On this episode, Drs. Blair Bigham and Mojola Omole delve into the evolution and advancements in virtual urgent care since the COVID-19 pandemic. The discussion centers around the study published in CMAJ entitled "Healthcare utilization and outcomes of patients seen by virtual urgent care versus in-person emergency department care," which analyzed patient usage and outcomes during the height of the pandemic. 

The study didn’t specifically track how many patients were redirected from emergency departments (ED) to virtual care. However, it found that around 80% of patients seen via virtual urgent care didn't require an immediate ED visit, suggesting that virtual care likely reduced some emergency presentations. However, it also noted that virtual urgent care didn't always prevent subsequent hospital visits. Importantly, the study reflects a specific period and doesn't capture the current state of virtual urgent care.

Dr. Justin Hall, director of the Toronto Health Region's Virtual Urgent Care Program, describes how the service has developed since 2020. Key improvements include enhanced technology for a more seamless patient experience and additional capabilities like imaging and laboratory testing. Dr. Hall says the program now acts as a crucial link for patients without regular access to healthcare providers and can successfully address acute, non-life-threatening conditions.

Drs. Bigham and Omole then speak with Mary Dimeo, a nurse practitioner working in the Toronto region's virtual urgent care service. She describes her role and experiences in the virtual environment. Ms. Dimeo says, typically only one patient per day needs to be referred to the emergency department which suggests the service helps divert patients from the hospital, especially those without family doctors or who cannot wait for an appointment.

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

On this episode, Drs. Mojola Omole and Blair Bigham speak with two vaccine experts about the necessity, timing and availability of vaccines as we move into the season when influenza, RSV and COVID-19 are on the rise.

Dr. Scott Halperin, co-author of a CMAJ practice paper on SARS-CoV-2 vaccination in pregnancy, emphasizes the importance of vaccination to protect against COVID-19 infection during pregnancy. He notes that while there is awareness among healthcare practitioners, it is crucial to continually highlight and reemphasize the importance of vaccination during pregnancy. The risk of severe outcomes from COVID-19 is higher in pregnant individuals compared to non-pregnant individuals. Vaccination during pregnancy not only protects the mother but also transfers antibodies to the fetus, providing protection in the first few months of life. 

Next, Dr. Trevor Arnason, Associate Medical Officer of Health with Ottawa Public Health, discusses the availability and administration of fall vaccines. He explains that the influenza vaccine is recommended for everyone over six months of age, with a higher dose available for older adults. The SARS-CoV-2 vaccine can be administered at the same time as the influenza vaccine, as there is now sufficient data on its safety. The RSV vaccine, currently approved for individuals over 60, is not government-funded and may not be accessible to everyone. Dr. Arnason emphasizes the importance of getting both the influenza and SARS-CoV-2 vaccines, particularly for high-risk groups such as young children, older adults, and individuals with underlying health conditions.

In summary, both Drs. Halperin and Arnason argue it is crucial for healthcare providers to educate and encourage their patients, especially pregnant individuals, to get vaccinated.

CMAJ article SARS-CoV-2 vaccination in pregnancy

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In this episode, Drs. Blair Bigham and Mojola Omole delve into the pressing issue of alcohol use disorder (AUD) in Canada with Dr. Evan Wood, the lead author of the “Canadian guideline for the clinical management of high risk drinking and alcohol use disorder” published in CMAJ. 

They explore the concerning prevalence of AUD in Canada, contrasting it with other countries and shedding light on the diagnostic criteria that underscore the significance of assessing clinically significant impairment or distress.

Dr. Wood clarifies the hurdles faced in identifying and treating AUD, highlighting the shortfall in healthcare provider education and resources. He underscores the importance of routine screening for alcohol use by physicians and offers invaluable tips to improve recognition of this pervasive disorder.

Dr. Wood outlines the recommended pharmacotherapies as stipulated in the guideline. He points out the frequency with which ineffective, or even harmful, treatments are prescribed for mood symptoms related to AUD and calls on physicians to follow evidence-based approaches.

Dr. Wood concludes by emphasizing the necessity of constructing a comprehensive system to tackle alcohol use disorder head-on in Canada, fostering a thorough understanding of this widespread health challenge among the medical community.

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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:

• Begin outreach at the age of 45 instead of at the age of 50 for colon cancer screening. This recommendation is based on the recognition that younger ages of diagnosis are being observed, particularly among people who are disadvantaged. The goal is to eliminate barriers for individuals ready to start screening and prioritize health equity during implementation.
• Offering publicly funded HPV self-testing for cervical cancer screening, especially for disadvantaged individuals who may face barriers to traditional screening methods.
• Implementing depression screening and offering online counseling programs or cognitive behavioral therapy for patients who screen positive.
• Providing resources for families experiencing poverty, such as a one-page sheet detailing available support.
• Prioritizing care for specific populations based on inequities in health outcomes, such as prioritizing cardiovascular disease screening in women due to discrimination and sexism within the healthcare system.

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.

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In this episode, Drs. Blair Bigham and Mojola Omole speak with two leading experts: Dr. Samira Jeimy, an allergist, and Dr. Isaac Bogoch, a specialist in infectious diseases, about the increasing prevalence of allergies and infections in Canada attributed to insects.

Dr. Jeimy authored the article in the CMAJ titled “Five things to know about… tick-borne red meat allergy (α-gal syndrome)”. Dr. Jeimy describes how tick bites introduce a carbohydrate, alpha-gal, leading the human body to manifest allergic reactions to red meat. She underscores the diagnostic challenges associated with this allergy due to its delayed reactions and the spectrum of symptoms, which can range from mild to critical.

Dr. Bogoch shifts the focus to the expanding footprint of tick and other insect-borne diseases in Canada, such as Lyme disease, anaplasmosis, and babesiosis. He attributes this surge to the climatic shift towards warmer temperatures and abbreviated winters. He emphasizes the indispensability of preventive measures, including vigilant tick checks, use of repellents, and donning protective clothing.

Both experts stress the urgency of heightened education, rigorous surveillance, and enhanced testing methodologies. As ticks and insects advance further north, physicians need to be alert to this emerging health challenge.

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Canada’s emergency departments are in crisis: hospital occupancy rates exceed 90% for many days in a row, and many Canadian hospitals have been exceeding 100% occupancy for months on end. As a result, quality of care has decreased, staff retention has become problematic and overcrowding of emergency departments, a symptom of the problem, is assured.

On this episode, Drs. Omole and Bigham speak with Dr. Catherine Varner, an emergency physician in Toronto, deputy editor of CMAJ, and author of two editorials in the journal detailing the state of Canada’s emergency departments, the causes of the crisis and possible solutions. Joining the conversation is Dr. David Petrie, an emergency physician in Halifax and co-chair of the Canadian Association of Emergency Physicians’ EM:POWER Task Force on the Future of Emergency Care who explores what a whole system approach to resolving this pressing issue might look like.

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On this episode, we revisit and update one of the most-read articles on the CMAJ website.

The article is titled, “Smartphones, social media use, and youth mental health.” It reviews the extensive literature linking poor mental health in adolescents with smartphone and social media use. The article details a variety of studies that implicate smartphone and social media use in increased mental distress, self-injurious behaviour, and suicidality among youth. It also indicates that there's a dose-response relationship, with the effects appearing to be most pronounced among girls.

The lead author of the paper is Dr. Elia Abi-Jaoude. He is a psychiatrist and researcher at The Hospital for Sick Children in Toronto. He delves into recent research exploring how social media and smartphone use negatively impact the mental health of young individuals.

Later in the episode, Dr. Michelle Ponti offers practical tips that physicians can provide parents to effectively manage their children's smartphone and social media use. Dr. Ponti is a paediatrician in London, Ontario, and Chair of the Digital Health Task Force for the Canadian Paediatric Society.

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== This is an encore presentation of an episode originally published on Jan 30, 2023 ==

Migraine is a common condition that affects around 12% of adults, with a higher prevalence in women (18%) than men (6%). Global burden of disease estimates in 2019 found migraine to be the leading cause of disability in women aged 15-49 years and the second leading cause of disability overall. 

On this episode, Drs. Mojole and Bigham interview three authors of two review articles on the topic published in CMAJ, which focus on diagnosis, acute treatment and prevention of migraine.  

Dr. Velina Tzankova is a neurology resident at the University of Toronto; Dr. Werner Becker is a neurologist and the founding director of the Calgary Headache Assessment and Management Program, and currently professor emeritus in the Department of Clinical Neurosciences at the University of Calgary; and Dr. Tommy Chan is a neurologist and director of John H. Kreeft Headache Clinic at University Hospital in London, Ontario. 

As well, Drs. Bigham and Omole interview two women who have battled severe migraine since childhood: psychologist, Dr. Shanthy Edward, and med student, Zikra Awosanmi. They discuss the impact migraine headaches have had on their lives, the challenges they have faced accessing adequate treatment, and their thoughts on what physicians could better understand about this disabling condition.

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 award-winning essay in the CMAJ, "Sometimes, often," beautifully showcases the power of narrative to forge a deep connection between physicians and patients. The article clearly resonated with our readers, as it was the most-read humanities piece this year. On this episode, the author, Dr. Simran Sandhu, delivers a powerful reading of her article. She then speaks with Drs. Blair Bigham and Mojola Omole about what inspired her to write the essay and how storytelling enables her to build deeper connections with her patients, and in turn, find meaning in her practice.

Next, Dr. Indu Voruganti joins the conversation. She is a radiation oncologist and instructor in the Narrative-Based Medicine Program at the University of Toronto.  Dr. Voruganti describes narrative medicine as a tool for combating burnout and promoting empathy in medical practice. She advocates for creating space for reflection and vulnerability, and argues that narrative medicine has the potential to enhance both patient care and physician well-being.

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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Radon gas exposure is the leading cause of lung cancer in non-smokers, accounting for approximately 3,000 cases annually in Canada. A “Five things to know about…” paper in CMAJ  entitled “Radon and lung cancer risk" encourages physicians to ask patients to test their home and workplace for the invisible gas.

Dr. Silvina Mema and Greg Baytalan are co-authors of the article, and on this episode, they detail the significant public health risk radon poses, the relative ease of testing, and the cost of successful mitigation. They argue that family doctors and specialists play a critical role in creating awareness about radon gas and reducing its impact on patient health and the public healthcare system.

Next, Dr. Aaron Goodarzi advocates for changes to cancer screening guidelines to include individuals with elevated lifetime radon exposure.  Dr. Goodarzi is the Scientific Director of the Evict Radon national study. He points out that 40% of people who experience lung cancer will never be eligible for current screening programs because they don't use enough tobacco.

Dr. Goodarzi goes on to describe the many ways public policy can be used to reduce the risk of radon exposure, from updated building codes to mandatory testing of public spaces like daycares, and financial assistance for radon gas mitigation.

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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Major hemorrhage is life-threatening and can occur in a variety of clinical settings. A review paper in CMAJ, entitled "Nonsurgical management of major hemorrhage," advocates for the implementation of massive hemorrhage protocols across all types of hospitals to optimize patient care.

Dr. Jeannie Callum, the article's lead author and the Director of Transfusion Medicine at Kingston's Health Sciences Centre speaks with Drs. Blair Bigham and Mojola Omole about her work standardizing massive hemorrhage protocols throughout Ontario. Dr. Callum shares the transformative moment that inspired her to develop a province-wide protocol, starting from the point of roadside patient care.

She then details the critical need for precision in managing major hemorrhage, emphasizing a rapid response within the "golden hour." Dr. Callum outlines key components of care such as swift administration of tranexamic acid and the detection of coagulopathy. She then simplifies the main elements of a massive hemorrhage protocol into what she calls "the seven 'T’s."

In rural settings, Dr. Callum identifies the need for a simplified protocol due to constraints like smaller medical teams and a lack of comprehensive laboratory tests. Despite these challenges, she recommends innovative solutions like the immediate administration of tranexamic acid and encourages physicians to educate themselves about novel point-of-care testing technologies such as viscoelastic testing.

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Many women complain that physicians are reluctant to treat menopause with the full range of available therapies, often dismissing symptoms as 'natural' and something to be endured. A review article in CMAJ  finds that physician fears around menopausal hormone therapy and lack of knowledge regarding treatment options often impede patients from receiving treatment.

On this episode, Drs. Mojola Omole and Blair Bigham speak with Dr. Iliana Lega, the lead author of the review entitled "A pragmatic approach to the management of menopause." Dr. Lega is a Clinician Scientist and Endocrinologist at Women’s College Hospital in Toronto. She encourages physicians to update their therapeutic understanding of menopause and to initiate conversations with women about the symptoms of perimenopause as they enter their forties.

Drs. Omole and Bigham also hear from Janet Ko, the co-founder and president of the Menopause Foundation of Canada. She shares her personal experience of receiving a delayed diagnosis of perimenopause and the impact of hormone replacement therapy on her well-being. Ms. Ko also shares the results of the foundation's study on women's experience receiving care for menopause, and reports that 72 percent of women found medical advice to be unhelpful or only somewhat helpful.

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On this episode, Dr. Greg Hundemar, co-author of the practice paper in CMAJ “Screening for primary aldosteronism in primary care” discusses primary aldosteronism, its implications and the need to expand screening guidelines. 

Primary aldosteronism, also known as primary hyperaldosteronism or Conn's syndrome, is an endocrine disorder where the adrenal glands secrete too much aldosterone, leading to hypertension. This condition was once thought to be a rare cause of hypertension, but recent research shows that it may account for 10-20% of cases.

Classic symptoms of primary aldosteronism include hypertension, low potassium, and metabolic alkalosis. Patients with this condition are at a disproportionately high risk for cardiovascular disease, rapid decline in kidney function, and higher mortality, independent of blood pressure. Early diagnosis and targeted treatments can significantly improve outcomes.

Dr. Hundemar stresses the importance of screening more people with hypertension for primary aldosteronism to diagnose and treat the condition earlier. Current guidelines recommend screening for those with severe or resistant hypertension, hypertension with low potassium, or hypertension with an adrenal nodule. However, Dr. Hundemar advocates for expanding screening for primary aldosteronism in patients with hypertension, as doing so can potentially identify a large number of undiagnosed cases.

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Allopurinol hypersensitivity syndrome (AHS) affects approximately 1 in 1,000 patients prescribed allopurinol, with reported mortality rates between 20% and 25%. The risk of AHS is nearly 100 times higher in carriers of the HLA-B*58:01 allele than in noncarriers. Populations with a high allele frequency include Han Chinese (6%-8%), Korean (12%), and Thai (6%-8%) people.

In this episode, Drs. Wid Yaseen and Jonathan Zipursky discuss their paper published in CMAJ, titled "Five things to know about…allopurinol hypersensitivity syndrome". Dr. Jonathan Zipursky is a general internist, clinical pharmacologist, and clinician scientist at Sunnybrook Health Sciences Centre. Dr. Yaseen is a second-year internal medicine resident physician at the University of Toronto. They argue that the syndrome's frequency is often underestimated and emphasize the importance of genetic testing in susceptible populations.

Next, Dr. David Juurlink broadens the discussion beyond allopurinol to describe other common medications whose effectiveness and safety are significantly influenced by genetic predispositions. Dr. Juurlnk is a staff internist and head of division of clinical pharmacology and toxicology at Sunnybrook Health Sciences Centre in Toronto. He is also a medical toxicologist at the Ontario Poison Centre.  He explores the need for expanded genetic testing to protect patients and ensure proper dosing.

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Fragility fractures are a major health concern for older adults and can result in disability, admission to hospital and long-term care, and reduced quality of life. 

The Canadian Task Force on Preventive Health Care guideline published in CMAJ provides evidence-based recommendations on screening for primary prevention of fragility fractures.

In this special episode of the CMAJ podcast, CMAJ editor-in-chief Dr. Kirsten Patrick speaks to Dr. Roland Grad, a family physician and an author of the new guideline, about the evidence reviews conducted by the task force, the main points of the new guideline, and how family doctors can use it in practice.

The guideline recommends screening females over 65 using the FRAX tool without bone mineral density (BMD) as a risk assessment first strategy. Dr. Grad emphasizes the importance of shared decision making, which can be facilitated using the Fragility Fracture Decision Aid, which incorporates the FRAX tool. This online, interactive tool helps  guide discussions with patients about their fracture risk and potential benefits of preventive treatment.

Links to resources mentioned in the interview:

Canadian Task Force on Preventive Healthcare guideline

Fragility Fractures Clinician Infographic

Fragility Fracture Decision Aid 

Article in Journal of Systematic Reviews

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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An estimated 23%-45% of patients undergoing major surgery have anemia, with the most common causes being iron deficiency anemia and anemia of inflammation or chronic disease.

In this episode, Drs. Mojola Omole and Blair Bigham speak with Dr. Clarissa Skorupski and Dr. Yulia Lin, two authors of the practice paper in CMAJ, "Five things to know about preoperative anemia in major elective surgery." Dr. Skorupski is a third-year internal medicine resident at the University of Toronto, and Dr. Yulia Lin is the division head of transfusion medicine and tissue bank at Sunnybrook Health Sciences in Toronto. They highlight the high prevalence of preoperative anemia, its adverse outcomes, and the importance of targeting a preoperative hemoglobin level of 130 g/L for both sexes.

Next, Drs. Bigham and Omole take a critical look at the WHO guideline which sets a lower hemoglobin threshold of 120 g/L for female bodies. They speak with Dr. Michelle Sholzberg, the head of hematology-oncology and the director of the Hematology Oncology Clinical Research Group at St. Michael's Hospital in Toronto. Dr. Sholzberg argues that the WHO's sex-based hemoglobin thresholds for diagnosing anemia perpetuate structural discrimination in medicine, as they normalize anemia in females and are based on outdated data with a high risk of bias. Dr. Sholzberg describes how the policies and clinical practices following the biased thresholds may impact health-related quality of life, cognitive function, and the health of pregnant individuals and their babies.

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Many patients report their symptoms of endometriosis are often dismissed by healthcare providers as “normal” dysmenorrhea. This worldwide trend results in delays to diagnosis that are estimated to range from 6 to 11 years from symptom onset. 

On this episode, Drs. Bigham and Omole speak with Dr. Catharine Allaire, a clinical professor at UBC's Department of Obstetrics and Gynaecology and co-author of the review in CMAJ entitled “Diagnosis and management of endometriosis”. Dr. Allaire discusses the challenges and delays in diagnosing endometriosis, its symptoms and causes, and the different varieties of the condition. She also explains the role of imaging in diagnosing endometriosis and how it can be managed through various treatment options from hormone therapies to surgery.

Drs. Bigham and Omole also speak with Hannah Robinson, an emergency department nurse who has struggled with endometriosis for seven years. She describes the challenges she faced receiving a diagnosis and accessing care.

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Clinicians may find diagnosing polyneuropathy challenging due to the vague and insidious onset of symptoms. Identifying signs consistent with polyneuropathy and determining which investigations to conduct and when to be concerned can be daunting.

Polyneuropathy involves simultaneous dysfunction of multiple peripheral nerves, with the most common form being distal symmetric polyneuropathy. Symptoms primarily occur distally, mainly at the bottom of the feet, and progress proximally. Sensory symptoms are more frequent than motor symptoms and signs. Patients with distal symmetric polyneuropathy may experience neuropathic pain, impairments in walking, and distal motor function, significantly impacting their quality of life.

Dr. Ario Mirian, a fifth-year neurology resident at the University of Western Ontario's Schulich School of Medicine and Dentistry, is the lead author of a review article in CMAJ entitled "Diagnosis and management of patients with polyneuropathy". In this episode, Dr. Mirian presents a practical approach to diagnosing and managing polyneuropathy while highlighting 'red flags' that should prompt clinicians to investigate potentially serious underlying causes, such as malignancy or vasculitis.

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The use of electric scooters (e-scooters) has witnessed a substantial surge globally.

However, the presence of these motorized vehicles on sidewalks poses a significant risk to pedestrians. A recent practice paper published in CMAJ describes the case of a 68-year-old woman who suffered serious injuries while walking on a city sidewalk after being hit by an e-scooter traveling at approximately 30 km/h. 

While the authors of the paper recognize e-scooters as a popular, efficient and green form of transportation, they argue effective policies are needed to mitigate risks associated with their use. 

On this episode, Drs. Blair Bigham and Mojola Omole speak with Zach Williams, the director of policy and government partnerships and Jamie Perkins the director of communications for  Superpedestrian. Superpedestrian is an e-scooter company that spun off from the MIT Sensible City Lab. They discuss the necessary changes to urban infrastructure as well as the responsibilities of e-scooter providers to ensure safety for riders and pedestrians.

The discussion then shifts to Catherine McKenney, a former Ottawa city councilor and mayoral candidate, who proposed substantial investments in biking infrastructure during their campaign. They argue that debates about safe urban transit have become too polarized and that it is not a matter of being for or against cars, but rather about finding effective solutions to make transportation safe and efficient for all users.

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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Uptake of the SARS-CoV-2 vaccine for children aged 5–11 years has been lower than anticipated in Canada. Although research has explored parental intentions toward SARS-CoV-2 vaccination for children, the drivers of parents’ decisions to seek vaccination for their children - or not -  have not been studied in-depth. 

A research paper published in CMAJ,  entitled Parents’ perspectives on SARS-CoV-2 vaccinations for children: a qualitative analysis, sought to explore parents’ decision-making. It was a collaboration between physicians, social scientists and research scientists. 

On this episode, four of the paper’s authors discuss their findings with hosts, Drs. Omole and Bigham. They emphasize the importance of existing trusting relationships between parents and their primary care providers when it comes to making difficult healthcare decisions for children.

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Early in the COVID-19 pandemic, Ontario saw a 5600% increase in virtual visits to health care practitioners, while in-office visits decreased by 79% from the previous year. In 2018, only 4% of family physicians in Canada were offering video visits while, at the peak of the pandemic, about 80% of primary care visits were being delivered virtually in Ontario.

Media reports at the time suggested patients were substituting emergency department (ED) visits when in-person consultations were unavailable, leading to additional strain on already stretched ED resources.

A research paper published in CMAJ looked at whether this shift in care was in fact taking place. Dr. Hemant Shah is an internal medicine physician and hepatologist at Toronto General Hospital and co-author of the study entitled Association between virtual primary care and emergency department use during the first year of the COVID-19 pandemic in Ontario, Canada.

On today’s episode, Dr. Shah discusses the study’s surprising findings with hosts Dr. Blair Bigham and Dr. Mojola Omole.  

Drs Omole and Bigham then speak with Toni Leamon, the CMA’s patient voice chair, a member of CMA's Virtual Care Taskforce and a co-author of the CMA's Virtual Care Companion for Patients. She offers the patient’s vision of high quality virtual care.

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 Twitter @BlairBigham and @Drmojolaomole

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

The CMAJ Podcast is produced by PodCraft Productions

Migraine is a common condition that affects around 12% of adults, with a higher prevalence in women (18%) than men (6%). Global burden of disease estimates in 2019 found migraine to be the leading cause of disability in women aged 15-49 years and the second leading cause of disability overall. 

On this episode, Drs. Mojole and Bigham interview three authors of two review articles on the topic published in CMAJ, which focus on diagnosis, acute treatment and prevention of migraine.  Dr. Velina Tzankova is a neurology resident at the University of Toronto; Dr. Werner Becker is a neurologist and the founding director of the Calgary Headache Assessment and Management Program, and currently professor emeritus in the Department of Clinical Neurosciences at the University of Calgary; and Dr. Tommy Chan is a neurologist and director of John H. Kreeft Headache Clinic at University Hospital in London, Ontario. 

As well, Drs. Bigham and Omole interview two women who have battled severe migraine since childhood: psychologist, Dr. Shanthy Edward, and med student, Zikra Awosanmi. They discuss the impact migraine headaches have had on their lives, the challenges they have faced accessing adequate treatment, and their thoughts on what physicians could better understand about this disabling condition.

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 Twitter @BlairBigham and @Drmojolaomole

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

The CMAJ Podcast is produced by PodCraft Productions

Diagnosing long COVID, or post-acute sequelae of SARS-CoV-2 infection (PASC), is challenging for clinicians. With up to 200 possible symptoms, heterogeneous presentations and no definitive diagnostic test, the diagnosis is a clinical one.

In this episode, Dr. Kieran Quinn, a general internist and palliative care physician at Mount Sinai and Bridgepoint Hospitals in Toronto, emphasizes the importance of judicious diagnostic testing in patients with suspected long COVID.

Dr. Quinn, who is co-author on three “Five Things to Know…” articles published in CMAJ that cover diagnosing, assessing and treating long COVID, suggests that limited routine blood work and, occasionally, an echocardiogram or pulmonary function test may be sufficient to make the diagnosis without the need for extensive testing and consultations.

The episode also features the personal experience of Suzie Goulding, the founder of COVID Long Haulers Canada, a support group for people struggling with long COVID, who shares her journey with the illness and her ongoing recovery process.

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 Twitter @BlairBigham and @Drmojolaomole

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

The CMAJ Podcast is produced by PodCraft Productions

On this special episode, Drs. Blair Bigham and Mojola Omole interview CMAJ editor-in-chief, Dr. Kirsten Patrick, and executive editor, Dr. James Maskalyk. They talk about the journal's accomplishments over the past year and some of the challenges related to its increased focus on social determinants of health and equity.

In the year ahead, Drs. Patrick and Maskalyk say the journal will focus on exploring topics related to access to care, and particularly encourage the submission of articles that discuss bold solutions that can bring about wide-reaching systemic change.

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 Twitter @BlairBigham and @Drmojolaomole

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

The CMAJ Podcast is produced by PodCraft Productions

A popular theory to explain the crisis in primary care in Canada is that newly graduating physicians simply do not see as many patients as previous generations. But recently published research has thoroughly debunked that myth.

David Rudoler is the lead author of research published in CMAJ entitled Changes over time in patient visits and continuity of care among graduating cohorts of family physicians in 4 Canadian provinces that looked at the number of patient contacts for physicians at all career stages. He and his co-authors found no generational differences in family physician practice.

On this episode, David Rudoler, who is an assistant professor in the faculty of health sciences at Ontario Tech University, tells Drs. Bigham and Omole that, while his research disproves the ‘lazy millennial physician’ trope, it does show that the number of patient contacts has declined for all primary care physicians over the years.

Dr. Tara Kiran,  Fidani Chair in Improvement and Innovation at the University of Toronto and a family medicine physician at St. Michael's Hospital Academic Family Health Team, then talks to the hosts about what Canada can do to ensure that everyone in Canada has access to adequate primary care. Dr. Kiran is the author of a commentary in CMAJ entitled Keeping the front door open: ensuring access to primary care for all in Canada. 

Dr. Kiran argues that interprofessional team-based care, coupled with payment reform, has the potential to improve primary care capacity, access and outcomes for patients, as well as  provider well-being. She advocates for more radical reforms such as regionally organized after-hours care and neighbourhood-based primary care, models that currently exist in several European countries.

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 Twitter @BlairBigham and @Drmojolaomole

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

The CMAJ Podcast is produced by PodCraft Productions