Post Archives

Drs. Jennifer Kask and Kirsten Duckitt
January 25, 2023

Vaginal progesterone for the prevention of preterm birth

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. read more...

Dr. Karin Kausky, Dr. Tracy Monk, and Daniela Michel, MPH
January 11, 2023

Bugs & Drugs guide to antimicrobial therapy

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. read more...

Dr. Steve Wong
December 19, 2022

Letter from the editor

While I do think AI will become a tool we integrate into all aspects of medical practice in the coming years, we still need our collective human intelligence to reflect on how our choices impact patients, their families, the medical system, and society. We might not always agree, but I've always held that respectful debate leads to learning and evolution of knowledge. read more...

Dr. Caitlin Dunne
November 30, 2022

Diagnosis and treatment of polycystic ovary syndrome (PCOS) using virtual health

Polycystic ovary syndrome is the most common endocrinopathy in women of reproductive age. It affects 8%–13% of young women and its symptoms are some of the most prevalent concerns that community physicians encounter. In many cases, diagnosis and management can be carried out in a virtual health setting using clinical criteria and judicious use of laboratory investigations. read more...

Drs. Piszczek, Wright, and Grant
November 16, 2022

Moving into the treatment phase of the COVID-19 pandemic

My approach now is to have the confidence to reassure patients who are low risk that SARS-CoV2 infection will most likely be mild for them and that no specific therapy is needed. Those who are of intermediate risk will also generally do well, but it is an opportunity to create a plan of what to do if they have flu-like symptoms, including their preferences should they test COVID positive. For those who are at high risk, especially CEV-1, I ensure them that there is a clear testing and treatment plan. Any physician can prescribe Nirmatrelvir/rt. A step-by-step instruction guide for prescribing is available on the BCCDC website. read more...

Drs. Cheryl Young and David McVea
November 2, 2022

Radon: a preventable cause of lung cancer

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. read more...

Dr. Elisabeth Baerg Hall
October 19, 2022

Women with ADHD — Practice Tips

October is ADHD Awareness month. Until recently, female presentations of ADHD have been largely overlooked in both clinical and research settings. With increasing awareness and media attention to women and ADHD, adult women are asking if ADHD could explain their longstanding challenges. read more...

Drs. Fiona Petigara and Joanna Cheek
September 28, 2022

Offering CBT skills by group medical visits

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. read more...

Dr. Konia Trouton
September 12, 2022

Why I talk about all Long Term Reversible Contraception (LARC)

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. read more...

Dr. Kevin Afra, Maggie Wong, PharmD, Tim T.Y. Lau, PharmD, and Dr. Victor Leung
August 15, 2022

Duration of antimicrobial therapy for common infections in primary care

Antibiotic treatment duration decision-making is fundamentally a balance of expected benefit and harm. Anchoring our expectations of benefit and harm with the most current literature can better inform clinical decision-making. The harms of antibiotics are often underappreciated. Shorter treatment durations are just as effective as longer durations for a wide range of common infections. read more...

Drs. Mel Krajden and Jim Gray
July 28, 2022

Hepatitis C birth cohort testing

WHO observes July 28th as World Hepatitis Day and aims to eliminate Hepatitis B and C by 2030. The Pan-Canadian Sexually Transmitted and Blood-Borne Infections (STBBI) Framework for Action released in 2018 echoes this goal and calls for 80% of eligible people in Canada to receive hepatitis C treatment by 2030. In order to achieve these goals by 2030, high rates of testing and diagnosis are essential. New HCV therapies are well tolerated, require 8–12 weeks of treatment, are publicly funded in BC, and have cure rates of about 95%. read more...

Arman Abdalkhani, MD FRCSC
July 15, 2022

It’s not the ear — how TMD can confound clinicians

Otolaryngologists receive many referrals for what is classified as Eustachian Tube Dysfunction, aural fullness, and subjective hearing loss. Practitioners frequently encounter ear fullness or subjective hearing loss, in the face of an otherwise normal exam. It may lead practitioners to “read into” their physical exam with abnormal tympanic membrane (TM) findings. read more...

Drs. Val Stoynova and Celia Culley
June 28, 2022

Mitigating the climate impact of asthma therapy

I have changed my practice to optimize patient care and planetary health by considering the climate impact of my prescribing choices while continuing to provide high-quality, evidence-based, lower cost, patient-centred asthma care. read more...

Drs. J Marie Kim and William Connors
June 15, 2022

Prevention of recurrent cellulitis

Skin and soft tissue infections (SSTIs) are exceedingly common and account for up to 10% of all hospital admissions in Western countries. The most common SSTIs, cellulitis, refers to diffuse, superficial, spreading skin infections, often with significant inflammation of lymphatic vessels. Cellulitis can frequently recur and studies have shown that up to 29% of admissions with cellulitis were due to repeat episodes. Prophylactic therapies and mitigating of risk factors have been recently shown to reduce recurrence. The focus of this article is the prevention of recurrent, lower-extremity, nonpurulent cellulitis that is not associated with major penetrating trauma, preceding leg ulceration, or surgery. read more...

Drs. Angela Hu, Jon Chan, and Neda Amiri
May 24, 2022

Inflammatory back pain: distinguishing it from common mechanical back pain

Low back pain is a common complaint encountered in the general practitioner’s office. In fact, about two-thirds of adults suffer from low back pain at some point in their life, and it is second to only upper respiratory problems as a reason for visits to a physician. Axial spondyloarthritis is an autoimmune disease that results in inflammation in the spine. A number of therapies exist for this condition and early therapy may prevent progressive spinal fusion. Given the sheer prevalence of low back pain, identifying patients with axial spondyloarthritis can be challenging. read more...

Dr. Katarina Wind
May 3, 2022

Why I no longer prescribe weight loss, calculate BMI, or use the term “obesity”

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. read more...

Dr. Michael Diamant
April 19, 2022

Identifying Advanced Heart Failure in your patient

The prevalence of ambulatory patients with advanced or end-stage heart failure (HF) is increasing over time, and now comprises as much as 14% of all patients with HF. Patients may be eligible for advanced therapies, including durable mechanical circulatory support (MCS) and heart transplantation, that can change their trajectory and markedly improve long-term survival. read more...

Shari Hurst
April 6, 2022

Practice tips for heart failure with reduced ejection fraction (HFrEF): supporting patients with medications and self-monitoring

There are a few tips and tricks to improve medication tolerance and adherence, and improve quality of life for patients with HF-rEF. Multiple studies have shown that a focus on patient education and empowerment along with clinical follow-up for HFrEF medical treatment improves survival, reduces hospitalizations, and improves quality of life. read more...