More in Medicine
Can having a concussion be a good thing? This is what I learned six months later
Boom. Flip! Bang.
In August of last year, I was in an accident. One moment, I was cycling back from the gym, and the next moment I was waking up with people around me. When I removed my mask it, it became clear that my chin was gushing blood. An ambulance was called and I was taken to the hospital. After being assessed in the emergency department, I was diagnosed with a concussion.
The accident happened on a Friday and I was supposed to work in the hospital the following Monday. I reluctantly called in sick and my colleagues helped to find me a replacement. The first few days were the most difficult. I felt I couldn’t even get out of bed. I was not able to walk properly. I was confusing my words and every little sound or bright light was like a dagger to my brain. I recently wrote an article about my experiences and concussion management in general in the medical journal Canadian Family Physician. The article is accompanied by a podcast in which I interviewed hockey icon Dr. Hayley Wickenheiser about sports, medicine, concussions and more.
When I tried to re-integrate my clinical work, my symptoms worsened. It was a roller coaster and any progress seemed to be followed by regression. Two steps forward, one step back. After three months with the injury, I was officially considered to have post-concussive syndrome. Although headache was fortunately not one of my symptoms, I experienced incredible nausea, fatigue, eye strain and dizziness. I’ve been seeing an occupational therapist and physiotherapist regularly and this has been an essential part of my healing.
Now, it’s been over six months since the accident, and I finally feel like I’m improving every week. I’m back doing clinical work (still part-time but working toward getting back to full-time). The main symptoms remaining are that I get tired more easily, and my concentration is not quite yet back to normal. Though it’s been one of the most challenging things I’ve ever experienced, there have been some silver linings.
Among other things, the injury has taught me how to slow down. Before the concussion, I was going at fast pace. As a doctor in a global pandemic, I think you can appreciate why that might be. With my concussion, I was forced to take a step back and sit on the sidelines for a while. Though I felt a sense of guilt for not being able to help, I also felt that my overall stress level went down. It’s interesting and weird that experiencing a brain injury made me feel less anxious.
Through my occupational therapy, I also learned strategies to help get me back to work in a healthy way. For example, when you have a concussion, taking breaks is very important. Since I also have non-clinical jobs, I was able to get back to those first. So I would set my timer, at first just for five minutes, then I’d take a break. Slowly, I increased this amount. Even though many of my concussion symptoms are gone, taking breaks during the work day is something I’d like to keep doing. Breaks during the work days are healthy for the eyes and the mind, and they help to make me more efficient and productive overall.
One of the main treatments for a concussion is cardiovascular exercise. By increasing the heart rate, you increase blood flow to the brain. Activities like biking, running or hiking help to feed the brain with fresh oxygen and thinking improves. Getting regular cardiovascular exercise in the mornings is another habit I’ve decided to keep!
Physiotherapy to improve balance has also been important in my recovering. Meditating more regularly helps with my focus. Having a concussion has also helped me in understanding my patients who have had concussions, or even other conditions where the symptoms can be more vague or the diagnosis elusive. Fibromyalgia and endometriosis come to mind. As I described in the article mentioned above, “Once when asked how I was feeling, I said it felt like a big syringe of water had been injected into the recesses of my brain.” By having experienced these hard-to-describe symptoms first-hand, I will be better able to appreciate it when my patients describe symptoms in ways that veer from the normal medical jargon.
Though it’s not a good thing to have a brain injury, I’ve learned a lot from this concussion. In the long term, I’m hoping that the benefit will be a net positive one, both for me and my patients.
An interview with Dr. Onye Nnorom
Over the last year, I’ve had the opportunity to host podcasts as part of my work with the medical journal Canadian Family Physician. This month, I had the most interesting conversation with Dr. Onye Nnorom, a family physician and public health specialist in Toronto. In this podcast, we dove into the details of the paper she published with her colleagues in the November edition of the journal. The research explores Afrocentric approaches to cancer screening for immigrant patients in Ontario. Enjoy!
Please have a listen to the interview and let me know what you think of it in the comments below!
Gaslighting in medicine
Recently, I had an experience being gaslit by a specialist colleague. As a woman family doctor, I haven’t experienced gaslighting at work frequently, but when I do, it sticks with me. This time, I did something about it. Not only did I call the specialist out about his behaviour, but I finally put a name to the this gendered form of bullying. I even wrote this essay about it:
One of the main articles that I cited in my essay was about the sociology of gaslighting. It was such a rich paper that I decided to contact the author, Dr. Paige Sweet, to see whether she would be interested in being interviewed on a podcast. To my delight, she agreed. In our discussion, we talk about the things that make it easier for one person to gaslight another. These may include factors like gender, race, nationality or place in the hierarchical structure that still exists in medicine today.
I hope you enjoy this content and let me know in the comments what you think!
From Northwest Territories to Halifax: getting it right in the COVID-19 pandemic
I recently returned from Northwest Territories where I’d been working as a physician for the last six months. Now, back in Nova Scotia, I’m reflecting on what it’s been like to have worked in areas of Canada with relatively few cases of COVID-19.
A large part of my work is hospital medicine. A hospitalist, as the name implies, is a doctor who cares for patients admitted to the hospital. Often, we work seven days in row, with a few of those nights being on call. Hospitalists care for patients with a variety of conditions. Examples might be pneumonia, heart conditions or a broken hip.
In addition to my work as a hospitalist during the pandemic, I was also able to witness the approaches of two separate public health departments. Comparing Nova Scotia with Northwest Territories, there are more similarities than differences. Here are some approaches that have worked quite well in both regions.
First, both locations have a mandatory two-week isolation period and it is taken seriously. Before traveling to Yellowknife, I had to submit a self-isolation plan and my documents were checked upon arrival. Only essential workers were permitted in the territory. From the airport, I had to go directly to my hotel. My food was delivered to my door. Rule-breakers received fines in the thousands of dollars.
I have now completed my two weeks of self-isolation back in Nova Scotia, where the rules are very similar. At Stanfield Airport, I had to give my email address. On a daily basis, I had to check in online to report any symptoms. Northwest Territories had a comparable online check-in system.
In both places, testing is very accessible. Nova Scotia Infectious Disease leaders made headlines in recent months after opening pop-up test sites. A Halifax night club was converted to a test site one night for people who were out downtown.
In both Nova Scotia and Northwest Territories, public health leadership is strong. Dr. Kami Kandola and Dr. Robert Strang are examples of excellence in as Chief Medical Officers of Health. They are role models. Their efforts strengthen trust and organization down to the levels of hospitals and communities. Early on in the pandemic, while working as a hospitalist in Antigonish, I witnessed the physicians, nurses and staff working tirelessly and collectively to prepare for the unknown. In Yellowknife, my colleagues took the pandemic very seriously even though there were usually no cases. They went above and beyond to advocate for their patients.
In Yellowknife, an Indigenous elder taught me about the importance of traditional knowledge and the link between health and the land in his culture. Some Indigenous communities in the territory responded to the pandemic by building on traditional knowledge such as hunting and fishing. This would help to ensure safe food supplies in case the pandemic resulted in the halting of goods coming in. This intelligent approach is on the backdrop of a tragic history.
In 1928, a decade after the 1918 flu pandemic, the Hudson Bay Company’s ship the SS Distributor brought supplies up the MacKenzie River. The company also brought a particularly deadly form of the flu. Approximately 15% of the entire territory’s Indigenous population died that year because of this introduced virus. Indigenous communities across Canada have suffered greatly during previous pandemics. This is not forgotten in the North and should not be forgotten elsewhere.
Days before departing, I learned that Air Canada had stopped their passenger service to Yellowknife, so my flight was switched to another carrier. This meant my trip back to Nova Scotia took place over the course of three days. As I boarded my flight to Edmonton, my sense of alertness was heightened. In Toronto, I didn’t leave my hotel room. Once on the plane to Halifax, I didn’t take my mask off the entire time, not even to take a sip of water. (I recognize that was likely overly strict. Given what we know so far, the risk of catching COVID19 on an airplane is probably low). But I felt a strange sense of ease and safety when I looked out my airplane window to see my home province.
The excellent pandemic management in these two regions of our country does not mean we remain unaffected. In both Nova Scotia and Northwest Territories, the hospitals have visitor restrictions. It is heart-wrenching when patients cannot see their loved ones in person, especially during their final hours. Non-urgent appointments and surgeries were postponed and sometimes patients’ medical conditions worsened as a result. Many clinics have shifted to provide more virtual care. While this has some benefits, there are also many challenges.
According the territorial government website, Northwest Territories had in increase in alcohol-related medical visits from May to July in 2020, compared with 2019. Despite low numbers of COVID-19 cases, anxiety and depression rates for Nova Scotians during the pandemic has been among the worst in the nation. And of course, we still mourn deeply for the loss of our elders at Northwood and other longterm care facilities across the country.
Public health officials do not have an easy job. They are often the victims of bullying, and even threats. A man from Alberta is being charged with threatening Dr. Kandola, for example. The trial date set for February 16, 2020. Dr. Strang has received personal threats as well.
With the Nova Scotia leadership changing hands, I hope that our government and community members alike continue to support public health officials and listen to the science. As we grapple with our losses and the general changes that our society and our world has faced this past year, I have been privileged to work in two regions of the country where the public health leadership is strong, and so are the people.
Season 16 of Grey’s Anatomy tackles the social determinants of health
A friend recently drew my attention to the fact that Season 16 of Grey’s Anatomy seemed different. I have to admit, I didn’t realize Grey’s Anatomy was still on air. Is that bad?
The difference this season is that Meredith Grey, the main character, is stirring things up. She falsified insurance documents so that one of her patients could receive the medical treatment that they otherwise would not have been able to afford. She was fired from her job and her medical license went under review. During her work in community service, she realizes that the current health care system leaves many people behind. She is becoming more aware of the social determinants of health.
The social determinants of health are those things that determine one’s health from a social point of view. Those who are poor or racialized, for example, often have worse health outcomes than those who are not. I’m currently working in Yellowknife where I am seeing this first-hand. Canada’s history of racism against Indigenous peoples has resulted in social, economic and cultural marginalization. This has a direct impact on their health.
Grey’s Anatomy is scratching the surface of this issue. And they don’t go far enough. Much can be said from the language they use. I notice Meredith uses the phrase ‘institutional discrimination’ rather than systemic racism, which is more accurate.
The irony in Grey’s Anatomy is that Meredith Grey is fired from her job for caring about her patients. As healthcare professionals, we can feel silenced in our desires to conduct advocacy work. We may feel pressure from the institutions that we work for or our professional or governing associations. We may fear losing our jobs and our security, or even damaging our reputations. But the work of advocacy is so important. It is this work that can make an even greater difference than prescribing a medication.
Overall, I’m impressed with Grey’s Anatomy for at least starting the conversation.
Now more than ever, there is a need for accurate health communication.
For those of you who may not know me, I’m a medical doctor in Canada. Last year, I also started my MA in Journalism at the University of Miami because I’m interested in the field of health communication. My fellow MA Journalism classmates and I produced this short video about CBD, or cannabidiol, which is an active ingredient found in the hemp plant. We were interested in knowing, is CBD safe and effective? Today, we are screening our film at the annual New York Sate Communication Association’s Annual Conference. If you missed the video before, you can check it out here:
In medicine, when I want to answer a question, I consult the evidence. The body of available research. What does science tell us? Instead of always turning to the literature, in journalism, I consult multiple people. I may interview 3 or 4 individuals to hear their experiences and opinions, allowing audiences to come to their own conclusions. Medicine often fails at taking into account the story behind the person. Journalism can help with this.
As we’re seeing in the current global pandemic and U.S. election, misinformation seems to be at an all-time high. This is in the context that facts are not constant. They change.
I’m reading a book called The Half-life of Facts. Things that we thought we once knew are no longer accurate. When graduating medical school, I was told that half of everything I learned will be obsolete in a matter of several years. We are now seeing facts change in real time. Don’t wear a mask, wear a mask. Be worried about surfaces transmitting COVID, don’t worry about surfaces.
Whether it’s CBD or COVID-19, as science advances, what we thought we knew is becoming obsolete. It is now more important than ever for scientists and journalists to have a media strong presence for accurate health communication of what we know. (At least for now).
The #medbikini controversy
There is nothing unprofessional about a #medbikini.
I was relieved to learn that an article published in the Journal of Vascular Surgery on Friday was retracted. In case you missed it…
Sexism in Medicine
In a clear example of sexism in medicine, the study went so far as to create false social media accounts to ‘creep’ vascular surgery residents’ social media profiles. Of note, all of the individuals who created the accounts, and most of the authors on the paper, were male. This was all done without the residents’ knowledge or consent. The study concluded by criticizing vascular surgery trainees for being too unprofessional on social media.
One of the numerous problems with this research was the authors’ definition of what constitutes unprofessional behavior. They deemed that it was unprofessional for women to share photos of themselves in 👙 bikinis or “provocative Halloween costumes” on their personal social media accounts.
The research ironically had an unintended side effect: since the publication of this paper, there has been a major backlash. So much, in fact, that the authors apologized and the Journal retracted the paper. Since Friday, women doctors have been taking to social media platforms like Twitter and using the hashtag #medbikini, posting photos of themselves in bikinis to protest the idea that wearing a bikini constitutes unprofessional behaviour. The study exposed some of the serious gender biases that are all-too prevalent in medicine.
Did you know that over half of my medical school class was comprised of women? Whether it’s medicine, engineering or stock trading women are increasingly occupying positions traditionally held by men. As these changes occur, we must closely monitor and advocate against sexism within the system.
Professionalism in Medicine
As doctors, whether male or female, we are encouraged to completely detach our personal lives, and even our personalities, from our role as a doctor.Could this be doing more harm than good?
I’ve always thought it was unfair that I have immediate access to my patients’ complete medical files while they usually know next to nothing about me. I know details about their last pregnancy, their recent mental health struggles, even about their food intolerances. Yet us doctors are supposed to remain mysterious and neutral. Caring but aloof. We are expected to refrain from divulging too much about ourselves. Would patients not feel more comfortable if we opened up a bit more, and if sharing was more like a two-way street? A study from 2017 actually found that sharing online biographies about physicians could help reduce communication apprehension among patients.
Doctors as Health Advocates
Another major issue with the paper is that it argued that it is unprofessional for doctors to discuss controversial political issues on social media. This runs contrary to the recommendations of many professional guiding bodies. If you examine the core competencies of being a physician, as outlined by the Royal College of Physicians and Surgeons of Canada, we should be serving as health advocates. Instead of encouraging such advocacy, the above-mentioned article considered the vascular surgery residents as acting unprofessionally if they discussed issues like gun control or abortion on their social medial platforms.
Discussing taboo issues is necessary for progress in society. Doctors deserve the right to weigh in on controversial issues just as much as anyone else. And maybe now and again we can also share an image of ourselves being regular humans and having fun in (gasp!) a bikini 🙂
Reducing sexism in medicine and reexamining professionalism in medicine is how we move forward.
Thoughts? Let me know in the comments below!
How long can the coronavirus stay on surfaces?
The number of COVID-19 cases now exceeds 378,000 worldwide. This new coronavirus, also known as SARS-CoV-2, is having unprecedented global effects. The number of deaths in Italy surpasses 6000 and there is a lock-down in many countries. The number of worldwide cases of COVID-19 increases each day and it is important we do everything we can to prevent the spread of disease. To achieve this, we need to understand how the virus works. Fortunately, we have research.
To understand the research on COVID-19, it helps to know that there are different types of coronaviruses. The SARS virus was a coronavirus. The common cold can be caused by a coronavirus, too. You can think of these other types of coronaviruses as cousins to COVID-19. In February, a group of researchers studied how long these cousins of COVID-19 remained on different surfaces. They reviewed 22 studies and found that other coronaviruses could live on surfaces for up to nine days. They also found that coronaviruses remain longer on plastic and metal.
Another study published in March compared how long COVID-19 remained active on different surfaces. They found that COVID-19 can live up to three days on plastic and on stainless steel. It can live on cardboard for up to 24 hours and on copper for up to four hours.
It’s important to be aware that even if you are practicing safe physical distancing from others, the virus could be present on surfaces nearby. If you touch a surface that has not recently been cleaned, you could be at risk of getting the infection. That’s why it is important to maintain clean surfaces, wash your hands frequently and avoid touching your face. Interestingly, a study from 2015 found that people touch their face on average 23 times per hour.
What you can do:
- The coronavirus can stay active on surfaces for days. Clean and disinfect surfaces frequently, especially high touch surfaces like door knobs, light switches, countertops, phones, keyboards, faucets and toilets.
- Wash your hands for at least 20 seconds or use hand sanitizer. Avoid touching your face.
- Listen to public health officials.
- If you stay at home, you will save lives.
COVID-19: A negative test doesn’t mean you’re in the clear
By Dr. Brendan McCarville and Dr. Sarah Fraser
We are in an unprecedented time. With the amount of information available, it is easy to feel overwhelmed. Sometimes the information we consume is confusing.
For example, at a March 16th press briefing, President Donald Trump addressed the public about COVID-19. He stood next to Vice President Mike Pence and other top officials. A reporter asked him whether he should be taking greater precautions for social distancing between himself and Pence to protect the chain of command in case one of them falls ill. According to the official White House transcript, Trump said,
“Well, we haven’t thought of it, but, you know, I will say this: That it’s—we’re very careful. We’re very careful with, you know, being together. Even the people behind me are very—they’ve been very strongly tested. I’ve been very strongly tested. And we have to be very careful…”
In other words, Trump seemed to use his negative test result as a reason to be less vigilant about social distancing. Our concern with this response is that it could create a false sense of security for people who test negative for COVID-19. The reality is that even with a negative COVID-19 test, you could still acquire the infection. If fact, your chance of getting the infection is basically the same as anyone else.
You still need to practice the same precautions, such as social distancing and hand-washing. While a negative test result means you might not have an active infection, it does not lower your risk of getting one in the future. You would still need to be concerned about getting infected and passing the virus on to others. The bottom line is–if you have tested negative for COVID-19, it doesn’t mean you’re in the clear. The best advice for everyone is to continue following the recommendations of our public health officials.
Learn about how we can stop the coronavirus from spreading at the Public Health Agency of Canada website.
Dr. Brendan McCarville is a physician in Nova Scotia. He has not yet been tested for COVID-19
Dr. Sarah Fraser is a physician in Nova Scotia. She is author of Humanity Emergency: Poetry of a medical student. She has also not yet been tested for COVID-19.
Flattening the Curve: Controlling the COVID-19 pandemic
In the time of COVID-19, a week feels more like an eternity. I find myself checking the news hourly just to keep up-to-date. This week, the World Health Organization officially named the COVID-19 outbreak as a pandemic. U.S. President Donald Trump has banned incoming flights from 26 European countries. The wife of Canadian Prime Minister Justin Trudeau, Sophie Gregoire-Trudeau, confirmed that she tested positive for COVID-19 today. Both individuals are in isolation.
With these developments and certainly more to come, there is a heightened focus on what we can be doing as a society to protect ourselves and each other.
Flattening the curve
It is a concept that has become increasingly talked about, especially in recent days. Flattening the curve is a method that can be used to ease pressures on the health care system during pandemics. Have a look at this graph:
The x axis (or horizontal axis) represents time. The y axis (or vertical axis) represents number of cases. In the case of COVID-19, if no public health interventions are put in place, we would expect the results of the yellow curve. There would be an exponential number of new COVID-19 cases over a shorter period of time. In health systems already pressured and operating at their maximum capacity (which is true of many health care systems in our world), a pandemic would create extra strain. It may lead to a scenario were there are not enough resources to treat everyone.
The blue curve represents what would happen if appropriate public health measures are followed. This includes policies like implementing social distancing and increasing public education. We are already seeing many measures such as this take place across Canada. The government of British Columbia requires the cancellation of all gatherings of 250 people or more. All publicly funded schools in Ontario will close for two extra weeks after March break.
Numerous professional sports leagues have suspended their seasons, including the NBA, NFL and MLB. Many governments are discouraging travel, or in some cases, prohibiting it. There is extensive public messaging around hand hygiene and cough hygiene. Alternatives to handshakes are being promoted.
The COVID-19 pandemic is overwhelming systems, even in countries that are well-resourced. Dr. Giacomo Grasselli is a senior Italian government health official coordinating the network of Intensive Care Units in Lombardi, Italy. In an interview with Channel 4 News, he described the severity of the pandemic in his region, which is the worst affected area in Italy.
“It’s worse than a bomb because a bomb is one event limited in time and space. This is an event that…keeps increasing and it’s contagious.”
Dr. Graselli added that he never thought he would be in a situation where he would have had to create 500 new ICU beds over a two-week period.
“If you are not very careful in controlling the spread of the disease, this disease will overwhelm your system, not matter how efficient, good, modern it is.”
Panic is never a helpful emotion, no matter what the situation. It will certainly not help in addressing the pandemic. For example, if an asymptomatic person goes to a testing centre or emergency department against government recommendations, they are unnecessarily putting themselves at risk. They are also contributing to strain on the system, preventing others from getting the care they need.
That being said, rational thinking and preparedness are essential. I think this pandemic presents another natural experimental question: Will society listen to scientists and follow governmental recommendations? I hope that the answer is yes.