Reflections

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Dan Small is a medical anthropologist and lecturer at the University of British Columbia.

 

Since 2018, British Columbia has been pursuing legal action against pharmaceutical companies for their involvement in the opioid crisis. Within the wider context of North America, there have been over 2600 such lawsuits against the pharmaceutical companies including Purdue, Johnston and Johnson, Teva Pharmaceutical and Endo International. The Purdue pharmaceutical company, the maker of OxyContin, has recently filed for bankruptcy in response to the lawsuits. I believe a suitable strategy for examining the wider variables that have contributed to the opioid crisis: a Royal Commission. This is needed in order to widen public scrutiny beyond the role of pharmaceutical companies to include investigation of the overarching causes of Canada’s overdose epidemic.

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Maureen Topps is the Executive Director and CEO of the Medical Council of Canada.

 

Nothing matters more in my role than helping Canadian and international medical graduates succeed as they prepare to practice medicine in Canada. But what does success look like and how do we measure it?

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Marika Warren is an Assistant Professor in the Department of Bioethics, Dalhousie University.

 

In early July The College of Physicians and Surgeons of British Columbia dismissed a complaint against Dr. Ellen Wiebe made by the Louis Brier Home and Hospital, an Orthodox Jewish long term care facility. Dr. Wiebe had provided medical assistance in dying (MAiD) to a patient who resided in Louis Brier who had requested it. She thereby contravened the Home's policy. Cases such as these are increasingly likely as the policies of institutions exercising conscientious objection conflict with both patients’ interests in accessing MAiD (and other services) and providers’ interests in practicing with integrity. One way to resolve such conflicts would be to recognize a claim to conscientious provision of health care services that parallels the claims of individuals and organizations to conscientious objection. ...continue reading

Iris Gorfinkel is a General Practitioner, and Founder and Principal Investigator at PrimeHealth Clinical Research in Toronto, Ontario.

 

Medical documentation in primary care is a balancing act between promoting timely connection with patients and reducing clerical demands placed on physicians. Clinical notes contain increasingly less by way of narrative. They are often made up of time-saving digitized checklists of symptoms, physical findings, and treatments. Or the progress note may be a copy-and-pasted template. Both checklists and templates lessen the need for clinician typing and offer detailed notes within a few clicks.

Prior to the electronic medical record (EMR), hand-written or dictated notes would often relate a patient’s experience by quoting patients' descriptions of their symptoms. With the arrival of the EMR, doctors, most of whom had little typing experience, were abruptly confronted with having to type detailed patient encounters. The degree to which a clinician must type has since been correlated with physician burnout, which has risen sharply in conjunction with EMR utilization. ...continue reading

Sarina Lalla is a medical student in class of 2020 at McMaster University.

 

 

 

When I was on an emergency medicine rotation, I asked for a room to tell a patient news about an X-ray. I was told that this was not a common practice given the scarcity of private rooms. It was advised that I inform them in the waiting room where other strangers sat nearby. I was also told to present cases to staff in small spaces in earshot of patients. This was unsettling to me, and pushed me to reflect on confidentiality and privacy breaches in the ED.

Canadian EDs are well-known to be overcrowded. With limited resources and a high patient volume, the space of a department is used to house a maximum of patients. Sometimes thin curtains are separating patients, or nothing is separating them at all. Often, they are placed in hallways and close to workstations where healthcare staff outside of their circle of care are working. ...continue reading

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Akina Fay is a medical student in the Class of 2020 at McGill University.

 

 

 

Days after my fourteenth birthday, I was diagnosed with a rare brain malformation and underwent emergency brain surgery to prevent my spinal cord from dissecting.

Days after my seventeenth birthday, my mother was diagnosed with a rare form of incurable cancer.

At the age of twenty, I started medical school and began to piece together the pathophysiological processes that lead to our illnesses.

At the age of twenty-two, my mother died in my arms after a grueling year of hospitalizations, pain and suffering.

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CMAJ’s Holiday Reading is back! CMAJ Blogs will host the popular Holiday Reading series online in December 2019.

We’re seeking witty, offbeat, whimsical stories grounded in medicine. Have ideas? Email blogs@cmaj.ca 

Need inspiration? Check out some popular stories from previous years:

Pooh has an addiction issue: holiday reading

Limitations

Diving into the ice bucket challenge

Kacper Niburski is a medical student in the Class of 2021 at McGill University. He is also the CMAJ student humanities blog editor. Follow his writing instagram: @_kenkan.

 

 

The following was written because of this floating into my inbox like ash.

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Dear dear,

You asked me what objects looked like breasts. It was morning and the sun was yawning and you said you needed to write a thing for a thing. What thing, I asked? For a class, you told me. I flopped pancakes onto your plate, watched them deflate like a frown. Your pajamas were hanging loose, threads licked skin. Hair was a brown bush for birds or fingers. Eyes tired, hungry. Coffee beans were roasting. Burning. ...continue reading

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Due to the sensitivity of the post, the author wished to publish the following piece anonymously. 

Dear Student,

On behalf of the Admissions Committee, we are pleased to reward you an offer of admission to the Doctor of Medicine Program!

This year our Committee received over 5,000 applications, and extended less than 250 offers of admission. However, medicine is not a meritocracy. Upon meeting peers from diverse backgrounds, you will quickly realize that applicants differed in their advantages throughout the admissions process. “Not every applicant had the same access to opportunities to demonstrate or enhance his or her commendable qualities”. ...continue reading

Sarah Chauvin is a PGY2 Family Medicine resident at McMaster University.

 

Palliative care empowers and comforts individuals with life-limiting illnesses. It may be sought at any point and serves as an adjunct to other treatments provided it falls within someone’s goals of care. It is not just trendy terminology or a “feel-good” concept; it is the cornerstone of a good death.

So why, then, after weeks of advocacy, was it denied from my grandmother. Denial? Arrogance? The belief that despite multi-system organ failure at the age of 88 years old we might still be able to “fix” her? So that rather than allowing her to control her environment and provide us with the opportunity to say goodbye, she passed away alone, minutes after being offered a colonoscopy. In fact, minutes after refusing further intervention stating, “I want to go home”. Perhaps an option she never knew existed to her until that moment. ...continue reading