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On this episode of the CMAJ Podcast, Dr. Mojola Omole and Dr. Blair Bigham speak with Dr. Sarina Isenberg and Dr. Modupe Tunde-Byass about the emotional and systemic challenges surrounding early pregnancy loss care in Canada. The conversation builds on themes from the recent CMAJ article, “Diagnosis and management of early pregnancy loss,” in which the authors advocate for a dedicated EPL pathway to care that bypasses the emergency department.

Dr. Isenberg shares her personal experiences with early pregnancy loss and the stark disparity in care she received—from a lack of empathy in an emergency room to comprehensive support in a specialized clinic. Her story underscores the spectrum of care needed, particularly access to emotional support during one of the most vulnerable times in a patient’s life.

Dr. Tunde-Byass, co-author of the CMAJ article and an obstetrician at North York General Hospital, highlights the success of dedicated early pregnancy loss clinics, which provide timely diagnosis, options for management, and a supportive environment. She emphasizes that emergency departments, often overstretched and lacking privacy, are not designed for the unique needs of early pregnancy loss patients. Instead, she argues for dedicated spaces staffed by trained personnel, including nurses and counselors, who can provide both medical care and emotional support.

Together, they explore practical solutions, including integrated care pathways outside of emergency departments, self-referral options, and the provision of bereavement resources. Dr. Tunde-Byass advocates for a holistic approach that could be standardized across Canadian hospitals, enabling patients to access sensitive, informed care without the retraumatization that often comes from repeating their stories in high-stress environments.

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On this episode of the CMAJ Podcast, Dr. Mojola Omole and Dr. Blair Bigham explore the structural and cultural barriers faced by surgical residents and early career surgeons in balancing parenthood with their careers. The conversation centers around the points raised in the CMAJ article “Policies to better support childbearing surgeons”, which outlines the need for reforms to better accommodate surgical residents during pregnancy and early parenthood.

The discussion highlights how surgeons experience higher rates of infertility and pregnancy complications, independent of age or other potential risk factors. Dr. Caroline Cristofaro and Dr. Maryse Bouchard, the article’s co-authors, propose solutions such as flexible call schedules, protected time for prenatal and postnatal appointments, and clear institutional guidelines supporting the needs of pregnant surgeons.

Beyond structural barriers, the prevalent culture within surgical departments, such as the glorification of exhaustion and the perception that taking time off is a weakness or a burden to fellow residents, contributes to the unsupportive environment. The co-authors argue that gradual, transparent, and detailed policy reforms based on evidence are necessary to avoid resistance and ensure successful integration into surgical practice.

Dr. Omole’s personal experience, marked by significant support from her department during her pregnancy and postpartum recovery, serves as an example of what a compassionate and well-supported environment can look like. Her story highlights how proactive leadership and peer support can make a profound difference, benefiting both surgeons and their patients.

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On this episode of the CMAJ Podcast, Dr. Kirsten Patrick speaks with Dr. Shane Neilson, the author of a CMAJ Encounters article entitled, “Professional stigmatizations.” Dr. Neilson is a physician, writer, and academic, who shares his experiences navigating medical school and practice as a neurodiverse physician with bipolar disorder and autism. 

Dr. Neilson reflects on the challenges he faced during medical school, including a moment when a preceptor told him, "There’s something wrong with you," without offering any support or guidance. He shares how this, along with the pressure to conform to normative expectations in medicine, made his training difficult, especially without any accommodations for neurodiverse students.

Dr. Patrick relates to these struggles, recounting her own experiences of feeling out of place in medical school. Together, they discuss how the culture of medical education at the time did not accommodate students who did not fit the traditional mold.

Dr. Neilson notes that while there are "little teeny, tiny occasional tales of change" happening now, such as program directors becoming more aware of neurodiversity and making small accommodations for students, these changes are still incremental. He expresses hope that this will continue to evolve, leading to broader acceptance and support for neurodiverse individuals in the medical profession.

He further argues that including neurodiverse physicians enriches the profession in several ways. By challenging rigid norms in medicine, neurodiverse individuals push the profession to be more inclusive and compassionate. They also provide care that is uniquely attuned to the needs of neurodiverse patients, offering identity-aligned support that can enhance patient satisfaction and outcomes. Dr. Neilson stresses that by fostering diversity, the profession not only lives up to its values but also improves care for all patients.

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On this episode of the CMAJ Podcast, Dr. Blair Bigham and Dr. Mojola Omole explore effective ways to manage pain during intrauterine device (IUD) insertions. They also address a broader issue: how women’s pain is often neglected during gynecologic procedures, and the failure of physicians to adequately seek consent. They are joined by Dr. Kristina Arion, an obstetrician and gynecologist at the Children's Hospital of Eastern Ontario, and Dr. Nadia Von Benzon, a lecturer and social geographer at Lancaster University.

The episode begins with Dr. Arion discussing the CMAJ article she co-authored, which outlines strategies for better management of pain during IUD insertions. She explains that the IUD is recommended as the first-line therapy for birth control and period management by the Canadian Pediatric Society and the Society of Obstetricians and Gynaecologists of Canada. Dr. Arion highlights how patient anxiety, lack of sedation options, and inconsistent practices contribute to unnecessary pain.Her key advice to doctors: listen to patients, explain each step of the procedure, and provide adequate pain management options.

Dr. Von Benzon broadens the discussion beyond IUD pain management to the neglect of women’s pain and autonomy during other gynecologic and obstetrical procedures. Her research article "My doctor just called me a good girl, and I died a bit inside: From everyday misogyny to obstetric violence in UK fertility and maternity services," illustrates how women’s pain is frequently dismissed and their consent overlooked. She discusses the long-term impact of these practices, with some women opting out of future pregnancies due to trauma. She advises healthcare professionals to clearly explain procedures, seek consent, and prioritize patient comfort and autonomy.

Dr. Omole and Dr. Bigham reflect on how patriarchal structures and time constraints within healthcare systems often lead to the failure to prioritize women’s pain and autonomy. The episode closes with a powerful call for healthcare providers to take the time to listen to their patients, ask questions, and ensure that consent and comfort are prioritized at every stage of care.

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On this episode of the CMAJ Podcast, Dr. Blair Bigham and Dr. Mojola Omole discuss how artificial intelligence (AI) significantly improves the identification of hospital patients at risk of clinical deterioration compared to physician assessments alone. They are joined by Dr. Amol Verma, a general internist at St. Michael’s Hospital in Toronto, an associate professor at the University of Toronto, and the holder of the Temerty Professorship in AI Research and Education, who shares findings from his recent CMAJ article, “Clinical evaluation of a machine learning-based early warning system for patient deterioration”.

Dr. Verma explains how the AI system, ChartWatch, analyzes over 100 variables from a patient’s electronic medical record to predict deterioration more accurately than traditional early warning scores like the NEWS score. He discusses how the integration of AI into clinical workflows improves patient outcomes by complementing human decision-making, leading to better results than relying on physicians or AI alone.

The episode also looks at the potential future of AI in medicine, with Dr. Verma sharing insights on how AI tools should be thoughtfully integrated to support clinicians without overwhelming them. He stresses the need for AI systems to fit seamlessly into clinical workflows, ensuring patient care remains the priority. While AI is currently a tool to assist clinicians, Dr. Verma argues that the full extent of AI's role in healthcare—and its impact on the physician's place within it—remains ultimately unknowable.

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On this episode of the CMAJ Podcast, Dr. Blair Bigham and Dr. Mojola Omole explore the ongoing public health concern of meningococcal disease, focusing on meningitis B outbreaks in Canadian universities. They are joined by Dr. Cristin Muecke, a medical officer of health in Halifax, and Dr. Savita Rani, a public health specialist at the University of Saskatchewan. The episode also features the personal story of Megan Plamondon, a Queen’s University student who contracted invasive meningococcal disease.

The discussion opens with a look at recent meningitis B outbreaks, including cases at Dalhousie University in 2022 and Queen’s University in 2023. The Halifax outbreak led to a targeted vaccination effort offering publicly funded MenB vaccines to students in congregate living environments, such as dormitories and residences.

Dr. Muecke provides insights into the Halifax outbreak and the public health response that followed. She discusses the complexities of identifying and controlling meningococcal disease in university settings, where asymptomatic carriers of Neisseria meningitidis can unknowingly contribute to the spread of the infection.

Dr. Rani expands on the current state of MenB vaccination, explaining why the vaccine is not included in routine immunization schedules and outlining the challenges of securing broader vaccine coverage across the country. She emphasizes the importance of early detection, given that meningitis can present with nonspecific symptoms which complicates diagnosis.

Megan Plamondon’s story brings a lived experience perspective to the conversation, highlighting the severe impact of meningococcal disease and the critical need for prevention efforts, particularly among students entering congregated living environments for the first time.

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On this episode of the CMAJ Podcast, Dr. Eve Purdy makes it clear what’s at stake when it comes to incivility in medicine. "It's very simple. Incivility kills patients, and that needs to be the single line of every healthcare leader responsible for managing and leading teams.” Dr. Purdy joins Dr. Sarah Kim and hosts, Drs. Blair Bigham and Mojola Omole, for an urgent panel discussion that looks into the deep-seated reasons behind incivility in medical settings. 

Dr. Eve Purdy is an emergency medicine physician and applied anthropologist at Gold Coast Hospital and Health Service in Australia. She focuses on helping healthcare teams perform at their best. Dr. Sarah Kim is a family physician and an assistant professor in the Department of Family and Community Medicine at the University of Toronto. She's also the Medical Education Health Humanities Lead at Temerty Faculty of Medicine, where she researches the intersection of high performance and hierarchical systems.

Together, they explore the structural failures, embedded cultures, and the detrimental role "a few bad actors" can have on the effectiveness of entire teams. The conversation underscores the importance of prioritizing healthy communication practices, cultivating respect within healthcare teams, and the essential role leadership needs to play in combating incivility to safeguard patient care.

The episode begins with a conversation with Dr. Armand Aalamian, a family physician and executive director at the Canadian Medical Protective Association. He is a co-author of the article in CMAJ titled, "Five things to know about…Physician incivility in the health care workplace.” Dr. Aalamian reviews the evidence of the pervasive nature of incivility in health care, its detrimental effects on professional relationships, and its direct correlation to patient outcomes. The discussion not only highlights the problem but also proposes actionable solutions, emphasizing, once again, the role of leadership in fostering a culture of civility.

This episode is structured to arm medical professionals with both an understanding of the causes of incivility and the skills to combat it.

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On this episode of the CMAJ Podcast, Dr. Blair Bigham and Dr. Mojola Omole address the increasingly urgent issue of adolescent vaping. Rates of use of e-cigarettes containing nicotine  by youth in Canada continue to be among the highest in the world. They speak with Dr. Madelynn Hannah, a clinical pharmacist, and Dr. Trisha Tulloch, a pediatrician specializing in adolescent and addiction medicine at CAMH and SickKids Hospital in Toronto. Both co-authors of the CMAJ article "E-cigarette use in adolescents.”  

Dr. Madelynn Hannah provides critical insights into the stark differences between nicotine exposure from vaping versus traditional cigarettes, highlighting the unexpectedly high nicotine concentrations found in many vaping products. She also shares her clinical experiences managing adolescents in nicotine withdrawal and the practical challenges of using nicotine replacement therapy (NRT). 

Dr. Tulloch discusses the broader physiological impacts of nicotine on adolescents, including cardiovascular issues and the potential for seizures. She emphasizes the need for behavioral interventions and technological tools, such as mobile apps, to aid in vaping cessation. Dr. Tulloch also highlights the critical role of parental involvement in supporting youth through their journey to quit vaping.

The conversation covers recent regulatory efforts, including Ontario's ban on vaping in schools, and calls for stronger enforcement and possible bans to protect young people. The guests argue for more stringent measures and better education to mitigate the health risks of vaping among adolescents.

Throughout the episode, the guests underscore the urgent and serious nature of adolescent vaping, and the need for immediate action. They advocate for a multifaceted approach that combines policy responses, such as increased taxation with comprehensive education for parents and young people about the dangerous and addictive nature of vaping.

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On this episode of the CMAJ Podcast, Dr. Blair Bigham and Dr. Mojola Omole tackle the complex issue of "socially admitted" patients, sometimes uncharitably referred to as "granny dumping." They explore the factors leading to these non-acute medical admissions, the challenges faced by healthcare providers and innovative solutions to the problem.

Dr. Jasmine Mah, a geriatrics fellow at Dalhousie University, shares insights from her qualitative study published in CMAJ, titled "Managing “socially admitted” patients in hospital: a qualitative study of healthcare providers' perceptions". She provides examples of typical “social admissions”, such as patients with chronic conditions whose care circumstances have changed, and highlights the high mortality rates associated with these cases.

The discussion moves to the attitudes of healthcare providers towards “socially admitted” patients, the systemic failures leading to these admissions, and potential solutions. Dr. Mah emphasizes the need for better understanding and support for these patients, suggesting systemic changes like integrating social vulnerability into case mix indices and improving community care to prevent unnecessary hospital admissions.

Dr. Andrew Boozary, a primary care physician and executive director of the Gattuso Center for Social Medicine at University Health Network in Toronto, expands on these ideas in an editorial response. He underscores that these issues are not personal failures but policy failures, advocating for increased support roles like peer support workers and social medicine navigators. Dr. Boozary highlights the importance of innovative team-based care models to address the gaps in the current healthcare system.

Throughout the episode, the hosts and guests call for a more integrated and empathetic approach to patient care, stressing the need for systemic changes to better manage “socially admitted” patients and improve overall healthcare outcomes.

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On this episode of the CMAJ Podcast, Dr. Blair Bigham and Dr. Mojola Omole explore groundbreaking advancements in HIV treatment and prevention. They examine various innovative approaches that are transforming the landscape of HIV care.

Dr. Darrell Tan, a clinician scientist at St. Michael's Hospital and associate professor at the University of Toronto, discusses the article he co-authored, "Long-acting injectable antiretroviral therapy for HIV-1 infection in adults." He explains the newly approved long-acting injectable cabotegravir for PrEP, an integrase inhibitor administered as a deep intramuscular injection administered every two months. Dr. Tan highlights its superior effectiveness compared to daily oral PrEP, emphasizing its adherence benefits and potential to revolutionize HIV prevention. Additionally, he covers the long-acting injectable treatment regimen for HIV, which combines cabotegravir with rilpivirine, administered as two intramuscular injections every one to two months. This regimen offers an alternative to daily oral medication, easing the treatment burden for individuals living with HIV.

Dr. Maxime Billick, a graduating infectious diseases fellow at the University of Toronto and co-author of "HIV postexposure prophylaxis-in-pocket," introduces the concept of "PIP" (prophylaxis-in-pocket). She explains how this approach allows individuals who might rarely have high-risk encounters to keep a 28-day supply of PEP (post-exposure prophylaxis) on hand, enabling immediate use after potential HIV exposure. Dr. Billick discusses the importance of ongoing patient-provider relationships and the role of PIP in empowering patients to proactively manage their sexual health.

Throughout the episode, the hosts and guests explore the challenges and opportunities presented by these new treatments. They emphasize the importance of accessibility, awareness, and the need to address health inequities in HIV prevention. The conversation underscores the potential of these advancements to significantly impact public health and improve the quality of life for individuals at risk of or living with HIV.

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On this episode of the CMAJ Podcast, Dr. Blair Bigham and Dr. Mojola Omole discuss the latest concerns surrounding the H5N1 virus. They explore the current state of its transmission, symptoms and treatments. They also assess our pandemic preparedness and whether we are applying the lessons learned from COVID-19 to this new potential threat.

Dr. Robert Kozak, a microbiologist at Sunnybrook Health Sciences Center and co-author of the article "Five things to know about highly pathogenic avian Influenza A: H5N1 Virus," addresses the recent cases of H5N1 transmission from dairy cattle to humans, explaining the symptoms and severity of the infections. He also discusses the current treatments available, the potential for human-to-human transmission, and the need for increased awareness among clinicians.

Dr. Thomas Piggott, the Medical Officer of Health and CEO of the city and county of Peterborough, Hiawatha, and Curve Lake First Nation Public Health, provides insights on pandemic preparedness. He reflects on the lessons learned from the COVID-19 pandemic and evaluates whether we are better equipped to handle another pandemic. Dr. Piggott stresses the importance of maintaining public health infrastructure, enhancing surveillance methods like wastewater testing, and ensuring equitable access to care for all populations. 

Throughout the episode, the hosts and guests highlight the need for ongoing vigilance, improved public health measures, and a proactive approach to pandemic preparedness. They advocate for sustained investment in public health resources and infrastructure to better manage and mitigate future health crises.

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