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Background: There has been a precipitous decline in authorizations for medical cannabis since non-medical cannabis was legalized in Canada in 2018. This study examines the demographic and health- and medical cannabis-related factors associated with authorization as well as the differences in medical cannabis use, side effects, and sources of medical cannabis and information by authorization status., Methods: Individuals who were taking cannabis for therapeutic purposes completed an online survey in early 2022. Multivariable logistic regression was used to determine odds ratios (OR) and 95% confidence intervals (CI) of demographic and health- and medical cannabis-related variables associated with holding medical cannabis authorization. The differences in medical cannabis use, side effects, and sources of information by authorization status were determined via t-tests and chi-squared analysis., Results: A total of 5433 individuals who were currently taking cannabis for therapeutic purposes completed the study, of which 2941 (54.1%) currently held medical authorization. Individuals with authorization were more likely to be older (OR ≥ 70 years vs. < 30 years, 4.85 (95% CI, 3.49-6.76)), identify as a man (OR man vs. woman, 1.53 (1.34-1.74)), have a higher income (OR > $100,000/year vs. < $50,000 year, 1.55 (1.30-1.84)), and less likely to live in a small town (OR small town/rural vs. large city, 0.69 (0.59-0.81)). They were significantly more likely to report not experiencing any side effects (29.9% vs. 23.4%; p < 0.001), knowing the amount of cannabis they were taking (32.1% vs. 17.7%; p < 0.001), obtaining cannabis from regulated sources (74.1% vs. 47.5%; p < 0.001), and seeking information about medical cannabis from healthcare professionals (67.8% vs. 48.2%; p < 0.01) than individuals without authorization., Conclusions: These findings offer insight into the possible issues regarding equitable access to medical cannabis and how authorization may support and influence individuals in a jurisdiction where recreational cannabis is legalized, highlighting the value of a formal medical cannabis authorization process., (© 2024. The Author(s).)

Medical cannabis access has been legalized in more than 30 countries worldwide and popularity among patients is increasing rapidly. Cannabinoid-based treatments have been shown to be beneficial for several symptoms such as chemotherapy-induced nausea and vomiting, spasticity, chronic pain, intractable seizures and insomnia, yet high-quality clinical trials are still limited. As millions of patients now have legal access to medical cannabis, little information is available about the development of best clinical practices and an effective medical cannabis clinic model. A medical cannabis clinic is an innovative and emergent practice model that may be necessary to bridge the gap between patient and healthcare provider interest and existing barriers to the prescription of medical cannabis treatments, such as limited medical education, lack of high-quality clinical research and challenging or evolving regulatory frameworks. In this paper, we describe the model of care and organization of a dedicated medical cannabis clinic operating in Quebec, Canada since 2014. We share the principles of medical cannabis practice, including the structure of its medical and support team, clinic organisation and procedure guidelines. Key clinic statistics and patient demographics are shared with year by year comparison. Operating since 2014, the clinic has endured a rapidly changing regulatory landscape in Canada, overcoming numerous challenges including medical and social stigma, limited funding, resources and institutional support combined with a high demand for services. To support medical cannabis leaders globally, an important knowledge-sharing is required. The clinic has expanded to a network of four clinic sites across Quebec and offers continuing education and preceptorships to health care providers and trainees as well as research services to both academic and industry partners. The description of the clinic offers guidance on medical cannabis treatment and care and discusses possible solutions to associated challenges. The clinic model of care can be adapted to different healthcare settings and regulatory frameworks; it may assist physicians and health care providers in the development of medical cannabis clinics or the implementation of best practices as medical cannabis access continues to evolve., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To study communication between family physicians (FPs) and oncologists, and to look at the factors that may influence FP involvement in cancer care., Design: This survey design uses a qualitative methodology, where the data are analyzed using a modified grounded theory approach., Setting: This was a multisite study using 14 focus groups of FPs, followed by structured telephone interviews with 116 FPs in 6 different Canadian provinces., Main Outcome Measure: Interview questions were used to explore the actual and desired roles of FPs in cancer care, and the quality of communication with oncologists with reference to a particular cancer patient in the FPs' practice., Results: Physicians providing cancer care must consider complex psychosocial and biomedical factors, more so than with other chronic diseases, and so written communication alone is inadequate. Family physicians require face-to-face and/or telephone communication with the oncologist to negotiate their respective roles, and to discuss the patient's prognosis and the effectiveness of proposed treatments. Family physicians expressed a desire to become more involved in all stages of cancer care in both the biomedical and psychosocial aspects, and to help better define their roles throughout the illness trajectory., Conclusion: These results suggest opportunities to improve the communication, coordination and comprehensiveness of shared cancer care provided by family physicians and oncologists in different clinical settings.

This article describes the development of a physician well-being committee at the Sir Mortimer B. Davis-Jewish General Hospital. It discusses the issue of physician stress, outlines the committee's mandate, and describes the various activities and services that were implemented.

Members in the Department of Family Medicine of a university teaching hospital were surveyed to find out their involvement in caring for cancer patients. Respondents indicated that many cancer patients were followed, but few cancer support services in the hospital and the community were used. The desire to take on new cancer patients was lacking, yet an interest in continuing medical education existed. Feedback from the department will help guide our Education Committee to develop continuing medical education programs for family physicians caring for cancer patients.

Objective: The authors examined the effect of patients' style of clinical presentation on primary care physicians' recognition of depression and anxiety., Method: The subjects were 685 patients attending family medicine clinics on self-initiated visits. They completed structured interviews assessing presenting complaints, self-report measures of symptoms and hypochondriacal worry, the Diagnostic Interview Schedule (DIS), and the Center for Epidemiologic Studies Depression Scale (CES-D). Physician recognition was determined by notation of any psychiatric condition in the medical chart over the ensuing 12 months., Results: The authors identified three progressively more persistent forms of somatic presentations, labeled "initial," "facultative," and "true" somatization. Of 215 patients with CES-D scores of 16 or higher, 80% made somatized presentations; of 75 patients with DIS-diagnosed major depression or anxiety disorder, 76% made somatic presentations. Among patients with DIS major depression or anxiety disorder, somatization reduced physician recognition from 77%, for psychosocial presenters, to 22%, for true somatizers. The same pattern was found for patients with high CES-D scores. In logistic regression models education, seriousness of concurrent medical illness, hypochondriacal worry, and number of lifetime medically unexplained symptoms each increased the likelihood of recognition, while somatized presentations decreased the rate of recognition., Conclusions: While physician recognition of psychiatric distress in primary care varied widely with different criteria for recognition, the same pattern of reduction of recognition with increasing level of somatization was found for all criteria. In contrast, hypochondriacal worry and medically unexplained somatic symptoms increased the rate of recognition.

Most family physicians state that they "do psychotherapy" and yet are often unclear as to whether they are using a supportive or an insight-oriented approach. This paper discusses short-term psychotherapy with an emphasis on the theoretical differences between these two approaches, as well as suggestions for learning them.

This paper describes a team approach to coronary rehabilitation in a tertiary care hospital and the unique role of the family physician in a shared, multi-disciplinary service for in- and out-patients. Primary care physicians facilitate and supplement the work of the coronary-unit team in establishing an optimal rehabilitative program for MI patients and their families.

The Native people of Northern Quebec/Labrador Peninsula face a growing conflict over the use of their traditional homeland for military flight training. The low-level flight training that supports a recent revision of NATO contingency plans for war in Europe causes social disruption and physical destruction. Current and proposed training at Goose Bay, Labrador, raises serious environmental and human-rights questions. A host of medical and psychological problems can be expected to follow in populations subject to the disruption and damage caused by low-level flight programs in their area. It is not possible for individuals to develop "coping strategies" adequate to meet the stress caused by stressors of this type.

Controversy exists over the usefulness of mammographic screening for breast cancer. A discussion of the risk-benefit analysis and high risk women profile help the family physician in making a decision about who should be screened with mammography. Although earlier clinical trials show no benefit, and possible risks, of screening women under age 50, current techniques of mammography subject women to far less radiation and presumably far less risk. Based on this evidence, there is merit in screening women aged 40-49 with mammography every two to three years.