By Dr. Heather Fulton on November 26, 2024
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.
By Dr. Michelle C. Chan on October 22, 2024
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.
By Dr. Ilona Hale on September 16, 2024
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.
By Dr. Sarah McCorquodale on June 17, 2024
Having evidence that remission of type 2 diabetes is possible through weight loss in select people, I have changed my approach to prevention and management of type 2 diabetes.
By Dr. Omesh Syal on April 15, 2024
I highly recommend registering with the Health Data Coalition and becoming more familiar with your measures within the HDC Discover application to recognize your contribution. We, as a collective profession, can make a positive impact on our own practices and larger communities.
By Dr. Paxton Bach on March 12, 2024
The new Canadian guideline situates alcohol-related harms along a continuum, recognizing that negative health and social consequences of alcohol can arise even at rates previously consistent with low risk.
By Rohit Singla PhD, Dr. Daniel Raff, Dr. Hester Vivier, and Dr. Andre Van Wyk on February 14, 2024
Conversational AI has become a valuable tool for family physicians in Canada. It helps us provide better patient care, eases the burden of documentation, and reduces burnout. Incorporating digital scribe technology brings marked efficiency, especially given the high patient volumes. With AI managing real-time transcription and summarization, physicians can give undivided attention to patients, deepening rapport and focus on prescriptions and referrals.
By Drs. Kevin Liang and Philip Hui on January 10, 2024
New asthma and COPD guidelines are changing the way we provide respiratory care; SABDs, such as salbutamol and ipratropium, are no longer the mainstay treatment for both conditions. Importantly, SABD overuse is a measure of poor disease control and suggests a need for treatment escalation.
By Dr. Shirley Samuel-Haynes on November 21, 2023
I learned that a palliative approach to care and serious illness conversations address and manage patients’ and families’ psychological, practical, social, loss/grief, spiritual, and physical issues like pain and symptom management in line with their goals of care and help prepare for eventual life closure. Here are practical tips on how to implement this in your practice.
By Dr. Nawaaz Nathoo and Sorayya Seddigh on October 11, 2023
There are currently no eye drops for presbyopia treatment that have been approved for use in Canada. In December 2021, pilocarpine hydrochloride 1.25% eye drops became the first drug approved by the FDA for the medical management of presbyopia. Pilocarpine is a miotic agent that uses the eyes’ natural ability to constrict the pupil via parasympathetic innervation. It has been shown to improve near-intermediate vision without impacting distance vision.
By Drs. Jill Norris and Jessica Otte on September 12, 2023
Primary care clinicians face an overwhelming volume of information to process and tasks to complete. There are new and sometimes conflicting guidelines and practice standards, forms to fill out, emails about meetings, and an inbox full of labs, documents to review, and messages to respond to. Now that I get Portraits in my email inbox from time to time, I schedule time to look at them, and focus on the listed recommendations and whether my pattern of practice is close to where it should be according to the evidence, and if not, why not.
By Drs. Domnick Manhas and Tony Wan on August 23, 2023
It is estimated that 15% of all cancer patients will develop VTE, resulting in significant morbidity and mortality. The cost of cancer-associated thrombosis is substantial to the healthcare system. Currently, routine thromboprophylaxis is not recommended given the fear of increased risk of bleeding, modest absolute risk reduction in VTE, and inconvenience. However, a selected group of cancer patients with very high VTE risk will benefit from thromboprophylaxis.
By Dr. Sander Veldhuyzen van Zanten on August 9, 2023
Helicobacter pylori (H. pylori) continues to be an important pathogen, associated with peptic ulcer disease, dyspepsia, and gastric cancer. The conventional triple combination of a PPI, clarithromycin, and either amoxicillin or metronidazole is no longer recommended because its success rates have decreased to less than 60%. The recommended first-line therapy is concomitant therapy (PPI, clarithromycin, amoxicillin, and metronidazole) and second-line therapy is bismuth-based therapy (PPI, bismuth, metronidazole, and tetracycline).
By Vinicio Delgado and Dr. Wayne Lai on July 19, 2023
Insomnia is one of the most commonly reported sleep disorders at our sleep clinic. Despite its prevalence, treating it can be challenging due to its complex and multifactorial nature. A comprehensive and personalized approach to treatment is, therefore, necessary for effective management. However, providing this level of support requires significant time and resources. Offering a self-help intervention as a complement to care can help reach patients who might not otherwise receive CBTi or refuse onsite treatment.
By Drs. Kevin Lee and Persia Pourshahnazari on May 31, 2023
While not a fundamentally dangerous condition, CSU can have a significant impact on a patient’s quality of life and can be challenging to manage. Symptoms can be prolonged and can recur even after a long symptom-free period. Escalate and taper non-sedating H1-antihistamines, encourage daily antihistamine use, and add corticosteroids or refer to an allergist if needed.
By Drs. Rohit Vijh and Jason Wong on May 17, 2023
Pregnant persons should be screened for syphilis during the first trimester (or first prenatal visit), and at delivery (or any time after week 35 for those planning home births).
By Dr. Emma Coffey on April 3, 2023
Many patients don’t know that an IUD is a highly effective option for emergency contraception. We can offer patients either the 52mg LNG-IUS (up to 5 days) or the copper IUD (up to 7 days) for EC. Both options are highly effective at preventing pregnancy (>99%).
By Drs. Kevin Lee and Persia Pourshahnazari on March 21, 2023
Despite being a fairly common problem, with an estimated prevalence of 0.5–5%, chronic spontaneous urticaria (CSU) is often a challenging condition for health-care providers to diagnose and for patients to accept as a diagnosis. A diagnosis of CSU does not equate to a diagnosis of a systemic autoimmune disease. We do not routinely recommend dietary modification for CSU. We advise patients with CSU to limit alcohol intake and to take a higher dose of antihistamines prior to receiving vaccinations.
By Drs. Clara Lu and Renée Janssen on March 7, 2023
Since the publication of the 2020 ATS Clinical Practice Guideline on pharmacologic treatment in tobacco-dependent adults, I now explain the goals of pharmacotherapy for tobacco use disorder in terms of reducing the compulsion to smoke and increasing readiness to quit, rather than abstinence alone. If patients are open to the conversation, I will discuss and offer all pharmacotherapy options — but emphasize the efficacy and safety of varenicline as my preferred first-line agent.
By Dr. John van Bockxmeer, Dr. Vishal Varshney, and Anthony Lau, PharmD on February 15, 2023
I incorporate this ‘NSAID ceiling’ into my prescribing practice for anti-inflammatory medications. I typically prescribe maximum doses of 400 mg oral ibuprofen TID with meals and 10 mg intramuscular ketorolac. I counsel my patients to limit their NSAID use to a 5-day window when possible and encourage other non-pharmacological and multimodal analgesia.
By Drs. Jennifer Kask and Kirsten Duckitt on January 25, 2023
Preterm birth is the leading cause of perinatal morbidity and mortality in British Columbia and worldwide. We now carefully elicit any history of previous preterm birth and offer vaginal progesterone therapy for ANY history of spontaneous preterm birth. We fill in the Special Authority Request and give out the patient handout even before the patient goes to the pharmacy. We also encourage women to continue the medications until 37 weeks of gestational age.
By Dr. Karin Kausky, Dr. Tracy Monk, and Daniela Michel, MPH on January 11, 2023
Antimicrobial resistance is recognized as a top public health threat and is estimated to be directly responsible for 5,400 deaths and $1.4 billion in health care costs in Canada in 2018 which underlines the critical importance of wise prescribing of antibiotics. Every time I prescribe an antibiotic now, I check the Bugs & Drugs guidelines via PathwaysBC.ca.
By Drs. Cheryl Young and David McVea on November 2, 2022
November is Radon Action Month. There are approximately 3,000 lung cancer deaths in Canada attributable to radon exposure each year, but there is limited awareness of radon both among the public and health care providers.
By Drs. Fiona Petigara and Joanna Cheek on September 28, 2022
A large part of physician’s day is spent on mental health and wait times to see specialists can be very long. In 2022 the BC Government created “Group Medical Visit” (GMV) codes to promote physicians to deliver services to groups of patients as “an effective way of leveraging existing resources; simultaneously improving quality of care and health outcomes, increasing patient access to care and reducing costs” (BC Gov, 2022). Physicians can now refer their patients to the Group Cognitive Behavioral Therapy program via cbtskills.ca or through PathwaysBC fillable PDF and they can also train to facilitate group medical visits.
By Dr. Konia Trouton on September 12, 2022
Patient satisfaction and continuation rates are very well documented for various contraceptives in Canada. Among the combined hormonal contraceptives — the pill, patch, and ring — only 50% of people are still using them after a year, despite all efforts to improve compliance and reduce side effects. In contrast, over 80% of people are still using long-acting and reversible IUDs a year later.
By Dr. Katarina Wind on May 3, 2022
Medical school taught me that “obesity” is a cause of morbidity and mortality, and that weight loss is its cure. I recorded patients’ BMIs and counselled them on weight-loss strategies, believing that I was helping them.
By Drs. Tandi Wilkinson and Shireen Mansouri on December 7, 2021
We are hearing from many of our medical colleagues about their distress in this time of COVID-19. Many are troubled by the fact that most of the people admitted to hospitals and intensive care units are not vaccinated. Faced with yet another variant and uncertainty, we hear that our colleagues are exhausted, frustrated, and angry. Both authors, being interested in supporting physicians to thrive in their work, have been studying compassion and its role in practitioner well-being for the last few years. As looking at this issue (and other challenges of the pandemic) through the lens of compassion has been personally helpful to both of us, we wanted to share our learnings with you.
By Dr. Linda Uyeda and Dr. Ashley Miller on July 7, 2021
The ingredients needed to create a happy workplace also largely reflect the principles of secure attachment. Across all levels within organizations, if people do not feel “safe, seen, soothed, and secure” they are more likely to make errors, breach safety protocols, and struggle working together as a team.
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