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August – Message From the President

Read the full August eNews & President’s Message.

Advanced Care Planning – A Personal Perspective

Having an advanced care plan easily available to any health care professional—be it home care nurses, paramedics with EMS or nurses on an active care unit in hospital—is very useful. In our own clinic, we discuss a personal directive with every patient who has a review of their complex care plan. It would be good to include follow-up and incorporate a Green Sleeve to ensure completion of a personal directive. On reflection, why only during review of a complex care plan; why not incorporate this into an annual review with any patient?

I’ve recently had a very personal brush with legal documents such as Power of Attorney and Personal Directive. I was recognizing signs of illness in my own father and had embarked on obtaining these documents in a proactive manner. However, it may not have been truly proactive when one sees a family member deteriorating as proactive means doing this before something happens. My father then became seriously ill and was hospitalized quite suddenly before I had these documents ready. In the weeks following, I had to have documents transferred from my lawyer in Red Deer to a lawyer in Calgary, then have that lawyer meet with my father in hospital to get a Power of Attorney and Personal Directive in place. My father had the capacity to remain his own agent while this was being pursued, however, it could just as easily not have been the case. And, in all honesty, it was truly the Power of Attorney that was most important to my father. He was bedridden in hospital and could not look after his affairs (even though he knows the value of his bank accounts better than I know mine). Since having the Power of Attorney, I have looked after a tax installment, insurance payments and other bills, and my father is very relieved.

Is having the Green Sleeve on the refrigerator door the best place? I’m not sure. It needs be with the patient in question. I know of one case in which the family had done all the right things for a member of the family receiving palliative care. The Green Sleeve was on the door of the fridge, but this patient rapidly deteriorated, paramedics were called, but the Green Sleeve had disappeared (no one knows to where) and, as a result, there was no personal directive. A husband had to watch his terminally ill wife receive CPR when this was explicitly not her wish, yet there was nothing he could do.

The bottom line is to advocate with your patients to be proactive and explicit about advanced care planning and to have those plans readily available for when and where they are needed. It truly does provide a much higher quality of care for your patient.

Sincerely,
Dr. Fred Janke, BSc, MSc, MD, FCFP, FRRMS
President, Alberta College of Family Physicians
acfppres@acfp.ca

Ankle Swelling in the Summer?

Seasonality of Ankle Swelling
Population Symptom Reporting Using Google Trends

You might expect to see an increase in sprains, strains, and fractures in the winter when patients are navigating icy sidewalks and shoveling loads of snow. What problems cross our path more in summer?

In my practice, complaints of ankle swelling are more common in the summer and are usually brought to clinic by injury-free and otherwise healthy patients. We established this phenomenon in our 2016 publication, Seasonality of Ankle Swelling.

“Each summer we encounter an increased volume of patients complaining of ankle swelling—patients who do not go on to develop cardiovascular, venous, or lymphatic disease … we looked for seasonal modulation in the public’s interest in ankle swelling as measured by the volume of Google Internet searches related to ankle swelling.”

While clinicians can expect to see an increase of swelling related complaints in office, many such patients will not seek medical advice. Whereas Internet searches for ankle swelling (or related terms) are highest in the summer, hospital admission for heart failure exhibit the opposite trend and peak in the winter. So, rest assured, your patients are certainly not alone—and probably in good health.

About the author

Scott Garrison, MD PhD
Associate Professor, Department of Family Medicine, University of Alberta
Director, Pragmatic Trials Collaborative

Scott spent the first 20 years of his professional career as a full time fee-for-service family physician. He has a passion for evidence-based medicine and left full time clinical practice in 2013 intent on pursuing clinical trials that address important, as yet unaddressed, primary care questions. He is working to build a platform for large primary care trials in both BC and Alberta.

Prevention and Management of Cardiovascular Disease Risk in Primary Care

Toward Optimized Practice (TOP) introduces a new clinical practice guideline (CPG): Prevention and Management of Cardiovascular Disease Risk in Primary Care.

By removing lipid targets and associated monitoring of lipid levels, as well as other streamlining measures, the management of lipids and cardiovascular disease risk has been significantly simplified. Additionally, by targeting risk, clinicians can identify patients most likely to benefit while actively involving these patients in their care.

The collaboration between the ACFP’s Evidence and CPD program team  and TOP has created a guideline and recommendations based on the most recent and highest quality of evidence. The background evidence to create the guideline included a review of more than two hundred articles. Authors for the Evidence Review include: Drs. Adrienne Lindblad, Mike Kolber, Scott Garrison, Mike Allan, and Ms. Candra Cotton.

This Prevention and Management of Cardiovascular Disease Risk in Primary Care guideline balances evidence, simplification/efficiency, and patient involvement. Related files are available from the TOP website:

The Prevention and Management of Cardiovascular Disease Risk in Primary Care CPG recently received an endorsement from the College of Family Physicians of Canada.

Welcome to the Doc Blog

Physician-Led Practice Improvement

This blog is managed by the ACFP and aims to share with you relevant topics of discussion, information, and stories and experiences. Contributions are driven by your peers and physician-led. This recent post includes additions from the Communications Committee.

The main motivation is to aggregate interesting and relevant articles that will save you time and improve your practice. Here are some articles your peers found interesting: