Blog
Ninety Seconds
A worsening doctor-patient communication problem Back in Medical school, we learned that doctors are quick to interrupt patients at the very start of the clinical encounter — my colleagues and I all committed to doing better. Interestingly, that study from the 1980s...
The four-part closure statement
When I'm working with trainees, many have ideas about starting clinical encounters but few have thought about conclusions. When I was in grad school, a professor spoke with us about how our society doesn't end things well — we'd rather say “see you later” than “this...
CASE STUDY: My patient with opioid use disorder (OUD) has terrible cancer pain.
Identifying challenges when treating patients with concurrent substance use disorders and cancer pain
CASE STUDY: My patient just told me they are trans. What do I say?
Communicating with transgender patients ISSUES IN PracticE Transgender patients experience significant barriers to accessing health care. As with many marginalized communities, physicians as a profession have contributed to the trauma inflicted on transgender people....
CASE STUDY: My obese gay patient just told me he is a Bear.
What does that mean, and how can I support his health?
FREE RESOURCE: Trans Care BC Primary Care Toolkit
This resource continues the groundbreaking work in gender-affirming care that has evolved from Vancouver-based healthcare providers for more than a decade.
FREE RESOURCE: Trans Primary Care Guide from Rainbow Health Ontario
Rainbow Health Ontario has created an excellent resource for healthcare providers and trainees with regards to providing gender-affirming care. initially launched in 2016, it was a recently updated along with the 4th edition of the primary care guidelines from Sherbourne Health Clinic in Toronto, a leading provider 2SLGBTQ+ care.
We have 15 minutes today
We know that doctors of different types and stripes have different appointment lengths, and if you're working on an inpatient service you may not have a specific schedule. Regardless of whether you have eight, fifteen or thirty minutes (like I do in my clinic for...
What if my patient has too many issues to discuss during the visit?
The laundry list A common gripe from doctors is the patient who arrives with a never-ending list of issues. “These patients have unrealistic expectations,” they complain. “We can’t possibly address them all in the short time we have.” We might think that...
Agenda setting for the doctor-patient clinical encounter
Ask ‘What else?’ As doctors, there are few things more frustrating than attending a department or other meeting without a clear agenda, so it makes sense that we and our patients have the same expectation of why we are meeting and why we’re gathering and what we’re...
An extraordinary full-circle moment
Rest in Power, Mary Lou! Mary Lou smiled wide as she spoke to me. Sure, she would help teach a safe sex workshop to the Friday night LGBTQ+ youth group, but first I'd have to come by the clinic myself for a check up. That way I could talk from experience, she...
How to diagnose gender dysphoria.
how do I know if my patient is transgender? In my practice I work with many medical students and residents who we train in part to provide gender affirming care. I frequently speak with colleagues who know I have a transgender-inclusive family practice and field many...
Treating cancer pain in patients with Opioid Use Disorder: FREE Resources
People who use drugs (PWUD) deserve same access to primary care as everyone else One of my biggest frustrations as a doctor are the “care-silos” patients get stuck in. A colleague who’d taken a gig at a methadone clinic told me she was reprimanded for prescribing...
Your Patients Don’t Have Too Many Problems if You Set an Agenda
“My patients come with too many problems,” is a common grievance I hear from doctors. Your patient wants your help with their shoulder pain, the diarrhea, a form and prescription refills, which doesn’t include your priorities which are checking the blood pressure and...
Guest Appearance on the Northern Exposure Podcast
Many of my patients living with addiction and homelessness who attend our downtown Vancouver health clinic refuse to go to the emergency room.
How Changing the Way Doctors Apologize Can Make a Difference
Many of my patients living with addiction and homelessness who attend our downtown Vancouver health clinic refuse to go to the emergency room.
How to Overcome a History of Medical Violence
We carry the burden of our patients’ past mistreatments. We know from history how doctors have participated in the medical violence brought upon Black people, transgender and queer community, and women--just to name a few. Think about the roles physicians played in...
How Do We Address Addiction in Long Term Care Facilities?
Last year, I was invited to speak at the Catholic Health Association of BC annual conference about a novel and, for some, controversial pilot project we’re undertaking at our long term care facility in Vancouver. We’ve invited patients taking methadone and other...
A Doctor’s Note Can Prescribe More Than Medicine
The power of even a short letter written by a physician cannot be overstated. I’m constantly pulling up the digital letterhead in my EMR to write a note to a service agency, landlord or employer to advocate for a change that I believe is in the best interest of my...
Patients Avoid the Emergency Room for Good Reasons – Doctors Can Change That
Many of my patients living with addiction and homelessness who attend our downtown Vancouver health clinic refuse to go to the emergency room.