Tag Archives: Diane Kelsall

Kelsall_Diane_01 croppedDiane Kelsall is Deputy Editor at CMAJ, and Editor of CMAJ Open. She's currently attending the 2015 Canadian Cardiovascular Congress in Toronto.


The opening ceremony of the 2015 Canadian Cardiovascular Congress began with a bang on Saturday October 24th, but by the end of the keynote address from Dr. Chris Simpson, past President of the Canadian Medical Association (CMA), some may have thought the opening ceremony ended with a whimper. The moderator used the term "depressing" to characterize Dr. Simpson's talk on "Seniors Care: The Paramount Health Care Issue of our Time."

All Dr. Simpson did was to point out some clear realities about the Canadian health care system to the attendees. For the first time in Canada history, there are more seniors than children. Despite the billions of dollars thrown at it, our health care system is ranked 11 out of 12 similar nations, just ahead of the United States. ...continue reading

Kelsall_Diane_01 croppedDiane Kelsall is Deputy Editor at CMAJ, and Editor of CMAJ Open. She's currently attending the 2015 Cancer and Primary Care Research International Network (Ca-PRI) conference, in Aarhus, Denmark.


Primary care researchers from around the world have gathered in the Danish city of Aarhus, May 20-22, 2015, to discuss the latest primary care research on cancer. In the context of the rising incidence of cancer, the big question of the conference is: where does primary care fit into this picture? At this conference, the question includes the roles of primary care clinicians, policy makers designing health care systems and primary care researchers.

Dr. Frede Olesen from the host university, Aarhus University, took participants through the complete trajectory of cancer: from prevention, screening, early diagnosis, treatment and care after treatment, and for those patients in which the disease progresses, through palliative care and care of grieving relations. ...continue reading

Kelsall_Diane_01 croppedDiane Kelsall is Deputy Editor at CMAJ, and Editor of CMAJ Open


"Just because obesity is complex, it doesn't mean that we should be paralyzed by inaction."

 So said Dr. Kim Raine, Professor, School of Public Health, University of Alberta, at the opening ceremonies for the 2015 Canadian Obesity Summit. The conference, being held in Toronto, Ontario, from April 28 to May 2, 2015, brings together researchers, clinicians, policymakers and industry to discuss advances in understanding of the causes, prevention and treatment of obesity.

Raine went on to say that making meaningful change in such a complex issue as obesity will require "the cumulative action of many small steps." There is no one single action, no matter how large, that will fix it all.

And so, I decided to look at the conference itself. What small steps did the Canadian Obesity Summit organizers undertake to address obesity ...continue reading

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

While wandering past the many posters at the Society of Hospital Medicine 2015 conference, I noticed that many of the research projects focused on very practical aspects of our care of patients in hospital — in particular, on not making them sicker. This seems obvious. After all, we admit patients to make them better, don't we? Yet many of the things we and other health professionals do, the way hospitals are built, the hospital routine, may actually make our patients sicker. ...continue reading

1 Comment

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


Yesterday was Match Day for CaRMS (the Canadian Resident Matching Service). The results were available at noon, and Twitter came alive with jubilant tweets from candidates who matched successfully.

@Want2beMD tweeted:



“Survived D-Day #CARMS #matchday results, excited to join @UofTFamilyMed for the next phase in my medical journey!”

For some, of course, the day was much less happy. They weren’t matched and now have to wait until the second round on April 14 to see if they will have a residency position beginning in July, or need to find something else to do for a year. Or perhaps they were matched, but to a program they were less interested in. ...continue reading

The December 9th issue summary podcast is presented by Dr. John Fletcher, editor-in-chief, and Dr. Diane Kelsall, deputy editor.

Dr. John Fletcher, editor-in-chief, CMAJ
Dr. Diane Kelsall, deputy editor, CMAJ







Dr. Fletcher and Dr. Kelsall discuss the following topics:

  • What matters to patients and their families in end-of-life discussions
  • Ibuprofen versus morphine for post-fracture pain in children
  • How to engage in deprescribing meds
  • Adverse health effects of solitary confinement
  • Importance of head-tilt chin-lift in CPR
  • Pap smears
  • Diagnosis in progressive headache
  • Holiday Reading highlights

And more....

...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.

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

In the newspaper, today, I found a bright gold flyer with a dire warning—and some hope. The flyer told me that heart disease, stroke and cancer are “the three leading causes of death in America!” The hope? In bold letters, the flyer proclaimed that

“A BODY SCAN Can Save Your Life!”

It told me that medical experts agree most heart disease, strokes and cancer can be prevented if detected early. And, lucky me, the US clinic was offering “painless, safe” colour ultrasound with no blood testing and no needle injection!

body scan_flyer

I could have everything from a “heart scan” for US $150 or “stroke scan” for $60 to an ultrasound imaging of my deep leg veins ($60) to find those pesky blood clots that may be lurking. They were even offering ovarian and uterus scans for $60 (which seemed to be the going rate for most of the 11 scans) to detect masses and cysts that apparently could lead to ovarian cancer or uterine cancer. For $500, I could have all the scans and reassure myself that my arms and legs had decent blood flow and that my gallbladder was cancer- and gallstone-free. They also offered two other packages: the Heart/Stroke scan and the Cancer/Organ scan.

In small letters at the bottom of the page, the flyer mentions that Medicare will not cover preventative scans at this time—which led me to think that Medicare was sitting in its office in Washington, mulling over the pros (there could hardly be cons, could there?) of providing full body scans to the entire US population.

The fact is that there is no evidence that full body scans save lives on a population basis. Full stop. Not only do they not save lives, the scans may show a small lesion that we as physicians are obligated to investigate, often with those very blood tests and needle injections that the authors of this flyer reassure me are NOT part of the scans. And these investigations may not be limited to a simple blood test. Sometimes, much more invasive procedures, with their accompanying risks to health, are required to determine whether the lesion is or is not something we should be worried about in the long run.

Of course, everybody knows somebody who had their life saved when [ADD CANCER/ANEURYSM/RARE LIFE-THREATENING MEDICAL CONDITION HERE] was found incidentally when they had [ADD INVESTIGATION HERE] for another problem. But that, my friends, is an n of 1. And that is not a good reason to subject countless others to important health risks related to unnecessary investigations.

So, to the authors of this flyer, I say NO to your kind offer. I’ll take my chances instead—with preventive care supported by evidence.