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Tales from the Uber Scene

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For the 6 months that I have not been able to drive because of medical reasons I have become a regular user of Uber. I find Uber more flexible and convenient than standard taxis. As regular users of Uber services know, many of the drivers are originally from elsewhere, by which I mean overseas and came as immigrants or refugees.

To anyone that knows me well, my interest in people and their stories plays a prominent role in my modus operendi. Also following many years of travelling overseas as part of my work as an academic geriatric medical specialist, I have learned that there are many interesting stories and points of view to be gleaned from taxi drivers. So it has come to pass with my multiple Uber trips. The point of initiation of engagement is if I recognize an accent and ask the driver from where he came. They often ask me to guess, but I have already had a hint by the Uber app which provides the name of the driver. If it is one of the typical names and the accent fits I may venture to say something like, "the Middle East or Former Soviet Union or Ireland". If I am close or correct I am usually complemented on my guess, with a question such as "do you know my country" which if positive opens the door to the conversation.

Because I have travelled a good deal during my medical school education in Scotland which at the time afforded me may months of free time to travel, sometimes combined with a medical elective experience in the country I was visiting, but also a chance to pick up some of the language, friendships with local residents and a travel experience—which often resulted in friendships some of which are still operative. I also witnessed historical moments like the coup in Greece during the 1960s, the build up to the Six-Day War in Israel and the vote that ousted the regime in Argentina that replaced the prime minister with Carlos Menem who shook the economy with economic reforms. I was in Argentina with my teenage son for a geriatric conference during the time of the election that brought Menem to power and we witnessed the hundreds of police officers patrolling the streets of Buenos Aries, with a favorite hangout of the blue uniformed police being the McDonalds in the Centre of the city on the Avenue de Mayo.

The driver answered, "Turkey-Istanbul, do you know it?" To which I replied with unbridled enthusiasm, "Yes I do, have been there and loved it." He turned towards me in the passenger seat and smiled. "It is a beautiful city". I followed with the question, "do you know the movie Kedi" He turned toward me with a huge grin, "it means cats" to which I acknowledged, "I love cats, we have three Abyssinians in the house and a number of feral cats in our backyard—three consisting of a mother and two of her litter that have adopted us or maybe allowed themselves to be adopted by my wife who diligently feeds and speaks to them. The bond is so close that we have purchased a number of cat shelters for them to increase their comfort which is helped by straw we bought from one of my wife's students who comes from a rural community outside of Toronto. Besides dry cat food many of her friends give her wet food that they have accumulated from their own cat adventures—we try to get them neutered and receive their vaccinations with the clipped ear being evidence that they were caught for this purpose before being released back to their feral home.

The driver and I talked about the wonderment of cats and how they are part of Istanbul life. To observe the seven cats and their litters featured in the movie was a real joy, with the film starting with a picture of kittens waiting for their mamma to return with breakfast—their tiny heads peering through the railing surrounding the birth site. The clips of the cat who ventures to the fish market every morning where the local fishmonger prepares the remnants of the carved fish for the dependable visitor as if it were a guest coming for dinner. Among the most moving scenes were that of people whose lives were either impacted or even saved by their feline companion who through the special sense that cats have of responding to human need.

One moving clip was of a fisherman whose adopted cat helped the small fishing boat captain deal with depression and loneliness, would roam the boat as it churned through the Bosphorus, acting like the queen of the sea as the captain beckons it for a pat. More devotion from an animal towards a human cannot be found—it is unfair to categorize the cat as a pet, it is more like a friend, companion and loved one.

We reached my destination, but not before sharing our common bond in the love of cats and their deserved place in the hearts of mankind—the Turks of Istanbul have done it, we should be able to emulate their devotion and bring the feline joy to our communities and individual families.

An Evidence-Based Approach to the Neck Assessment

Teaser: 

Dr. Julia Alleyne, BHSc(PT), MD, CCFP, Dip. Sport Med MScCH1 Pierre Côté, DC, PhD2 Dr. Hamilton Hall, MD, FRCSC3

1is a Family Physician practising Sport and Exercise Medicine at the Toronto Rehabilitation Institute, University Health Network. She is appointed at the University of Toronto, Department of Family and Community Medicine as an Associate Clinical Professor. 2Professor and Canada Research Chair in Disability Prevention and Rehabilitation, Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT); Director, UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC). 3 is a Professor in the Department of Surgery at the University of Toronto. He is the Medical Director, CBI Health Group and Executive Director of the Canadian Spine Society in Toronto, Ontario.

CLINICAL TOOLS

Abstract:Neck pain is a common musculoskeletal condition that frequently resolves spontaneously or with conservative treatment and only occasionally requires surgical intervention. The purpose of the neck examination is to determine if the etiology is neurological or mechanical pain, which determines treatment planning, and then to rule out red flags. There is good evidence that on examination clinicians cannot reliably differentiate specific anatomical structures but they should still perform a focused clinical examination to locate typical pain on movement and establish the neurological status. Base treatment on exercise, activity management and pain control.
Key Words: neck, examination, treatment, differential diagnosis.

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www.cfpc.ca/Mainpro_M2

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If your patient is presenting with symptoms of systemic disease, deteriorating neurological status or focal severe pain, initiate further investigations and or referral.
Once red flags have been ruled out, neck pain will fall into two categories: neurological or mechanical pain.
Range of Motion testing should be done in 3 specific planes; flexion-extension, lateral flexion and rotation. Moving the neck in circles does not provide useful clinical information.
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The Resuscitative Power of Stories: The Importance of Narrative Medicine in Training, Practice and Patient Centered Health Systems—Part 1

Teaser: 

Dr. Zahra Bardai BSc MD CCFP (COE) MHSc FCFP 200hRYT,

Lecturer, Department of Family and Community Medicine, University of Toronto, Staff Physician, Brock CHC Primary Health Care Program, Cannington ON.

CLINICAL TOOLS

Abstract: Stories have the capacity to move us by evoking strong powerful emotions and unlocking potent insights. The narratives that convey the lived experience in medicine bring a sense of meaning and compassion to the science of the discipline. This article is an introduction in a series that depicts stories in medicine and the influence they have on patient care, medical education and physician well being.
Key Words: narratives, patient care, medical education, physician well being.
The art and science of medicine as seen through a narrative based lens is interwoven in the telling and retelling of the patient and provider's experience.
Narrative based medicine involves honing skills of listening, exploring, deciphering and reflecting in order to understand and improve the humanitarian practice of medicine.
The practice of narrative medicine involves bearing witness and holding space through attentive mindful listening during a clinical encounter.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
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Goal-setting in the Office: Tips for Success

Teaser: 

Dr. Marina Abdel Malak

is a Family Medicine Resident at the University of Toronto. She graduated and completed her Bachelor of Science in Nursing and went on to study Medicine. She has a passion for medical education, patient empowerment, and increasing awareness about the relationship between mental, emotional, and physical health.

CLINICAL TOOLS

Abstract:Empowering patients to set health-directed goals can be a challenging process. The skilled clinician successfully supports patients in setting goals that are SMART (specific, measurable, achievable, realistic/relevant, and time-related). When goals are made in collaboration with patients, they are more likely to be long-lasting and impactful. This article will focus on how physicians can work with patients to identify, create, and work towards meaningful interventions that optimize health.
Key Words: motivation, behaviour changes, counselling, goals, treatment.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Goal-setting should be a partnership between physicians and patients
Asking patients what THEY want—and can—change in their lives/health is the first step to eliciting what behaviours can be targeted
After goals are set, it is important for physicians to reassess patients' progress by asking them if goals were met, and why or why not. When success occurs, patients should be congratulated on their achievements. If the goals were not met, physicians should seek to understand why this occurred, and work with patients to create new goals that are more realistic or achievable
Physicians should motivate patients to set goals that are SMART (specific, measurable, achievable, realistic/relevant, and time-related)
Patients are more likely to adhere to behaviours, habits, or interventions if they feel understood, supported, and empowered
Supporting patients in achieving goals that optimize health can have significant impacts on patient wellness, self-esteem, functioning; and strengthens the physician-patient relationship
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
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