All articles

Dr. Shirley Samuel-Haynes
November 21, 2023

Palliative approach to care and serious illness conversations

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. read more...

Beata Chami
November 8, 2023

Effectively managing imposter syndrome in medicine

Experience of imposter feelings is linked to poor mental health outcomes such as anxiety, depression, and burnout and results in lower professional fulfillment. There may not be a “cure” for imposter syndrome, but there are strategies available to minimize the onset of it. Addressing symptoms that can have a significant impact on your well-being and those that you care for. read more...

Dr. Rachel Grimminck, Dr. Jo Hoffman, and Dr. Laura McLean
October 25, 2023

Psychedelics: safely navigating a new frontier

Given the rapidly shifting social, political, and legal contexts surrounding the use of psychedelics, we realized the need to offer an informed opinion on the use of psychedelics in the same way we offer information and harm reduction strategies for substances such as opiates, cannabis, and alcohol. read more...

Dr. Nawaaz Nathoo and Sorayya Seddigh
October 11, 2023

No more reading glasses: daily eyedrops for presbyopia

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. read more...

Dr. Ken Tan, Dr. Julia Stewart, Dr. Doug McTaggart, Dr. Sandra Lee, Chase Simms (MPH)
September 26, 2023

Changing the game for Acute Infectious Diarrhea — IDP for the win!

A new laboratory test has been introduced in BC: the Infectious Diarrhea Panel (IDP). This combines the previous three tests with a single-specimen test, and replaces the stool C&S and O&P in BC. Note, however, that standalone C. difficile tests are still available. read more...

Drs. Jill Norris and Jessica Otte
September 12, 2023

Implementing Prescribing Portraits — Therapeutics Initiative

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. read more...

Drs. Domnick Manhas and Tony Wan
August 23, 2023

Thromboprophylaxis in ambulatory cancer patients

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. read more...

Dr. Sander Veldhuyzen van Zanten
August 9, 2023

Management of Helicobacter pylori in 2023: who should be tested, treated, and how

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). read more...

Vinicio Delgado and Dr. Wayne Lai
July 19, 2023

Offering Brief Behavioral Therapy for insomnia (BBTi) in primary care settings

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. read more...

Hans Haag and Dr. Ricky Turgeon
July 5, 2023

Identifying and treating iron deficiency in patients hospitalized for heart failure

Heart failure is the third leading cause of hospitalization in Canada and leads to readmission in 1 in 5 patients within 30 days after discharge. Iron deficiency (with or without anemia) is an important comorbidity in patients with HF and is associated with worse outcomes. Assess iron deficiency for all patients with HFrEF and HFmrEF admitted for acute HF. read more...

Jamison Falk, PharmD
June 19, 2023

SGLT2i in patients with diabetes: translating an evolving body of evidence to the nuances of practice

While I’ve been hard on newer medications like SGLT2i for their relatively small benefit in lower-risk patients, recent systematic reviews show that our traditional interventions are no better, and may be worse, at reducing risks of outcomes. I now discuss the option of adding an SGLT2i with patients with diabetes and pre-existing cardiovascular or renal disease or with symptomatic hyperglycemia where blood glucose reduction would be expected to reduce day-to-day symptoms. I reduce or discontinue doses of other antihyperglycemic medications if possible when starting an SGLT2i and I educate patients about potential adverse events. read more...

Drs. Kevin Lee and Persia Pourshahnazari
May 31, 2023

Help, “hive” got a rash! – Article 2: Practical tips in the management of chronic spontaneous urticaria (CSU)

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. read more...