Month: January 2013

David Kuhl has been awarded the Queen Elizabeth II Diamond Jubilee Medal.

He was nominated for his work in co-founding the Veteran’s Transition Program (VTP).

This is a truly remarkable acknowledgement of the work David has done for veterans and as a department we should feel very proud of his commitment and scholarship that led to the development and success of the program.

David is the Director of the Centre for Practitioner Renewal and  Professor for the Department of Family Practice, Faculty of Medicine at the University of British Columbia. Previously, he was the physician leader for palliative care at Providence Health Care for many years. As the Director of CPR, he is working to combine his interests in medicine and psychology to develop a program of service, education and research to sustain health care providers in the workplace.

Could this be another effective way to change doctors’ behaviour? Not really, says a linked editorial (doi:10.1001/jamainternmed.2013.1984). Healthy people with uncomplicated bronchitis should never be given antibiotics. We have known this for 40 years and should be aiming for prescribing rates below 10%.

Efforts to change have been well made and well evaluated. We know what works, but nothing seems to work well enough. Traditional medical interventions have failed, and it may be time to look further afield to business leaders, behavioural economists, and psychologists for inspiration. We might also be clearer with patients about just what they can expect from antibiotics—a few will recover slightly faster, between 5% and 25% will have an adverse reaction, and at least one in every 1000 will present to an emergency department with a serious drug related event.

This year will be challenging for the department. We have accreditation, a new post graduate curriculum, expansion and the development of new postgraduate training sites and that is just post graduate. In undergraduate the renewed curriculum development continues and the role for family practice is going to be significant. In faculty development the activity continues apace with one of the largest events being Family Medicine Forum which is this November in Vancouver. Amongst other research activities we await the first community based primary health care team grants from CIHR that will be announced in April. So it will be an exciting twelve months.

To address some of the expansion issues we have been working closely with the faculty of medicine to restructure the payment system for clinical faculty. We have a temporary fix in place and will now be putting into place a new finance process run from the department as the long term solution. The training to implement this will take six months but at the end of that period faculty should see a much improved payment process. To enable this we have undertaken several structural changes in the department to create space for groups of administrative staff to work more closely. We are continuing changes and in six weeks will see three new offices being constructed. I am grateful to the patient of staff and faculty living through these departmental disruptions!

Outside of the department we are seeing some interesting developments. A world wide call for open access to clinical trial data is starting to really gather momentum. With many of Tamiflu’s trials results still not revealed the pressure is on various governments to reassess recommendation for its use (http://www.bmj.com/tamiflu). This might be very appropriate as we face such a demand and yet we don’t have access to the evidence. At this stage you might expect to see a Cochrane review . Roche have now promised to release their data to the Cochrane trialists (November 2012). There are other examples of this but as the flu epidemic hits it is really quite worrying that eight of the ten randomised controlled trials using Tamiflu have not yet been published or their data released.

So what should we do in response to patients with symptoms. The real question is what source of evidence do you use. I usually check Dynamed on my cell phone. In head to head comparisons it came off better than UptoDate for timeliness but did not have so much breadth of coverage (Prorok et al The quality, breadth, and timeliness of content updating vary substantially for 10 online medical texts: an analytic survey, Journal of Clinical Epidemiology, Volume 65, Issue 12, December 2012). In the end one source of evidence is rarely enough and I suggest having two or three you become familiar with. Rx files is another of my regular sources as it has the advantage of showing some information on cost.

Whatever the source of information you use I hope the flu epidemic is mangeable in your clinical setting. In the end Semmelweiss’s advice on hand washing is never wrong!