Just Medicine

39. Addressing inequities within Canada's death investigation systems

In this episode, Dr. Kona Williams, a Cree and Mohawk forensic pathologist and coroner based in Sudbury, Ontario, talks to host Sandra about what forensic pathology is (and isn’t). They also discuss death investigation systems, why some communities in so-called Canada are left waiting years for answers about their loved ones’ deaths, and what needs to happen to ensure health care is more equitable for all – including those who are no longer living. Resources: - Watch Dr. Williams’ TedX talk entitled “Investigating Indigenous deaths: Looking beyond the pathological diagnosis [https://www.ted.com/talks/kona_williams_investigating_indigenous_deaths_looking_beyond_the_pathological_diagnosis]”, on how the social, structural, and colonial determinants of health factor into her work in death investigation. - For additional context on Murdered and Missing Indigenous Women and Girls (MMIWG), read the final report of the National Inquiry [https://www.mmiwg-ffada.ca/final-report/], and this news story: McCue, D. (2019, Jun 10). MMIWG report missed chance to change how deaths are investigated, says Indigenous forensic pathologist. CBC News. https://www.cbc.ca/radio/checkup/mmiwg-report-missed-chance-to-change-how-deaths-are-investigated-says-indigenous-forensic-pathologist-1.5167987 [https://www.cbc.ca/radio/checkup/mmiwg-report-missed-chance-to-change-how-deaths-are-investigated-says-indigenous-forensic-pathologist-1.5167987] - Read about the Goudge Inquiry, mentioned by Dr. Williams, which prompted a change in death investigation systems in Canada: Eggerston, L. (2008, Nov 4). Goudge: “Systemic failings” in Ontario coroner’s office. CMAJ, 179(10), 995. https://www.cmaj.ca/content/179/10/995 [https://www.cmaj.ca/content/179/10/995] - Learn more about the Canadian Association of Forensic Medicine on their website [https://cafm-acml.ca/], and familiarize yourself with what’s happening at the Centre of Forensic Sciences [https://www.ontario.ca/page/centre-forensic-sciences] in North York, Ontario. - Have a listen to relevant past episodes, eg. ⁠⁠⁠on the structural determinants of health⁠⁠⁠ [https://creators.spotify.com/pod/profile/justmedicine/episodes/34--Breaking-down-the-Structural-Determinants-of-Health-e31v76d/a-abtfp4g], trauma-informed care [https://open.spotify.com/episode/6hDjZWpy3VXjVPjI6nWg7m?si=6MgZfuFpR3G_S96HnhdCaA], and ⁠realizing the Truth and Reconciliation Commission’s health-related calls to action [https://open.spotify.com/episode/4TfJt0OiLapPzjuzFCF8is?si=tRQJnweEQ0aYiVYbaL13sw]⁠. Credits: Additional music by Aleksey Voronin [https://pixabay.com/users/amaksi-28332361/?utm_source=link-attribution&utm_medium=referral&utm_campaign=music&utm_content=226857]⁠ [https://pixabay.com/music/beats-cenizas-en-el-amanecer-490183/], used under the ⁠⁠⁠⁠Pixabay content license [https://pixabay.com/music//?utm_source=link-attribution&utm_medium=referral&utm_campaign=music&utm_content=226857]⁠⁠⁠⁠. Survey: To help us make the best possible podcast, please consider filling out ⁠⁠⁠⁠this short, anonymous survey⁠⁠⁠⁠ [https://ubc.ca1.qualtrics.com/jfe/form/SV_06dxPTYrRda9vj8] after listening.

38. "Rooming in" and speaking out: The essentials of perinatal substance use care

In this episode, host Sandra speaks to Dr. Eric Cattoni, a family physician and Medical Director at the Families In Recovery (FIR) Unit at BC Women’s Hospital. They discuss what’s unique about providing substance use care to people who are pregnant and postpartum and their families, as well as the elements of perinatal substance use care, like compassion and a trauma‑informed approach, that are relevant to any area of medicine — especially in the context of the toxic drug crisis. Resources: - Read more about “rooming in” and the evidence behind it in the BC Women’s Hospital Rooming-In Guideline (2020) [https://cms.psbchealthhub.ca/sites/default/files/2023-10/Rooming%20In%20Guidelines%20for%20Perinatal%20Women%20Using%20Substances.pdf], in Abrahams et al. 2007 [https://pubmed.ncbi.nlm.nih.gov/17934036/] and Abrahams et al. 2010 [https://pubmed.ncbi.nlm.nih.gov/21050520/], and in the 2025 Canadian Pediatric Society statement [https://cps.ca/en/documents/position/nas-nows] referenced in the episode. - Learn the basics of treatment for opioid use disorder during the perinatal period in the BC Centre on Substance Use’s 2017 Guideline Supplement [https://www.bccsu.ca/wp-content/uploads/2018/06/OUD-Pregnancy.pdf] and this toolkit on Mothering and Opioids from the Centre of Excellence for Women’s Health [https://www.substanceuse.ca/sites/default/files/2021-03/CEWH-01-MO-Toolkit-WEB2.pdf] (CEWH). - Dive deeper into the FIR model of care here: BC Women’s Hospital + Health Centre. (2020). FIR model of care. [https://www.bcwomens.ca/Pregnancy-Prenatal-Care-Site/Documents/BCW%20FIR%20Renewed%20Model%20of%20Care.pdf]  ⁠- Consult the BC Government’s announcement on ending birth alerts: Government of British Columbia. (2019, September 16). Minister’s statement on ending ‘birth alerts’.⁠ Ministry of Children and Family Development. https://news.gov.bc.ca/releases/2019CFD0090-001775 [https://news.gov.bc.ca/releases/2019CFD0090-001775] - Brush up on Trauma-Informed Principles with this discussion guide [https://cewh.ca/wp-content/uploads/2018/06/Opioid-TIP-Guide_May-2018.pdf] from CEWH, and our past episode on ⁠⁠providing trauma-informed care⁠⁠ [https://creators.spotify.com/pod/profile/justmedicine/episodes/5--Reframing-Encounters-and-Partnering-with-Patients---Trauma-Informed-Care-e28sigi/a-aaaharv]. Credits: Additional music by Susana Cipriano [https://pixabay.com/music/beats-cenizas-en-el-amanecer-490183/], used under the ⁠⁠⁠Pixabay content license⁠⁠⁠ [https://pixabay.com/service/license-summary/]. Survey: To help us make the best possible podcast, please consider filling out ⁠⁠⁠this short, anonymous survey⁠⁠⁠ [https://ubc.ca1.qualtrics.com/jfe/form/SV_06dxPTYrRda9vj8] after listening.

37. The trailblazing Black trainees righting medicine's historical wrongs

In this episode, host Sandra speaks to Dr. Gbolahan (GB) Olarewaju, a public health resident physician, academic activist, and past and inaugural chair of the Black Medical Students’ Association of Canada. They discuss how decades of discriminatory policies and practices have thrown up obstacles to the medical profession for Black folks – and how the efforts of Black learners and trainees and their allies are righting these wrongs. Tune in as we delve into the history of medical violence against Black communities, and the role we all play in dismantling structural barriers to health and the health professions.  Resources: * Learn more about the history of medical violence against Black communities in Harriet A. Washington’s 2008 book, Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present [https://www.penguinrandomhouse.com/books/185986/medical-apartheid-by-harriet-a-washington/]. * Familiarize yourself with the concept of race correction with this primer [https://www.endracecorrection.com/content/files/2025/02/End-Race-Correction-Primer_FINAL--2025--1.pdf] from the Canada-US Coalition to End "Race Correction" in Health Care and in Vyas, D. A., Eisenstein, L. G., and Jones, D. S. (2020). Hidden in plain sight — Reconsidering the use of race correction in clinical algorithms [https://www.nejm.org/doi/abs/10.1056/NEJMms2004740]. NEJM, 383. 874-882. * Review some papers about the health impacts of a demographically diverse health care workforce: * Marrast, L. M., Zallman, L., Woolhandler, S. et al. (2014). Minority physicians’ role in the care of underserved patients [https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1792913]. JAMA Internal Medicine, 174(2). 289-291. * Greenwood, B. N., Hardeman, R. R., Huang, L., and Sojourner, A. (2020). Physician-patient racial concordance and disparities in birthing mortality [https://www.pnas.org/doi/10.1073/pnas.1913405117]. PNAS, 117(35), 21194-21200. * Snyder, J. E., Upton, R. D., Hassett, T. C. et al. (2023). Black representation in the primary care physician workforce and its association with population life expectancy and mortality rates in the US [https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2803898]. JAMA Network Open, 6(4). E236687. * Watch Dr. GB’s keynote, “Progress and Protection: Intersectional Vigilance and Justice in Research and Advocacy” [https://www.cbrc.net/summit_2024_progress_and_protection], given at 2024’s The Summit Conference [https://www.cbrc.net/]. * Read ‘The End of Diversity’ [https://read.dukeupress.edu/public-culture/article-abstract/31/2/393/138418/The-End-of-Diversity] (2019) by Rinaldo Walcott, a critique of the language often used around equity and diversity, and a meditation on what true transformative change and structural justice could look like. * Check out this list [https://docs.google.com/document/d/1jd7VaTzkTRenLWSo0CGCypQ7QyL9CIKNHZ9uaVCy2x0/edit?tab=t.0] of Canadian anti-racism resources. * Have a listen to relevant past episodes, eg. ⁠⁠on the structural determinants of health⁠⁠ [https://creators.spotify.com/pod/profile/justmedicine/episodes/34--Breaking-down-the-Structural-Determinants-of-Health-e31v76d/a-abtfp4g], and realizing the Truth and Reconciliation Commission’s health-related calls to action [https://creators.spotify.com/pod/show/2ykb1I5MSJQFDb44ai59AM/episode/4TfJt0OiLapPzjuzFCF8is/details]. Credits: Additional music by ScovinieBeatz [https://pixabay.com/music/ambient-scoviniebeatz-my-remedy-450337/], used under the ⁠⁠Pixabay content license⁠⁠ [https://pixabay.com/service/license-summary/]. Survey: To help us make the best possible podcast, please consider filling out ⁠⁠this short, anonymous survey⁠⁠ [https://ubc.ca1.qualtrics.com/jfe/form/SV_06dxPTYrRda9vj8] after listening.

36. Because it helps! Making the most of the social history

The success of a treatment plan can depend heavily on social factors – for example, income, housing status, or whether or not someone has drug coverage. The social history is where we, as medical learners, trainees and practitioners, are meant to gather that information so that we can apply it in our care. For this episode, host Sandra spoke to Dr. Ritika Goel, a family doctor and activist based in Toronto, about how to make the most of that part of our conversation with patients. What's important to ask about? And what can we do with the answers? Resources: - Download the ⁠IFITHELPS tool⁠ [https://cep.health/download-file/1542915867.061284-96/] for taking and actioning a social history. - Explore 211, a database of information for government and community-based, non-clinical health and social services across Canada, at ⁠211.ca⁠ [https://211.ca/]. - Familiarize yourself with the ⁠Canada Disability Benefit⁠ [https://www.canada.ca/en/services/benefits/disability/canada-disability-benefit], a new program to supplement the incomes of working-age folks living with disabilities. Applicants must be approved for the Disability Tax Credit, which requires certification by a medical practitioner. - Learn more about social accountability in this article series in Canadian Family Physician: Buchman S, Woollard, R., Meili R, Goel R. Practising social accountability: From theory to action. Can Fam Physician. 2016 Jan;62(1):15-8. PMID: 26796826; PMCID: PMC4721832 .⁠https://pmc.ncbi.nlm.nih.gov/articles/PMC4721832/⁠ [https://pmc.ncbi.nlm.nih.gov/articles/PMC4721832/] - Have a listen to relevant past episodes, eg. ⁠on the structural determinants of health⁠ [https://creators.spotify.com/pod/profile/justmedicine/episodes/34--Breaking-down-the-Structural-Determinants-of-Health-e31v76d/a-abtfp4g], ⁠providing trauma-informed care⁠ [https://creators.spotify.com/pod/profile/justmedicine/episodes/5--Reframing-Encounters-and-Partnering-with-Patients---Trauma-Informed-Care-e28sigi/a-aaaharv], and ⁠taking a good substance use history⁠ [https://creators.spotify.com/pod/profile/justmedicine/episodes/6--Taking-a-Good-Substance-Use-History-with-Dr--Elise-Jackson-e2aan6q/a-aaf0e4u]. Credits: Additional music by ⁠kontraa⁠ [https://pixabay.com/music/trap-hype-drill-music-438398/], used under the ⁠Pixabay content license⁠ [https://pixabay.com/service/license-summary/]. Survey: To help us make the best possible podcast, please consider filling out ⁠this short, anonymous survey⁠ [https://ubc.ca1.qualtrics.com/jfe/form/SV_06dxPTYrRda9vj8] after listening.

35. Climate action: Just what the doctor ordered

Climate change is presenting a big problem for health, with significant implications for equity. As medical trainees, when it comes to addressing the health impacts of climate change in our patients, it can be hard to know where to even start.  In this episode, our guest Dr. Melissa Lem – a family physician, environmental advocate, and the president of the Canadian Association of Physicians for the Environment (CAPE) – shares ideas on how to integrate considerations about planetary health into medical practice. Resources: - Ready to get involved in climate action? Check out CAPE [https://cape.ca/], the Canadian Coalition for Green Health Care [https://greenhealthcare.ca/], and EnviroMed [https://ubcenviromed.wordpress.com/] at the University of British Columbia's Faculty of Medicine. - Dive into some of the health research and recommendations around time spent in nature at the website of PaRx⁠ [https://www.parkprescriptions.ca/], Canada’s evidence-based nature prescription initiative. - Consult inhalerguide.ca [https://www.inhalerguide.ca/] (or BCinhalers.ca [https://www.bcinhalers.ca/] for folks practicing in BC) to learn more about the carbon footprint of and coverage for different asthma and COPD inhalers. Credits: Additional music by ⁠ [https://pixabay.com/music/beats-doubt-moody-trap-beat-281304/]LP-Studio-music [https://pixabay.com/music/acoustic-group-royalty-free-acoustic-guitar-raindrops-333998/], used under the ⁠⁠Pixabay content license⁠⁠ [https://pixabay.com/service/license-summary/].