VOL 60: SEPTEMBER • SEPTEMBRE 2014
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Canadian Family Physician Le Médecin de famille canadien797
Letters | Correspondance
Pandemic of great expectations
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n addition to a pandemic of multimorbidity,1 what we might have on our hands is a pandemic of great expectations. Aldous Huxley said that “medical science has made such tremendous progress that there is hardly a healthy human left.” I fnd that many of my patients have rather lofty and unrealistic expectations of how they should feel at all times. And if circumstances lead to their not feeling well, their doctors should certainly be able to “fx” the problem. We likely have only ourselves to blame for raising peoples’ expectations beyond what we can deliver.—Laura Muldoon MD CCFP Ottawa, Ont
Competing interests None declared Reference
1. Genuis SJ. Pandemic of idiopathic multimorbidity. Can Fam Physician 2014;60:511-4 (Eng), e290-3 (Fr).
Response
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hanks to Dr Muldoon for her thought-provoking let- ter. There are certainly individuals who present to physicians with seemingly trivial complaints and some who do not follow basic health measures, yet express surprise when they become ill. People are not baffed when poorly maintained or aging automobiles mal- function, yet some people pay little heed to basic self- maintenance and are somehow astonished when they feel unwell. Furthermore, there are individuals who sus- tain utopian ideals of how they should consistently feel and harbour unrealistic expectations of health provid- ers, expecting to be “fxed” despite less-than-ideal health practices. However, this is not the general presenta- tion of most patients with multimorbidity with sensi- tivities (MWS) as discussed in the article “Pandemic of idiopathic multimorbidity.”1 Furthermore, with specifc laboratory and environmental testing, objective and measurable abnormalities are usually identifed when assessing patients with MWS.However, it is my experience that many physicians are unfamiliar with sensitivity-related illness and might thus be unable to account for the symptoms and con- cerns of patients with MWS. I routinely hear the frustra- tion of individuals who comment that their doctors are unable to explain multisystem health complaints and therefore think that such patients are “whiny” or per- haps mentally ill. I think it is important for us, as phy- sicians, to be cautious that our dismissal of patients’
symptoms does not represent a visceral response to our own inability to elucidate the source of their concerns.
Dr Muldoon’s letter provides an opportunity to raise a noteworthy point with regard to physician perspectives.
The 2003 Canadian Medical Association survey of mem- bers2 and other publications in Canada3 and abroad4,5
provide insight into the attitudes, beliefs, and morale of some physicians in this country and elsewhere. The fndings reveal that many physicians feel discouraged, clinically ineffective, and unproductive in their work. As a result, some doctors fnd the practice of medicine to be intellectually unrewarding. In fact, a number of e-mails I received in response to my article talked about frus- tration, futility, and ineffectuality in managing patients with MWS. I have often wondered whether many empa- thetic practitioners, particularly primary caregivers, fnd it diffcult to repeatedly listen to the sad and sometimes desperate accounts of innumerable chronically ill per- sons day after day, and perhaps fnd it hard to maintain motivation when encumbered by a palpable inability to alleviate suffering in many cases. This is particularly rel- evant as about 72% of the global burden of disease in adults now represents chronic illness,6,7 often involving multiple ongoing conditions. The frustration all around is encapsulated by the name of a recent paper entitled
“‘Where do we go from here?’ Health system frustrations expressed by patients with multimorbidity, their caregiv- ers and family physicians,”8 one of the many dozens of medical publications on this matter released in the past few months. Furthermore, this issue is clearly of enor- mous relevance and concern to the medical community, as a previous article on the subject of multimorbidity9 is one of the most cited papers ever published in Canadian Family Physician.10
In the 2 articles on multimorbidity in the June issue of Canadian Family Physician,1,11 I presented information about sensitivity-related illness—an emerging immune disorder resulting from toxicant exposures—and its relationship to MWS and chronic illness. With the rec- ognition that numerous chronic affictions can be ame- liorated and that health can often be restored with the guidance and care of informed physicians, expecta- tions of good health are very realistic. With the knowl- edge and tools to investigate and successfully assist many patients to overcome their chronic conditions,
Top 5 recent articles read online at cfp.ca
1. Emergency Files: A hot mess. A case of hyperemesis (July 2014)
2. Clinical Review: Evolution of lipid management guidelines. Evidence might set you free (July 2014) 3. Tools for Practice: Acetaminophen in preg-
nancy and future risk of ADHD in offspring (July 2014)
4. Commentary: Keep it simple. Easing the care burden of fbromyalgia (July 2014)
5. Commentary: Pandemic of idiopathic multimor- bidity (June 2014)
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Canadian Family Physician Le Médecin de famille canadien|
VOL 60: SEPTEMBER • SEPTEMBRE 2014Letters | Correspondance
the practice of medicine can be effective, intellectually challenging, and immensely rewarding.
—Stephen J. Genuis MD FRCSC DABOG DABEM Edmonton, Alta
Competing interests None declared Reference
1. Genuis SJ. Pandemic of idiopathic multimorbidity. Can Fam Physician 2014;60:511-4 (Eng), e290-3 (Fr).
2. Canadian Medical Association. Who cares for the caregiver? CMA Interface 2003;4:2.
3. Leiter MP, Frank E, Matheson TJ. Demands, values, and burnout: relevance for physicians. Can Fam Physician 2009;55:1224-5.e1-6. Available from: www.
cfp.ca/content/55/12/1224.full.pdf+html. Accessed 2014 Aug 7.
4. Smith R. Why are doctors so unhappy? There are probably many causes, some of them deep. BMJ 2001;322(7294):1073-4.
5. Regehr C, Glancy D, Pitts A, LeBlanc VR. Interventions to reduce the conse- quences of stress in physicians: a review and meta-analysis. J Nerv Ment Dis 2014;202(5):353-9.
6. World Health Organization. Preventing chronic diseases. A vital investment.
WHO global report. Geneva, Switz: World Health Organization; 2005. p. 1-202.
7. Horton R. The neglected epidemic of chronic disease. Lancet 2005;366(9496):1514. DOI:10.1016/S0140-6736(05)67454-5.
8. Gill A, Kuluski K, Jaakkimainen L, Naganathan G, Upshur R, Wodchis WP.
“Where do we go from here?” Health system frustrations expressed by patients with multimorbidity, their caregivers and family physicians. Healthc Policy 2014;9(4):73-89.
9. Fortin M, Lapointe L, Hudon C, Vanasse A. Multimorbidity is common to family practice. Is it commonly researched? Can Fam Physician 2005;51:244-5. Available from: www.cfp.ca/content/51/2/244.full.pdf. Accessed 2014 Aug 14.
10. Canadian Family Physician [website]. Most-cited articles as of August 1, 2014.
Mississauga, ON: College of Family Physicians of Canada; 2014. Available from: www.cfp.ca/reports/most-cited. Accessed 2014 Aug 8.
11. Genuis SJ, Tymchak MG. Approach to patients with unexplained multimor- bidity with sensitivities. Can Fam Physician 2014;60:533-8.
Correction
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n the article “Assessment of patient-reported out- comes using a Web-based EHR patient portal,”1 which appeared in the supplement to the July 2014 issue of Canadian Family Physician, an author was inadvertently excluded. The correct list of authors is as follows:Eric Shafonsky
MDAmanda Kelly Allen Hayashi
MDKristine Votova
PhDChristine Hall
MDAndrea Piccinin
PhDJonathan Rush
MScScott Hofer
PhDCanadian Family Physician apologizes for this error and any confusion it might have caused.
Reference
1. Shafonsky E, Hayashi A, Votova K, Hall C, Piccinin A, Rush J, et al.
Assessment of patient-reported outcomes using a Web-based EHR patient portal. Can Fam Physician 2014;60(Suppl 1):S17. Available from: www.cfp.ca/
content/60/7/S1.full.pdf+html. Accessed 2014 Jul 17.
Correction
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ans la table des matières du numéro de juillet du Médecin de famille canadien, une erreur s’est glis- sée par inadvertance dans le titre de la traduction de l’article par Dr N. John Bosomworth1. Le titre exact aurait dû se lire comme suit:e333
EXCLUSIVEMENT SUR LE WEB: www.cfp.ca Révision clinique: Évolution des lignes directrices sur le traitement de la dyslipidémieLes données pourraient vous libérer N. John Bosomworth
Dans l’article2, le Tableau 2 comporte une erreur de traduction. Le quatrième point sous le groupe de traite- ment aurait dû se lire comme suit:
Prévention primaire pour les patients de 40 à 75 ans sans MCV ni diabète et dont le cholestérol LDL se situe entre 2,0 et 5,0 mmol/L.
Le Médecin de famille canadien présente ses excuses pour la confusion ou les inconvénients que ces erreurs auraient pu engendrer.
Références
1. Sommaire. Can Fam Physician 2014;60:591.
2. Bosomworth NJ. Évolution des lignes directrices sur le traitement de la dys- lipidémie. Can Fam Physician 2014;60:612-7 (ang), e333-9 (fr).
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