CMAJ Podcasts

Physicians working in hospitals see the mountains of medical waste generated each day. Meanwhile, the climate crisis challenges the medical system to reduce its contribution to greenhouse gas emissions. Globally, healthcare systems contribute as much carbon dioxide as the airline industry. In Canada, healthcare accounts for 4.6% of our total emissions. The problem is urgent, but potential solutions are both easier and more complex than many might think. 

Guests on this episode are advocates in the climate and health space. Dr. Samantha Green is the co-author of the CMAJ article, Five Things to Know About Metered Dose Inhalers and their Impact on Climate Change. She's a family physician at Unity Health Toronto and the climate and health lead at the University of Toronto's Department of Family and Community Medicine.

In the article, she and her co-authors point out that pressurized metered-dose inhalers (pMDIs) are an important contributor to greenhouse gas emissions.  Dr. Green says measurements done in the United Kingdom by the National Health Service found that MDIs contribute 3.1% of the entire health system's carbon emissions. One MDI contributes the equivalent of driving 290km by car.

Meanwhile, dry powdered inhalers (DPIs) and soft mist inhalers (SMIs) are effective available alternatives with lower environmental impact. Dr. Green encourages physicians to make the switch for eligible patients and explains how her clinic has created resources to facilitate the prescribing change.

Addressing such low-hanging fruit of climate action in the healthcare system is important but, according to Dr. Andrea MacNeill, reducing waste, changing prescriptions, and recycling are the tip of the iceberg. What’s really needed is profound systemic change. Dr. MacNeill argues that emissions are driven by a system focused on providing the most complex and carbon-intensive care. 

“New healthcare funding seems to go into very complex resource-intensive treatments that modify very advanced disease processes. And I would suggest that we need to shift that focus upstream and start to think, okay, could we have prevented this from ever happening? And in many cases, the answer to that is yes,” says Dr. MacNeill.

Along with a focus on prevention, Dr. MacNeill argues healthcare systems need to put pressure on the supply chain, which accounts for the bulk of emissions. In England, the NHS is demanding that vendors match the NHS's climate target to decarbonize by 2030.

 Links to resources discussed on the episode:

Inhaler Toolkit for Physicians

Cascades

Planetary Health Lab

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The CMAJ Podcast is produced by PodCraft Productions

The clinical teaching unit is a widely-used clinical training model that requires reform to prepare physicians for practice in the 21st century.

In a systematic review in CMAJ, Dr. Brandon Tang and co-authors identified practices in internal medicine clinical teaching units that contribute to improved clinical education and health care delivery.

Dr. Tang, a PGY4 in general internal medicine at the University of Toronto, speaks with Drs. Blair Bigham and Mojola Omole about the findings of the review, his experience with CTUs, what inspired him to look into the research, and his thoughts on how CTUs can be reimagined to improve both learner and patient outcomes. 

Drs. Bigham and Omole then speak with Dr. Lisa Richardson, a clinician-educator in the U of T’s Division of General Internal Medicine, about other aspects of medical training that are due for a rethink.

Dr. Richardson, who also practices at the University Health Network and is an Education Researcher at the Wilson Centre, argues that medical training needs to create space for learners to bring their whole selves to their educational experience, rather than struggle to conform to a narrower sense of what it means to be a physician.

CMAJ is the journal of the Canadian Medical Association.

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The CMAJ Podcast is produced by PodCraft Productions

Reported gonorrhea cases have more than doubled in recent years. Untreated gonorrhea may occasionally cause potentially fatal conditions, such as infective endocarditis. 

In this episode, Dr. Carl Boodman, infectious disease and medical microbiology fellow at the University of Manitoba, discusses a case of disseminated gonococcal infection in a 54- year old man who presented to ER with a new heart murmur. The case was described in a recent CMAJ article, which explains that the patient had developed an aortic root abscess and a fistula from his right ventricle to the aortic root.

Dr. Boodman tells Dr. Blair Bigham and Dr. Mojola Omole that, while severe cases of disseminated gonococcal infection such as this remain relatively rare, he is seeing more of them in Manitoba. He emphasizes the importance of detecting and treating gonococcal infection before it has a chance to progress.

Gonorrhea is just one of the bacterial STIs on the rise. Drs. Bigham and Omole also speak with Dr. Jason Wong, a Public Health and Preventive Medicine specialist in BC, about what’s behind the rise in STIs and about what lessons can be learned from the relative decline in HIV infections.

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The CMAJ Podcast is produced by PodCraft Productions

Operative vaginal delivery (OVD) is considered safe if carried out by trained personnel; however, the rate of maternal trauma following OVD in Canada greatly exceeds that of any other OECD country. In Canada, maternal trauma occurred in more than one-quarter of deliveries with forceps, whereas in the UK, the rate is 8%-12%, and in Australia, it sits at ​​9.3%-14.1%.

A research study published in CMAJ found that rates of trauma following OVD in Canada are higher than previously reported, irrespective of region, level of obstetric care and volume of instrument use among hospitals. The authors argue these results support a reassessment of OVD safety in Canada. 

In this episode, Dr. Bigham and Blair and Dr. Mojola Omole speak with Dr. Giulia Muraca, the lead author of Maternal and neonatal trauma following operative vaginal delivery: a national cohort study. They explore possible causes for these troubling findings.

They then speak with Dr. Nirmala Chandrasekaran, an OB/GYN and Maternal-Fetal-Medicine specialist at St. Michael’s hospital in Toronto. Dr. Chandrasakan trained in the UK, and she describes how exposure to OVD during residency differs in the two countries. She also discusses the vital role OVD plays in safe deliveries.

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The CMAJ Podcast is produced by PodCraft Productions

People with kidney failure who live in rural and remote areas of Canada do not have the same access to the full suite of dialysis modalities as urban dwellers. Many need to relocate for life-sustaining renal replacement therapy. Often this means moving hours away from their home communities for months, sometimes years, at a time.

In this episode, hosts Drs. Mojola Omole and Blair Bigham speak with Dr. Aaron Trachtenberg, a nephrologist at the University of Manitoba about his commentary in CMAJ, in which he and coauthors argued that patients who must leave their home communities for dialysis should be prioritized for the allocation of deceased donor kidney transplants.

They also speak with Vanessa Tait whose father needed to relocate to Winnipeg, twelve hours away from his home community of O-pipon-na-piwin Cree Nation, for dialysis. Ms. Tait became a living donor to her father in an effort to bring him back home. She talks about the toll relocation takes on patients from remote communities.

Commentary in CMAJ
CMAJ

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The CMAJ podcast is taking a break for one episode as everyone enjoys their holidays and gets prepared for the year ahead. In this brief chat, Mojola and Blair preview some of the upcoming episodes and wish all our listeners a happy and safe holiday.

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Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.

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The CMAJ Podcast is produced by PodCraft Productions

One simple question can offer clinicians a powerful insight into the lives of their vulnerable patients. Asking, “Do you ever have trouble making ends meet at the end of the month” can help physicians identify significant barriers to restoring the health of their patients.

The link between the social conditions in which we live and health outcomes is well-known. However, health provider action to address the social determinants of health is an emerging area of practice innovation and research. This episode looks at what social prescribing looks like in action and what the evidence tells us about its effectiveness.

Drs. Mojola Omole and Blair Bigham speak with Janet Rodriguez, a patient at St. Michael’s Family Health Care Clinic in Toronto. She describes the profound impact social interventions had on her physical and mental health.  

They also speak with Dr. Gary Bloch, a family physician at St. Michael’s Family Health Care Clinic and a co-author of the analysis published in CMAJ titled “An Evidence-Based Guide to Social Interventions in Primary Care.”

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The pandemic recovery period presents an opportunity to address health inequities that have led to an unfair distribution of the burden and harms of COVID-19. 

New guidance for policy published in CMAJ  proposes 13 practical ways to address inequities exposed and worsened by COVID-19 in the pandemic recovery period, based on evidence that was accumulating before the pandemic.

In this special episode of the podcast, CMAJ interim editor-in-chief Dr. Kirsten Patrick talks to Dr. Nav Persaud, lead author on the new guideline, about its genesis, the evidence underpinning its recommendations, and the importance of positioning equity at the centre of policy-making as Canada emerges from the pandemic.

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Pain is one of the most common complaints among patients visiting the ER, and pain management has become a quality of care indicator. But the options available for the treatment of acute pain that isn’t controlled by over-the-counter medications are limited. 

With the opioid epidemic leading physicians to avoid prescribing narcotics, the anaesthetic drug, ketamine, is being reconsidered for the treatment of pain, as well as other indications. 

A practice article  in CMAJ argues that ketamine is an underutilized and effective analgesic and a safer alternative to opioids for the management of acute pain, with reported adverse effects at low doses occurring at the same frequency as placebo. 

In this episode, Blair and Mojola speak to Dr. William Silverstein, a co-author of the practice article “Five things to know about the use of ketamine in the treatment of acute pain” about ketamine’s indications and contraindications, how to prescribe it in the ambulatory care setting, and practical steps physicians can take to add ketamine to their pain-busting arsenal.

They also speak with Dr. Marshall Ross, a physician who also uses ketamine as an emergency physician, but has also pioneered its use in patients with treatment-resistant depression, using cutting edge techniques.

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One in four women physicians report a diagnosis of infertility. One reason for this is physicians tend to delay attempts to become pregnant until “the time is right” for their career.  But, in the medical profession, it seems there is really no “good” time to have children. Parenthood, especially motherhood, is seen as an inconvenience during medical training and beyond. 

In this episode, Dr. Sophia Park speaks with hosts Dr. Mojola Omole and Dr. Blair Bigham about her personal struggle with infertility. And, Dr. Andrea Simpson, the lead author of a commentary in the CMAJ titled, “The inconvenience of motherhood during a medical career”  calls for systemic change in medicine to support parenthood.

Dr. Sophia Park is a medical biochemist at Royal Columbian Hospital and a Clinical Associate Professor at the UBC Department of Pathology and Laboratory Medicine.

Dr. Andrea Simpson is an obstetrician and minimally invasive gynaecologic surgeon at St. Michael’s Hospital. She is also an assistant professor at the University of Toronto.

She co-authored her commentary with Drs. Maria Cusimano and Nancy Baxter. It is published in CMAJ: https://www.cmaj.ca/content/193/37/E1465

Episode transcript: https://www.cmaj.ca/transcript-211255

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Comments or questions? Text us.

Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.

You can find Blair and Mojola on X  @BlairBigham and @Drmojolaomole

X (in English):  @CMAJ
X (en français): @JAMC
Facebook
Instagram: @CMAJ.ca

The CMAJ Podcast is produced by PodCraft Productions