Measles in pregnancy and beyond

Measles is resurging in Canada, with particularly serious implications for pregnant patients and newborns. A recent CMAJ article, Five things to know about measles in pregnancy, outlines the risks and clinical considerations. On this episode of the CMAJ Podcast, we speak with one of the article’s co-authors, Dr. Michelle Barton-Forbes, about what physicians need to know when caring for pregnant patients during a measles outbreak. We also get an update on the current state of the outbreak in Canada from Dr. Marina Salvadori.

Dr. Michelle Barton-Forbes, division chief of infectious disease at the Children’s Hospital at London Health Sciences Centre, highlights the risks of measles in pregnancy, including atypical presentations, preterm labour, and rare but severe complications like subacute sclerosing panencephalitis. She discusses the limitations of existing research, current guidance on immunoglobulin use in newborns, and the use of vaccines during pregnancy.

Dr. Marina Salvadori, senior medical advisor at the Public Health Agency of Canada, describes the scope of the ongoing measles outbreaks and their concentration in undervaccinated communities. She explains the public health challenges of engaging with vaccine-hesitant populations and outlines practical steps physicians can take to support informed vaccination decisions and to prevent further spread of the virus.

This episode offers physicians clinical guidance on recognizing measles in pregnancy, managing exposures and complications, and navigating conversations about vaccination during an ongoing outbreak.

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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Transcript

Dr. Mojola Omole
I'm Mojola Omole.

Dr. Blair Bigham
I'm Blair Bigham. This is the CMAJ Podcast. So, Blair, this…

Dr. Blair Bigham

 …in the news.

Dr. Mojola Omole
So much in the news. So we are talking today about the five things you need to know about pregnancy and measles. 

Dr. Blair Bigham
Which is pretty scary given that this wasn't really something I thought I needed to memorize  back in medical school.

Dr. Mojola Omole
I didn't even know what measles was because I thought it was eradicated. And as most of us know, it's all over the news—the outbreaks of measles and trying to contain them. But it's happening south of the border, also in Canada. And as most of us know, measles does have very dire effects in pregnancy.

Dr. Blair Bigham
And just in our own province, Jola, we had a measles death last year. That was the first time someone had died of measles in Ontario since 1989.

Dr. Mojola Omole
Didn’t we have one recently?

Dr. Blair Bigham
Well, yeah—and we've had more since. And just recently had a neonate who passed away from measles. It's a scary time. It's somewhat unprecedented for at least a contemporary world. This isn't supposed to happen, 

Dr. Mojola Omole
But I do think this is a very topical topic because it has a lot of implications and maybe things that are easily—maybe time-consuming, but that could be easily done by frontline physicians and healthcare practitioners to help mitigate and increase vaccine uptake for measles, prior to pregnancy.

Dr. Blair Bigham
Certainly. And so today, we're sadly going to dedicate time to learning about measles in pregnant women. And then we're going to zoom out and talk about the current measles outbreak here in Canada and elsewhere in the world, and what we might be able to do to turn around the slide in vaccination rates. That's up next on the CMAJ Podcast.

Dr. Mojola Omole

Dr. Michelle Barton-Forbes is the Division Chief of Infectious Diseases at the Children's Hospital London Health Science Centre. She's the co-author of the article in CMAJ, “Five things to know about measles in pregnancy.” Michelle, thank you so much for joining us today.

Dr. Michelle Barton-Forbes

Yes, thank you for having me.

Dr. Mojola Omole

So we've all seen the news clips of measles that are now cropping up in Ontario. How many cases of measles in pregnancy have you personally dealt with recently?

Dr. Michelle Barton-Forbes

I would say that we have dealt with just under 10.

Dr. Mojola Omole

And let's say three years ago, what was that number?

Dr. Michelle Barton-Forbes

Zero.

Dr. Mojola Omole

Okay.

Dr. Michelle Barton-Forbes

Zero. I've never seen measles in pregnancy until now, even though I've seen measles. I'm from the developing world.

I've seen measles, but I've never seen measles in pregnancy because we don't see measles in pregnancy usually in the developing world.

Dr. Mojola Omole

Is this why you decided to write this paper?

Dr. Michelle Barton-Forbes

Yes, because this was a new phase of measles that most people are not aware of. I mean, we know that measles affects pregnant women, definitely causing more adverse effects, but we hadn't had much experience with measles in newborn babies. And even though it still is rare in this outbreak, it's still important enough to raise awareness.

Dr. Mojola Omole

What were some of the gaps that you were noticing when you were looking at the literature?

Dr. Michelle Barton-Forbes

Oh, so basically the literature doesn't really have any huge studies. It basically, lots of case series and a few case cohorts from Africa, Saudi Arabia, U.S. mainly. And basically what was happening is that we didn't have much guidance as to how long babies who have congenital measles, how long they need to be isolated for, how long do they shed for since their immune system is so immature.

We wanted to be better guided, but the literature doesn't really have much on that. The series described more what was happening in the mothers, but it was really deficient in giving us a good picture of what was happening in the babies.

Dr. Mojola Omole

Why do you think that is, that they don't really describe what's happening in babies?

Dr. Michelle Barton-Forbes

So first and foremost, not every pregnant woman who has measles will end up giving birth to a baby with measles. So it's not a hundred percent that if they have measles, they will end up with their babies. Some babies will get it and some babies won't.

So the numbers, you'll definitely see much more pregnant women than you will see congenital measles. And then in the developing world, where some of the case cohorts were from, they basically, with the pressure of bed space and stuff, they probably can't really follow up shedding and how long shedding goes on for. Sometimes PCRs are not, so how do we tell if measles is shedding?

How do we tell you have a measles infection? You can look either at antibody response or you can look for the virus itself, looking, doing a PCR test. But a lot of the developing world doesn't have PCR tests available, so you would not be able to get shedding data because they can't follow that.

They can only check for antibodies. And so you don't have that. So in a first world country, if we're having it and we don't know, now is the time to learn as much as we can.

Dr. Blair Bigham

So this is in some ways an opportunity. 

Dr. Michelle Barton-Forbes

I don't like to say that.

Dr. Blair Bigham

I hate saying that, but never let a crisis go to waste.

Dr. Michelle Barton-Forbes

We shouldn't make a crisis, but I don't want to ever say it's an opportunity because it's not nice.

Dr. Blair Bigham

It is a unique moment to understand this better.

Dr. Michelle Barton-Forbes

That's better.

Dr. Mojola Omole

So does measles present differently in someone who's pregnant compared to someone who's not?

Dr. Michelle Barton-Forbes

Yes, it can. So as pregnancy is that in that period of pregnancy, you don't want to reject the baby. And so as a result, the body's immune system is a little bit dampened so that she doesn't reject her baby.

And so as a result, some pregnant women can have measles without any fever. Some pregnant women can have measles without any rash. So they can have rash, they can have fever, or they may have fever and no rash or rash and fever, various presentations.

Dr. Blair Bigham

Hang on. So if they don't have a rash, do I need to consider measles in every pregnant woman with a fever? 

Dr. Michelle Barton-Forbes

No, no, no, no, no, no, no, no. So remember, we are always starting at the point of no vaccination in a community where it's circulating. So those are your red flags. And then the other thing is that measles in pregnancy can also present as preterm labour because measles can trigger preterm labour.

So it might even be the first manifestation of measles. So a pregnant woman who gets exposed to measles within seven days, almost a third of them will manifest, I mean, will go into labour. So it depends on when you get exposed.

If you get exposed way before your term, then you'll go into preterm labour. If you get exposed at term, then you won't obviously. So within seven days of exposure, almost a third of them will go into labour, and then by three weeks, up to 60% of them will be in labour.

So it triggers labour. So when you see that in a vulnerable person who is coming from a community where it's circulating, and they tell you they've been exposed to measles, you always start to think, is this the beginning of measles? So then you start to do the evaluation, to look for features, things in the mouth, et cetera, and do the testing if they've been exposed. 

Dr. Mojola Omole

What testing do we do?

Dr. Michelle Barton-Forbes

Okay. So the testing basically consists of antibody testing, and that's to look if the body has started to mount a response, and then PCR testing, where you're actually looking for the virus. So the PCR testing is done on throat swab, or nasopharyngeal swab, and the urine.

Dr. Mojola Omole

What does treatment look like with someone who's pregnant and has measles?

Dr. Michelle Barton-Forbes

So it's no different from someone who is not pregnant. There is no specific treatment for measles, and it's really supportive management. So you're looking at if they're dehydrated, hydrating them, you're looking at supporting, giving fever management, and then you're looking to see if they're having features of a pneumonia, because a lot of times they'll be coughing.

So you're assessing them to see if they've developed pneumonia, and if they have, then you manage the pneumonia accordingly, whether it needs antibiotics or even oxygen support, et cetera.

Dr. Mojola Omole

Can newborns be treated with the immunoglobulins? 

Dr. Michelle Barton-Forbes

Yes. So immunoglobulins are often given in the prevention phase of measles. So like in older children or adults who are at risk for severe manifestations, so the young infants, the pregnant women, the immunocompromised cancer patients, if they get exposed, we'd normally give them immunoglobulins within the first six days of the exposure to break the cycle. With the newborn born to the mom with measles, what we do know from the literature is that it states that before the era of immunoglobulins being available, what would happen is that congenital measles was associated with a mortality ranging from 20 to 50 percent.

But since the advent of immunoglobulins, that has definitely improved, the risk of mortality has improved. So as a result, because of that data, we go ahead and give the babies at birth the immunoglobulins. Often the babies don't necessarily show any features of measles at birth, but some may have a rash at birth, but they may not.

And basically what we're doing at birth is to test them. So they may test positive and still not show any symptoms and then over the next few days begin to show symptoms. So we go ahead and give them the immunoglobulin, even though they may already have them.

So that's a big difference in the older children and adults. We give it only to prevent. In the newborn, we don't know where it's going, so we just go ahead and give it at birth if they've had a significant exposure.

Dr. Mojola Omole

What's the current recommendations around vaccination for people who are pregnant?

Dr. Michelle Barton-Forbes

Okay, so usually outside of measles outbreak, the recommendation is that birthing parents should not receive live vaccines during pregnancy. However, NACI has updated their statement to say in the context of measles outbreak, there may be potential benefits with an MMR vaccine and those benefits may outweigh the theoretical risks and so a measles vaccine, MMR vaccination may be considered with guidance from public health officials.

Dr. Mojola Omole

What is the long-term sequelae of having congenital measles?

Dr. Michelle Barton-Forbes

So most children won't have any problems, but you can have a rare complication where you get what we call SSPE, which is subacute sclerosin panencephalitis. That usually happens six to ten years after measles. However, the younger you get it is the earlier it would manifest.

So in young, if you get it when you're extremely young, it could present as early as a year to 18 months of age. And the younger you get it, the risk is higher for that. But the risk is very, I want to emphasize that it is rare, it's one in 10,000, the usual level of risk.

But when you get it when you're younger, it can be up to a 16-fold increase. And then one other complication, which is probably much more common, is the fact that measles paralyzes the immune system. It stays in the lymphocytes and affects the function of the lymphocytes, and therefore your ability to fight infections after measles is well recognized that you can get serious infections after measles.

And we don't know exactly how long that lasts for, but some experts feel that it may last for up to six months after. So it means that a child who gets measles, even if they didn't get admitted for measles from that acute infection, they could come back in another six weeks with a serious bacterial infection, could come back with meningitis or some other infections, and that could be repetitive over the next six months.

Dr. Blair Bigham

Can you paint a picture of what panencephalitis, like what the impact of that is for a kid's life?

Dr. Michelle Barton-Forbes

Okay, so that is basically, there is no effective treatment for that. So this is a slow, degenerative disorder where you start off with seizures and you lose cognition, then you go comatose and then you die.

Dr. Blair Bigham

Oh, okay. Big impact.

Dr. Michelle Barton-Forbes

It's fatal.

Dr. Blair Bigham

It's fatal. Okay. And it can happen a decade after.

Dr. Michelle Barton-Forbes

Yeah.

Dr. Blair Bigham

So like a 10-year-old could just...

Dr. Michelle Barton-Forbes

And I've seen that when I was in Jamaica, I've seen, unfortunately, I've seen it and it's not a pretty picture. You feel helpless because you can't help this kid who's having seizures and then they just continue to deteriorate and then die.

Dr. Mojola Omole

Wow. So what should physicians, especially OB and emerg medicine be watching for right now?

Dr. Michelle Barton-Forbes

So I think before we watch for what we are watching for, what we should be doing is trying to prevent other prospective women who are planning to get pregnant, preventing them as much as possible from getting measles by ensuring or emphasizing to them the importance of immunization if they haven't been immunized. And so I think that should be the first thing, prevent, because measles is preventable, so we should be spreading the message of prevent. And so I would encourage reproductive women, I would encourage everybody who is not immunized, as long as there is no medical reason to prevent them from being immunized, I would encourage them to ensure that they have their measles vaccines, their two measles vaccines, and that's done.

So if they are already pregnant and in communities where it is circulating, I would say to them, be aware and if you know that you have been exposed, contact your doctor right away, because we can intervene in the first six days. There's immunoglobulins available. And so that's what I would say to them.

Dr. Mojola Omole

Perfect. Thank you so much for joining us today. 

Dr. Michelle Barton-Forbes

You're welcome. 

Dr. Blair Bigham

Yeah, thank you.

Dr. Mojola Omole

Dr. Michelle Barton-Forbes is Division Chief of Infectious Diseases at the Children's Hospital, London Health Sciences. Thank you.

So we're going to step back from the specific risks during pregnancy and just to get a clearer picture of the current state of the outbreak itself. Dr. Marina Salvadori is a Senior Medical Advisor at the Public Health Agency of Canada. She's also a Professor of Pediatric Infectious Disease at McGill University and Montreal Children's Hospital.

And importantly, for this conversation we’re about to have, she was the section head for 20 years at London Health Science Centre, which sits at the centre of the current outbreak. Thank you so much for joining us, Marina.

Dr. Marina Salvadori 

Thank you very much for having me. Very happy to talk about measles today.

Dr. Mojola Omole

So what's the current state of the measles outbreak in Canada?

Dr. Marina Salvadori

Yeah, so at a national level, this current outbreak, which really started in the end of October of 2024, we have more than 3,000 cases. And there's been cases in many different provinces and territories. At the present time, the vast majority of the cases are in southwestern Ontario, and also in the southern health areas of Alberta.

Dr. Mojola Omole

Okay, and can you walk us through how this outbreak unfolded?

Dr. Marina Salvadori

Absolutely, yes. So the current outbreak that we're experiencing across the country started, as I said, at the end of October with someone visited Canada, went to New Brunswick and actually was part of a very large wedding celebration. And most of the attendees at that wedding were part of an unvaccinated, closely knit community.

And then people, many people got measles at that New Brunswick wedding and went back to different areas across the country. And a large number of them were from southwestern Ontario. So that then we started to see a lot of cases transmitting among the under-vaccinated community that has like cultural and religious ties to Texas and to Chihuahua, Mexico.

And we've had a lot of transmission within those communities. And it's the same group of people and the same measles infections that are going from Canada around southwestern Ontario to Alberta, to Texas, to Chihuahua, Mexico. This is a very connected community.

So there's been a lot of transmission in and around those groups. In addition to that, because there's measles circulating all over the world, and we're certainly at a peak right now, partly due to a reduction in immunization after the pandemic, etc., we do get occasional imports from other countries that are not related to this group that is currently having a large circulation right now. And the importations do end up with usually having a few transmissions within their immediate family and maybe one or two transmissions beyond that.

But for the most part, those transmissions have been sort of stopped in their tracks.

Dr. Mojola Omole

So have there been efforts made historically to increase vaccinations in this community?

Dr. Marina Salvadori

Yeah, so there have been lots of efforts to increase vaccination in this community and in many other communities. So many unvaccinated communities have different reasons and their thinking is different around vaccinations. It's not a one-size-fits-all for any group of people who are unvaccinated.

I think it's really, really important to meet people where they're at. This particular community is an extraordinarily law-abiding and pacifist community who cares a great deal about neighbour. They really want to contribute to the good of society, and they care a lot about each other and the area in which they live.

And so part of the reason that they ended up in Canada and not in these other countries is because they left their original settlements many hundreds of years ago because of a strong sense of individual choice and not having government interference. So it's really important in these individual communities to always frame immunization as a matter of personal choice and in the best interests of the person themselves, their family, and their community. And the local public health units in southwestern Ontario and in southern Alberta and in other areas where there's large unimmunized populations have very good relationships on an ongoing basis with many of these undervaccinated communities.

They know how these people feel. They understand their culture. They understand their motivations.

And they are the best-placed people to discuss immunization and help to move the needle on making these people feel more comfortable and that it's their own choice, that they have agency, and that they're doing it for the best interests of their family.

Dr. Mojola Omole

Would it make sense to say, OK, you've chosen not to be vaccinated. Maybe right now we shouldn't gather. Like we should limit gathering to just essential gathering to reduce transmission of measles.

Would that work?

Dr. Marina Salvadori

Yeah, so that's a really fair question. I think that we can't really think about it necessarily in that way without also considering the context of COVID. So many people feel that for two or three years they were not allowed to gather.

They weren't allowed to go to school. They weren't allowed to have their weddings. And so it's really hard in public health to balance all of these different things and individual choice.

We certainly in Ontario, there are certain levers, for example, that public health have that if someone is unvaccinated, they can be what we call furloughed or kept out of school if there's measles circulating and things like that. But at the same time, enacting really strong views on these sorts of things does not bring the community along with you. And so it's a very difficult and tough balance.

As we head into summer, I do think it's important to say if you're going to have some large celebrations, having them outside is safer. And try and if you have been exposed, please stay home. If it's circulating in your community and you're a person at particular risk, so a pregnant woman, someone who's immunocompromised, a baby under about 12 or 18 months of age, those people should stay home and not attend very large gatherings where almost for sure people know at this point in time in their community there will be measles circulating.

Dr. Mojola Omole

So what does the measles vaccination rate look like across Canada right now?

Dr. Marina Salvadori

I think one of the most important things to bring out in this outbreak right now is that of the people who are getting measles, the known cases, 95% are either unvaccinated or don't know their vaccine status and so are presumed unvaccinated. So the vast majority of people are unvaccinated people. And of those, 75% are children under the age of 18.

So, yeah, so that's actually quite a lot. So if we look at vaccination status across the country, I can give you a number statistic. So I can say that, you know, by age two, actually 92% of children have had one MMR. But that's not really the picture. The picture is that groups of people who have like cultural values, who have religious values, who live in certain communities are big pockets of almost completely unvaccinated or very under-vaccinated communities. And that's really the risk as this sort of spreads from group to group. It's said that if you have 95% vaccination, then any importation of a case should stop fairly dead in its tracks.

To be fair, we're doing really well with our 92% of kids up to age two. And then up to age seven for the second dose, we say it's about 73%. But to be honest with you, one of the things about Canada is we don't have electronic records for immunizations, that every province has the same one, that every immunization is sort of put in and marked.

And you can tell from place to place and as you move across the province who's being vaccinated. So our immunization records aren't the best. And it's hard to know if, you know, the seven year saying 72% of kids have had two doses of vaccine is probably not totally correct.

It's probably more than that. But honestly, I think the message is we should have no children unvaccinated because of lack of accessibility, family chaos, they didn't get around to getting it, people kept thinking they had a snotty nose or an ear infection. Those are not reasons not to get your vaccine.

So every opportunity in our healthcare system to give someone a vaccine who wants one, we should give one. And then we need special and different work and groups of people and people who are skilled and experienced to talk to the other people and meet them where they're at. Because every person who chooses not to be vaccinated or is vaccine hesitant often have very different reasons.

They're not all cookie cutter people. They're different. And we all have the common ground of wanting our children to be safe and healthy.

And I think it's just sometimes takes a lot of work and a lot of effort to get those few hesitant ones to, you know, get vaccinated.

Dr. Blair Bigham

What is the danger of an outbreak in a community that has very low vaccination rates leaving that community and entering the more general population that has higher vaccination rates? Or do these tend to stay in those close knit communities?

Dr. Marina Salvadori

Yeah, so that's a really good question and one that we've been watching very closely because it just takes one or two people who have active measles to go to a place like Walmart or to a Toronto Maple Leafs game or something like that. And part, some of these communities who are affected live quite geographically sort of remote, very, very rural areas, but some live quite intermingled. So you can see the difference in Texas there's been a lot of people who are not in the unvaccinated community who have been affected. So there will occasionally be some people who have been vaccinated. You know, someone can take some mode of transport.

They can go to health care. That's one of the big places where transmissions occur. But we do know that we've been screening really carefully in health care settings.

So anyone who's at any risk of measles or may have measles should immediately be brought into a negative pressure room and isolated from everyone else in the waiting room. We've been talking to people in these communities and saying, please phone ahead if you're coming and you may have measles. Let us know so we can meet you at the door and bring you right in.

And those kinds of things are really helping to mitigate it.

Dr. Mojola Omole

So what's the most important takeaway for physicians who aren't in outbreak zones but they might still encounter measles and cases?

Dr. Marina Salvadori

Yeah, I think the most important thing with measles is to recognize it and move quickly. So first of all, you should know the signs and symptoms. And very few of us have seen them, actually.

I have to say, I have seen a few cases, but not that many. So I live in fear of being called down to the emerg and miscalling it. But your index of suspicion should be high right now.

So high index of suspicion if you live in an area where there's circulating measles, you have traveled at all. And those are the really important factors. And then anyone who presents with fever, it's fever and rash.

The rash usually starts on the face and neck and goes all the way down. It's said not to be itchy, but it's a very extensive rash. And then the three C's, which are cough, coryza, and conjunctivitis.

So those are how they often present with some of those things. There is a very specific thing, they say it's pathognomonic for measles, which is Koplik spots on the buccal mucosa, these white little dots. But to be honest, I really downplay that because they're incredibly hard for most physicians who don't have experience to see.

And they're not that important. So right now, if someone's traveled, they've been anywhere near the circulating areas, you're worried about it. You send a PCR measles from their throat and from the urine.

You don't actually have to do serology. IgM is a difficult test. It's not that easy to interpret.

It's not that important. So you don't have to do blood work or poke the kid. And then, so once you have a high index of suspicion and you send for testing, the other two important things are to say, stay home until we have an answer, you will be called.

And secondly, immediately pick up the phone and call public health. You should definitely not be waiting until you get the result to call it measles. If you think it's measles, public health wants to hear from you right now, because you have to isolate these people very quickly so that they don't go around spreading it.

And particularly their family members and siblings may not know that they're infected yet. And you sort of have to do some careful isolation to try and contain it. So I think those are the important things that your average doctor needs to know.

That's great. Thank you so much.

Dr. Blair Bigham

Thank you.

Dr. Marina Salvadori

Thank you very much for having me. It's been a real pleasure.

Dr. Mojola Omole

Dr. Marina Salvadori is a senior medical advisor at the Public Health Agency of Canada. She's a professor of pediatrics and infectious disease at McGill University and Montreal Children's Hospital. Thank you for joining us.

Dr. Blair Bigham

Okay, Jola, you go first.

Dr. Mojola Omole

I have to say, throughout the whole time, listening to both Michelle and Marina talk about the dire consequences of measles in pregnancy, and just, like, measles, yes, it's in certain communities, but my fear is, as we intermingle, what if that gets larger? What does that mean for all of us?

Dr. Blair Bigham

Yeah, and second, just how, like, bad it can get. Like, we're not talking about a few days on a ventilator. We're talking about years later, what, dying of dementia at the age of 10?

Like, it's so unfathomable to me that this risk is out there.

Dr. Mojola Omole

And I do think that the way we handled COVID vaccines is part of the problem, and just the fact that the public has completely lost trust in us, in terms of conveying the importance of vaccinations, and then the dire consequences if you don't get vaccinated, right? 

Dr. Blair Bigham

The trend was definitely starting before the pandemic, but you're right we've learned a lot of lessons about how certain ways of handling the pandemic may have pushed certain communities further away instead of closer towards science. And so that's definitely a learning point to take away from. But I think now we have to ask ourselves, like, what is the secret to building that public trust?

And I think that's something that is intensely under investigation right now.

Dr. Mojola Omole

I would say that it's how do we slowly, person by person, community by community, rebuild the public trust in us as physicians about everything.

Dr. Blair Bigham

And this is something that you and I weren't trained to do. We were trained to talk to individuals, we were trained to counsel individuals, but we weren't taught how to depolarize a topic as fraught as vaccination. We weren't taught how to build trust before or during our advice so that that trust is part of the conversation.

It leverages the information that we try to present so that people say, yes, not only are you in a white coat or have an MD beside your name, but you also are here to help me. You are benevolent. You are not in the pocket of pharma or just doing this because a computer told you to.

You are doing this because you actually care. And I think that's an element that we all need a little bit more practice at.

Dr. Mojola Omole

I also think, though, that we can do that, but we also need to fill the void that we have left in the sphere of the social media and of the internet.

Dr. Blair Bigham

The entire information ecosystem is totally different than it was 10 years ago, five years ago, two years ago. It's always changing.

Dr. Mojola Omole

And I do think as part of our job to take care of people is we also have to evolve with that. And so it's us not being in the white coat. It's us being with people and being in communities and being able to have a conversation with them of why do you need vaccines?

Dr. Blair Bigham

And with that comes a need for authenticity, vulnerability, like we need to just be very real with people. And I feel like that actually means dismantling things like the white coat that might actually present a bit of a barrier to people really understanding who we are as people. Because until they know us as people and not just doctors, there's always the possibility that they're not going to trust the doctor's decisions that we recommend, but they might trust the human personal decisions.

Dr. Mojola Omole

And the connections that we make with people. And I do think that it is our structure, our health care system makes it difficult and challenging to develop those relationships and those physicians who do? I commend them.

And they also have a high burden of burnout because it is so difficult to do in the ecosystem that we're in. 

Dr. Blair Bigham

Absolutely. The shift towards episodic care is making it harder and harder to have those longitudinal relationships with patients. That's it for this episode of the CMAJ Podcast. If you like what you heard, do us a favor, help us spread the message and like or share our podcast wherever it is you download your audio.

The CMAJ Podcast is produced by PodCraft Productions. Neal Morrison is our producer. Catherine Varner is our senior editor on the podcast and deputy editor at CMAJ.

Thanks so much for listening. I'm Blair Bigham. 

Dr. Mojola Omole

I'm Mojola Omole.

Until next time, be well.