Canadian Doctors Research Articles

“Knowing Something I Was Not Meant to Know”: Exploring Vulnerability, Sexuality, and Childhood, 1900–50

In this Forum, I explore the discourse of Canadian doctors and educators regarding childhood sexuality, a topic laden with emotional import and moral hand-wringing, and some of the ways youngsters responded to it between 1900 and 1950. Historians have largely overlooked the “everydayness” of sexuality in childhood in Canada perhaps because the topic risks challenging long-standing associations between childhood and innocence. History, however, points to more complex relationships among youngsters, adult experts, and discourses of sexuality and, in particular, sexuality education. Here, I put expert discourse in conversation with oral histories of Canadians who felt the impact of this adult-produced discourse in their childhoods. The participants testify to the inadequate and inaccurate information about their own bodies that resulted in silence and miseducation regarding sexuality. This miseducation produced fear, shame, and, ultimately, vulnerability in many young people and reinforced unequal relations of power. In the most extreme cases, children were rendered more, not less, vulnerable to abuse by adults and even other children.

Curb prescriptions to combat opioid crisis.

Canadian doctors need to stop prescribing high doses of opioids to patients with pain and slowly taper off patients already on high doses, urged experts at the federal Opioid Conference Nov. 18 in Ottawa. “If opioids were a new drug ... they would almost certainly be pulled,” said Dr. Jason

Shifting from picking up the pieces to preventive health

Dr Lori Teeple has been a family and emergency medicine physician for over 25 years. She is an award-winning teacher and has published several national papers for physician education. Currently, Dr Teeple is a part of the Bluewater Area Family Health Team, which serves approximately 3500 patients with an interdisciplinary team of health care professionals. Dr Teeple recently published Overweight is a Disease: A Canadian Doctor’s Prescription for Self-Management,1 a workbook designed to provide an evidence-based approach to lifestyle modification using self-reflection, healthier diet, and exercise habits. Her main academic interests are in education; she is currently on an educator sabbatical, developing small group educational modules for continuing professional development.

Behind the Lines: War Books of the Canadian Army Medical Corps, 1914 - 1918 (pp 233-260)

An analysis of published and unpublished materials generated by the Canadian Army Medical Corps during the First World War demonstrates that Canadian doctors and nurses serving in France created a narrative of the Great War that was more optimistic in its message than the canonical war books written in the 1920s and 1930s and more internationalist in orientation than the dominant narrative of the war created in Canada after the war.

Risk talk: Using evidence without increasing fear

Objectivethis paper explores unexpected findings about how to "do risk talk" which emerged during a broader research project on of the application and misapplication of evidence-based practice in Canada. Designthe study used qualitative methods such as semi-structured interviews and thematic analysis of inter-professional maternity care conference presentations. SettingCanada Participantsfifty Canadian midwives, doctors and nurses involved in maternity care were interviewed to uncover the "how and whys" of differing interpretations and uneven application of evidence. Resultscare providers described a "lean to technology" as an unexpected result of using evidence in their discussions with pregnant women. They perceived risk talk as undermining low intervention approaches and reassurance about the safety of birth. Across professional groups, interviewees described how they attempted to mitigate this unwanted effect. Their strategies to put risk in perspective include finding comparable everyday risks, using words and pictures to describe numbers and using absolute risk and numbers needed to treat rather than relative risk. They warned about the need to balance a culture of fear combined with maternal altruism. Time, reassurance, awareness and humility were seen as key tools. Key conclusions and implications for practicemidwives and other maternity care providers can use a variety of techniques to put risk into perspective. It is important to discuss evidence and risk with an awareness that the process itself can exaggerate risk. Care providers in all professional groups were motivated to avoid contributing to a culture of fear about childbirth and increasing rates of intervention.

A Defence of Conscientious Objection in Medicine: A Reply to Schuklenk and Savulescu.

In a recent (2015) Bioethics editorial, Udo Schuklenk argues against allowing Canadian doctors to conscientiously object to any new euthanasia procedures approved by Parliament. In this he follows Julian Savulescu's 2006 BMJ paper which argued for the removal of the conscientious objection clause in the 1967 UK Abortion Act. Both authors advance powerful arguments based on the need for uniformity of service and on analogies with reprehensible kinds of personal exemption. In this article I want to defend the practice of conscientious objection in publicly-funded healthcare systems (such as those of Canada and the UK), at least in the area of abortion and end-of-life care, without entering either of the substantive moral debates about the permissibility of either. My main claim is that Schuklenk and Savulescu have misunderstood the special nature of medicine, and have misunderstood the motivations of the conscientious objectors. However, I acknowledge Schuklenk's point about differential access to lawful services in remote rural areas, and I argue that the health service should expend more to protect conscientious objection while ensuring universal access.

Effects of individual immigrant attitudes and host culture attitudes on doctor-immigrant patient relationships and communication in Canada

IntroductionIn many countries doctors are seeing an increasing amount of immigrant patients. The communication and relationship between such groups often needs to be improved, with the crucial factor potentially being the basic attitudes (acculturation orientations) of the doctors and patients. This study therefore explores how acculturation orientations of Canadian doctors and immigrant patients impact the doctor-patient relationship.MethodsN = 10 participants (five doctors, five patients) participated in acculturation orientation surveys, video recordings of a regular clinic visit, and semi structured interviews with each person. Acculturation orientations were calculated using the Euclidean distance method, video recordings were analyzed according to the Verona Coding System, and thematic analysis was used to analyze the interviews. Interviews were used to explain and interpret the behaviours observed in the video recordings.ResultsThe combined acculturation orientations of each the doctor and immigrant patient played a role in the doctor-patient relationship, although different combinations than expected produced working relationships. Video recordings and interviews revealed that these particular immigrant patients were open to adapting to their new society, and that the doctors were generally accepting of the immigrants’ previous culture. This produced a common level of understanding from which the relationship could work effectively.ConclusionA good relationship and level of communication between doctors and immigrant patients may have its foundation in acculturation orientations, which may affect the quality of care, health behaviours and quality of life of the immigrant. The implications of these findings are more significant when considering effective interventions to improve the quality of doctor-patient relationships, which should have a solid foundational framework. Our research suggests that interventions based on understanding the influence of acculturation orientations could help create a basic level of understanding, and therefore improved interaction between doctors and immigrant patients.

Chiropractors' Characteristics Associated With Physician Referrals: Results From a Survey of Canadian Doctors of Chiropractic

ObjectiveThe purpose of this study was to identify characteristics of Canadian doctors of chiropractic (DCs) associated with the number of patients referred by medical doctors (MDs). MethodsSecondary data analyses were performed on the 2011 cross-sectional survey of the Canadian Chiropractic Resources Databank. The Canadian Chiropractic Resources Databank survey included 81 questions about the practice of DCs. Of the 6533 mailed questionnaires, 2529 (38.7%) were returned and 489 did not meet our inclusion criteria. Our analyzed sample included 2040 respondents. Bivariate analyses were conducted between predetermined potential predictors and the annual number of patients referred by MDs, and negative binomial multivariate regression was performed. ResultsOn average, DCs reported receiving 15.6 (standard deviation, 31.3) patient referrals from MDs per year and nearly one-third did not receive any. The type of clinic (multidisciplinary with MD), the province of practice (Atlantic provinces), the number of treatments provided per week, the number of practicing hours, rehabilitation and sports injuries as the main sector of activity, prescription of exercises, use of heat packs and ultrasound, and the percentage of patients referred to other health care providers were associated with a higher number of MD referrals to DCs. The percentage of patients with somatovisceral conditions, using a particular chiropractic technique (hole in one and Thompson), taking his/her own radiographs, being the client of a chiropractic management service, and considering maintenance/wellness care as a main sector of activity were associated with fewer MD referrals. ConclusionCanadian DCs who interacted with other health care workers and who focus their practice on musculoskeletal conditions reported more referrals from MDs.

Factum of the Charter Committee on Poverty Issues and the Canadian Health Coalition in: Canada (Attorney General) v. Canadian Doctors for Refugee Care (Federal Court of Appeal)

The Charter Committee on Poverty Issues (CCPI) together with the Canadian Health Coalition, sought leave to intervene in before the Federal Court of Appeal to challenge Juctice Mactavish's finding, at trial, that depriving refugees of federal health benefits did not violate of the rights to life and to security of the person guaranteed under section 7 of the Charter. The intervention sought to challenge this finding, and the implication that those who rely on publicly funded health care do not enjoy the same level of section 7 protection found, in the 2005 Supreme Court of Canada decision in Chaoulli v Quebec (Attorney General), to apply to those who can afford privately funded health care. The CCPI/CHC application for leave to intervene was rejected by the Federal Court of Appeal.

Relationship Between Chiropractic Teaching Institutions and Practice Characteristics Among Canadian Doctors of Chiropractic: A Random Sample Survey

ObjectiveThe objectives of this study were to determine if faction membership among Canadian doctors of chiropractic (DCs) is associated with differences in educational program characteristics among English-speaking Canadian and United States chiropractic colleges and to determine if those differences are expressed in terms of surveyed attitudes and behaviors regarding treatment efficacy, radiographic imaging, vaccinations, and interprofessional referrals. This study also aims to identify if educational programs may be a potential source of multiple professional identities. MethodsA randomly selected sample of Canadian DCs, stratified across the English-speaking provinces, was surveyed by mail. Survey items included school of graduation, self-categorization by chiropractic subgroup, perceptions of condition-specific treatment efficacy, use of plain film radiographic imaging, vaccination attitudes/behaviors, and patient referral patterns. Self-categorization by chiropractic subgroup included: the unorthodox faction (associates the chiropractic subluxation as an encumbrance to the expression of health) and the orthodox perspective (associates with musculoskeletal joint dysfunction, public health, and lifestyle concerns). For data analysis, chiropractic schools were divided into 2 groups according to location: English-speaking Canada and the US. The US was further clustered into liberal (“interested in mixing elements of modern and alternative therapies into the practice of chiropractic") and conservative categories (“chiropractors who believe in continuing the traditions of chiropractic"). ResultsOf 740 deliverable questionnaires, 503 were returned for a response rate of 68%. χ2 Testing revealed significant differences in self-categorized faction membership associated with the clustering of colleges based on ideological viewpoints (χ2 = 27.06; P = .000). Descriptive results revealed a relationship between school of origin and perceived treatment efficacy, use of radiographic imaging, and vaccination attitudes. No significant differences were found relative to interprofessional referral patterns. ConclusionChiropractic program attended is a significant predictor of orthodox vs unorthodox faction membership and professional practice characteristics for Canadian DCs. This suggests that the current chiropractic education system may contribute to multiple professional identities.

Two Wings and a Prayer: Should Canada Make It Easier for Canadian Doctors Trained Abroad to Enter Practice Here?

About 3,600 Canadians are currently studying medicine abroad (CSMAs). Most hope to return to practise in Canada. But the road back is not easy. These graduates must complete postgraduate residency training in Canada and alas, there are less openings than there are aspirants. One might have thought, amid the endless rhetoric of "physician shortages," that an obvious solution would be to increase the number of residency positions. But provincial governments are well aware, even if the media are not, that Canada is in the early stages of a dramatic expansion in physician supply fuelled by increased domestic training capacity. Last time the physician supply outpaced population growth, as it is doing today, governments choked off the entry of international graduates. It could happen again.

Foreign OR, Canadian doc: medical tourism with a twist

Orthopedic surgeons in Canada are well aware that people sometimes travel abroad for quicker access to procedures such as hip and knee replacements, but news that Canadian doctors are accompanying patients to exotic locales has caught some by surprise. “It is an unusual practice to bring the

Written Representations of the Proposed Interveners:  Charter Committee on Poverty Issues and the Canadian Health Coalition in Canada V Canadian Doctors for Refugee Care (Federal Court of Appeal)

Written Representations of the Proposed Interveners:  Charter Committee on Poverty Issues and the Canadian Health Coalition in Canada V Canadian Doctors for Refugee Care (Federal Court of Appeal)

Henry Morgentaler: model for the UK?

The life of Henry Morgentaler (19 March 1923 to 29 May 2013),1 the Canadian doctor and abortion rights activist, has important lessons for the future of abortion law in the...

Canadian doctor is new president of MSF International

Pediatric emergency physician and the new president of Médecins Sans Frontières (MSF) International, Dr. Joanne Liu, calls herself a “doctor by day, humanitarian always.” The second Canadian to head the nongovernmental organization, Liu started her career with MSF in 1996, working with Malian

Placebos in the clinic

Placebos in the clinic

Canadian doctor led bombing response at a Boston hospital

It was just after 3 pm on Monday, Apr. 15, when Dr. Ron Walls’ office and cell phones began ringing simultaneously. His assistant’s phone was also sounding. Then a banner alert from USA Today slid across his phone’s screen, and he knew it was real. Brigham and Women’s Hospital had twice

Characterisation of retinoblastomas without RB1 mutations: genomic, gene expression, and clinical studies

Retinoblastoma is the childhood retinal cancer that defined tumour-suppressor genes. Previous work shows that mutation of both alleles of the RB1 retinoblastoma suppressor gene initiates disease. We aimed to characterise non-familial retinoblastoma tumours with no detectable RB1 mutations. Of 1068 unilateral non-familial retinoblastoma tumours, we compared those with no evidence of RB1 mutations (RB1(+/+)) with tumours carrying a mutation in both alleles (RB1(-/-)). We analysed genomic copy number, RB1 gene expression and protein function, retinal gene expression, histological features, and clinical data. No RB1 mutations (RB1(+/+)) were reported in 29 (2·7%) of 1068 unilateral retinoblastoma tumours. 15 of the 29 RB1(+/+) tumours had high-level MYCN oncogene amplification (28-121 copies; RB1(+/+)MYCN(A)), whereas none of 93 RB1(-/-) primary tumours tested showed MYCN amplification (p<0·0001). RB1(+/+)MYCN(A) tumours expressed functional RB1 protein, had fewer overall genomic copy-number changes in genes characteristic of retinoblastoma than did RB1(-/-) tumours, and showed distinct aggressive histological features. MYCN amplification was the sole copy-number change in one RB1(+/+)MYCN(A) retinoblastoma. One additional MYCN(A) tumour was discovered after the initial frequencies were determined, and this is included in further analyses. Median age at diagnosis of the 17 children with RB1(+/+)MYCN(A) tumours was 4·5 months (IQR 3·5-10), compared with 24 months (15-37) for 79 children with non-familial unilateral RB1(-/-) retinoblastoma. Amplification of the MYCN oncogene might initiate retinoblastoma in the presence of non-mutated RB1 genes. These unilateral RB1(+/+)MYCN(A) retinoblastomas are characterised by distinct histological features, only a few of the genomic copy-number changes that are characteristic of retinoblastoma, and very early age of diagnosis. National Cancer Institute-National Institutes of Health, Canadian Institutes of Health Research, German Research Foundation, Canadian Retinoblastoma Society, Hyland Foundation, Toronto Netralaya and Doctors Lions Clubs, Ontario Ministry of Health and Long Term Care, UK-Essen, and Foundations Avanti-STR and KiKa.

Doctors promise protests along with court challenge to refugee health cuts

Canadian doctors who have launched a legal challenge against the federal government’s cuts to health benefits for refugees promise further protests and disruption of federal Cabinet ministers’ announcements, starting this spring. Medical students and residents who have “never been in the

Triangulation in Canadian Doctoral Dissertations on Aging

Triangulation in Canadian Doctoral Dissertations on Aging