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Author: <span class="vcard">Michael Kalin</span>

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By Michael Kalin June 14, 2016 Fun Facts

The Next Frontier

With Grand Prix behind us, there is lots to look forward to in Montreal this summer. In honor of the upcoming Comiccon convention from July 08 to 10, 2016, it’s time to look forward to some exceptional .medical innovations on the not-so-distant horizon.

Qualcomm Tricorder XPrize moving forward

Winner of $10 million contest expected to be named in early 2017

By Mike Freeman | May 26, 2016 |

Tatiana Rypinski, a Johns Hopkins student, heads Team Aezon, which is one of seven contestants remaining in the $10 million Qualcomm Tricorder XPrize competition.

Now in its fifth year, the $10 million Qualcomm Tricorder XPrize competition — which aims to create a portable medical device akin to the fictional tricorder of Star Trek fame — is moving toward naming a winner in early 2017.

The ambitious milestones for teams trying to develop the tricorder have been eased a bit. Instead of being capable of diagnosing 16 conditions without the help of a physician as originally proposed, the tricorders now must diagnose 13 ailments.

And the number of remaining teams has dropped from 10 to seven. One team dropped out and two merged.

Now teams are refining and testing their tricorders in preparation for a preliminary evaluation slated at UC San Diego late this summer.

“What we are attempting to do is require teams to demonstrate to us a certain level of performance on their devices so that we can qualify them to come back at UCSD and enter the final phase,” said Grant Campany, senior director of the Tricorder XPrize.

The final evaluations — including tests with real patients and doctors — are expected to begin in September and continue into early next year. San Diegans who wish to volunteer can email xprize-ctri@ucsd.edu or call (858) 230-4339.

When it officially kicked off in early 2012, the Tricorder XPrize expected to name a winner early this year. But building a hand-held medical device that can continuously read five vital signs, diagnose conditions ranging from pneumonia to diabetes to urinary tract infection and still be easy to use for the layman has proven difficult.

“As with most XPrizes, we set the bar relatively high,” said Campany. “We like to say it is audacious yet achievable. We are trying to create a high hurdle because we want to see breakthroughs occur.”

UC San Diego built a regulatory/approval framework to pave the way for consumer testing of these experimental tricorders. That framework has been used by teams to conduct initial tests in their hometowns in preparation for this summer’s preliminary cut.

Team Final Frontier, for example, includes emergency room physician Basil Harris, who is getting feedback on the team’s device with patients in Pennsylvania, said Campany.

Team DMI of Boston, headed by physician Eugene Chan, has posters up at public transit stations to recruit volunteers, he added.

“I think we are all going to be pleasantly surprised at the improvements that these teams have made in their operating systems and how these devices operate without the interaction of a health care provider,” he said.

The Tricorder XPrize aims to push wireless medical technology into the mainstream. San Diego-based Qualcomm pledged the prize money. The company has long viewed mobile technology as key to cutting health care costs and improving results.

“When you look at the developing world, which has a shortage of doctors, how do you allow technology to step in and extend the reach of health care providers through these types of devices?” said Campany. “That is really what this is all about.”

In addition to Final Frontier and DMI, others teams are: Aezon, which is made up of undergraduate students from Johns Hopkins; CloudDX of Canada; Danvantri of India; Dynamical Biomarkers Group of Taiwan; and Scanadu/Intelesens from the U.S.

 

By Michael Kalin June 9, 2016 Health Promotion

Further Cuts to Important Services

Please read this powerful article published on CBCNews Montreal about more vital services being cut in our neighborhood…

The Douglas Hospital has suspended a successful program to treat teenagers with serious mental health problems, saying it’s exploring more “cost-effective” options over the next year.

The treatment, called dialectical behavior therapy (DBT), helps patients cope with severe depression, suicidal thoughts, eating disorders and self-harming.

It also includes group therapy and invites parents in to learn how to support and talk to their child.

‘The years from hell’

Andrea, whose last name CBC has agreed to conceal to protect her child’s privacy, said her 16-year-old daughter was part of the last group to go through the program.

She’s devastated other families no longer have access to DBT at the Douglas, which she calls a “miracle” program that “gave us our daughter back.”

“How can the government do this?” asked Andrea. “How can you let these kids just flounder like that?”

Andrea describes 2013 to 2015 as “the years from hell.”

Andrea says the first signs of her daughter’s mental health struggles began in Grade 7, when she became moody and withdrawn, often difficult to coax out of her room. (CBC)

When her daughter Jessica started Grade 7, she became increasingly withdrawn – no longer spending time with her friends and losing interest in everything.

“She just wasn’t her,” said Andrea. “There was no spark in her.”

Jessica had always been a strong student, but her grades started to slip.

A mediocre mark on a test or a critical remark from a teacher could easily send her into a tailspin.

After one of a series of visits to the emergency room at the Montreal Children’s Hospital for suicidal thoughts in May, 2015, Jessica refused to go home.

“I didn’t think I’d be safe if I was at home,” said Jessica. “I did not feel I was strong enough to take care of myself in a way that I should.”

Jessica’s therapist suggested the dialectical behavior therapy program at the Douglas Hospital.

For the first six weeks, Jessica did one-on-one sessions, followed by 20 weeks of group therapy.

“You were in a room, surrounded by people who had things going on that were similar to you, who were feeling ways that you felt and would believe you if you said something,” said Jessica.

“They all understood.”

How DBT works

Together, the teens learn how to identify their triggers and break down potentially stressful situations into smaller steps.

Parents also attend the group sessions to learn new skills which they had to practise at home.

“They really teach you how to talk together again,” said Andrea. “So the bond that was kind of lost has been re-established. I feel we can talk to each other about everything and anything again.”

According to the regional health agency that now administers the Douglas Hospital, the DBT program has helped around 225 teens since 2001.

The Montreal West Island Integrated University Health and Social Services Centre (known by its French acronym CIUSSS de l’Ouest-de-l’Île-de-Montréal) says a decision was made early this year by the DBT team to “temporarily pause” the program for one year, starting last April.

This step was taken in order to “examine new emerging best practices and enhance services provided to the clientele.”

A spokesperson for the CIUSSS de l’Ouest-de-l’Île-de-Montréal refused an interview but said in an email that some DBT services are still available on an individual and family basis.

However, the group portion is “very costly and time intensive” and is no longer being offered. Doctors who usually referred patients to the program were told to hold off this year.

‘We see very significant changes’

One of those doctors, Dr. Lila Amirali, the chief of child psychiatry at the Montreal Children’s Hospital, said she believes the DBT program at the Douglas is the only one of its kind for English-speaking teenagers with severe mood disorders.

Amirali said the combination of individual, group and family therapy is powerful.

“We see very significant changes,” said Amirali.

She said many of the adolescents in the program can go through intense mood swings in the space of a day.

She said some may be the life of the party, then something will happen that will cause them to become very suicidal. The program helps them to learn to use their judgement to make calmer, more sound decisions when they are feeling upset, she said.

“They learn how to adapt better,” said Amirali.

The chief of psychiatry said she wasn’t given any reason for the program’s suspension, but she’s hopeful it will be reinstated next year.

She acknowledges that every hospital is carefully scrutinizing how it uses its resources nowadays.

‘We have her back’

Until the fall, Jessica is still being followed individually by a therapist from the program.

Next month, she’s heading to Philadelphia for a month-long arts program – something that was unthinkable a year ago.

“This year, I am so excited. All I can think about is, just a few more weeks, and I’ll be there,” said Jessica.

Andrea and her husband did pay for private therapy prior to Jessica being admitted to the DBT program, but say the program made a huge difference.

“We have her back,” said Andrea, who no longer worries about what’s happening behind her daughter’s closed door.

Andrea contacted her MNA to raise her concerns about the DBT program’s suspension but was told the same thing: The program is just being put on hold temporarily.

“When people say they put something on pause, it’s never really on pause,” said a skeptical Jessica.

“Chances are, now that this program isn’t happening anymore, it won’t happen again for a long time, which is just terrible because there’s going to be people struggling because of this.”

She and her mother feel they have a responsibility to try and get the program back for other teens who need it right now.

Andrea pleads with the government to reassess its priorities.

“Step up and help these kids,” she said.

http://www.cbc.ca/news/canada/montreal/douglas-dialectical-behaviour-therapy-suspended-1.3623104

By Michael Kalin June 3, 2016 Clinic News, Health Promotion

Check-ups matter!

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Check-ups matter!

My 15 year old daughter is a skillful debater. We have lively discussions about politics, religion, school, and the Marvel Cinematic Universe. But when she wants to win the debate, she conjures up an obscure reference in a fictitious journal to prove her point – definitively. After all, who can dispute a prestigious scientific publication?

This week, the healthy check-up in Quebec fell victim to a “meta-analysis.“ Experts confidently announced that “medical science no longer recommends these types of exams.“ Even the Minister of Health challenged “What does an annual visit prevent? Nothing.”

Specifically, these experts were citing a 2012 analysis by Lasse T Krogsbøll of the Cochrane Collaboration. His analysis of sixteen randomized studies concluded that “general health checks are unlikely to be beneficial.”

Further words of reassurance were imported from the Maritimes where a media relations advisor for the Nova Scotia Department of Health and Wellness added ““We’re not aware of any concerns or issues since this change (eliminating the health annual check-up) took effect.“

And to allay any final concerns, the experts assured the public that when they “go to (the) doctors at any time for other reasons like an ankle injury or a bad chest infection, …a good doctor will use that opportunity to ask how things are going otherwise.“

With all this seemingly overwhelming scientific evidence condemning the relevance of the health check-up, why are we sad to see it go? Simply – because it shouldn`t.
We increasingly live in a world where human contact for the delivery of services is endangered – and it bothers us. Mail home delivery is threatened, bank branches are not profitable, established brick-and-mortar retail stores are restructuring. Seeing your doctor seemed immune – or at least it felt that it should be. Where else could a person go after accumulating a long “list“ of health problems full of fears, questions and concerns. Dr. Oz? Google? Just like the Crawleys in Downton Abbey, we all want a Dr. Carson to look out for and to look after us and our families. Someone who knows us, listens and cares.

The problem with scientific studies is that they are often misquoted and rarely read. The “definitive“ Cochrane review questioned whether general health checks in adults reduce morbidity and mortality from disease. It did not include geriatric trials. It did not study the value of the doctor-patient relationship. Most of the studies were not conducted in Canada, and according to the authors, “most of the trials were old, which makes the results less applicable to today`s settings because the treatments used for conditions and risk factors have changed.“

To be exact, nine of the fourteen studies included were conducted over thirty-five years ago. The most recent study was initiated twenty-five years ago. That`s like current Habs General Manager Marc Bergevin conducting the 2016 draft based on scouting reports from Sam Pollock and Irving Grundman in the 1970s and 1980s.

The Cochrane Review further qualifies its findings, commenting that “because the majority of the included studies were unblinded with considerable loss to follow-up, analysis of outcomes other than death and hospitalization may be subject to bias.“
Even the Canadian Task Force on the Periodic Health Examination from 1979, purportedly anti- check-up, recommended “ a specific strategy comprising a lifetime health care plan based on a set of age- and sex-related health protection packages.“ Maybe not annually, but more selectively.

Scientific meta-analyses are only as good as the data that is entered. There is lots of talk about the importance of Corsi scores in hockey, but as far as I can tell, neither the Pittsburgh Penguins nor the San Jose Sharks lead the NHL informatics race. Nevertheless, one of these two teams will be raise the Stanley Cup.

Interestingly, if experts are going to quote the merits of the Maritime experience, in which journal has this well-designed experiment been published?

In the end, we are quoting weak medical data from a generation ago, in another jurisdiction, with poor follow-up. None of these studies examine the essence of why general check-ups really matter. Seeing your family doctor on a routine basis fosters a trusting, lasting relationship. It does not exist to order tests; its existence provides comfort and security, knowledge and understanding. Health promotion is not a brochure or a pep-talk: it is a collaborative effort to live better. It is not a sprint, but a marathon.

Honestly, do “experts“ really expect family doctors to do a prostate exam because the patient conveniently limped in with an ankle sprain? Or discuss colorectal screening while the patient is febrile with a bad chest infection?

Air Canada (hopefully) does not wait for the airplane to make funny noises before checking it out. They don`t wait for one wing to fall off before checking the other. Routine maintenance is neither a luxury nor superfluous – it is common sense. Let`s not embrace a crisis-initiated medical model – but improve our efforts towards health promotion. Let`s design a system that rewards doctors for keeping healthy people healthy.

In the end, all the analysis to devalue the annual check-up simply cannot compete with the primal benefit of nurturing a meaningful, trusting, patient-physician relationship. Studies, even “scientific“ ones, need to be understood and properly applied.

Consider the 2003 systemic review of parachute use to prevent death and major trauma related to gravitational challenge published in the prestigious British Medical Journal. Despite a rigorous review, the authors “were unable to identify any randomised controlled trials of parachute intervention.“ As such, they concluded, “the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomized controlled trials. Advocates of evidence based medicine have criticized the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organized and participated in a double blind, randomized, placebo controlled, crossover trial of the parachute.”

Please use a parachute – and please continue to see your family physician for general check-ups.

By Michael Kalin February 27, 2015 Clinic News

The Death of Family Medicine

The Death of Family Medicine

Moments ago, while sitting on the ward completing a death certificate, a disturbing thought entered my mind. It should have been of the lonely man who just died of esophageal cancer, but instead it was of my profession. Tonight, after months of reading and studying Bill 20, it felt like I was writing a death certificate for Family Medicine.

It might sound melodramatic, but this how many of us feel – abandoned, powerless, misunderstood, betrayed. Despite our eloquent speeches and thoughtful editorials, the Minister of Health stubbornly pushes ahead with proposed Bill 20.

What is Bill 20? Truthfully, most of us don`t know. The Minister of Health has provided few clues besides threats of unspecified quotas. We know he will restrict IVF based on age, and deny women the choice to discuss and seek care publically and privately beyond age 42. We know he will demand proof of sexual relations for women under age 42, as well as psychiatric assessments in certain cases, before funding IVF. However, for Family Physicians, there are few to no details.

The Minister has stated one clear objective – a Family Doctor for each citizen – but the Bill to improve access will likely accomplish the opposite because it fails to recognize who Family Doctors are and what we do.

Let`s assume Bill 20 passes and each Family Doctor is legislated to increase his or her patient roster to 1000-1500 patients. Simply, one of two outcomes will happen: Family Doctors will comply or not. For those who choose not to increase the number of patients, a salary cut of 30% will be imposed. For the remainder, the practices will swell and patients, who already experience long wait times to see the doctor, will have to wait longer.

Next, the Minister will impose minimum daily quotas. Again, doctors will have the same two options: comply or absorb a 30% pay cut. Predictably, patient care is compromised: appointments are shorter and hurried.

You see, it`s easy to manipulate statistics, or in this case, patients and Family Doctors. After all, is it not more convenient to blame the lack of Family Doctors on Family Doctors as opposed to, say, Government policy? It seems as if there is nothing that Family Doctors cannot be faulted for nowadays – spending too much time with patients, spending too much time with our families, spending too much time at the hospital, spending too much time teaching, etc.

However, the paradox of Bill 20 is that while it will increase the number of citizens who have a Family Doctor, it will actually worsen access. After all, how many hours a day can each Family Doctor legitimately work? The dirty secret of Bill 20 is that patients actually lose choices and access by being limited only to their Family Doctor. Forget about calling the walk-in clinic around the corner on nights and weekends – you are contractually bound to your Family Doctor. Break this bond and your Family Doctor gets fined. How much? You guessed it – 30%.

The great irony of Bill 20 is that not having a Family Doctor improves access. Having a Family Doctor should improve care but only if patients are treated as individuals not numbers.

All this brings us back to the essence of Family Medicine. Who is a Family Doctor? Unlike “GPs“, Family Doctors are specialists who provide community-based, skilled, comprehensive care to a defined population. This care is forged through the doctor-patient relationship and emphasizes evidence-based health promotion and disease prevention while advocating for patients and respecting community resources.

But Family Doctors are people to. We are husbands and wives, mothers and fathers, children and caregivers. We are not civil servants; we do not receive pensions or vacation time or sick time. We pay for our supplies and our equipment, our rents and our staff, and we do not get paid when we do not work. We all made choices to go in to the service of others, and at times, made sacrifices for this education and training.

So, why the obituary for Family Medicine in Quebec? Frankly, who will choose to stay? Would you accept a 30% pay cut? The older Family Doctors may choose to close shop; the younger doctors may not consider starting at all. For the rest of us, will we be content practicing a form of medicine that bears little resemblance to our chosen and beloved profession? The heart of Family Medicine lies in the special doctor-patient relationship: a professional friendship cultivated over a lifetime, built on trust and caring. Family Medicine is about listening and teaching, educating and treating. We may click more cards with fast-food medicine, but we won’t be healthier.

So on this lonely evening, I fear for the future of Family Medicine in Quebec. The deliberations for Bill 20 have just begun. Make your voice heard. Don`t settle for a system that makes you Patient #1499; insist on a system that gives you choices, timely access and quality care. Every patient deserves a real Family Doctor who has the time to listen.

By Michael Kalin January 7, 2015 Clinic News , , , , , , , , , , , , ,

King Pharoah

It’s no secret that doctors often make lousy leaders. Just think of Francois (Papa Doc) Duvalier (Public Health, Haiti), Bashar Al-Assad (Ophthalmology, Syria), and Radovan Karadžić (Psychiatry, Bosnia).

There are many reasons for the dearth of physicians in politics – after all, the qualities that make the best politicians are not necessarily the same attributes of the finest clinicians. Great politicians may be opportunistic, ambitious, partisan, and calculating. Alternatively, the best clinicians are driven by humility, empathy, curiosity, and passion for patient care. When the physician and politician collide, one is reminded of the famous joke – “What’s the difference between God and a Doctor? God doesn’t think He’s a Doctor.”

To be successful, in both fields, one must understand the limits to one’s skills and power. A leader must recognize what he or she can realistically accomplish; to control situations not simply react to them.

Regrettably, our neophyte Health Minister, Dr. Gaetan Barrette, has charged to power as a victorious conqueror. Like so many before him, he is determined to save us from ourselves. With swift edicts and magisterial decrees, He alone will fix the health care system. Apparently, the solution is simple; like Pharoah, Dr. Barrette has commanded that we all work harder or be punished. Mercifully, Minister Barrette’s proposed contraception policy only imposes steep fines and not discarding in-vitro newborns into the Saint Lawrence River.

Some aspects of Dr. Barrette’s proposed Bill 20 purpose are noble – to promote access to family medicine and specialized services. However, towards this end, Dr. Barrette has prescribed a disappointing, misguided and unimpressive treatment. Like an overbearing parent, Dr. Barrette demands “certain obligations…to provide medical care to a minimum caseload of patients” likes chores for an allowance. Failure to comply will result in monetary punishment to be judged and executed by the authority of the Minister of Health Himself.
Other aspects of Bill 20 are simply nauseating. Women over age 42 are forbidden to have children by IVF, public or private, in Quebec and elsewhere, with fines of up to $150 000. Moreover, the Bill legislates a mandatory prerequisite “period of sexual relations…determined by government regulation.” This is not a typo.
In the end, the Minister will inform us, “by directive, of the rules that [we] must follow.” Supreme Ruler Barrette, like Kim Jong-un, claims to speak for the people and to act in their best interest.

How does this Bill improve access? What brilliant, insightful and innovative mechanisms are established to improve access? Simply – none. The Minister is convinced that doctors that can be scared into seeing more patients, women can be intimidated to work longer hours, and women in their 40s can be frightened not to have children. It is a Bill befit for the “Democratic People’s Republic of Quebec “– not our Quebec.
Our goal for this Bill should be access to quality and timely care – not patients seen. We should be building on a model that allows young physicians to balance family and work, decrease stress, improve flexibility and encourage part-time physicians to carry a broader work load. A load not defined by quantity, but in its complexity (ie. mental health, chronic illness, elderly, etc.).
We need a Minister who listens, a leader who collaborates, and a government that cares about people more than numbers. We need to celebrate families and diversity. Dr. Barrette has no place in our bedrooms or in our offices.
Bill 20 is not bad medicine, it is poison. Bill 20 criminalizes fertility in older women. It antagonizes and discourages young doctors who wish to make a life and family in Quebec and will push older doctors to early retirement. Take note Minister Barrette – Pharoah’s regime ended with the great Exodus. Bill 20 threatens us all.

Dr. Michael Kalin is the Medical Director of GMF Sante Kildare located in Cote Saint Luc.

www.assnat.qc.ca/fr/exprimez-votre-opinion/petition/Petition-5029/index.html

By Michael Kalin December 25, 2014 Uncategorized

Bill 20

OPEN LETTER TO MR. DAVID BIRNBAUM, MNA DARCY MCGEE

Bill 20 – will adversely affect Cote Saint Luc’s only GMF Clinic

 

Dear Mr. Birnbaum,

As the Medical Director of Cote Saint Luc’s only GMF clinic, I must express my concerns regarding the proposed Bill 20.

GMF Sante Kildare serves almost 20 000 registered patients in our community.  We are a group of 25 family physicians – offering medical services 365 days per year, including evenings, weekends and holidays.

We have an open, daily walk-in clinic for any patient (even “orphaned persons”).  We provide services to local Foster Homes, collaborate with McGill, coordinate with CSSS Cavendish, conduct research studies – all in an effort to provide the best, comprehensive and timely care to all persons.

We started with two physicians in October 2011 – and now pride ourselves on exceptional growth with a stellar and superb team of 25 committed doctors, nurses, and other health care professionals.

Of the 17 family doctors based at my location, 14 are female.  In fact, most are young doctors who recently completed their Family Medicine Residencies.  They were attracted to Sante Kildare for many reasons: our inclusive philosophy, teamwork, supportive network, flexibility and GMF status.

And this is my point – GMF works.  The incentives offered by previous Ministers of Health were working.  We actively remove orphaned patients from the CLSC Guichet list.  We keep doctors in our territory.  We offer extended hours.  We keep patients out of the ERs.  We cover young female doctors during maternity leaves.  We cover patient practices when doctors are away fulfilling their AMPs.

Group GMF coverage is the only solution.  80% of Family Medicine graduates are female!  While I personally work 70 hours each week, most doctors don’t.  It is ridiculous, unrealistic and unreasonable to demand young, female doctors to work 36+ hours/week.  They have made sacrifices to continue schooling to serve and heal others.  They should not be penalized for striving to balance home and work.

But this Bill punishes everyone.  Why should I be fined (or docked pay) if my patient sees another physician – even if I am open and available?  If you live in Quebec City and your family doctor works in Cote Saint Luc, should he/she be penalized if you seek urgent or semi-urgent attention locally?  What if someone lives in Dollard and works downtown?  What about chest pain at 3 am?  In all scenerios, it’s the family doctor who pays.

I care about quality.  I book 30 minutes per physical.  The RAMQ agrees that a check-up requires more time.  Am I to work 15 hours each day to meet the Minister’s quota of 30 patients?
Should I tell patients to book multiple appointments to “get through their list of problems?”

We need a system that rewards productivity – not a plan that punishes.  We need a Bill that recognizes the reality of our workforce – not an outdated, punitive vision that frowns upon families.  We need an open dialogue – not a demagogue.  Quality and commitment should be recognized and embraced – not attacked.  The family physician is the backbone of the health care system – the quarterback – the human face.  We only succeed by developing and nurturing the doctor-patient relationship – not timing it.

Family Medicine is not radiology.  We see patients – not their films.  We talk to patients – teach, advise, advocate, heal.

Please, please, please.  I urge you to visit our clinic and see how this Bill will devastate us.

Leadership should not be achieved through bullying.  We desperately need collaboration, discussion, vision.

Thank you.

Dr. Michael Kalin

 

 

 

By Michael Kalin July 15, 2014 Uncategorized

Sante Kildare Green Thumb

715b1ce1a4bf0ff01966952d374ec726Seems simple enough.  We have lots of talented, educated, successful professionals at Sante Kildare.  Surely, one of the doctors or nurses can nurture and sustain an office plant – after all, we treat acute and chronic illnesses all day.
Our challenge – to maintain an office plant for a month (or beyond)
The subject – The African Violet
According to Canadian Gardening, “the African violet may just be the perfect houseplant.  It blooms readily and has no specific flowering season, so it can be in bloom year-round. And it’s easy to multiply and share with others. As a result, it’s found worldwide, from the Far North to the Antarctic, anywhere there’s a cozy windowsill for it to grow on.”

To help us succeed, we have selected a plant that “can also cope with less light than most other flowering plants.”  Apparently, we should look for a spot that gets bright light most of the day with little full sun in the afternoon.
Here comes to tricky part: According to the Canadian Gardening website, we need to “ let the plant tell [us] what it needs: long, stretching petioles and leaves that bend toward the sun, or lack of bloom

indicate insufficient light, while dense, compact, hard growth with bleached-out leaves tells you the plant is getting too much light.”  Yikes – medicine already seems simpler.
We should “keep the growing mix (peat-based houseplant mix is fine) slightly moist; wait until it feels dry, then water abundantly, drenching it. Wet leaves can result in leaf spot, so it’s best to water from below by pouring tepid water into the plant’s saucer and letting it soak up what it needs. After 20 to 30 minutes, drain any surplus.”
Finally, we should “fertilize” the young plant with a foliage-plant fertilizer rich in nitrogen.”
I wonder if pharmaceuticals will help!  Maybe a little Cialis or testosterone?

violet

By Michael Kalin May 5, 2014 Clinic News, Health Promotion

Introducing Scripps

What`s a Scrip?
According to the dictionary, the term scrip has been around for over 400 years. It may be as simple as a scrap of paper or even possess a monetary value. A quick Wikipedia search describes scrips as vouchers, used by companies to provide workers with credit when their wages had been depleted. In the 19th century, the federal government devised a plan to distribute land grants, called scrips, in Western Canada. Scrips were widely used during the Great Depression and after conflicts, to pay employees and POWs. During the Korean and Vietman Wars, U.S. soldiers were sent on leave with a scrip marked with expiration dates which could be spent at establishments cooperating in the program. Most recently, scrips are used as gift certificates or by companies for point of sale transactions (think Canadian Tire Money and Disney Dollars).
scrip def

So – what`s a Scripp?
In 2009, the New Zealand Ministry of Health implemented an innovative and ambitious nationwide program to address obesity and lack of fitness. This program, Green Prescription (GRx), relies on a health professional`s written advice to a patient to be physically active, as part of the patient`s health management.
Research published in New Zealand and British medical journals support Green Prescriptions as an effective and inexpensive way of increasing activity and improving a patient`s quality of life, without evidence of adverse effects.
This concept – of prescribing exercise – has gained international recognition and momentum including in Canada:

cbc

bc

doc

But why limit a script to just exercise?
Scripps – Strategic Care Recommended & Influenced by Physician Prescriptions – conceived of and implemented at Sante Kildare, is a uniquely Canadian, second-generation Green Prescription, designed to promote and wellness beyond exercise. Scripps target patient well-being through recommendations to diet, exercise, income and environment.
More to follow…

By Michael Kalin May 1, 2014 Clinic News

Welcome!

I have to admit, never pictured myself as a blogger.

This blog is inspired by my friend, classmate and colleague, Dr. Yoni Freedhoff, who has been writing blogs (weightymatters) for almost 10 years. Yoni has demonstrated that a single, passionate voice can inspire change – both on an individual and societal level.

To borrow from Yoni`s introduction in 2005, my name is Michael Kalin and I’m a medical doctor who specializes in family medicine and I’m located in Cote Saint Luc, Quebec, Canada. I run a multi-disciplinary family practice, known as a GMF or Groupe de Medecine de Famille, that strives to provide the highest level of medical care through health promotion, disease prevention, and in the words of the great Dr. William Osler, undertanding the person behind the illness.

In this blog I will share my thoughts on items relevant to family practice – and invite members of my multidiscplinary team to participate in this discussion with insights of their own. I hope you join us.