Why are medical records so difficult for patients and families to access?
Opinions
Why HIV testing needs informed consent
What’s in a name – defining hospitalists in Canada
Over the past two decades, delivery of inpatient care at acute care institutions has changed dramatically in Canada, with fewer family doctors following their patients in hospitals and the emergence of a growing number of hospitalists. Despite this growth, there is no uniform understanding of who hospitalists are, what they do and what types of …
More Ontarians should have access to team-based primary care
In our family medicine practice, we regularly ask patients to give us feedback on how we’re doing. They tell us, over and over, that one of the things they like best about our practice is the teamwork – how much they love their doctor but also their social worker, or nurse, or dietitian. And how …
Canada needs to develop standards for Goals of Care conversations
I don’t remember much about my Grandma, but I do remember how she died. It was one of those perfectly tranquil winter nights in January of 2009. My family was at our home finishing dinner when Leisureworld, her long-term care (LTC) facility, called to inform us that she had a fever and low oxygen levels. …
Physicians and hospitals can work together for a patients-first system
When patients enter a typical hospital, they sense that their needs don’t come first. Nobody seems to listen to them. Nobody seems to care how long they have to wait, or what will happen to them once they are transferred to another service. At times, members of the care team seem to work at cross-purposes. …
Disparities in health between north and south – we are surprised that any one is surprised
We are happy to see Health Quality Ontario (HQO) embarking on a systematic approach to assessing the quality of Ontario’s diverse health system through their “Common Quality Agenda”. This agenda is an evolving list of indicators that measure the health system along eight domains including health status, public health, primary care, hospital care, home care, …
Lost in transition: the gap between child and adult mental health services
I first met “Alice” during my pediatric residency. She is a shy and articulate 17 year old girl, who has been struggling with depression since her early teen years. Over the past several years, she has been seeing a counsellor at her local pediatric mental health centre. She has learned to trust and rely on her …
The role of call scheduling in resident burnout
Today my son Hunter is 821 days old (2 years, 3 months, 0 days). As a resident, I have spent 129 of those days in the hospital while on call; after-hours care that are over and above my ‘regular’ working day (0 years, 4 months, 3 days). In other words, I have missed 15% of …
Why are so many members of the palliative care community opposed to physician assisted death?
On February 6, 2015, the Supreme Court of Canada unanimously ruled to strike down the provisions of the Criminal Code that prohibit Physician Assisted Death (PAD, which includes both physician-assisted suicide and euthanasia). Although public support for PAD in Canada has been very high for decades, support among the medical community has been lukewarm at …
The evolving definition and scope of palliative care
Is our health system’s definition of palliative care correct? The World Health Organization (WHO) describes palliative care as “an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness.” Keeping this in mind, most of us associate palliative care with comfort-focused care that is delivered within …
A tribute to Dave Sackett
David Sackett, the most important mentor of my professional career, died last month. I am writing this article partly to acknowledge and thank him for his incredible contributions to medicine, critical thinking and evidence-based medicine. However, others such as Andre Picard have already done so beautifully. I am writing this partly because I fear that …
What will the “sharing economy” mean for health care?
Boomers have marveled at the return of bellbottoms, skinny ties, mullets, and moustaches. Memories of misspent youth, suddenly became exciting trends for the generations that followed. Now we’re discovering that the process of rejuvenation applies not only to fashion, but business models too. Take, as examples, the kid across the street who cut your grass …
Gupta in Nepal: a physician-reporter pushing past the ethical limits
Nepal is a disaster zone. Katmundu hospital is overflowing. Sanjay Gupta is on the scene, showing and telling CNN audiences the scope of the tragedy with the expert eyes of a physician and the skills of a reporter but then, what’s this? Dr Gupta is asked to operate and there he is performing emergency surgery …
The psychiatrist of tomorrow
Mental health leaders have the opportunity for courageous change as they assemble in Toronto this week. Psychiatrists from around the world will be attending the American Psychiatric Association’s Annual Meeting, and I hope that there will be serious and thought provoking conversation on the future of the specialty. As a neurologist, new to the mental …
What’s really driving high-cost use of health care
So-called “high-cost users” of health care – the 5% of the population who use nearly two-thirds of health care resources – have become a major policy focus, both in Canada and abroad. But in the rush to save money on the care of patients who are already high-cost users, too little attention has been paid …
Our casual attitude towards risk is taking a grim toll
On the average commute home from work, it’s easy to observe people regularly carry out any number of “at-risk” behaviors on the roads: not following traffic signals, texting while driving, or driving at excessive speeds. When it comes to driving, it seems Canadians have a very high risk tolerance. This is certainly understandable in a …
Culture of bullying: what can medicine learn from the Ghomeshi report?
When people learn that I pivoted from broadcast journalism to health care, they are rightly surprised: the two fields don’t seem to have a lot in common. But in my experience, they share at least this: both occasionally celebrate a culture of blame, celebrity and an eat-your-young mentality that fosters fear, undermines team work and …
Best part of being a doctor? The stories
The best thing about being a doctor and practicing Medicine are the stories – the patient’s stories. Each day, I get to hear someone’s life story, to share in their life’s successes, their failures, and the meaning they derive from their experiences. I have heard of the adventures and the atrocities of The Great Wars, …
Modernizing scopes of practice to improve the value of physician services
In 1987, a high-profile and unpopular doctors’ strike over reimbursement shook the profession, leading to the creation of CanMEDS roles framework studied by every Canadian medical student. 18 years later, income is again the focal point in the latest negotiations between the Ontario Medical Association and the provincial government. As former Chief Justice Warren Winkler …