Post Archives

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...

Drs. Tracy Monk, Nick Graham, Karin Kausky, Michele Thomasse, and Ryan Gallagher
March 22, 2022

Practice tip (for BC practitioners) utilizing PathwaysBC beyond specialist lookups — finding patient handouts, requisitions, point-of-care tools

We all used PathwaysBC.ca to help us find specialists for our patients, to look up wait times and what information to include in a referral, but we learned that Pathways could help streamline our clinical work in so many more ways. read more...

Drs. Shirley Jiang and Hin Hin Ko
March 9, 2022

Use of non-invasive tests for liver fibrosis

While liver biopsy is crucial in determining the stage of liver fibrosis in chronic liver disease, it is not the most accessible or appropriate test in most general practice settings. Non-invasive tests (NITs) for liver fibrosis, on the other hand, are more widely available and applicable to different liver conditions. NITs can be a useful tool in general practice to stratify high-risk patients who may require further investigations and referral to specialist care. read more...

Drs. Alejandro Dau, Agnes Lee, and Tony Wan
February 22, 2022

Pharmacologic thromboprophylaxis in hospitalized patients with COVID-19

COVID-19 is associated with an increased risk of venous, arterial, and microvascular thrombosis. Early reports documented high rates of venous thromboembolism (VTE) in hospitalized patients with COVID-19, with pooled incidences of 20-30%, despite standard-dose thromboprophylaxis. Multiple randomized control trials (RCTs) have sought to determine the safety and efficacy of therapeutic anticoagulation in both critically ill and non-critically ill hospitalized patients with COVID-19. read more...

Brendan McNeely and Dr. Amanda Hu
February 9, 2022

Tokes in the throat: cannabis smoking-related harm in otolaryngology

Recent evidence has emerged that shows cannabis smoking is related to significant patient morbidity. Namely, cannabis smoke exposure increased the risk of oropharyngeal cancer in a dose-dependent manner. Cannabis use may also be associated with hearing loss, vestibular dysfunction, tinnitus, and sinusitis. read more...

Drs. Taylor Drury, Poupak Rahmani, and Tony Wan
January 26, 2022

Perioperative anticoagulation management in mechanical heart valves, the PERIOP2 trial

We continue to use full dose therapeutic low molecular weight heparin (LMWH) for bridging in the pre-operative period. However, we now use post-operative prophylactic LMWH as an alternative bridging strategy in patients undergoing high-risk bleeding procedures. In patients at high risk of thromboembolism (including mechanical mitral valve and atrial fibrillation) undergoing a high-risk bleeding procedure, we are now less aggressive in resuming full dose therapeutic anticoagulation, as we feel comfortable using prophylactic LMWH for up to several days post-operatively before resuming therapeutic anticoagulation. read more...

Gerri Klein
January 12, 2022

Advances in diabetes glucose monitoring

For all my patients who are on hypoglycemic medications, oral or injectable, I suggest using rtCGM or isCGM. Even intermittent use or a short trial of 10 days to two weeks with either of these devices can be enlightening for patients. With the ongoing COVID restrictions, many of my patients have been unable (or unwilling) to obtain an A1C from a lab test. In my practice, I have found it helpful to use glucose TIR to assess glucose control as an adjunct measure to A1C results; when an A1C is not available; and to guide treatment recommendations. read more...

Dr. Steve Wong
December 21, 2021

Letter from the editor

Who would have thought 2021 could bring with it even more dreadful events than the year before? In this past year, we all became familiar with words that were previously obscure — terms like heat dome, atmospheric river, and now Omicron. Yet, there are words that I'm glad we're hearing more often these days, too. Words like representation, reconciliation, and the focus of our last article this year: compassion. read more...

Drs. Tandi Wilkinson and Shireen Mansouri
December 7, 2021

Cultivating compassion for people who are unvaccinated

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. read more...

Drs. Elina Liu, Erin Morley, and Anna Rahmani
November 15, 2021

PAUSE Trial & Thrombosis Canada Guidelines: practice tip

Each year, 1 in 6 patients with atrial fibrillation, or an estimated 6 million patients worldwide, will require perioperative anticoagulant management. An increasing number of atrial fibrillation patients are using direct oral anticoagulants (DOACs) in place of warfarin for stroke prevention. However, there has been uncertainty regarding perioperative management of DOACs, with significant variability noted in clinical practice. This can lead to potential harm with an increased risk of thrombosis if a DOAC is held for too long versus increased risk of post-operative bleeding if interruption intervals are too short. read more...

Dr. Elisabeth Baerg Hall
October 27, 2021

Adult ADHD — Practice Tip

October is ADHD Awareness Month. Patients may be increasingly aware of ADHD, having heard about the associated functional impairment and identifying with these stories. Treatment for adults with ADHD is effective. For best results, treatment includes both medications and Executive Function Skills support. read more...

Beata Chami
October 5, 2021

Physician well-being during COVID-19 — burnout & moral injury

It has been eighteen months since COVID-19 emerged in Canada. The trajectory of the pandemic has placed a strain on our citizens’ mental health, particularly our frontline workers. While physician well-being has been a longstanding concern, the global pandemic has magnified the daily challenges that clinicians so bravely navigate to safeguard the health of their patients. read more...

Drs. Lauren Hughes and Heather L. O'Donnell
September 15, 2021

Approach to the patient with flashes and/or floaters

Acute onset of monocular flashes and/or floaters is a common presentation to primary care providers. Most often, this represents a posterior vitreous detachment (PVD), an age-related condition with a prevalence that increases from 24% in adults aged 50 to 59 to 87% among those aged 80 to 89 years. read more...