CMAJ Podcasts: Exploring the latest in Canadian medicine from coast to coast to coast with your hosts, Drs. Mojola Omole and Blair Bigham. CMAJ Podcasts delves into the scientific and social health advances on the cutting edge of Canadian health care. Episodes include real stories of patients, clinicians, and others who are impacted by our health care system.
What medical conditions and social factors increase the risk of drowning?
Drowning accounts for hundreds of deaths in Canada every year. A study published in CMAJ examines how pre-existing medical conditions contribute to drowning deaths. Drs Mojola Omole and Blair Bigham speak with the study’s lead author Dr. Cody Boone about what the study’s findings mean for physicians and patients.
They then speak with Audrey Giles, a professor of human kinetics at the University of Ottawa, about the high rates of drownings experienced by Northern Indigenous communities in Canada. Professor Giles has spent decades working with people in Northern regions to adapt and customize water safety programs so that they meet communities’ specific cultural and practical needs. She discusses issues from cold water drowning to cultural safety.
The link between medical conditions and fatal drownings in Canada: a 10-year cross-sectional analysis
Decades of water safety training culturally “irrelevant” to First Nation people
Is it time to re-think the quality improvement enterprise?
In this episode, Dr. Kaveh Shonjania argues that despite the billions of dollars spent on clinical and quality improvement research, most of the interventions that are studied are shown not to work and those that do work produce only marginal benefits for some patients.
Dr. Shojania is the Vice Chair of Quality and Innovation for the Department of Medicine at the University of Toronto and past Editor-in-Chief of BMJ Quality and Safety. He joins Drs. Blair Bigham and Mojola Omole to discuss a study published in CMAJ recently, entitled Inappropriate Use of Clinical Practices in Canada: A Systematic Review, in which the authors sifted through 174 studies to identify ineffective clinical practices that are either overused, effective practices that are underused, or other practices that are just misused..
Dr. Shojania wrote a short commentary related to the study, entitled What problems in health care quality should we target as the world burns around us? In which he called for health research resources to be shifted more towards research on the social determinants of health, for a greater return on investment. Drs. Bigham, Omole and Shojaniadiscuss how this might actually work in practice.
Lack of diversity in healthcare leadership
A study of more than 3000 health care leaders in Canada found that while gender parity was present, racialized executives were substantially under-represented. Diversity among health care leaders in Canada: a cross-sectional study of perceived gender and race was published in CMAJ. It found that at the ministry level fewer than 7 percent of health care leaders were racialized.
The representation gap between racialized executives in healthcare and the racial demographics of the population it serves ranged from a low of 7.3% for Prince Edward Island to a high of 27.5% for Manitoba. The gap was highest in geographic locations with a greater percentage of racialized residents.
On this episode, Drs. Omole and Bigham speak with the lead author of the study Anjali Sergeant, a final year medical student at McMaster University. She describes how researchers determined race, compares results in different parts of the country and discusses how closely the results of the study reflect what she is seeing in her medical school cohort.
Drs Omole and Bigham also speak with Anna Greenberg, the Chief Regional Officer, Toronto and East for Ontario Health. Ms. Greenberg is also the agency’s Executive Lead for Equity, Inclusion, Diversity, and Anti-Racism. She discusses the efforts her agency is making to address this disparity. She also explains why it is important for healthcare leaders to ask themselves, “Why does this matter?”
Is it time to replace high-stakes exams with graduated licensure?
COVID-19 disrupted the medical licensing examination system in Canada. During the pandemic, exams delivered by The College of Family Physicians of Canada (CFPC) and the Royal College of Physicians and Surgeons of Canada (RCPSC) were delayed, canceled or adapted, disrupting the lives of hundreds of physicians.
However, those challenges prompted many to rethink the historical approach to medical licensure in Canada.
In this episode, Drs. Brent Thoma and Teresa Chan discuss their proposal to shift away from all-or-nothing examinations and towards a system of graduated licensure. They are two authors of a recent CMAJ commentary entitled Replacing high-stakes summative examinations with graduated medical licensure in Canada.
Dr. Thoma is an emergency and trauma physician in Saskatoon and an associate professor of emergency medicine at the University of Saskatchewan. Dr. Chan is an associate professor of medicine at McMaster University, where she is the Associate Dean of Continuing Professional Development.
Recognizing and treating POTS
Postural orthostatic tachycardia syndrome (POTS) is a disorder that can profoundly affect patients' quality of life. Its main characteristic is tachycardia on standing without a drop in blood pressure. Patients complain of lightheadedness and palpitations when upright, which sometimes leads to syncope. This can cause substantial functional disability, which may be economically devastating.
Despite these serious consequences for patients, diagnosis can be delayed up to 6 years.
In this episode, Dr. Satish Raj, author of the recent CMAJ narrative review article Diagnosis and management of Postural Orthostatic Tachycardia Syndrome talks to our hosts about difficulties in making the diagnosis of POTS, its complex range of comorbidities, how patients are typically affected by the syndrome and treatment options.
Tackling carbon emissions in healthcare: from low-hanging fruit to systems change
Physicians working in hospitals see the mountains of medical waste generated each day. Meanwhile, the climate crisis challenges the medical system to reduce its contribution to greenhouse gas emissions. Globally, healthcare systems contribute as much carbon dioxide as the airline industry. In Canada, healthcare accounts for 4.6% of our total emissions. The problem is urgent, but potential solutions are both easier and more complex than many might think.
Guests on this episode are advocates in the climate and health space. Dr. Samantha Green is the co-author of the CMAJ article, Five Things to Know About Metered Dose Inhalers and their Impact on Climate Change. She's a family physician at Unity Health Toronto and the climate and health lead at the University of Toronto's Department of Family and Community Medicine.
In the article, she and her co-authors point out that pressurized metered-dose inhalers (pMDIs) are an important contributor to greenhouse gas emissions. Dr. Green says measurements done in the United Kingdom by the National Health Service found that MDIs contribute 3.1% of the entire health system's carbon emissions. One MDI contributes the equivalent of driving 290km by car.
Meanwhile, dry powdered inhalers (DPIs) and soft mist inhalers (SMIs) are effective available alternatives with lower environmental impact. Dr. Green encourages physicians to make the switch for eligible patients and explains how her clinic has created resources to facilitate the prescribing change.
Addressing such low-hanging fruit of climate action in the healthcare system is important but, according to Dr. Andrea MacNeill, reducing waste, changing prescriptions, and recycling are the tip of the iceberg. What’s really needed is profound systemic change. Dr. MacNeill argues that emissions are driven by a system focused on providing the most complex and carbon-intensive care.
“New healthcare funding seems to go into very complex resource-intensive treatments that modify very advanced disease processes. And I would suggest that we need to shift that focus upstream and start to think, okay, could we have prevented this from ever happening? And in many cases, the answer to that is yes,” says Dr. MacNeill.
Along with a focus on prevention, Dr. MacNeill argues healthcare systems need to put pressure on the supply chain, which accounts for the bulk of emissions. In England, the NHS is demanding that vendors match the NHS's climate target to decarbonize by 2030.
Links to resources discussed on the episode:
Inhaler Toolkit for Physicians
Planetary Health Lab