Today's Family Medicine News Highlights
July 11, 2017
Globe and Mail
CIHI report finds provincial health care system struggles to provide adequate home care for seniors
Changes to Ontario cervical cancer screening guidelines have lead to missed chlamydia cases
Global News
Calgary researchers developing app to help pregnant women manage depression or anxiety
CTV News
International studies say coffee consumption associated with longer life span
CBC News
For-fee service allows patients to consult with doctors via video chat causes controversy
Researchers find meningitis vaccine offers moderate protection against gonorrhea as side effect
Medical Post
Quebec health minister cuts medical school admissions
WRITTEN BY MARK CARDWELL ON JULY 10, 2017 FOR THE MEDICAL POST
Quebec City – Quebec Health Minister Dr. Gaétan Barrette says he is only following the wishes of the province’s medical regulator and officials at its four medical schools. But his announcement on Friday that he is cutting medical school admissions by 17 spots this fall, and the same number in each of the next two years, has left some medical stakeholders in la belle province shaking their heads.
“We have enough (doctors),” Dr. Barrette told journalists on Friday. “People have been telling me to cut the number of admissions for three years, and I’m finally doing it for the first time.”
The health minister said he made the decision based on a recent government projection that at the current rate of 850 medical school graduates a year, Quebec would have a surplus of 600 family doctors and 500 specialists in Quebec within 20 years.
He added that reducing the number of admissions by 17 in each the next three years, for a total of 51, would help to reduce those projected surpluses.
Dr. Barrette said he was open to an annual readjustment of the numbers if needed. “I prefer to be a little more high than low,” he said when asked if the 51-seat cut was too aggressive for dealing with the projected surplus.
The minister added that the cuts will save the province money. “It costs a lot (to train doctors) and we want to avoid medical overconsumption like we see in Europe,” Dr. Barrette told reporters.
The announcement was met with both incredulity and ridicule by some critics.
The president of the Fédération des medécins omnipracticiens du Québec—the FMOQ, which represents the province’s 9,000 family doctors—questioned both the timing and impact of the admission cuts. “Unemployed doctors are not at all a reality we face (and) we can absorb the coming cohorts,” Dr. Louis Godin told the Journal de Montréal.
He also noted that Quebec was the only province in Canada that failed to fill all its vacancies in family medicine in 2017. The province was left with a staggering 50 vacancies in family medicine, 29 of them at Univérsité Laval alone. Dr. Godin also questioned the reliability of the data Dr. Barrette used to make the decision to cut admissions.
He noted, for example, that the government’s projections are based on a majority of medical school graduates—55%—choosing family medicine as a career path.
That percentage is currently below 50%.
For his part, the president of Quebec’s 3,800-member Fédération des médecins résidents du Québec, a professional union that represents resident associations at Quebec’s four medical schools, believes admission cuts are a necessary evil. “It we keep the same numbers of admissions we will have a surplus,” Dr. Christopher Lemieux told the Journal de Montréal.
He added however that more needs to be done to ensure a more balanced repartition of students entering medical specialties. “In some fields, especially specialized surgeries, there are too many residents for the positions available,” said Dr. Lemieux.
The result, he added, is the exodus of highly-trained doctors to other jurisdictions. He said residents should be directed to fields with growing demand, like geriatrics.
Family doctors are doing too many ECGs, Ontario study concludes
Researchers find that more than 20% of low-risk patients get the test as part of their health exam
ON JULY 10, 2017 FOR CANADIANHEALTHCARENETWORK.CA
More than one in five Ontario patients receive an electrocardiogram (ECG) during their annual health exam despite being at low risk for heart disease, according to a new study from the Institute for Clinical Evaluative Sciences (ICES).
“An ECG is a valuable test that can save a patient’s life if they are experiencing chest pains or are at high risk of heart disease, but there is little value when patients are at low risk of cardiovascular disease and this certainly should not be a routine test as part of an annual physical exam,” Dr. Sacha Bhatia, a scientist at ICES, cardiologist and director at the Women’s College Hospital Institute for Health System Solutions and Virtual Care, said in a news release.
The study, published in JAMA Internal Medicine, showed that low-risk patients who had an ECG were five times more likely to receive another test like a stress test, echocardiogram or a cardiology consultation than those who did not have an ECG.
“Our findings show that ECGs conducted on patients as part of an annual health exam are common, and the downstream effect is an increased risk for subsequent cardiology testing and consultation cascade, even though the overall cardiac event rate in this group was very low,” added Dr. Bhatia.
The researchers analyzed Ontario administrative data on 3,629,859 adult patients who had at least one “annual health examination” between fiscal years 2010/11 and 2014/15. The researchers noted that the billing code for the annual health examination was replaced by “periodic health visit” billing codes for different ages in 2013, but they considered these codes interchangeable for the purposes of the analysis.
Of these patients, 21.5% had an ECG within 30 days. The proportion of patients receiving an ECG after their examination varied from 1.8% to 76.1% among 679 primary care practices and from 1.1% to 94.9% among 8,036 primary care physicians.
Patients who had an ECG were five times more likely to receive additional cardiac tests, visits or procedures than those who did not. However, the rates of death (0.19% versus 0.16%), cardiac-related hospitalizations (0.46% versus 0.12%) and coronary revascularizations (0.20% versus 0.04%) were low in both the ECG and non-ECG cohorts.
“Our findings suggest that even low-cost procedures like ECGs in low-risk patients occur with significant frequency, and importantly can lead to more advanced testing that ends up costing the health system more with little potential benefit to patients,” Dr. Bhatia said in the news release.
One of the five recommendations the Canadian Cardiovascular Society developed for the Choosing Wisely Canada campaign is “Don’t order annual electrocardiograms (ECGs) for low-risk patients without symptoms.” In addition, the College of Family Physicians of Canada’s 11-item list includes the following: “Don’t order screening chest X-rays and ECGs for asymptomatic or low-risk outpatients” and “Don’t do annual physical exams on asymptomatic adults with no significant risk factors.”
La Presse
La consommation de café augmenterait la longévité
Démission en bloc de membres du C.A. du CUSM en contestation contre Barrette
Le Devoir
Les interventions urgentes reportées augmentent le risque de décès
Le Journal de Montréal
Réseau de la santé : Les congés de maladie pour problèmes de santé mentale en hausse considérable
Ici Radio-Canada
Des changements aux tests de Pap nuisent à la détection de la chlamydia
Dépistage du cancer avec exactitude grâce à une sonde lumineuse mise au point à Montréal