Dr. Kelvin Lou & Dr. David M. Williscroft
Jun 25, 2025
Matters of the HEEART: How to discuss code status when stakes are high in acute care
Discussing code status is a critical part of the larger goals of care discussion, but code status discussions often happen in emotional and high-stake situations. Directly addressing the high levels of emotion in these situations can greatly enhance communication and decision making. The focus of this approach is on building a personal connection and fostering trust at each step. To address the time limitations in acute care, we have streamlined multiple communication tools into the acronym HEEART, and provided tips on word choice and helpful practices. read more...
Dr. Douglas Green
May 28, 2025
Diagnosis of anxiety conditions in primary care: Part 1
Studies indicate that anxiety conditions are often underdiagnosed and undertreated in primary care. The Ottawa Anxiety Algorithm has been designed to be evidence-based and practical, and contains guidance as to when and how to screen for and diagnose anxiety conditions, self-help resources that can be emailed to patients, links to community resources and treatment algorithms for the commonly used medications for these conditions. read more...
Dr. Ilona Hale
Apr 23, 2025
Environmental impacts of clinical practice: reducing unnecessary care
Until recently, I had never really considered that testing and treatments have an environmental cost. The burden of overuse is not trivial: up to 30% of all tests and treatments we order are unnecessary and an additional 10% are harmful to our patients. I have realized that if I really want to make a difference to my carbon footprint at work, reducing unnecessary care has a greater impact than recycling clinic waste or powering down my computer. read more...
Dr. Katelyn Halpape
Mar 26, 2025
Buprenorphine/naloxone for chronic non-cancer pain
One in five Canadians live with chronic non-cancer pain (CNCP). Due to the historical role opioids had as a key component of CNCP treatment, a number of patients living with CNCP are on long-term opioid therapy (LTOT). I discuss the off-label use of buprenorphine/naloxone as a distinctive treatment option for CNCP and LTOT. read more...
Dr. Kerstin Gustafson and Dr. Colleen Dy
Feb 26, 2025
Menopause: Don’t sweat it: Part 1
Women often seek medical care around the time of menopause, yet, in one survey, only 27% of Canadian women reported that their family physician proactively discussed menopause with them. The root of this care gap is thought to be the paucity of education that medical professionals have received regarding menopause in the last 20 years. Now, we try to include at least one question about menopausal symptoms proactively in our seemingly asymptomatic patients over the age of 40. read more...
Dr. Judy Dercksen
Jan 22, 2025
Trauma-informed high impact chronic pain care
My interactions with high impact chronic pain patients have become more effective as my approach has changed from a relentless pursuit to decrease their pain, to a more compassionate one, where in a safe space I listened as patients shared their needs and goals, while I provided them with tools when they were receptive to change. read more...
Dr. Steve Wong
Dec 20, 2024
Letter from the editor
It's an all too common refrain to say we are short on time, but from a very personal perspective, suffice it to say time has never meant more to me than it does now as we rally around the care of a dear family member. I've always hoped that TCMP represents a time-saver for our readers. Sifting through the endless stream of new medical data to find the trials that impact practice can be overwhelming. By selecting and presenting trials through the lens of practice change, our mission is to provide you with data and tools to enhance your care of patients across a range of conditions. read more...
Dr. Heather Fulton
Nov 26, 2024
CRAFTing a response: expanding support options available for families affected by substance use
I recommend Community Reinforcement and Family Training (CRAFT) for families who have a loved one with substance use challenges. It is a is a science-backed approach that helps family members change the way they interact with their loved one that makes change more likely while also helping themselves in the process. read more...
Dr. Michelle C. Chan
Oct 22, 2024
What I talk about when I talk about family planning
Recent studies on options in family planning have changed my practice, and I now routinely take the opportunity when reviewing family planning options for people who are at risk of becoming pregnant and do not want to be pregnant to review emergency contraception and abortion as options in family planning. read more...
Dr. Ilona Hale
Sep 16, 2024
Introduction to planetary health in primary care
For many years, I failed to recognize the unique potential I had to make a difference to the environment as a clinician, from within my own practice. However, using a planetary health approach in clinical practice not only allows us to reduce environmental impacts but also offers many co-benefits: better health outcomes, lower costs, decreased workload, and a more resilient and sustainable system. read more...
Dr. Laura Sauvé, Winnie Fu, Dr. Sofia Bartlett, Dr. Orlee Guttman, Dr. Chelsea Elwood, Dr. David Goldfarb, Dr. Neora Pick
Aug 19, 2024
Hepatitis C virus: cascade of care in infants and children
Children perinatally exposed to hepatitis C virus (HCV) in pregnancy have a 5-11% chance of becoming infected with HCV. Data suggests that a high proportion of infants exposed to HCV may be lost to care in the current system in BC. We recommend interventions to help identify and treat babies and infants exposed to HCV. read more...
Anthony Lau, Katherine Daley, Hans Haag, Dr. Martha Ignaszewski
Jul 22, 2024
Therapeutic considerations of gabapentin versus pregabalin in treating chronic neuropathic pain
I now advocate for deprescribing gabapentin when patients do not achieve adequate pain relief for chronic neuropathic pain at a cumulative daily dose of 1800 mg. Instead, I consider pregabalin as a substitute for gabapentin in patients with inadequate pain control rather than further dose escalations. read more...
