On this episode of the CMAJ Podcast, Dr. Blair Bigham and Dr. Mojola Omole explore the intricate relationship between medical assistance in dying (MAiD) and palliative care in Canada. They focus on a qualitative study titled "Perspectives of Canadian healthcare leaders on the relationship between medical assistance in dying and palliative and end-of-life care services: a qualitative study," which interviewed 36 professionals from both fields. The study reveals significant gaps in collaboration and coordination, leading to feelings of exclusion among MAiD providers.

Dr. Gilla Shapiro, a co-author of the study, discusses the diverse perspectives of health leaders on the integration of MAiD and palliative care services. She highlights the challenges posed by geographical, institutional, and personal factors in standardizing the relationship between these services. Dr. Shapiro shares insights into the initial tensions and the gradual improvements in cooperation, stressing the necessity for enhanced education, reduced stigma, and improved communication with patients to foster a collaborative environment that prioritizes their welfare.

Following this, the conversation shifts to Dr. Christopher Blake, a palliative care physician from Peterborough, Ontario. Dr. Blake shares his surprise at the study's finding that support for physician assisted dying among MAiD and palliative care practitioners is lower than that of the general population. He articulates a clear distinction between the objectives of palliative care and MAiD, the need for a seamless transition between services, and the ethical implications when patients are moved from palliative care to MAiD without adequate support. Dr. Blake advocates for robust funding for coordination and the establishment of clear standards across healthcare services, highlighting the importance of a unified approach in end-of-life care.

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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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Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.

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On this episode of the CMAJ Podcast, Dr. Blair Bigham and Dr. Mojola Omole closely examine anorexia nervosa in male adolescents, a topic that frequently escapes notice. Their discussion highlights the disorder's prevalence, especially among high-risk groups like LGBTQ+ individuals and those from varied racial and ethnic backgrounds. It also underscores the severity of anorexia nervosa in young males and stresses the critical need for early recognition and intervention.

This episode features an in-depth conversation with Sterling Renzoni, a fourth-year biochemistry student at Trent University, who shares his personal journey through diagnosis, treatment, and recovery from anorexia nervosa. Sterling's narrative provides valuable insights into the complexities of identifying and treating the disorder in males, highlighting the societal and personal challenges that can impede recognition and care.

Next, Drs. Omole and Bigham speak with Dr. Basil Kadoura, an adolescent medicine physician at BC Children's Hospital and the lead author of the article in CMAJ entitled, "Anorexia nervosa in adolescent males." He discusses diagnostic challenges, the distinct clinical presentation in males versus females, and the need for tailored approaches for effective treatment. Kadoura's insights contribute to a nuanced understanding of anorexia nervosa's impact on male adolescents and the critical role of healthcare professionals in facilitating early intervention and support.

This episode is structured to provide medical professionals with a deeper understanding of anorexia nervosa in male adolescents, underscoring the need for awareness and specialized care approaches. It serves as a resource for clinicians seeking to enhance their diagnostic and treatment strategies for this often-overlooked condition.

This podcast has been sponsored by the Yarmouth Region Medical Professional Recruitment Partnership. Click here for more information.

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On this episode, Dr. Blair Bigham and Dr. Mojola Omole explore a clinical case involving a rare infection in a returned traveler, highlighting the critical role of travel history in diagnosing unusual diseases. They discuss the case of a woman in her 60s who presented with fever and ankle pain after returning from India. Initial concerns for septic arthritis led to further investigation when standard treatments failed to alleviate her symptoms. Dr. Mara Waters is the lead author of the clinical case entitled “Melioidosis with septic arthritis in a returning traveller,” published in Canadian Medical Association Journal (CMAJ). She details the steps the infectious diseases team took to ultimately identify the infection as caused by Burkholderia pseudomallei.

Dr. Waters, an infectious diseases fellow at the University of Toronto, describes the challenges of diagnosing and treating melioidosis, emphasizing the importance of considering travel history and the evolving geography of infectious diseases. She highlights the broader implications of climate change on the spread of infectious diseases and the interconnectedness of human, animal, and environmental health.

Following the case discussion, Dr. Jeffrey Pernica, a specialist in infectious diseases and tropical medicine, offers a refresher on common infections in returning travelers, such as malaria, dengue, and typhoid. He stresses the importance of considering these more prevalent conditions when evaluating a returning traveller with fever, providing practical advice on diagnosis and management.

This episode serves as a reminder of the complexities of diagnosing travel-related infections and the need for clinicians to be vigilant about travel history, especially in the context of global travel resurgence and the impacts of climate change on infectious disease patterns.

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On this episode, Dr. Blair Bigham and Dr. Mojola Omole explore two articles in CMAJ focused on the critical importance of trust in the health care system. They speak with Louis Lochhead, who shares his experiences navigating the health care landscape as a caregiver after his wife's serious accident, which resulted in a coma lasting nearly two months. Lochhead highlights the difficulties in building trust with the medical team, pointing to challenges in communication and empathy. He recounts moments where the lack of clear, compassionate communication from health care providers compounded the stress and uncertainty of the situation, leaving him feeling isolated and disconnected from the decision-making process regarding his wife's care.

Next, Dr. Omole and Dr. Bigham speak with Dr. François Lamontagne, an intensive care specialist, who offers insights into how health care professionals can better connect with families and build trust, especially when faced with uncertain diagnoses or prognoses. He emphasizes the importance of acknowledging the inherent unpredictability of medicine and the value of being transparent about known facts and areas of ambiguity. Dr. Lamontagne suggests that by engaging in open, honest dialogues that respect the family's perspective and concerns, health care providers can create a more supportive environment that encourages shared decision-making. This approach not only helps in building trust but also empowers families during challenging times, making them feel valued and part of their loved one's care journey.

This podcast has been sponsored by MD Financial Management. Click here for more information. 

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On this episode of the CMAJ Podcast, Dr. Catherine Varner, deputy editor of CMAJ, sits in for Dr. Blair Bigham and joins Dr. Mojola Omole to explore two articles published in the journal that highlight troubling findings concerning the treatment of opioid use disorder.

They begin with a study that revealed significant gaps in treatment for opioid overdose patients, where only 5.5% received opioid agonist therapy within a week of their hospital visit. This comes five years after the release of guidelines for opioid use disorder management in Canada, which recommended starting opioid agonist therapy, specifically Suboxone, in patients with opioid use disorder. One of the paper’s co-authors, Dr. Jessica Kent-Rice, a PGY5 resident in emergency medicine and toxicology fellow at the University of Toronto, dissects the complexities of treating opioid use disorder in the emergency department and makes a passionate plea for physicians to increase their prescriptions of these life-saving therapies.

Transitioning to the second article, the hosts examine the presence of xylazine, a veterinary sedative, in the illicit opioid supply. Dubbed the "zombie drug" due to its effects on people's skin and prolonged effects during overdose, xylazine is raising alarm bells among emergency physicians. However, the article's co-author, Dr. Peter Wu, an internist and clinical pharmacology and toxicology physician at the University Health Network in Toronto, advocates for a balanced response. He cautions against excessive concern, noting that treatment continues to revolve around providing supportive care.

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On this episode of the CMAJ Podcast, Dr. Blair Bigham and Dr. Mojola Omole examine an article published in CMAJ titled, 'Tackling barriers to Canadian medical school admissions for students with disabilities.' The analysis highlights how medical education has historically devalued or excluded trainees with disabilities and emphasizes the need for more flexible and inclusive admission processes. 

They are joined by Shira Gertsman, the lead author and a medical student at McMaster University, who shares her personal battle with Crohn's disease and the hurdles she encountered applying to medical school. Gertsman underscores the critical need for accommodations for individuals with disabilities and the importance of greater representation and understanding within the medical field.

Next, the hosts speak with Dr. Caroline Bowman, a family physician who developed multiple sclerosis mid-career, to discuss her initial symptoms, her fears and concerns, and the impact of MS on her ability to work as a family physician. She also talks about the challenges she faced in accepting her disability and the shame associated with it. Dr. Bowman offers her thoughts on how the medical profession can be more accommodating and understanding towards physicians with disabilities, and the benefits that both physicians and patients can gain from addressing shame and creating a more compassionate culture in medicine. The discussion acknowledges how strains in the medical system reduce flexibility and challenge its capacity to make systemic changes.

This podcast has been sponsored by MD Financial Management. Click here for more information. 

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On this episode of the CMAJ Podcast, Dr. Blair Bigham and Dr. Mojola Omole discuss the practice article in the journal entitled, “Five things to know about…Novel obesity treatments". They discuss the impact of new medications like semaglutide and tirzepatide in treating obesity with Dr. Shohinee Sarma, the lead author. Dr. Sarma explains the significant effects these drugs have on weight loss and cardiometabolic health. They also discuss how these treatments can be combined with behavioral therapies for improved results, while considering potential side effects and complications.

Next, Dr. Ashley White, a family physician and diplomate of the American Board of Obesity Medicine, emphasizes the need for a comprehensive approach to obesity management. She stresses the importance of establishing realistic expectations with patients, addressing self-image concerns, and considering the long-term impacts on metabolic health. The conversation also touches on the societal biases and stigmas around obesity, highlighting the necessity for a change in how physicians and society view this medical condition.

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On this episode, Dr. Emmanuel Bujold addresses the gross underutilization of acetylsalicylic acid (ASA) in Canada during pregnancy, a treatment highly effective in preventing preterm preeclampsia among those at risk.

Dr. Bujold is an OB-GYN in Quebec City and a professor of Obstetrics & Gynecology at Laval University's School of Medicine. He is a co-author of the commentary in CMAJ entitled, “Screening for preeclampsia risk and prophylaxis with acetylsalicylic acid”.

Dr. Bujold presents evidence showing ASA's effectiveness in preventing more than 80% of severe preeclampsia cases. He advises that high-risk pregnant women take ASA up to 36 weeks of gestation, with ongoing research potentially adjusting this recommendation.

Dr. Bujold describes a simple, relatively inexpensive, and widely available testing protocol that can effectively predict preeclampsia in the first trimester and that starting aspirin before 16 weeks of pregnancy can prevent severe cases.

Next, Dr. Modupe Tunde-Byass, an OB-GYN based in Toronto and the inaugural president of the Black Physicians of Canada, emphasizes the disparities in pregnancy outcomes among racialized communities, particularly the higher rates of morbidity and mortality among Black women. She advocates for the implementation of race-based data collection in healthcare to better understand and address these disparities, highlighting the importance of tailored medical approaches to improve outcomes for these communities.

This podcast has been sponsored by PrescribeIT. Click here for more information.

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On this episode, we revisit and update one of the most-read articles on the CMAJ website.

The article is titled, “Smartphones, social media use, and youth mental health.” It reviews the extensive literature linking poor mental health in adolescents with smartphone and social media use. The article details a variety of studies that implicate smartphone and social media use in increased mental distress, self-injurious behaviour, and suicidality among youth. It also indicates that there's a dose-response relationship, with the effects appearing to be most pronounced among girls.

The lead author of the paper is Dr. Elia Abi-Jaoude. He is a psychiatrist and researcher at The Hospital for Sick Children in Toronto. He delves into recent research exploring how social media and smartphone use negatively impact the mental health of young individuals.

Later in the episode, Dr. Michelle Ponti offers practical tips that physicians can provide parents to effectively manage their children's smartphone and social media use. Dr. Ponti is a paediatrician in London, Ontario, and Chair of the Digital Health Task Force for the Canadian Paediatric Society.

Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.

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On this episode, Drs. Blair Bigham and Mojola Omole discuss the CMAJ paper "Cost-effectiveness of pharmacogenomic-guided treatment for major depression". The paper examines the potential of pharmacogenomic testing in the treatment of major depression and its implications for health care costs.

The study suggests that implementing pharmacogenomic testing for adults with moderate to severe major depressive disorder in British Columbia could save the health system about $956 million over 20 years, equating to roughly $4,926 per patient.

The hosts interview the study's authors, Dr. Jehannine Austin, Professor of Psychiatry and Medical Genetics at UBC, and Dr. Shahzad Ghanbarian, a mathematical modeler and research scientist, also at UBC.

They explain how pharmacogenomic testing can reduce the often lengthy trial and error process of selecting medication for depression. The study demonstrates that this approach facilitates more effective early intervention, potentially reducing the number of patients with refractory depression by 37%. 

Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.

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