changes to public-health organization and infrastructure. During my Public Health and Preventive Medicine elective at the Interior Health Authority in Kelowna, B.C., I discovered that no matter how distant that fifth-floor board room might seem from the exam table in my future, public health is changing the lives of individuals for the better every day. ...continue reading →

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Grace Zhao is a third year MD/MSc student in the Systems Leadership and Innovation program at the Institute of Health Policy, Management and Evaluation.

 

Ontario is undergoing its biggest health system reform in 50 years. Under Premier Doug Ford, 20 health agencies will be merged into a superagency – Ontario Health. The rationale behind this is to eliminate duplicative back office infrastructure and administration in order to streamline work to achieve integrated and coordinated care. The functional unit would be the Ontario Health Teams, which are made up of local health care providers who work together to provide coordinated care through technology.

With much attention being placed on health systems innovation and transformation, I asked two health system leaders on their thoughts about leading system innovation and transformation and the current climate of Ontario’s health care system. ...continue reading →

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Richeek Pradhan is a Ph.D. candidate in Pharmacoepidemiology at McGill University.

If you want to find out what Lady Gaga’s met gala costume looked like, or where Queen Elizabeth dined last night, you Google. In a world that spins out terabytes of data every day, awareness of the minutest triviality is the norm. It is intriguing, thus, when data regarding some of the most important aspects of our lives remains hidden from public access. ...continue reading →

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Kate Peiyin Zhang is a medical resident at University of Toronto.

 

“I can’t afford to see a dentist or pay for medication,” says the patient sitting across from me. “Can you help me?”

Ten years ago, I was in this patient’s shoes. I immigrated to Canada with my parents when I was 13; we were a family of three living on $12,000 a year. It was tough being poor. I worked multiple jobs to help make ends meet while attending school full-time. Studying medicine never crossed my mind as a possibility. My family experienced multiple barriers to accessing health care, but we also met compassionate physicians who made all the difference in our lives, and they are the ones who inspired me to pursue a career as a doctor.  ...continue reading →

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Imagine yourself as a family physician seeing a 68-year-old woman with type 2 diabetes, chronic obstructive pulmonary disease, hypertension, and chronic knee pain. While these medical concerns are well-managed, things for your patient are tough socially. She has become increasingly isolated since her husband passed. Her apartment is in an older building with good heating but no air-conditioning and near to no sidewalks, green spaces, or public transit routes in the area. She often requires friends or a cab to drive her around.

How can you assess and mitigate the acute and chronic environment-related health risks faced by this woman, and other patients like her? ...continue reading →

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

 

Research conferences should be an opportunity to gain insights from discussion and collegial debate about new research. At times, though, I have seen debate become adversarial and counterproductive; questions can be aggressive and speakers defensive. But one of the great attributes of the North American Primary Care Research Group annual meeting (NAPCRG) is the culture intellectual rigor yet respectful and collegial discussion, and the support for early career researchers. Researchers with impressive track records in publication in international journals are always keen to share their knowledge and help their colleagues. David Meyers, a long time NAPCRG supporter unable to attend the conference this year due to illness sent a video message in which he said, "May you find meaning in your work and friendship in your colleagues." ...continue reading →

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Nicolas Senn is professor and director of the Institute of family medicine at the University of Lausanne in Switzerland

 

In Lausanne, Switzerland, we are in the process of transforming our medical curriculum with new learning objectives (PROFILES), with the perspective of finally having a stronger focus on family medicine and primary care (PC). Before embarking in these important changes, we thought that it would be good to visit another University renowned for its strong PC teaching and research tradition.

So we, eight people, four from the Swiss Institute of family medicine and four from the medical pedagogy unit of the faculty of medicine, decided to go to Glasgow to learn about how academic PC developed over 40 years there. Academic primary care is only 10 years old in Lausanne! ...continue reading →

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Domhnall MacAuleyDomhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK. He's currently also Chair of the Jury for the National Research Award of the Swiss College of Primary Care Medicine

 

Swiss primary care research has a very bright future, from what I could see at the early career researchers meeting (TAN HAM) that I attended recently in Bern. Oliver Senn put together a superb programme but the key to its success was the commitment and contribution of the researchers. It was their programme and, not only did they present their work with skill and style, and almost exclusively in English, but each research presentation was chaired by one of their peers as the senior academics looked on from the side lines. The presentations were fantastic, covering a range of topics, as described below. But I thought the peer chaired sessions were an innovation worth replicating at other national and international meetings.

Many countries are struggling to recruit and retain a family medicine workforce and Switzerland is little different. ...continue reading →