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Medicine remains frequently inaccessible to people with disabilities, despite their higher-than-average need for healthcare services. On this episode of the CMAJ Podcast, Dr. Blair Bigham and Dr. Mojola Omole tackle the systemic barriers that patients with disabilities face, from inaccessible clinic spaces to discriminatory attitudes.

The discussion is inspired by the CMAJ practice article, "Five ways to support people who use wheelchairs," authored by Dr. Lisa Freeman. Dr. Freeman, a public health and preventative medicine physician who uses a wheelchair, shares her lived experiences navigating a healthcare system riddled with obstacles. She introduces practical steps that physicians can take to make their practices more inclusive, such as improving communication, ensuring referrals are effective, and addressing physical accessibility.

David Lepofsky, chair of the Accessibility for Ontarians with Disabilities Act Alliance, explains the legal obligations that healthcare providers must meet to comply with human rights and accessibility laws. He offers actionable guidance on how physicians can reduce barriers, from small changes like posting signage to long-term planning for accessible infrastructure.

This episode underscores that accessibility is both a legal requirement and a fundamental part of equitable patient care. It challenges physicians to take immediate steps toward making their practices more inclusive for patients with disabilities.

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On this episode of the CMAJ Podcast, Dr. Mojola Omole and Dr. Blair Bigham discuss necrotizing fasciitis, a diagnosis that can strike fear into the hearts of clinicians due to its rapid progression and devastating consequences. The discussion builds on insights from the CMAJ practice article, “Necrotizing soft tissue infections caused by invasive group A Streptococcus,” co-authored by Dr. Saswata Deb and Dr. Stephanie Mason.

Dr. Deb, an emergency physician and clinician scientist at Sunnybrook Health Sciences Centre in Toronto, outlines the key clinical signs of necrotizing fasciitis, including pain out of proportion to physical findings and rapid hemodynamic deterioration. He emphasizes the importance of considering NSTI in the differential diagnosis for cellulitis and the need for prompt surgical consultation when red flags arise. Crucially, Dr. Deb explains that no imaging or laboratory tests can definitively rule in or rule out the diagnosis—only surgical exploration can confirm it.

Dr. Mason, a burn and general surgeon at Sunnybrook’s Ross Tilley Burn Centre, provides a surgeon’s perspective on managing these infections. She addresses common missteps in diagnosis, the need for aggressive surgical debridement, and the role of multidisciplinary care in saving patients’ lives. She also discusses how surgeons can overcome their fear of creating extensive wounds, reassuring listeners that reconstruction is possible once the patient is stabilized.

Together, the guests and hosts explore practical solutions to reduce delays in care, including the potential for institutional protocols—possibly a "code nec fasc"—to streamline decision-making and improve outcomes.

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On this episode of the CMAJ Podcast, Dr. Mojola Omole and Dr. Blair Bigham explore the growing challenge of antimicrobial resistance and how shorter courses of antibiotics are reshaping prescribing practices. The conversation builds on insights from the CMAJ practice article “Five things to know about shorter courses of antibiotics” co-authored by Dr. Maria Ivankovic, an emergency physician at St. Joseph’s Health Centre in Toronto.

Dr. Ivankovic explains why shorter courses of antibiotics are as effective as longer ones for many common infections and how this approach can reduce the risk of antimicrobial resistance and adverse effects for patients. She highlights key conditions with strong evidence for shorter durations and discusses practical strategies for implementing these changes in practice.

Dr. Lynora Saxinger, an infectious diseases specialist and professor of medicine at the University of Alberta, broadens the discussion by examining the current state of antimicrobial resistance in Canada and globally. She explores the drivers of resistance, including unnecessary and inappropriate antibiotic use. Dr. Saxinger introduces the concept of the antibiotic footprint as an analogue to the carbon footprint, encouraging physicians to consider the collective impact of their prescribing decisions.

This episode provides actionable advice for physicians looking to balance patient care with stewardship practices, helping to preserve the effectiveness of antibiotics for future generations.

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On this encore episode of the CMAJ Podcast, Dr. Blair Bigham and Dr. Mojola Omole discuss how artificial intelligence (AI) significantly improves the identification of hospital patients at risk of clinical deterioration compared to physician assessments alone. They are joined by Dr. Amol Verma, a general internist at St. Michael’s Hospital in Toronto, an associate professor at the University of Toronto, and the holder of the Temerty Professorship in AI Research and Education, who shares findings from his recent CMAJ article, “Clinical evaluation of a machine learning-based early warning system for patient deterioration”.

Dr. Verma explains how the AI system, ChartWatch, analyzes over 100 variables from a patient’s electronic medical record to predict deterioration more accurately than traditional early warning scores like the NEWS score. He discusses how the integration of AI into clinical workflows improves patient outcomes by complementing human decision-making, leading to better results than relying on physicians or AI alone.

The episode also looks at the potential future of AI in medicine, with Dr. Verma sharing insights on how AI tools should be thoughtfully integrated to support clinicians without overwhelming them. He stresses the need for AI systems to fit seamlessly into clinical workflows, ensuring patient care remains the priority. While AI is currently a tool to assist clinicians, Dr. Verma argues that the full extent of AI's role in healthcare—and its impact on the physician's place within it—remains ultimately unknowable.

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On this episode of the CMAJ Podcast, Dr. Mojola Omole and Dr. Blair Bigham explore a surprising case of scurvy. The conversation builds on the CMAJ practice article “Scurvy in a 65-year-old woman with severely limited function and social supports,” co-authored by Dr. Sally Engelhart, an internal medicine specialist at Mount Sinai Hospital.

Dr. Engelhart recounts the case of her patient, whose unexplained bruising and other symptoms led to a diagnosis of a rarely seen condition, scurvy. She explains how food insecurity and a diet lacking fruits and vegetables contributed to the patient’s condition and discusses the practical steps taken to diagnose and treat her.

Dr. Gary Bloch, a family physician at St. Michael’s Hospital and Inner City Health Associates, expands on the broader issue of food insecurity as a driver of nutritional deficiencies. He shares actionable strategies for identifying at-risk patients and connecting them with community resources, while highlighting the importance of addressing the social determinants of health in medical practice.

This episode offers valuable insights into recognizing and managing scurvy and other conditions linked to food insecurity, reminding physicians to think beyond the lab results

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On this episode of the CMAJ Podcast, Dr. Mojola Omole and Dr. Blair Bigham explore Premenstrual Dysphoric Disorder (PMDD), a debilitating condition affecting 5% of people who menstruate, yet it is often misdiagnosed or misunderstood. The conversation builds on insights from the CMAJ article, “Five things to know about…: PMDD,” co-authored by Dr. Erin Brennand, an associate professor at the Cumming School of Medicine in Calgary.

Abhi Bala shares her lived experience with PMDD, describing the profound impact of cyclical depressive symptoms, suicidal ideation, and emotional dysregulation on her life. Her journey from misdiagnosis to awareness highlights the importance of tracking symptoms and recognizing patterns linked to the menstrual cycle, which can lead to earlier diagnosis and treatment.

Dr. Brennand explains how PMDD is frequently mistaken for depression or bipolar disorder, delaying accurate diagnosis and treatment. She highlights the importance of recognizing that PMDD's cyclical symptoms align specifically with the luteal phase—the final two weeks of the menstrual cycle. Dr. Brennand also discusses evidence-based treatments, including SSRIs, oral contraceptives, and, in severe cases, GnRH agonists.

This episode provides valuable insights into diagnosing and managing PMDD, helping physicians better support their patients.

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On this episode of the CMAJ Podcast, Dr. Mojola Omole and Dr. Blair Bigham discuss the growing evidence around the impact of diet on mental health, particularly depression. The conversation is inspired by the CMAJ practice article, “Diet and depression,” co-authored by Dr. Nicholas Fabiano.

Dr. Fabiano explains how the mechanistic connection between diet and depression is not well understood, but it is theorized that diets known to promote inflammation may play a part in exacerbating symptoms. He highlights findings from the SMILES trial, which demonstrated how dietary interventions like the Mediterranean diet—rich in leafy greens, fish, fruits, and whole grains—reduced depression symptoms in trial participants.

Dr. Rachelle Opie, an accredited practicing dietitian and credentialed eating disorder clinician, offers practical advice on how physicians can coach patients toward dietary changes in a way that is inclusive, sustainable, and sensitive to individual needs. Drawing from her work on the SMILES trial, Dr. Opie highlights the importance of a whole-of-diet approach that prioritizes small, achievable changes, such as incorporating legumes, beans, or frozen and canned foods. She emphasizes trauma-informed, weight-neutral approaches to avoid triggering or alienating patients and encourages focusing on what patients can add to their diet rather than restricting foods.

Together, the hosts and guests explore how subtle, realistic changes in dietary habits can provide meaningful improvements in mental health without placing undue pressure on patients.

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On this episode of the CMAJ Podcast, Dr. Mojola Omole and Dr. Blair Bigham speak with Dr. Sarina Isenberg and Dr. Modupe Tunde-Byass about the emotional and systemic challenges surrounding early pregnancy loss care in Canada. The conversation builds on themes from the recent CMAJ article, “Diagnosis and management of early pregnancy loss,” in which the authors advocate for a dedicated EPL pathway to care that bypasses the emergency department.

Dr. Isenberg shares her personal experiences with early pregnancy loss and the stark disparity in care she received—from a lack of empathy in an emergency room to comprehensive support in a specialized clinic. Her story underscores the spectrum of care needed, particularly access to emotional support during one of the most vulnerable times in a patient’s life.

Dr. Tunde-Byass, co-author of the CMAJ article and an obstetrician at North York General Hospital, highlights the success of dedicated early pregnancy loss clinics, which provide timely diagnosis, options for management, and a supportive environment. She emphasizes that emergency departments, often overstretched and lacking privacy, are not designed for the unique needs of early pregnancy loss patients. Instead, she argues for dedicated spaces staffed by trained personnel, including nurses and counselors, who can provide both medical care and emotional support.

Together, they explore practical solutions, including integrated care pathways outside of emergency departments, self-referral options, and the provision of bereavement resources. Dr. Tunde-Byass advocates for a holistic approach that could be standardized across Canadian hospitals, enabling patients to access sensitive, informed care without the retraumatization that often comes from repeating their stories in high-stress environments.

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On this episode of the CMAJ Podcast, Dr. Mojola Omole and Dr. Blair Bigham explore the structural and cultural barriers faced by surgical residents and early career surgeons in balancing parenthood with their careers. The conversation centers around the points raised in the CMAJ article “Policies to better support childbearing surgeons”, which outlines the need for reforms to better accommodate surgical residents during pregnancy and early parenthood.

The discussion highlights how surgeons experience higher rates of infertility and pregnancy complications, independent of age or other potential risk factors. Dr. Caroline Cristofaro and Dr. Maryse Bouchard, the article’s co-authors, propose solutions such as flexible call schedules, protected time for prenatal and postnatal appointments, and clear institutional guidelines supporting the needs of pregnant surgeons.

Beyond structural barriers, the prevalent culture within surgical departments, such as the glorification of exhaustion and the perception that taking time off is a weakness or a burden to fellow residents, contributes to the unsupportive environment. The co-authors argue that gradual, transparent, and detailed policy reforms based on evidence are necessary to avoid resistance and ensure successful integration into surgical practice.

Dr. Omole’s personal experience, marked by significant support from her department during her pregnancy and postpartum recovery, serves as an example of what a compassionate and well-supported environment can look like. Her story highlights how proactive leadership and peer support can make a profound difference, benefiting both surgeons and their patients.

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On this episode of the CMAJ Podcast, Dr. Kirsten Patrick speaks with Dr. Shane Neilson, the author of a CMAJ Encounters article entitled, “Professional stigmatizations.” Dr. Neilson is a physician, writer, and academic, who shares his experiences navigating medical school and practice as a neurodiverse physician with bipolar disorder and autism. 

Dr. Neilson reflects on the challenges he faced during medical school, including a moment when a preceptor told him, "There’s something wrong with you," without offering any support or guidance. He shares how this, along with the pressure to conform to normative expectations in medicine, made his training difficult, especially without any accommodations for neurodiverse students.

Dr. Patrick relates to these struggles, recounting her own experiences of feeling out of place in medical school. Together, they discuss how the culture of medical education at the time did not accommodate students who did not fit the traditional mold.

Dr. Neilson notes that while there are "little teeny, tiny occasional tales of change" happening now, such as program directors becoming more aware of neurodiversity and making small accommodations for students, these changes are still incremental. He expresses hope that this will continue to evolve, leading to broader acceptance and support for neurodiverse individuals in the medical profession.

He further argues that including neurodiverse physicians enriches the profession in several ways. By challenging rigid norms in medicine, neurodiverse individuals push the profession to be more inclusive and compassionate. They also provide care that is uniquely attuned to the needs of neurodiverse patients, offering identity-aligned support that can enhance patient satisfaction and outcomes. Dr. Neilson stresses that by fostering diversity, the profession not only lives up to its values but also improves care for all patients.

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