Top 3 posts of the week by Canadian doctor-bloggers

What's going on this week in the Canadian physician blogosphere?

(Note to self: opportunity for new coinage. Phlogosphere? Physlogosphere? Physiblogiciansphere? Perhaps not.)

Here are the week's top posts:

1. "DNE (Do not evacuate)" by Nunavut's own Dr J, Adventures in Medicine. An excerpt:

My own agenda for the visit is to discuss his wishes around extent of treatment and end of life care. The patient in front of me has end stage COPD and it seems an important thing to clarify. In hospitals this is framed as a DNR discussion, but here it is much more. It is a discussion about values, beliefs, and a cultural divide that at times seems as vast as the arctic itself. The current group of Inuit elders are the last Inuit people who were mainly born and grew up living on the land (that is; living a traditional nomadic lifestyle centered around hunting and survival). They are pragmatists, and when asked if they wish any particular medical intervention the usual response is 'yes, if that is what you think needs to be done'. When I first arrived in the north I had a few DNR discussions in the usual southern style, and they didn't go too well. Like they had talked about in medical school I asked the patients if their heart were to stop would they like us to try to restart it, even though the chance of success was small given their particular condition. They would look at me quizzically and through the interpreter say 'Of course he wants that, if he would die or live he wants to live. Now he wants to not talk about that anymore!'. It took me a few go-rounds to catch onto the fact that I was having the wrong conversation.

2. "Sangria" by Dr Martina Scholtens, FreshMD.

I use an interpreter for the Spanish-speaking patients at the clinic, and sangria is one word that I hear regularly. It's usually buried in a long descriptive passage by the patient, and while I'm waiting for the English version, I think of a chilled red wine beverage with brandy and floating citrus slices.
Finally, I asked the translator why the word kept cropping up. Turns out sangria means bleeding, and my pleasant reveries are completely at odds with the experiences the patients are recounting. I think I may even have been smiling while someone described a hemorrhage.

According to SpanishDict.com sangria means: "alcoholic punch made from red wine mixed with fruit juice and soda water; bend; indentation; bleeding; phlebotomy, drawing blood for medical purposes." Makes sense when you think about it, considering sang is French for blood, and exsanguination is English for what happens during hypovolemia: the loss of blood. But, like Dr Scholtens, I hadn't before thought in such detail about the connection between Spanish cocktails and ways to die.

3. "A BSc. in Obesity?" by Dr Yoni Freedhoff, Weighty Matters. Dr Freedhoff's reaction to the news that the University of Guelph will offer a four-year degree in the fitness and nutrition issues related to obesity:

For me, this hammers home two messages:

Firstly, that clearly there's a crying need for more health professionals trained in obesity management.

Secondly, that medical schools and residency programs are failing our obese patients.

Frankly in an ideal world, I don't think obesity management should be a University course. The reason you don't see 4 year degrees in blood pressure or diabetes is because doctors are taught how to adequately manage those conditions in medical school and residency. Unfortunately the same cannot be said for obesity.

In my ideal world obesity medicine would be a sub specialty program within the department of Family Medicine and/or a real 5 year physician specialist program.

If you're interested in the course, you'd better have good grades - they've already received 430 applications for the 60 available spots.

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