Tag Archives: primary care

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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

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

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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

Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK. He recently attended the Society for Academic Primary Care annual conference in Exeter, England.

 

The declaration of Alma Ata, over forty years ago, was a key milestone in the development of general practice. Generations of physicians may remember how it defined their career. Dr Shannon Barkley, World Health Organisation Technical Officer for Primary Health Care Services and Family medicine, described the changes that have occurred since then, leading to the 2018 Declaration of Astana. Looking back, we can see why the Declaration of Alma Ata was so important and how the principles outlined are still as fresh and relevant as they then were. There has been progress although different countries move at different speeds. “Health for all by the year 2000” wasn’t achieved but the Millennium Development Goals” were quite successful and the focus has been, more recently, on universal health coverage. I asked Shannon to tell us a little more about the Declaration ...continue reading

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Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK. He recently attended the Society for Academic Primary Care annual conference in Exeter, England.

 

Resources for primary care in the United Kingdom are under increasing pressure, as Dr. Jennifer Dixon, Chief Executive of the Health Foundation, outlined in her keynote address to the  Society for Academic Primary Care meeting in Exeter last week. A healthy growth in spending from about 1990 until 2008 was followed by a rather dismal change in the funding landscape: the proportion of overall health spending allocated to primary care gradually declined and has now been flat for the last 6 years at roughly 9%. Overall, however, spending on health as a percentage of GDP is about average within the EU and despite austerity policies, spending on health has been relatively well preserved compared to education, for example. When it comes to public satisfaction with primary care, the main problem mirrors what we see in Canada - access. ...continue reading

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Mark Speechley is a Professor of Epidemiology at Western University

 

The age-old debate over who should be addressed as ‘doctor’ lives again in recent letters to CMAJ. Of course, it is important not to confuse the public. Since more people get sick than get university educated, members of the public are more likely to have met a physician-doctor than a professor-doctor. As a PhD epidemiologist, ‘the population is my patient’. Consequently, when I meet my medical colleagues in the hospital, I do not expect to be addressed as ‘Doctor’, but should the whole population be in the hospital, and the crowding in the corridors be so acute that I would have the statistical power to practice my profession by expertly assembling the massed throngs of gurneys into long rows of cases and controls, or exposed and unexposed, as appropriate, I would most certainly expect to be addressed as such.  ...continue reading

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Pat Rich is an Ottawa based medical writer and editor.

 

Cometh the hour, cometh the man.

It would be the very height of pretentiousness to apply this phrase to Dr. Liam Farrell, an author and former family physician from Rostrevor, Co. Down, Ireland and I am sure he would be the last person to do so.

But at a time when family medicine seems to be at its lowest ebb, if not globally then very much here in Canada, there is much to be said for having a physician who can so eloquently write about both the rigors and the ...continue reading

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 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

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