EP-07 Supporting Patients through MAiD: The Internist's Role

EP-07 Supporting Patients through MAiD: The Internist's Role

In this episode, hosts Dr. Meredith Chiasson and Dr. Peter Gregory speak with Dr. Gordon Gubitz – neurologist, professor of medicine at Dalhousie University, and clinical lead for the Nova Scotia MAiD program – about medical assistance in dying (MAiD) and the role internists can play in supporting patients through these complex and deeply personal conversations. Dr. Gubitz explains the eligibility criteria and assessment process for MAiD in Canada, addresses common misconceptions, and discusses how conversations about MAiD fit into broader goals-of-care and end-of-life discussions. He also explores the role of internists in initiating conversations, supporting patients and families, participating in assessments, and navigating referral pathways and available resources. Looking ahead, Dr. Gubitz outlines emerging legislative developments, including MAiD for mental illness as a sole underlying condition and the evolving discussion around advance requests. Listeners of this episode will gain insights into: * Common misconceptions about MAiD eligibility and process * How to approach conversations about MAiD within goals-of-care discussions * The role internists can play in supporting patients considering MAiD * Referral pathways and educational resources available in Nova Scotia * Emerging legislative and ethical developments in MAiD practice Resources mentioned in this episode: * Nova Scotia Health MAiD resource page: Medical Assistance in Dying (MAID) | Nova Scotia Health [https://www.nshealth.ca/maid] * Canadian Association of MAiD Assessors and Providers (CAMAP) educational modules: CMC 3.0 Home - CAMAP | ACEPA [https://camapcanada.ca/cmc-3-0/] * Mental health support for physicians involved in MAiD care: Professional Support Program [https://www.dnspathways.com/program/psp/] * Grief and bereavement support resources for families and clinicians: Life Changes | Nova Scotia Health [https://www.nshealth.ca/lifechanges#bereavement] * CAMAP clinician forums and peer support: Join CAMAP - CAMAP | ACEPA [https://camapcanada.ca/join-camap/] * Hospice bereavement support resources: Grief Support Groups in Nova Scotia | Hospice Halifax [https://hospicehalifax.ca/grief-support-groups-in-nova-scotia/] * Nova Scotia MAiD referral pathway and contact information: To make a referral, clinicians are encouraged to contact the Nova Scotia Health MAiD Access and Resource Team. Information can be found under "Contact" at Medical Assistance in Dying (MAID) | Nova Scotia Health. [https://www.nshealth.ca/maid#Contact%20information] * Nova Scotia Health patient and family guide: https://www.nshealth.ca/sites/default/files/documents/2229-2024.03.13.pdf [https://www.nshealth.ca/sites/default/files/documents/2229-2024.03.13.pdf] Clinical Currents is produced by the Dalhousie Department of Medicine for internal medicine physicians across the Maritimes. This podcast is for professional education only and should not be taken as personal medical advice. Content reflects Canadian practice unless otherwise noted.

EP-06 Acute Kidney Injury – Practical Questions for Internists with Dr. Amanda Vinson

In this episode, Dr. Meredith Chiasson and Dr. Peter Gregory speak with Dr. Amanda Vinson – nephrologist and kidney transplant clinician-researcher with Nova Scotia Health and associate professor of medicine at Dalhousie University – about practical approaches to managing acute kidney injury (AKI). Dr. Vinson shares how the approach to AKI has evolved, with a growing emphasis on early recognition, careful monitoring, and thoughtful follow-up. She outlines what to prioritize in the first 24 hours, when AKI should prompt further investigation or consultation, and how to navigate common challenges like fluid management and medication decisions. The episode also highlights the importance of follow-up care, emphasizing that even mild or resolved AKI carries long-term risk and requires ongoing monitoring. Listeners of this episode will gain insights into: * · Key priorities in the first 24 hours of AKI management * · When AKI is not following the expected course – and what to do next * · Practical approaches to fluid management in complex patients * · How to manage common medications in both acute and outpatient settings * · Why AKI should be treated as a long-term risk factor Clinical Currents is produced by the Dalhousie Department of Medicine for internal medicine physicians across the Maritimes. This podcast is for professional education only and should not be taken as personal medical advice. Content reflects Canadian practice unless otherwise noted.

EP-05 Bone Health & Osteoporosis: Guidance for Everyday Practice

When should you screen for osteoporosis – and what should you do when you find it? In this episode, hosts Dr. Meredith Chiasson and Dr. Peter Gregory speak with Dr. Vicki Munro, endocrinologist with Nova Scotia Health and assistant professor of medicine at Dalhousie University, about practical approaches to identifying patients at risk for fragility fractures and managing osteoporosis in everyday clinical care. Dr. Munro explains how clinicians can recognize at-risk patients, when bone density testing is most helpful, and how to interpret risk factors such as glucocorticoid exposure, family history, and comorbid disease. She also reviews current treatment strategies, including when to consider bisphosphonates, anabolic therapies, and referral to specialty care. Listeners will gain insights into: * Key clinical clues that should prompt osteoporosis screening * Risk factors that may warrant earlier testing than age-based screening alone * Lifestyle and prevention strategies to support bone health * When to initiate pharmacologic therapy – and when to consider specialist referral Show notes (timestamps): * 08:10 – Morin, Suzanne N., Sidney Feldman, Larry Funnell, et al. "Clinical Practice Guideline for Management of Osteoporosis and Fracture Prevention in Canada: 2023 Update." Canadian Medical Association Journal 195, no. 39 (2023): E1333–48. https://doi.org/10.1503/cmaj.221647 [https://can01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fdoi.org%2F10.1503%2Fcmaj.221647&data=05%7C02%7CCandice.Albright%40nshealth.ca%7C9512527082674446841208de59f562ae%7C8eb23313ce754345a56a297a2412b4db%7C0%7C0%7C639047107606003247%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=KjmdNg1A1SAi3xkztSoYTIP2cyJ3UGUYnGbKWy7FVrU%3D&reserved=0]. * 14:15 – Khan, Aliya A., Hajar Abu Alrob, Dalal S. Ali, Karel Dandurand, Wendy Wolfman, and Michel Fortier. "Guideline No. 422g: Menopause and Osteoporosis." Journal of Obstetrics and Gynaecology Canada44, no. 5 (2022): 527-536.e5. https://doi.org/10.1016/j.jogc.2021.09.013 [https://can01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fdoi.org%2F10.1016%2Fj.jogc.2021.09.013&data=05%7C02%7CCandice.Albright%40nshealth.ca%7C9512527082674446841208de59f562ae%7C8eb23313ce754345a56a297a2412b4db%7C0%7C0%7C639047107606040608%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=%2BWG1k6bjydr8YP%2BHd8umPSrJUXCysl9ifjLJb62vPNU%3D&reserved=0]. * 18:25 – Humphrey, Mary Beth, Linda Russell, Maria I. Danila, Howard A. Fink, Gordon Guyatt, Michael Cannon, Liron Caplan, et al. "2022 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid‐Induced Osteoporosis." Arthritis Care & Research 75, no. 12 (December 2023): 2405–19 Clinical Currents is produced by the Dalhousie Department of Medicine for internal medicine physicians across the Maritimes. This podcast is for professional education only and should not be taken as personal medical advice. Content reflects Canadian practice unless otherwise noted.

EP-04 AI in Clinical Practice: What Internists Need to Know

Artificial intelligence is increasingly part of clinical workflows – from documentation to clinic preparation – but how can internists use it safely and effectively? In this episode, hosts Dr. Meredith Chiasson and Dr. Peter Gregory speak with Dr. Islam Eissa, general internist at Nova Scotia Health, assistant professor at Dalhousie University, and experienced AI practitioner, about the realities of AI use in internal medicine. Dr. Eissa discusses how AI tools can support note generation, clinic efficiency, and medical education, while also highlighting the ongoing need for physician oversight, patient privacy protections, and transparency. Listeners will gain insights into: · Where AI can reduce administrative burden · Common risks, including hallucinations and over-reliance · Ethical considerations around privacy and consent · Practical ways to integrate AI into daily practice Show notes (timestamps): · 00:07 – Artificial Intelligence Glossary: Learn AI Vocabulary · 19:37 – OntarioMD AI Scribe Evaluation (Executive Summary | Full Report PDF) · 22:30 – CMPA - AI Scribes: Answers to frequently asked questions · 23:52 – Royal College of Physicians and Surgeons Canada's position on AI Reminder: Use AI tools in accordance with institutional policy and patient privacy requirements. Clinical Currents is produced by the Dalhousie Department of Medicine for internal medicine physicians across the Maritimes. This podcast is for professional education only and should not be taken as personal medical advice. Content reflects Canadian practice unless otherwise noted.

EP-03 Thrombosis in Practice: Referral Decisions, Treatment Failures, and Common Dilemmas

Thrombosis is a frequent – and often complex – part of internal medicine practice. In this episode of Clinical Currents, hosts Drs. Meredith Chiasson and Peter Gregory are joined by hematologists Drs. Erica Kelly and Amye Harrigan for a practical discussion on managing thrombosis in everyday clinical care. The conversation focuses on real-world decision-making – from referral thresholds and initial workup to managing patients with recurrent thrombosis while on anticoagulation – highlighting when hematology input is most helpful and how to avoid unnecessary testing. Listeners will gain insights into: * When to refer patients with venous or arterial thrombosis * Helpful baseline investigations before referral * A structured approach to suspected anticoagulation failure * Key factors influencing anticoagulant choice and dosing * When thrombophilia testing and cancer screening are appropriate Produced by the Dalhousie Department of Medicine for internal medicine physicians across the Maritimes. This podcast is for professional education only and should not be taken as personal medical advice. Content reflects Canadian practice unless otherwise noted.