This is a story about Mr. D, a lovely 85-year-old gentleman who I cared for on our General Internal Medicine service. He suffered significant cognitive impairment due to both dementia and the deposition of protein in his brain caused by chronic inflammation (known as cerebral amyloidosis). He also had advance prostate cancer. As a consequence …
At the end of January, the Ontario Ministry of Health and Long-Term Care (MOHLTC) announced almost $10 million in new funding to address type 2 diabetes, with a focus on screening and the ‘promotion of healthier lifestyles.’ There is a lot to celebrate in this announcement, particularly community-based screening initiatives. And who could complain about …
It’s a weekend shift in a Canadian Emergency Department. On a stretcher lies a woman in her sixties. She has, just this week, been diagnosed with an advanced cancer. Her symptoms crept up on her, unnoticed or passed off as the result of inactivity during a long cold winter. These multiple niggling things had finally …
Virtual care (where the provider and patient are separated in space and sometimes in time) is a natural next step in technological innovation for healthcare. Increasing care virtualization has the potential to improve quality of life for patients while increasing the healthcare system’s efficiency but it presents substantial challenges for clinicians and policy makers. The …
It is no secret that Canada suffers from an inequitable distribution of health professionals. A 2012 report from the Canadian Institute for Health Information revealed that 18% of Canadians live in rural and remote areas, yet only 8% of doctors live in these regions. The lack of access to medical services in rural communities contributes …
As with any parent whose child has a serious health condition, Amy Gleason is actively involved and ever watchful of her 15-year old daughter, Morgan, who has a life-threatening autoimmune condition called Juvenile Myositis. Amy and I are ePatients – the ‘e’ includes: being engaged, empowered, and most always incorporates gathering information and, often as …
The Ontario government deserves applause for tackling global funding for hospitals. “Global budgets provide[d] little incentive for hospitals to focus on efficiency, innovation, improving access, coordinating care across facilities and sectors or improving quality.” In 2012, the Ontario Ministry of Health announced its commitment to patient-based funding. It promised to deliver patients: • Shorter wait …
‘Worldwide, overdose is the leading cause of avoidable death among people who use injection drugs.’ United Nations Office on Drugs and Crime, 2013 In newspapers, on social media, and on tv, the death of actor Philip Seymour Hoffman is being framed as a tragedy. We have heard this narrative before. Someone famous dies from an …
Modern health care is very much concerned with outcomes. The language of outcomes is common in policy development, clinical work, and research. For example, Health Quality Ontario states that the overall quality aims are: Better outcomes, better experience, better value for money. In the context of clinical care, outcomes are broadly considered to be the …
Hello Healthy Debate community, Since launching the opinions section two years ago, we have published over 200 blogs from a wide range of people, including patients, front-line practitioners and health system leaders. In that time, we have never published an anonymous blog. Our current policy for publishing guest blogs specifically states that the author’s real …
The global public health success of vaccination is astounding. According to the World Health Organization, vaccinations save the lives of 2-3 million people worldwide each year and prevent millions of others from suffering and disability. Marvelous achievements from the use of vaccinations continue; just this month India was declared Polio-free . Past and ongoing studies …
While on call on the internal medicine service at my hospital, I recently admitted a 47-year old woman overnight, who had increased swelling in her ankles and a fluid collection in her abdomen. After taking a thorough clinical history and performing a complete physical examination, I presumed the cause to be alcoholic liver cirrhosis. I …
On November 7th 2013, the United States’ Food and Drug Administration (FDA) announced their proposed measures “to completely eliminate artificially produced trans fatty acids (TFAs) from the American food supply”. This measure would prevent food manufacturers from selling products containing artificial TFAs. Just as many Americans made their own New Year’s resolutions, their government has proposed quite a respectable one indeed. …
Physician Assistants are “handmaids” to doctors. PAs were “created by physicians” who were frustrated that nurses no longer tolerate being ordered around by MDs. And that’s just a taste of the negative reaction from some nurses to a recent Healthy Debate article on integration of physician assistants in Canada. I found it disheartening, but not …
People with end-stage kidney disease have two treatment options: dialysis or transplantation. Dialysis is the process of removing waste and excess water from the blood, by hooking up to a machine that mimics the function of the kidney. Transplantation, however, is the optimal treatment for end-stage kidney disease, because it reduces a patient’s risk of …
Last week, a Healthy Debate column written by Dr. Ritika Goel used a patient narrative to help support her argument that the minimum wage should be increased, from $10.25 to $14 an hour. The patient, Raj, drifted between low-wage jobs as many aspects of his life and health became more difficult. Unfortunately, a higher minimum …
Months before my life was upended, a doctor friend tried to explain my forthcoming role in terms I’d understand. “Imagine being on call 24 hours a day, seven days a week,” he said. “You’re in charge of a single patient, but she is needy as hell.” Medical training prepared me for motherhood in some ways …
The first time I met Raj, I remember feeling completely helpless in what to offer him. A middle-aged South Asian man with a wife and two kids, Raj had moved to Canada looking for a better life 7 years ago. He came to the clinic looking for help, but what ailed him was more complicated …
This is not a piece that is pro-vaccination or anti-vaccination. I am writing this as a citizen and consumer of the health system in Canada. I have watched the messaging about the influenza vaccination both in 2009 and now in 2014. It may be time for our health officials to pause and take the time …
Health care system governance is important. CEOs of health care organizations need to report to someone and health care boards fulfill this oversight role. Besides recruiting and hiring a CEO, boards also hold CEOs accountable for achieving outcomes, act as mentors and support CEOs when necessary in taking the heat from the unhappy segments of …