Gingerbread Post

I have wanted to develop "Just-in-time" care for patients with diabetes via the idea of a virtual clinic.  What this means to me is that the right patient is connected with the right diabetes team at the right time. Our current paradigm is to have pre-scheduled clinic visits - a nice, tidy, orderly progression of patients coming to see the team for advice.  There are several problems with this model - it's not really the best use of limited resources.  Patient selection is random in that patients who come happen to be the ones who were referred, but this does not necessarily equate to those who need to be seen the most.  Conceivably, if each member of the team (RN, RD, MD) spends time with the patient, up to 3 or more hours are dedicated to serving one patient.  It's just not efficient and it's not really patient centred care when the patient has to take time away from work and the costs also include transportation, parking, childcare etc.  For many patients

I subscribed to Peloton about 6 months ago.  I've been a fairly consistent exercise enthusiast for most of my life. I belong to a great fitness club and have access to excellent personal training, which I have taken advantage of for years. In search of a decent spin class that I could take from home, I discovered Peloton's online digital membership. At first I was hesitant, because I've subscribed to online programs and apps before and never really got into them.  I prefer the motivation from a group and the in-person experience.  I don't like the effort of slogging through exercises to create my own workout (who has time for that, by the time I'm done I could have worked out?).  However, after a friend* bought a Peloton bike, complete with classes, and began raving about them, I decided to take another look. I have been very impressed - not only do I LOVE the spin classes, but I've also tried strength classes, yoga and stretching and there are lot of

I've been watching Jeff Cavalier of Athlean-X for several years now.  Jeff is a physiotherapist, exercise therapist and personal trainer extra-ordinaire.  He really knows his stuff. He goes to great lengths to post no-nonsense advice, explain the science behind training and has put together some fabulous programs for those interested in getting fit, lean and strong.  His side-kick Jessie, is a hoot and together they make some great free videos that you can follow on their you-tube channel.  I go there whenever I have a workout question or concern, and I spent a LOT of time reviewing Jeff's advice after I injured my back 2 years ago.  His advice has really changed the way that I work out. Athlean-X is really focussed on men, but Jeff has also created a series of workout plans for women and the trainers on the Athlean-XX website are excellent.  Susan is my favorite, but I really like all of them.  I subscribed to their workout and diet plan for a  while, but because I

I am reading the book "The Fearless Organisation" by Amy C. Edmondson, of Harvard Business School. A lot of her points really hit home for me.  I have been privileged  to  inhabit several work environments that have very open to feedback and willing to hear divergent opinions and ideas.  We enjoyed healthy disagreement,  that helped us make positive changes at work.   As I have progressed through my career, I've been rewarded with increasing responsibility and with it a broader influence, and the opportunity to experience different environments with differing degrees of psychological safety.   In the unhealthy environments, I have observed pockets of subversive behaviour, dishonesty,  fear and a general malaise in the team atmosphere.  Much of this is predicated on those who turn small mistakes into catastrophe by spreading exaggerated and false statements about potential risks, blaming and shaming or creating cliques.  There are also those who lead wit

I cried when I saw the image of Abdullah Kurdi, holding the body of his 3-year-old drowned son Alan, just before he was buried in a public funeral in Kobani. http://www.cbc.ca/news/world/drowned-syrian-boys-mother-buried-in-kobani-1.3215349 It's an image that I won't forget.  His is just one of hundreds of thousands of stories that highlight how our world deals with humans in an unkind and unfair way.  I'm not an expert in politics, economics, religion, or law - but I can say that we all live on this earth and I'm pretty sure that we could share it more equitably. The thing about this story that made me cry the most - was the fact that Abdullah and his deceased family were flown to a city near Turkey's border with Syria and the enscorted to Kobani by police.  Why did I cry?  I couldn't help but think about how much that must have cost, and how many children like Alan could have been fed, clothed, housed, or relocated to safety for the price of this expen

Stories From a Night On-Call or How I Spent My Youth Saying Goodbye Mr. T.Y. had difficult problems.  He was a 60 something pipe fitter who was suffering from metabolic disease.  Metabolic disease is a term that doctors use to lump together health problems that are related to problems with glucose and fat metabolism and often lead to heart attacks, stroke and kidney diseases.  Mr. T.Y. was overweight, had high blood pressure, diabetes, kidney disease, and he had some smoking-related lung disease.   I had met him several times over my first two years of my internal medicine residency.  Usually we met late at night in the emergency room.  He would come in, finding it hard to breathe, leaning forward on his swollen knees huffing and puffing saying “Doc, I just can’t catch my breath, my feet have swollen up and I feel like crap”.  Our usual routine was to do some tests, and start him on some diuretics; often he was suffering from heart failure related to underlying heart disea