No abstract

Canada has a long history of accepting immigrants and refugees. These populations may have unique health care needs that the Canadian health care system must adequately address. Currently, there are numerous barriers to the treatment of refugee mental health concerns. These include cultural, language, financial, and systemic barriers. Best practices for treatment in this population include psychotherapies such as cognitive behavioural therapy and narrative exposure therapy, medications, and health promotion and psychosocial interventions. Physicians have previously advocated for improving health care for Canada’s refugee population and medical schools are working to incorporate multicultural education into their curricula.

Cancer treatment and prevention is a continuously evolving field. Canadian guidelines suggest that women of average breast cancer risk receive mammography screening regularly. Screening seems an intuitive approach to diagnosing cancer in its early and curable stages. However, repeat cancer screening is not without drawbacks; as the intensity and frequency of cancer screening increases, so do the consequences of overdiagnosis, including avoidable testing and treatment, pain, stress, unwillingness to participate in future testing, and healthcare spending. Therefore, achieving optimal screening outcomes requires an accurate understanding of the costs and benefits associated with this procedure. By empowering patients to make informed decisions regarding cancer screening, one potential strategy to improve patient care is to improve communication and decision-making between physicians and patients. Other strategies to achieve better screening include targeted screening programs for high-risk patients that rely on different screening modalities.

Physician wellness and burnout have long been important topics in Canadian health care. Though burnout presents in various occupations, physicians experience unique professional challenges that predispose them to experience burnout. Elements inciting this chronic condition are introduced early in medical education, reinforced during residency training, and poorly addressed during clinical practice. Substantial evidence demonstrates that burnout has significant and undesirable impacts on patient outcomes and care delivery. Physician quality of life and well-being as well as health care spending are also negatively impacted by burnout. However, there is an ongoing need to apply these research results in the clinical setting. Currently, research suggests that individual, cultural, and organizational factors play a role in the development and maintenance of burnout. Best practices to prevent burnout and manage its effects, including interventions during medical education and greater work autonomy, are required to address barriers to wellness at each of these levels.

Informed consent plays an important role in critical care medicine (CCM) because patients are vulnerable so their rights must be carefully protected, and research in CCM may be associated with high risks of morbidity and mortality. However, the process of obtaining consent may be a significant barrier to CCM research. There is often limited time in which to make decisions, patients or substitute decision makers may not be able to make those decisions, and complex consent documents may be an additional barrier. This is an important issue, both because vulnerable patients should not be denied access to the benefits of research and because the loss of eligible patients from CCM clinical trials due to lack of consent could introduce bias and limit the generalizability of research. This article will explore why getting consent is challenging in CCM research, and how this can process could be improved.