Practice Change

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

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.

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

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

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.

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

By Brendan McNeely and Dr. Amanda Hu on February 9, 2022

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.

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Perioperative anticoagulation management in mechanical heart valves, the PERIOP2 trial

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

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.

Advances in diabetes glucose monitoring

By Gerri Klein on January 12, 2022

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.

Curing Through Connection: A 3-part series on attachment, resilience, and health. Article 3: The Importance of Attachment Theory in Healthcare

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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Concussion rehabilitation update and a free self-management concussion tool

By Sue Barlow and Carolyn Rondeau on June 3, 2021

Concussions or mild traumatic brain injury are the most common type of traumatic brain injury. It is estimated that every year in British Columbia (BC), there are approximately 14,500 visits to the emergency department and that this number is most likely an underestimate of the “true burden of concussion”.

Curing Through Connection: A 3-part series on attachment, resilience, and health. Article 2: Parenting During a Pandemic

By Dr. Ashley Miller and Dr. Linda Uyeda on May 12, 2021

As I started to understand that this pandemic would wear on, I had to figure out how to help my patients’ families and my own family navigate our way through this totally new reality. I drew on the science of attachment, resilience and healthy relationships to make a plan. (Please stay tuned for Article #3!)

Rate versus Rhythm Control in Patients with Atrial Fibrillation: Time to Change the Paradigm?

By Drs. Christopher C. Cheung, Kenneth G. Gin, Jason G. Andrade on February 10, 2021

Patients with persistent AF, less symptomatic and/or older patients, and those with prior anti-arrhythmic failure are best managed with a rate control strategy. The EAST-AFNET 4 study is a practice-changing trial, and strongly supports the role of early rhythm control in patients with newly-diagnosed AF.

Psychological PPE during COVID-19

By Dr. Jennifer Russel & Françoise Mathieu MEd RP on November 18, 2020

A few weeks into the COVID-19 crisis and as a psychiatrist working in a tertiary care hospital, while homeschooling my two boys, I had a strong awareness that I needed to really work to keep myself healthy in a way that I have never felt before to make sure I was able to survive this crisis. I needed to grab my psychological PPE.

Portable ultrasound

By Drs. Philip Lee and Stefanie Falz Mclellan on September 30, 2020

The integration of point of care ultrasound (PoCUS) in the emergency department workflow is not always easy, and these challenges have been amplified in the time of COVID-19. The COVID-19 pandemic has led to an increased interest in the use of handheld ultrasound devices as they simplify infection control procedures and take up little space in emergency rooms crowded with critical care equipment.

Icosapent Ethyl to Reduce Atherosclerotic Events in Patients with Hypertriglyceridemia

By Omid Kiamanesh, MD, FRCPC on August 26, 2020

Despite intensive lowering of LDL-C using lipid-modifying therapy, residual ASCVD risk persists, particularly in those with hypertriglyceridemia. Icosapent ethyl has been shown to reduce residual ASCVD risk and cardiovascular death in select patients with hypertriglyceridemia while on statin therapy.

Stress First Aid as a form of Peer Support

By Dr. Joanna Cheek on August 5, 2020

It’s not easy to train in new skills to support our mental health when the race has already begun. We are all going to cycle out of the green zone many times, regardless of our practice of self-care. We need each other right now to provide peer support to help each of us notice when we’re moving to the right of the stress continuum and pause or pace ourselves so we can complete this marathon together.

Serious Illness Conversations in the Time of COVID-19

By Drs. Lawrence Chow and Rose Hatala on May 6, 2020

In the era of the COVID-19 pandemic, our most vulnerable patients (the elderly and those with chronic illnesses) are disproportionately at the highest risk of mortality. In this difficult and chaotic time, it’s more important than ever that we maintain a humanistic approach to care. This involves keeping the patient, and their values and preferences, front and center in our care.

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Taking care of each other during COVID-19 – peer support for physicians

By Tandi Wilkinson MD CCFP-EM on April 1, 2020

I conducted a study examining effective peer support in rural Canadian physicians. (Spoiler alert: those who have had good peer support say it is essential to their career in medicine.) Here is what I am doing now to ensure I, and my team, can manage through this unprecedented time at work.

Government Assistance Forms: Do they leave you bewildered?

By Dr. Janet McKeown on March 11, 2020

Government Assistance: Health Resources and Forms tool has helped me understand assistance with a more organized approach. It has helped me access information quickly and it has helped me be more knowledgeable about billing provincially, federally and privately. It is also an efficient tool to use in a teaching environment to help learners better understand government assistance.

Hiding in plain sight: men’s mental health

By Dr. Dan Bilsker on January 8, 2020

It is well-known that men die on average 3-4 years before women – but why? We identified three main factors contributing to Years of Life Lost by men compared to women: cardiovascular disease, suicide, and motor vehicle accidents. As a psychologist, I was intrigued by the substantial contribution of suicide.

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Use of endometrial aspirators as a uterine sound for IUD insertion

By Dr. Lisa Nakajima on December 4, 2019

One of the risks of IUD insertion includes perforation of the uterus. Although uterine perforation is relatively uncommon and often does not cause long-term harm, it does increase the risk of unplanned pregnancy and often requires surgery. I have chosen to use endometrial aspirators that are commonly used for endometrial biopsy sampling as a sound for IUD insertions, instead of the traditional metal sounds.

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

By Dr. Tahmeena Ali on August 21, 2019

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.

Practice Tip: Cutaneous larva migrans

By Dr. Miguel Imperial on July 30, 2019

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.

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

By Dr. Daniel Ngui on June 12, 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.

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

By Dr. Joanna Cheek on May 8, 2019

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.

Parkinson’s disease: burden of non-motor problems

By Dr. Darly Wile on April 3, 2019

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?”

Decreasing pain of osteoarthritic knees

By Dr. Muxin (Max) Sun on March 6, 2019

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.

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

By Mark W. Hull MD MHSc on November 13, 2018

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.

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Learning to meet my patient where they are at – how letting go changed my practice

By Michelle C. Danda, RN, BN on October 10, 2018

I realized that engagement is paramount when working with an ambivalent patient, because the change that they want to make is often important in their life, even if the clinician views it as a problem behavior. Motivational interviewing education has been shown to improve patient alliance and treatment adherence.

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Trauma Informed Practice (TIP) makes perfect (or at least it is a good start)

By Dr. Carol-Ann Saari on September 5, 2018

In the general population, approximately 75% of Canadians will report having experienced an adverse and potentially traumatic experience in their lifetime, with 9.2% meeting criteria for PTSD. We have to become trauma informed. Trauma informed practice (TIP) is a way of providing services that recognizes the need for physical and emotional safety, choice and control in decisions affecting one’s treatment and an environment where patients do not experience further traumatization.

Equity-oriented health care

By Dr. Colleen Varcoe and Dr. Heather Smith on August 15, 2018

Health equity-oriented care is now part of my daily practice; the tools created with, and provided by, the EQUIP study have helped to make health care inequity an issue that I can screen for and offer options for management.

Baby aspirin for extended DVT prophylaxis after elective hip and knee arthroplasty

By Drs. Terence Yung and Tony Wan on July 24, 2018

For those who had an elective hip or knee arthroplasty who have no other risk factors for VTE, after initial 5 days of DVT prophylaxis with rivaroxaban 10mg a day, I complete the remaining DVT prophylaxis with aspirin 81mg once daily for an additional 30 days for hip arthroplasty and 9 days for knee arthroplasty. Those who already were on once-daily 81mg aspirin prior to surgery will receive 162mg aspirin once daily instead in this period.

Hip surveillance in children with cerebral palsy

By Dr. Min S. Phang, MRCP, FRCPC and Stacey Miller, PT on June 13, 2018

I now refer all children with cerebral palsy, or suspected cerebral palsy, to the Child Health BC Hip Surveillance Program. Information about the program is available at www.childhealthbc.ca/hips, including a referral form for physicians. The incidence of hip dislocations can be significantly reduced!

Practice Change

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

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

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

Perioperative anticoagulation management in mechanical heart valves, the PERIOP2 trial

Advances in diabetes glucose monitoring

Curing Through Connection: A 3-part series on attachment, resilience, and health. Article 3: The Importance of Attachment Theory in Healthcare

Concussion rehabilitation update and a free self-management concussion tool

Curing Through Connection: A 3-part series on attachment, resilience, and health. Article 2: Parenting During a Pandemic

Rate versus Rhythm Control in Patients with Atrial Fibrillation: Time to Change the Paradigm?

Psychological PPE during COVID-19

Portable ultrasound

Icosapent Ethyl to Reduce Atherosclerotic Events in Patients with Hypertriglyceridemia

Stress First Aid as a form of Peer Support

Serious Illness Conversations in the Time of COVID-19

Taking care of each other during COVID-19 – peer support for physicians

Government Assistance Forms: Do they leave you bewildered?

Hiding in plain sight: men’s mental health

Use of endometrial aspirators as a uterine sound for IUD insertion

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

Practice Tip: Cutaneous larva migrans

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

Parkinson’s disease: burden of non-motor problems

Decreasing pain of osteoarthritic knees

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

Learning to meet my patient where they are at – how letting go changed my practice

Trauma Informed Practice (TIP) makes perfect (or at least it is a good start)

Baby aspirin for extended DVT prophylaxis after elective hip and knee arthroplasty

Hip surveillance in children with cerebral palsy

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