Primary Care

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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 →

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

 

In my capacity as Chair of the Jury for the National Research Award of the Swiss College of Primary Care Medicine, I was recently invited to give a Plenary lecture at the Early Career Researchers Academic meeting for academic primary care physicians in Bern, Switzerland. I enjoyed listening to other great speakers at the event. One was Kali Tal, a professional writer, who, in addition to her many other talents and accomplishments, works as a senior Editor, grant writer and qualitative researcher at the Institute for Primary Care Medicine at the University of Bern. Kali gave a workshop on research writing at the recent early career researchers’ group meeting.

Many researchers struggle with writing research papers, grants and reports. ...continue reading →

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Barbara Zelek is Associate Professor and Co-Chair for the Section of Family Medicine at the Northern Ontario School of Medicine

 

Marathon, a rural community on the North shore of Lake Superior, made CMAJ headlines in 1997 because it boasted a stable workforce of seven physicians for the first time in over a decade. 2017 marks the 20th anniversary of that CMAJ article and of the arrival of Dr. Sarah Newbery and Dr. Eliseo Orrantia in Marathon.

The article described “a medical renaissance” taking place in Marathon and an end to “the revolving door that has affected rural medicine across the country”. That door has stopped revolving in Marathon since 1997 thanks, in many ways, to the leadership of Eli and Sarah.

Let me put this important milestone in context. ...continue reading →

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

 

Have we lost something in the success of academic family medicine? We produce quality research, have created successful interdisciplinary academic teams, demonstrate competitive publication outcomes and generate significant grant income. But, academic primary care may have drifted away from, and perhaps even alienated, some family medicine colleagues. There are thoughtful and reflective family doctors who read, write, discuss and debate many aspects of general practice but feel undervalued as they do not fit the university based academic profile. ...continue reading →

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

 

Was I wrong!

Pioneering Professional Practice doesn’t sound like the most stimulating title of a Plenary Address but Helen Stokes-Lampard, Chair of the UK's Royal College of General Practitioners (RCGP) Council, gave an uplifting, encouraging and inspiring address on the topic on day 2 of the SAPC ASM 2017. Helen encouraged us all to rediscover the joy and sparkle of general practice despite poor morale, a constant feeling of being under siege, and increasing resource limitations in the profession. I liked her analogy that primary care, secondary care and social care were interdependent and need to be together- a three legged stool that depended on all three components to remain stable. ...continue reading →

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

 

Shakespeare’s Warwickshire was the background to last week's 46th Annual Scientific Meeting of the Society of Academic Primary Care (SAPC) where Professor Christine Ennew, Provost of the University of Warwick, introduced the meeting by emphasising the importance of primary care in the development of their young medical school. She also underlined her belief in the transformational power of universities and how their contribution to academic medicine can alter clinical practice.

It saddened me that her optimism and enthusiasm contrasted with the stark reality of general practice as outlined by Candace Imison, Director of Policy at the Nuffield Trust ...continue reading →