In this episode, Dr. Blair Bigham and Dr. Mojola Omole speak with two co-authors of a new guideline published in CMAJ entitled "Preventive care recommendations to promote health equity".
Dr. Nav Persaud and Dr. Aisha Lofters explain the importance of embedding health equity into healthcare and discuss specific ways public policy and individual primary care physicians can work together to promote equity in their practices. The conversation highlighted some key recommendations such as:
Overall, Drs. Persaud and Lofters advocate for a shift towards recognizing that inequities in health outcomes exist and that primary care physicians need to embed equity into their healthcare practices.
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
In this episode, Dr. Blair Bigham and Dr. Mojola Omole speak with two co-authors of a new guideline published in CMAJ entitled "Preventive care recommendations to promote health equity".
Dr. Nav Persaud and Dr. Aisha Lofters explain the importance of embedding health equity into healthcare and discuss specific ways public policy and individual primary care physicians can work together to promote equity in their practices. The conversation highlighted some key recommendations such as:
Overall, Drs. Persaud and Lofters advocate for a shift towards recognizing that inequities in health outcomes exist and that primary care physicians need to embed equity into their healthcare practices.
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
Dr. Blair Bigham:
I'm Blair Bigham.
Dr. Mojola Omole:
And I'm Mojola Omole. This is the CMAJ podcast.
I just want to apologize ahead of time. The raspiness in my voice is not that I'm becoming a jazz singer, is that I am still going through a cold and a cough. So excuse me for sounding not my bubbly self. I'm not bubbly.
Dr. Blair Bigham:
Ah, September was a bad month for people with colds. So Jola, there's a new paper out in CMAJ, a guideline, titled “Preventive care recommendations to promote health equity”. And as soon as we saw this, we wanted to jump on it. You were really keen. Do you want to lead us off?
Dr. Mojola Omole:
For me, finding ways to embed health equity into providing healthcare is something that's very dear to me and I'm very passionate about. Oftentimes, I think because of the way we've trained, we don't necessarily see how we can embed EDIA work into our work. And this paper, why it was really compelling for me was that it really spells out in primary care how to promote equity to disadvantaged populations.
Dr. Blair Bigham:
And quite a few populations mentioned in this paper, everything from cancer to cardiovascular risk, diabetes, depression, infectious disease like HIV and tuberculosis. The list goes on, it's very comprehensive. Is there anything you're most keen to delve into with the authors today?
Dr. Mojola Omole:
Well, I think for me as my interest in surgical oncology and my practice being surgical oncology, that is always something that is of interest to me. But really for me, what actually stood out was the mental health and them talking about depression screening. And that to me was I thought was quite interesting, because we do know that different populations and different racialized people experience mental health differently, and the symptoms and the signs are quite different. So that was something that stood out to me that I would love to explore more with them.
Dr. Blair Bigham:
Totally. I'm excited for that one. So let's jump into it. We have two of the co-authors to discuss these guidelines with us. That's coming up.
Dr. Mojola Omole:
We have two members of the team here today to speak with us. Dr. Nav Persaud is the lead author. He's the Canadian Research Chair in Health Justice, and he's a family and community physician at St. Michael's Hospital in Toronto.
And, Dr. Aisha Lofters is a family physician and Chair in Implementation Science at Women's College Hospital, also in Toronto. Thank you both very much for joining us today.
Dr. Aisha Lofters:
Thanks for having us.
Dr. Mojola Omole:
So, I just want to start off with that this is a very extensive study of equity in medicine. Were there any surprises for either of you as you were putting together the guidelines?
Dr. Aisha Lofters:
I would say it wasn't a surprise. I think we were very purposeful about pulling together the panel that we had, both in terms of healthcare providers and patients who provided their expertise. But our panel really consisted of a lot of people who were either women who were racialized or both, and people who had a real passion for health equity. And I think the fact that that is so unusual in guideline panels isn't surprising, but I think it's definitely something worth noting.
Dr. Mojola Omole:
Why is that unusual in guideline panels to have a diverse group of people?
Dr. Aisha Lofters:
Well, I think the why is a big question. I think that ties into why when we think of leadership and think of lots of social hierarchies. But we do know from a lot of the previous work that Nav has done is that a lot of guideline review panels really are dominated by white men. And I think we have to always consider what that's going to mean in terms of where health equity and lived experience play out in guidelines.
Dr. Mojola Omole:
Sure. And Nav, what was anything that surprised or jumped out at you as you guys were putting together this study?
Dr. Nav Persaud:
I think building on what Aisha said, it was relatively easy to recruit a panel that did reflect the diversity of Canada, and namely, included racialized women. We posted in medical journals and we offered people compensation for their time in participating, and we had an overwhelming response. We had dozens of qualified applicants who we could not invite to join the panel. So that was a surprise given that most panels don't look like ours.
Dr. Mojola Omole:
Is this something that when talking to primary care practitioners that's been brought up that there needs to be, or maybe just in your experience working with others, that there needs to be more awareness built around the inequities in our healthcare system?
Dr. Aisha Lofters:
I think for both Nav and I working clinically as family physicians and seeing firsthand patients experiencing inequities, we both realized from our day-to-day being at the frontline that a lot of guidelines that are out there, people experiencing disadvantage are often not mentioned or there might be a line in the guideline.
So I think that we both experience that, and I think the whole world experienced through COVID-19 this very obvious... It was very in our face what we had long known had long existed as far as how these disadvantages can actually play out. It played out in terms of who was affected the most by this global pandemic. And there seemed to be some momentum during and after the pandemic to actually now starting to really think about health inequities not as an afterthought, not after the work has been done, but from the very beginning.
So I think for both of us it was having that clinical experience, those clinical frustrations, and then seizing the momentum that was finally there.
Dr. Mojola Omole:
For sure. And Nav, what were you going to say?
Dr. Nav Persaud:
Yeah, I was going to say, I think maybe there's some recognition of inequities. And we know we've all seen statements from hospitals and universities about the need to address inequities. Our guidance addresses what primary care providers can do on a day-to-day basis. We discuss core topics, like cancer screening, cardiovascular disease screening, and talk about how primary care providers can perform those services equitably.
Dr. Mojola Omole:
Aisha, you guys actually had some recommendations around lowering the age of cancer screening. Can you describe this for us?
Dr. Aisha Lofters:
So for colorectal cancer screening specifically, what we've talked about in the guidance is beginning outreach at the age of 45 instead of at the age of 50, because we recognize that we are seeing, when we look at the literature at least, younger ages of diagnosis, specifically for people who do experience disadvantage.
And we know that sometimes outreach can take time. You have to have sometimes many more than one conversations before people are ready to start screening. But we also do say that if people are ready, that there shouldn't be barriers for them and they should be able to go ahead and screen if they are interested in doing so.
Dr. Mojola Omole:
And I guess as a surgical oncologist, why not just lower the age of screening for everyone when we talk about colon cancer?
Dr. Aisha Lofters:
So I think one of the things with these guidelines is that we recognize that when it comes to implementation, there has to be some work done. But it might be that for the guideline to be able to be implemented, that it would apply to everyone.
So for example, with HPV self-collection, which is one of our recommendations, in Australia they do have this as part of the screening program, and it is available to everyone. So that might be the best way to implement it. But I think we just want to make sure that we keep health equity front and center when we do implement.
Dr. Mojola Omole:
Why haven't we implemented the self-screening for cervical cancer?
Dr. Aisha Lofters:
So I think the first thing is, you've got to have the infrastructure in place for HPV testing. So the first step is to shift from Pap testing or cytology testing to HPV testing, so that even when you're going to the doctor's office and getting on the exam table, that what's happening is an HPV test, not a cytology test. Many provinces, Ontario included, are making that move. So it is coming. So I certainly hope that as they start to shift from Pap screening to HPV, that HPV self-collection be a part of it as well.
Dr. Mojola Omole:
I didn't note in the guidelines any recommendations regarding breast cancer in racialized people. Is there a reason you guys didn't include that in the guidelines?
Dr. Nav Persaud:
I think there are a number of important topics we didn't address. Breast cancer and prostate cancer screening would be examples of those. We had to prioritize certain topics based on limited resources, and we considered a few factors including the burden of the disease, the effectiveness of screening interventions, and the likelihood that equitable access to preventive care could promote health equity or equity in health outcomes.
And so, some important topics like breast cancer screening and prostate cancer screening got left out. Potentially we could include those topics if we were to repeat the process again in five years.
Dr. Mojola Omole:
Is it possible to imagine how this might cause some conflict for a physician with their patients? How should a family physician explain to a patient that they will be screened five years later than another patient?
Dr. Nav Persaud:
Yes, I think it is possible that some people might view attempts to address inequities as unfair. And I think our rationale is that we observe inequities in health outcomes. We observe that people with a low income, racialized people generally experience poor outcomes and have poor access to care, and experience discrimination within the healthcare system.
We could continue to bemoan those inequities and talk about how sad it is that there are bad outcomes and unfair outcomes, or we can change what we do in order to address inequities. So there is a decision that needs to be made, whether or not we are content just to observe inequities or we want to change things.
I think there is an argument to be made for many of these interventions that it could make sense to apply them to the general population. Taking the example of colorectal cancer screening, starting screening at age 45 versus age 50 is expected to avert one colorectal cancer death per 1000 screened. That's true in the general population. Our recommendation is focused on people experiencing disadvantages. So we would leave it to others to provide guidance that would apply to the general population. But I think given the inequities that can easily be observed, it makes sense to prioritize people for care.
Dr. Mojola Omole:
What's another recommendation, Nav, do you think would be the most impactful?
Dr. Nav Persaud:
I think considering the burden of disease and the effectiveness of intervention, likely the most effective interventions that we recommend will be related to colon cancer screening and cardiovascular disease.
However, I think there are some other really important recommendations and I'm glad I don't have to choose the most important one, because I think actually part of primary care is providing comprehensive care. And from the perspective of patients, I don't think a person who has depression would view depression screening as less important. That's another example where our guidance differs from some existing guidance. We recommend depression screening for people experiencing disadvantages where some existing guidance does not recommend screening, other guidance does recommend screening.
Interestingly there, one of the rationales for not recommending screening for depression in other guidance is that there's an assumption that people will receive assessments for depression as part of routine care. So organized screening programs are therefore not needed for depression because everyone's getting a clinical assessment. Whereas, our guidance is focused on people experiencing disadvantages who may not be receiving adequate care or any care in some situations. So that would be an argument for depression screening.
Also, one of the potential problems with depression screening is sometimes people who answer yes to questions about feeling down, for example, may have a problem that's not depression. And so, in studies of the accuracy of depression screening instruments, that would be viewed as a problem. But in primary care, that may actually be an opportunity to talk to a patient about something that's bothering them or maybe to offer them a support, such as a social support that could help address an issue even if that issue is not depression.
Dr. Mojola Omole:
So for the depression screening, I'd go to my physician. Is this something that should be done on a yearly basis, or what is the recommendation around that?
Dr. Nav Persaud:
For many of the recommended interventions, there are not comparative studies assessing the effects of different frequencies of screening. So we provide standard advice about providing screening every three to five years based on judgements made by the panel about what's feasible and likely to be beneficial.
Dr. Blair Bigham:
I'm wondering, as you improve access to screening, you are bound to find more people who require follow-up from positive screenings. What type of tricks have you guys used in your system to get access to that follow-up? Because I know right now it's so hard to get people the care that they need when they need it. If we're finding more things, which is great, what type of ways have you been able to take that to the next step?
Dr. Aisha Lofters:
I think one comment that I can make with regards to that is that we certainly are both lucky enough to work in team-based primary care models. So I think if we start to think about policy implications from our recommendations, one of our recommendations is about improving access to primary care so people are able to access primary care, and people with disadvantage would be prioritized for that.
But I think also taking that further, when we look at quality of primary care, that working in an interprofessional team really does allow for you to have team members, whether it's social workers, pharmacists, et cetera, who you are able to really, truly collaborate with in a team model to help to support your patients. But we also know that many Ontarians, and more likely if you're experiencing disadvantage, do not have access to these team-based primary care models.
Dr. Nav Persaud:
Many of the interventions we recommend could be implemented today. For example, depression screening can be administered by asking questions. Either clinicians can ask those questions in interviews or they can be administered in waiting room surveys or email surveys. And treatments for depression can be offered online. There are online counseling programs, online cognitive behavioral therapy programs. And primary care providers are also well positioned and qualified to prescribe medications where that's appropriate after an appropriate assessment is done.
One of the surprises for me was how effective resources were for families with children who are experiencing poverty. There were a few clinical trials that have showed offering patients relatively simple interventions such as a one-page sheet of paper that lists social issues and local resources that are available, has been shown to meet the needs of these families. So that is something that could be offered entirely within primary care.
I think it's also important just in terms of thinking about what happens after people screen positive. I think it's also important just to keep in mind, even though there are resource constraints in our system, people are accessing specialist care all the time. People are visiting hospitals, being seen by surgeons, and being seen by consultants.
So when we're talking about screening people who are experiencing disadvantages, I think we have to be careful not to overemphasize resource limitations within the system, because people are seeing these same consultants right now, and these are not necessarily people who are always screening positive for cancer.
Dr. Blair Bigham:
We'll be back after a short break.
Dr. Mojola Omole:
Maybe just to help define it for our audience a bit better is, when you're saying people who are experiencing disadvantages, what does that encompass?
Dr. Nav Persaud:
Sure. So we provide a list. It's based on data about health inequities in Canada. So the list of inequities in the paper would include people with a low income, racialized people, Indigenous people, members of the 2SLGBTQ community. And we also specify other groups who might be prioritized for care for specific interventions.
For example, we specify that women should be prioritized for cardiovascular disease screening based on inequities in cardiovascular disease outcomes that are thought to be related to discrimination and sexism within the healthcare system and the way that screening and other care is provided today. The recommendation for tuberculosis applies to people who've arrived in Canada within the last five years from a high-incidence country.
Dr. Mojola Omole:
And what do you think that would look like if we prioritize those who are experiencing disadvantage and we prioritize them for accessing? How do we do that?
Dr. Aisha Lofters:
Yeah, it's not an easy question to answer, certainly. I think people have talked about the model as how it works with education, so that based on your address. And perhaps we'd have to think about other metrics of experiencing disadvantage that would then allow for automatic enrollment.
So I think how that would be measured, what that would look like, certainly would take some time to think through, but I think it's something that warrants the time to figure it out, to figure out how to do it right. Because I think one of the things that you notice time and time again is if we don't think about health inequities from the get-go, we implement models, and programs, and systems that actually increase inequities. And then after the fact we're scrambling to try and tackle those inequities and tackle what we call the low-hanging fruit.
Dr. Mojola Omole:
What if a physician, a primary practitioner is like, "Well, if my patients want to see me, they can see me. If they need colon cancer screening, I get that to them. I don't have any inequities in the way I practice." What's your response to that?
Dr. Nav Persaud:
Sure. I think those same healthcare providers who believe that they are providing care that's fair, probably have read reports about inequities in health outcomes, inequities in the way healthcare is provided. And they have continued to do the hard work of primary care, seeing the patients in front of them, doing the outreach for colorectal cancer screening, et cetera.
And I would put myself in the category of a clinician who believes that he provides care equitably. But the reality is it's probably not the case. The data would suggest it's not the case that my patients are experiencing similar outcomes, that social gradients don't matter.
I sometimes use the analogy of flat earthers. You could present someone who believes that the earth is flat with evidence that the earth is round, and they might say, "Oh yeah, that's really interesting." But then they would continue believing that the earth is flat. And a flat healther would be someone who sees reports that describe inequities, but continues practicing medicine as though health outcomes are flat.
So flat healthers provide care to patients who come into clinic and do outreach for colon cancer screening, without trying to prioritize people who are likely to experience bad outcomes. And that's what we need to change. If we're really going to engage with health inequities, we need to change the core part of what we're doing, which is providing care.
Dr. Mojola Omole:
So just looking a little forward, this is focused on how physicians can impact health equity, as you mentioned before, Nav. Outside these guidelines, how can physicians just change the way they approach their practice and their patients to increase equity? So for example, how would this work for me as a surgeon?
Dr. Nav Persaud:
I think maybe, hopefully, this is a start to thinking about how we can organize and deliver primary care in a different way. I think there might be analogous work that's done in other disciplines to try and think about how to address inequities through changing the core things that you do every day. The way that you triage referrals, the way that you decide which patients are going to be put on the cancellation list, et cetera. Those are all potential areas where inequities can be at play.
I think we all know there are certain rules about who gets prioritized for care, and that those rules can be bent or they only apply to some. And certainly I see that in primary care, and I suspect some of the same things apply to consultants. So, yeah, in terms of who gets prioritized for specialized care, there might be some opportunity to provide guidance and to change the way that practice is being delivered.
Dr. Mojola Omole:
Aisha, what are your thoughts?
Dr. Aisha Lofters:
Yeah, I would love to see work like what we've done being reproduced. So I think first of all, we would love to keep reviewing the literature every few years, and I think it would be fantastic if we see other specialties taking up the same call. And similarly, taking a look at their guidelines with a health equity focus and health equity priority. And thinking through, what are the evidence-based actions that you take every day in your specialty, and how could those be adapted or how could those be tweaked a little bit to have a health equity focus? I think that the possibilities are endless for how this work could continue.
Dr. Blair Bigham:
Aisha, you had mentioned the primary care crisis. And we all know that many Canadians struggle to find a family doctor, and they often end up in walk-in clinics or emergency rooms. What role do episodic care providers like ER docs play in terms of how this guidance can be applied pragmatically?
Dr. Aisha Lofters:
I think there's always the possibility with, especially thinking about walk-in clinics, because as you say, there are more and more people across the country who are using walk-in clinics, both for acute episodic care, but also even as a bit of a stopgap measure for primary care. So I think as much as is feasible and reasonable within that setting, there are opportunities I think for, as Nav said, a question could be asked about depression. Or I think that some of these recommendations that we have, many of them are actually quite simple to implement. And I think taking an extra minute or two, or a few minutes in a visit, can save a lot of time down the road and have a big health impact.
So I think that we think of primary care broadly. So not just academic team-based models, but thinking about community-based care, walk-in care, rural, urban. There's lots of applications for these recommendations. But I think it's just a matter of keeping this work going, keeping the momentum that started in the pandemic, and just making sure that a focus on health equity is not just a one-time or a short-term thing.
Dr. Nav Persaud:
Yeah. Actually, Aisha said the most important thing. I think the most important thing to do next is to ensure that care actually changes, that practice changes. So, yeah, I think the most important thing for us to do, as Aisha was saying, is to ensure that the recommendations are implemented. Many of them can be implemented now.
It would also be great to integrate the decision tool that we've developed in electronic health records and make sure they're at the point of care. One small step towards that is we have created an online decision tool at screening.ca where clinicians can determine which interventions apply to a particular patient. Patients could also use this same resource to find out about the care they should be offered.
So I think that is really the most important point to make, is that many of these changes could be made right now. We need to put additional time and resources into changing the policies that need to change. HPV self-testing should be generally publicly funded. Right now it's only available under certain circumstances. The blood test for tuberculosis should be generally publicly funded. Right now, again, it can only be ordered by specialists in most circumstances. So we need changes from government and clinicians can make changes right now.
All of these things require money and resources. And when we're talking about health inequities, when we're talking about racism and sexism, we're definitely talking about money. And our guidance, that includes 16 recommendations, was all done with a relatively small budget, around a hundred thousand dollars.
Other bodies that produce guidance have much larger budgets than we do, and those bodies do important work. And in some cases we cite the work of others. But if we want to address health inequities, we need to invest in this. And so, one call-out here is money. Let's invest more in addressing inequities. Maybe a goal could be, let's try to invest 10% of what we invest in guidelines that don't address inequities, in guidelines that do address inequities. Right now, we're probably not even at 1%.
One quick point, I think there are some examples where focusing on inequities can lead to better care in general. I think one example is the HPV self-test. So our guidance is focused on people experiencing disadvantages who may not be getting any screening for cervical cancer right now because they cannot book appointments, they don't want to have a pelvic exam. And so, we recommend offering HPV self-testing that can be done at home.
But that's an example of something that if it were rolled out broadly and if the capacity to run HPV testing was increased, likely most patients would prefer it. I think the blood test for tuberculosis is another example. It is effective, accurate. It's cost-effective. If it were more widely available to people experiencing disadvantages, to people who have recently arrived in Canada from a high-incidence country, it could make sense for others to get it. So I think if we lead with inequities, we can end up with a better healthcare system for everyone.
Dr. Mojola Omole:
Aisha?
Dr. Aisha Lofters:
I think that was a great point to end on.
Dr. Blair Bigham:
It's a great quote to end on. Thank you so much for joining us.
Dr. Mojola Omole:
Dr. Nav Persaud is the Canadian Research Chair in Health Justice and a family physician at St. Michael's Hospital. And Dr. Aisha Lofters is a family physician and the Chair in Implementation Science at Women's College Hospital. Both are in Toronto. Thank you for joining us.
Dr. Nav Persaud:
Thank you.
Dr. Blair Bigham:
All right, Jola, a lot of content there. What's your key takeaway from that discussion?
Dr. Mojola Omole:
It was really fascinating. I think this is thought-provoking. And hopefully it really gets educators who are training residents in family medicine and practitioners to trying to find ways to embed equity into the work they do. I thought that it was really fascinating talking about using the self-screening for HPV. That was something that it was the first time I've heard about it and I was like, "Well, that makes sense because we're removing some of the barriers of actually being able to go to primary care."
It's similar to Ontario breast screening program, over 50, you can self-refer. So there are ways that we're trying to build equity into the system. And I think for me, it actually makes me think of ways that I already practice, or considerations of when you have a population or when you have a patient that is from a disadvantaged group, how can you make it more equitable for them when accessing healthcare?
Dr. Blair Bigham:
And I love the idea of empowering people to take it on themselves. Not that it should be that way, but it is a nice sort of stopgap to say, "Well, you don't have to necessarily see a physician or get into your primary care if we're able to disseminate some of the screening to the population."
Nav was mentioning some online ways that people can screen or even receive therapy. Because at the end of the day, we always talk about implementation, and I feel like this has come up a few times in the past year. We talked about PSA screening and how the guidelines might not recommend screening for everyone who could benefit from it along some race bias with previous data sets. And it just seems like it's a perennial conversation that the screening itself might be flawed, and that the access to the screening, as we all know, is also pretty flawed.
And I'm always wondering, in the era of burnout for healthcare providers, and also the extreme lack of access, the extreme workloads that have had family doctors say, "I'm sorry, I can't take on more people," how do we actually get this to come to fruition so we can move the needle and get people early access to screening, or if needed, treatment?
Dr. Mojola Omole:
I would say that, talking to my friends who are in family medicine, that this is the part of their job they love. It's the paperwork that they hate. And if we can design a system and if we can rethink a system that allows family physicians to actually do the work that they wanted to do. And when I talk to my medical students and residents who want to go into family medicine, they're really passionate about this. They're passionate about social justice and about equity work.
And so, this is in line with what family medicine is purported to be about. And it's just unfortunate that we burden our family physician colleagues with work that's really not what they were supposed to be doing. But unfortunately, sometimes specialists, we're poor communicators and we drop the bag, and we leave it in their hands. And so, I think that this is the type of thing that would excite people to be in family medicine, finding a way to combine things that they see in their environments and being able to actually make a difference in that.
And so, I do think that we need to... Part of redesigning healthcare is to look at, "This is what the population needs and this is what we also are passionate about," and trying to marry those, and trying to limit the things that actually cause burnout.
Dr. Blair Bigham:
And as part of that redesign, making sure that we have, as I think Nav was saying, at St. Mike's they have those health teams that have lots of resources so that it's not all on a single provider in a single practice to be able to keep track of all of this.
And in some ways, I wonder if this is where health record systems and all this new electronic charting could actually be of benefit in terms of helping to track when people should be screened. I think nine out of 10 Epic reminders that pop up in front of my face, I just delete right away. But the screening ones, I feel like maybe that is where artificial intelligence or computer-based charting can help us-
Dr. Mojola Omole:
A hundred percent.
Dr. Blair Bigham:
... keep track of that in these teams. So maybe a little bit of a glimmer of possibilities there as we strive to implement this very thorough guideline.
That's it for this week on the CMAJ podcast. Thank you so much for listening. If you can, please do us a favor and like or share our podcast wherever it is you download your audio, or just tell your colleagues about it. We'd love to get the word out and get more listeners.
This podcast is produced by Podcraft Productions. Big shout-out to our producer, Neil Morrison. I'm Blair Bigham.
Dr. Mojola Omole:
And I'm Mojola Omole. Until next time, be well.