Post Archives

Dr. Amin Javer
September 11, 2019

Sinusitis: appropriate diagnosis and management

Sinusitis is a commonly encountered condition for the Canadian family physician. Chronic sinusitis has worse quality of life scores than COPD, CHF or angina. The total cost of diagnosing and treating sinusitis remains one of the most expensive chronic disorders experienced by the North American population and continues to increase yearly. read more...

Dr. Tahmeena Ali
August 21, 2019

ACEs (Adverse Childhood Experiences): One Family Physician’s Experience

I now ask all patients, young and old, new to my practice and established for years, male and female, to complete an ACEs questionnaire in my clinic. I garner a new level of respect for my patients' resilience and for the ongoing turmoil many of my young patients face. I make finding supports for these young vulnerable patients one of my top priorities—as important as a referral to a specialist or for diagnostic imaging. read more...

Dr. Miguel Imperial
July 30, 2019

Practice Tip: Cutaneous larva migrans

Once I diagnose a patient with CLM based on a compatible travel history and characteristic serpiginous rash, I continue to treat the itch and inflammatory symptoms symptomatically if indicated, but I am able to much more readily offer systemic therapy with ivermectin since it no longer requires a Health Canada Special Access application. read more...

Beata Chami
July 10, 2019


Have you ever felt unable to make it to work, but disregarded the idea completely? These days, a common question either asked or assessed by healthcare organizations is to uncover the reason behind why doctors become unwell in their professional roles. read more...

Dr. Janet Simons
June 26, 2019

Correcting the Myth of Calcium Correction

Formulae to adjust total calcium for the albumin concentration should be abandoned. The use of these formulae overestimates ionized calcium in patients with hypoalbuminemia, causing false negatives for hypocalcemia and false positives for hypercalcemia. Measurement of ionized calcium is now relatively inexpensive and is available in most hospitals and many outpatient settings. read more...

Dr. Daniel Ngui
June 12, 2019

Facing a College Physician Practice Enhancement Program Assessment? What you need to know in 2019?

The Physician Practice Enhancement Program Assessment is highly educational and it helps physicians enhance the quality of their patient care through a peer review. It provides valuable feedback and creates opportunities to guide professional development and lifelong learning. read more...

Drs. Nawaaz Nathoo and Samir Nazarali
May 29, 2019

Dry Eye Syndrome

Much difficulty is faced by clinicians in identifying DES as there is no single diagnostic tool to indicate the condition. Furthermore, patient symptoms do not always correlate with clinical exam findings. Rather, when diagnosing DES, the clinician must consider the full constellation of patient history combined with various clinical findings. read more...

Dr. Joanna Cheek
May 8, 2019

The myth of the “Manipulative Personality Disorder”: taking the blame out of the illness

View personality disorder symptoms as important treatment targets in themselves. Be curious about each patient’s story, validate PD symptoms as coping mechanisms, focus on collaborative problem solving, set proactive regular visits, and also be mindful of your own emotional reactions providing compassion and empathy while setting clear boundaries. read more...

Dr. Ed Weiss
April 17, 2019

Anal cancer: information to get you out of the dark!

We know that the diagnosis of anal cancer in Canada is often delayed: ano-rectal symptoms such as pain and bleeding are often attributed to hemorrhoidal disease and clinicians are often hesitant to perform a digital ano-rectal examination (DARE). read more...

Dr. Darly Wile
April 3, 2019

Parkinson’s disease: burden of non-motor problems

What I have found is that while it can sometimes be assumed that motor problems are the patient’s “biggest problem”, this is often not the case; instead, I now make a point of asking the patient, and their family directly: “What is the biggest problem for you right now?” read more...

Nichole Fairbrother
March 20, 2019

Anxiety disorders among pregnant and postpartum women

Unwanted, intrusive thoughts of accidental harm to one’s infant are reported by 100% of new mothers, and unwanted, intrusive thoughts of intentionally harming one’s infant are reported by 50% of new mothers. Ask specifically about unwanted, intrusive thoughts of infant-related harm. Educate pregnant women and normalize the occurrence of the thoughts. Reassure women that, in the absence of any additional risk factors for child abuse, disclosure of these thoughts will not result in any action on the part of the care provider/physician. read more...

Dr. Muxin (Max) Sun
March 6, 2019

Decreasing pain of osteoarthritic knees

I have decreased my frequency of giving steroid injections for decreasing pain of osteoarthritic knees. I educate patients on evidence, placebo effects and risks. I recommend less invasive therapies including physiotherapy, exercise (quadriceps and hip abductor strengthening, Tai Chi), hot compress, antiinflammatory creams, weight loss, TENS machine, orthopedic & orthotic devices, etc. read more...

Dr. Leslie Sadownik
February 13, 2019

Help – the steroids are not working – Helping women with refractory vulvar lichen sclerosus

Lichen sclerosus (LS) is a chronic skin disorder with a remitting and relapsing clinical course. Women commonly present with severe vulvar itch and an urge to scratch the skin. The recommended treatment is a course of topical steroids. Most women will improve with treatment. However, some will report, “the steroids did not help”. Here are some practice tips to help. read more...

Drs. Maysam Khalfan and Kam Shojania
January 30, 2019

Pearls and Pitfalls of Rheumatologic Lab Investigations

Patients who present with non-specific symptoms are sometimes tested with rheumatologic lab investigations as part of a ‘panel’ of tests. When these tests come back positive, it can lead to more confusion, patient anxiety, misdiagnosis or unnecessary referral. read more...

Andrea Holmes
January 16, 2019

Dietary and physical activity recommendations for cancer survivors

Breast and prostate cancer survivors want to know what to eat to prevent cancer from coming back. HealthLink BC healthy eating resources that support successful dietary and physical activity change for prostate and breast cancer survivors are available for your patients. read more...

Dr. Steve Wong
December 19, 2018

Letter from the editor

More than ever, it seems, it’s important to share opinions that are backed by facts, be willing to revisit and update what you thought you knew before, and be inspired to seek out more information about something you learned anew. read more...

Drs. Terence Yung and Steve Ham
December 5, 2018

Postoperative “troponinitis” is not benign: highlighting the importance of surveillance

All postoperative troponin elevation should be treated seriously. Troponin elevation after surgery is associated with significant mortality at 30 days. Myocardial injury after non-cardiac surgery (MINS) diagnosis is made after other causes of troponin elevation are ruled out. Up to 90% of patients with a troponin elevation postoperatively do not exhibit any symptoms, yet their outcomes are still poor. read more...

Mark W. Hull MD MHSc
November 13, 2018

HIV pre-exposure prophylaxis (PrEP) for individuals at risk for HIV infection

Over the last five years, on an ongoing basis, we have seen new HIV infections occurring in young gay, bisexual and other men who have sex with men (MSM). The majority of these individuals had had a prior negative HIV test within the last year, or were presenting with signs or symptoms supportive of an acute HIV infection, suggesting recent exposure and transmission of HIV infection, highlighting the need for novel HIV prevention strategies. read more...