"Head of the Class": equity discourses related to department head appointments at one Canadian medical school.

Purpose: Equitable appointments of departmental leaders in medical schools have lagged behind other Equity, Diversity, and Inclusion (EDI) advancements. The purpose of this research was to 1) analyze how policy documents communicate changing ideas of EDI, employment equity, and departmental leadership; and 2) investigate department heads' (DH) perspectives on EDI policies and practices. Methods: We conducted a critical discourse analysis to examine underlying assumptions shaping EDI and departmental leadership in one Canadian medical school. We created and analyzed a textual archive of EDI documents (n = 17, 107 pages) and in-depth interviews with past (n = 6) and current (n = 12) DH (830 minutes; 177 pages). Results: Documents framed EDI as: a legal requirement; an aspiration; and historical reparation. In interviews, participants framed EDI as: affirmative action; relationships; numerical representation; and relinquishing privilege. We noted inconsistent definitions of equity-deserving groups. Conclusions: Change is slowly happening, with emerging awareness of white privilege, allyship, co-conspiracy, and the minority tax. However, there is more urgent work to be done. This work requires an intersectional lens. Centering the voices, and taking cues from equity-deserving leaders and scholars will help ensure that EDI pathways, such as those used to cultivate department leaders, are more inclusive, effective, and aligned with intentions.

Objectif: La nomination des directeurs de département dans les facultés de médecine accuse un retard en matière d'équité, de diversité et d'inclusion (EDI) en comparaison avec d'autres avancées. L'objectif de ce travail était 1) d'analyser dans quelle mesure les documents de politique reflètent l'évolution des idées liées à l'EDI, à l'équité en matière d'emploi et au leadership départemental; et 2) de sonder le point de vue des directeurs de département (DD) sur les politiques et les pratiques en matière d'EDI. Méthodes: Empruntant le cadre d'une analyse critique du discours, nous avons examiné les conceptions sous-jacentes qui façonnent l'EDI et le leadership des DD dans une faculté de médecine canadienne. Nous avons créé et analysé un corpus de documents relatifs à l'EDI (n=17, 107 pages) et d'entrevues approfondies avec des directeurs de département anciens (n=6) et actuels (n=12) (830 minutes; 177 pages). Résultats: Les documents décrivent l'EDI comme une obligation légale, une aspiration et une réparation historique. Lors des entretiens, pour définir l'EDI, les participants ont évoqué l'action positive, les relations, la représentation numérique et l'abandon de privilèges. Nous avons noté des incohérences quant à la définition de « groupe en quête d'équité ¼. Conclusions: Le changement s'opère lentement, avec une prise de conscience des notions de privilège blanc, d'alliance, de complicité et de taxe pour les minorités ¼. Cependant, il y a un travail plus urgent à accomplir. Ce travail nécessite une perspective intersectionnelle. Le fait d'écouter les leaders et les universitaires en quête d'équité et de leur accorder une place centrale fera en sorte que les voies de l'EDI, comme celles empruntées pour cultiver le leadership dans les départements, soient plus inclusives, plus efficaces et plus en adéquation avec les objectifs.

[Measuring the impact of a multimodal intervention on falls and the fear of falling]. / Mesure de l'impact d'une intervention multimodale sur les chutes et la peur de chuter.

Falls are common among the elderly, and can have serious consequences: fracture, hospitalization, loss of independence, institutionalization and death. However, falls are not inevitable, and they can be prevented. The "autonomy prevention" kit (Equilibr'Age workshops, occupational therapy advice) has helped to reduce the number of falls and improve people's quality of life. The program will now be rolled out to a wider public.

Call to action: equity, diversity, and inclusion in emergency medicine resident physician selection.

OBJECTIVES: This call to action seeks to improve emergency care in Canada for equity-deserving communities, enabled by equitable representation among emergency physicians nationally. Specifically, this work describes current resident selection processes and makes recommendations to enhance the equity, diversity, and inclusion (EDI) of resident physician selection in Canadian emergency medicine (EM) residency programs. METHODS: A diverse panel of EM residency program directors, attending and resident physicians, medical students, and community representatives met monthly from September 2021 to May 2022 via videoconference to coordinate a scoping literature review, two surveys, and structured interviews. This work informed the development of recommendations for incorporating EDI into Canadian EM resident physician selection. At the 2022 Canadian Association of Emergency Physicians (CAEP) Academic Symposium, these recommendations were presented to symposium attendees composed of national EM community leaders, members, and learners. Attendees were divided into small working groups to discuss the recommendations and address three conversation-facilitating questions. RESULTS: Symposium feedback informed a final set of eight recommendations to promote EDI practices during the resident selection process that address recruitment, retention, mitigating inequities and biases, and education. Each recommendation is accompanied by specific, actionable sub-items to guide programs toward a more equitable selection process. The small working groups also described perceived barriers to the implementation of these recommendations and outlined strategies for success that are incorporated into the recommendations. CONCLUSION: We call on Canadian EM training programs to implement these eight recommendations to strengthen EDI practices in EM resident physician selection and, in doing so, help to improve the care that patients from equity-deserving groups receive in Canada's emergency departments (EDs).

ABSTRAIT: OBJECTIFS: Cet appel à l'action vise à améliorer les soins d'urgence au Canada pour les collectivités méritant l'équité, grâce à une représentation équitable parmi les médecins d'urgence à l'échelle nationale. Plus précisément, ce travail décrit les processus actuels de sélection des médecins résidents et formule des recommandations pour améliorer l'équité, la diversité et l'inclusion (EDI) de la sélection des médecins résidents dans les programmes de résidence en médecine d'urgence (SE) du Canada. MéTHODES: Un groupe diversifié de directeurs du programme de résidence en GU, de médecins résidents, d'étudiants en médecine et de représentants communautaires se sont réunis mensuellement de septembre 2021 à mai 2022 par vidéoconférence pour coordonner une analyse documentaire, deux sondages et des entrevues structurées. Ces travaux ont orienté l'élaboration de recommandations pour l'intégration de l'IDE dans la sélection des médecins résidents en SE au Canada. À l'occasion du Symposium universitaire 2022 de l'Association canadienne des médecins d'urgence (ACMU), ces recommandations ont été présentées aux participants au symposium composé de dirigeants, de membres et d'apprenants de la communauté nationale de la GU. Les participants ont été divisés en petits groupes de travail pour discuter des recommandations et aborder trois questions facilitant la conversation. RéSULTATS: Les commentaires recueillis lors du symposium ont servi à formuler une dernière série de huit recommandations visant à promouvoir les pratiques de l'IDE au cours du processus de sélection des résidents qui traitent du recrutement, du maintien en poste, de l'atténuation des inégalités et des préjugés, et de l'éducation. Chaque recommandation est accompagnée de sous-éléments précis et réalisables pour orienter les programmes vers un processus de sélection plus équitable. Les petits groupes de travail ont également décrit les obstacles perçus à la mise en œuvre de ces recommandations et décrit les stratégies de réussite qui sont intégrées aux recommandations. CONCLUSION: Nous demandons aux programmes canadiens de formation en GU de mettre en œuvre ces huit recommandations afin de renforcer les pratiques d'IDE dans la sélection des médecins résidents en GU et, ce faisant, d'aider à améliorer les soins que les patients des groupes méritant l'équité reçoivent dans les services d'urgence du Canada.

Adherence to the Canadian CT Head Rule in a Nova Scotian Emergency and Trauma Center.

Background and aims Choosing Wisely Nova Scotia (CWNS), an affiliate of Choosing Wisely Canada (CWC), aims to address unnecessary care and tests through literature-informed lists developed by various disciplines. CWC has identified unnecessary head CTs among the top five tests, procedures, and treatments to question within the emergency department setting. The Canadian CT-scan Head Rule (CCHR) has been found to be the most effective clinical decision rule in adults with minor head injuries. This study aimed to better understand the current status of CCHR use in Nova Scotia, we conducted a retrospective audit of patient charts at the Charles V. Keating Emergency and Trauma Center in Halifax, Nova Scotia. Materials and methods Our mixed methods design included a narrative literature review, a retrospective chart audit, and a qualitative audit-feedback component with physicians who work in the emergency department (ED). The chart audit applied the guidelines for adherence to the CCHR and reported on the level of compliance within the ED. Results Analysis of qualitative data is included here, in parallel with in-depth analysis to contextualize findings from the chart audit. A total of 302 charts of patients presenting to the surveyed site were retrospectively reviewed for this study. Of the 37 cases where the CT head was indicated as per the CCHR, a CT was ordered 32 (86.5%) times. Of the 176 cases where a CT head was not indicated as per the CCHR, a CT was not ordered 155 (88.1%) times. Therefore, the CCHR was followed in 187 (87.8%) of the total 213 cases where the CCHR should be applied. Conclusions Our review revealed that the CCHR was adhered in 87.8% of cases at the surveyed ED. Identifying contextual factors that facilitate or hinder the application of CCHR in practice is critical to achieving the goal of reducing unnecessary CTs. This work will be presented to the physician group to engage and understand factors that are enablers in the process of ED minor head injury care.

Academic Productivity of Equity-Deserving Physician Scholars During COVID-19: A Scoping Review.

PURPOSE: The COVID-19 pandemic presented new barriers and exacerbated existing inequities for physician scholars. While COVID-19's impact on academic productivity among women has received attention, the pandemic may have posed additional challenges for scholars from a wider range of equity-deserving groups, including those who hold multiple equity-deserving identities. To examine this concern, the authors conducted a scoping review of the literature through an intersectionality lens. METHOD: The authors searched peer-reviewed literature published March 1, 2020, to December 16, 2021, in Ovid MEDLINE, Ovid Embase, and PubMed. The authors excluded studies not written in English and/or outside of academic medicine. From included studies, they extracted data regarding descriptions of how COVID-19 impacted academic productivity of equity-deserving physician scholars, analyses on the pandemic's reported impact on productivity of physician scholars from equity-deserving groups, and strategies provided to reduce the impact of the COVID-19 pandemic on academic productivity of physician scholars from equity-deserving groups. RESULTS: Of 11,587 unique articles, 44 met inclusion criteria, including 15 nonempirical studies and 29 empirical studies (22 bibliometrics studies, 6 surveys, and 1 qualitative study). All included articles focused on the gendered impact of the pandemic on academic productivity. The majority of their recommendations focused on how to alleviate the burden of the pandemic on women, particularly those in the early stages of their career and/or with children, without consideration of scholars who hold multiple and intersecting identities from a wider range of equity-deserving groups. CONCLUSIONS: Findings indicate a lack of published literature on the pandemic's impact on physician scholars from equity-deserving groups, including a lack of consideration of physician scholars who experience multiple forms of discrimination. Well-intentioned measures by academic institutions to reduce the impact on scholars may inadvertently risk reproducing and sustaining inequities that equity-deserving scholars faced during the pandemic.

Moving beyond 'think leadership, think white male': the contents and contexts of equity, diversity and inclusion in physician leadership programmes.

The lack of both women and physicians from groups under-represented in medicine (UIM) in leadership has become a growing concern in healthcare. Despite increasing recognition that diversity in physician leadership can lead to reduced health disparities, improved population health and increased innovation and creativity in organisations, progress toward this goal is slow. One strategy for increasing the number of women and UIM physician leaders has been to create professional development opportunities that include leadership training on equity, diversity and inclusivity (EDI). However, the extent to which these concepts are explored in physician leadership programming is not known. It is also not clear whether this EDI content challenges structural barriers that perpetuate the status quo of white male leadership. To explore these issues, we conducted an environmental scan by adapting Arksey and O'Malley's scoping review methodology to centre on three questions: How is EDI currently presented in physician leadership programming? How have these programmes been evaluated in the peer-reviewed literature? How is EDI presented and discussed by the wider medical community? We scanned institutional websites for physician leadership programmes, analysed peer-reviewed literature and examined material from medical education conferences. Our findings indicate that despite an apparent increase in the discussion of EDI concepts in the medical community, current physician leadership programming is built on theories that fail to move beyond race and gender as explanatory factors for a lack of diversity in physician leadership. To address inequity, physician leadership curricula should aim to equip physicians to identify and address the structural factors that perpetuate disparities.

Compression Devices as an Alternative Approach After Unsuccessful Ring Removal Attempts.

Removal of a stuck ring is a medical problem sufficiently common for most practitioners to have an approach. However, there is limited consensus on the best approach to care. Commonly used approaches include lubricant, localized cooling, various forms of finger wrapping, attempts at ring and finger manipulation, and finally cutting or breaking the ring for removal. Each approach has its limitations and potential complications. Rings can also have sentimental value to the patient and destroying or damaging a ring may not be acceptable to the patient. This case report presents an approach to ring removal using a compression device (CD) that successfully allowed medical professionals to remove an intact ring from an injured finger. Several unsuccessful attempts at removal were made before using this CD.

CAEP 2021 Academic Symposium: recommendations for addressing racism and colonialism in emergency medicine.

PURPOSE: Racism and colonialism impact health, physician advancement, professional development and medical education in Canada. The Canadian Association of Emergency Physicians (CAEP) has committed to addressing inequities in health in their recent statement on racism. The objective of this project was to develop recommendations for addressing racism and colonialism in emergency medicine. METHODS: The authors, in collaboration with a 40 member working group, conducted a literature search, held a community consultation, solicited input from expert medical, academic and community advisors, conducted a national survey of emergency physicians, and presented draft recommendations at the 2021 CAEP Academic Symposium on Equity, Diversity and Inclusion for a live facilitated discussion with a post-session survey. RESULTS: Sixteen recommendations were generated in the areas of patient care, hospital and departmental commitment to Equity, Diversity, and Inclusion, physician advancement, and professional development and medical education. CONCLUSION: Emergency physicians are uniquely positioned to promote equity at each encounter with patients, peers and learners. The 16 recommendations presented here are practical steps to countering racism and colonialism everyday in emergency medicine.

RéSUMé: OBJECTIF: Le racisme et le colonialisme ont une incidence sur la santé, l'avancement des médecins, le développement professionnel et l'éducation médicale au Canada. L'Association canadienne des médecins d'urgence (ACMU) s'est engagée à lutter contre les inégalités en matière de santé dans sa récente déclaration sur le racisme. L'objectif de ce projet était d'élaborer des recommandations pour lutter contre le racisme et le colonialisme en médecine d'urgence. MéTHODES: Les auteurs, en collaboration avec un groupe de travail de 40 membres, ont effectué une recherche documentaire, tenu une consultation communautaire, sollicité les commentaires d'experts en médecine, en enseignement et en services communautaires, mené une enquête nationale auprès des médecins d'urgence et ont présenté des ébauches de recommandations lors du Symposium académique de l'ACMU 2021 sur l'Équité, la Diversité et l'inclusion pour une discussion animée en direct avec un sondage après la séance. RéSULTATS: Seize recommandations ont été formulées dans les domaines des soins aux patients, de l'engagement de l'hôpital et du service en matière d'Équité, de Diversité et d'Inclusion, de l'avancement des médecins, du développement professionnel et de l'éducation médicale. CONCLUSION: Les médecins urgentistes sont particulièrement bien placés pour promouvoir l'équité à chaque rencontre avec les patients, les pairs et les apprenants. Les 16 recommandations présentées ici sont des mesures pratiques pour contrer le racisme et le colonialisme au quotidien dans la médecine d'urgence.

Six ways to get a grip by calling-out racism and enacting allyship in medical education.

Actively addressing racism in our faculties of medicine is needed now, more than ever. One way to do this is through allyship, the practice of unlearning and re-evaluating, in which a person in a position of privilege and power seeks to operate in solidarity with a traditionally marginalized group. In this paper, we provide practical tips on how to practice allyship, giving educators and leaders background understanding and important tools on how to actively promote equity and diversity. We also share tips on how to promote inclusivity to more accurately reflect the communities we serve. Through six broad actions of being, knowing, feeling, doing, promoting, and acting, we can empower individuals to become allies and address racism in medical education and beyond. Creating psychologically safe spaces, educating ourselves on our complex histories and how they influence the present, recognizing racism, and advocating for change, augments awareness from which we can pivot conversations. Acknowledging potential feelings of shame, guilt, and embracing our loss of privilege, allow necessary, but challenging, personal growth to occur. Finally, dismantling the racist structures that exist within medicine, moving us beyond individual interventions, will address the systemic nature of racism in medicine. Everyone can find a starting place within this guide, as simple, consistent actions foster change in our spheres of influence; and the ripple effect of these changes will impact attitudes and behaviours broadly.

Il est plus que jamais nécessaire de s'attaquer activement au racisme dans les facultés de médecine. Une des stratégies qu'on peut adopter à cette fin est celle de l'allié, désignée en anglais par le terme allyship. Il s'agit de la pratique du désapprentissage et de la réévaluation, par laquelle une personne en position de privilège et de pouvoir s'efforce d'agir en solidarité avec un groupe marginalisé. Cet article vise à proposer aux enseignants et aux responsables des conseils pratiques sur la façon d'agir en alliés, notamment en offrant les informations nécessaires à une compréhension générale de la problématique en toile de fond, ainsi que des outils importants pour promouvoir activement l'équité et la diversité. Nous partageons également des stratégies pour encourager l'inclusivité afin de représenter plus fidèlement les populations auxquelles nous offrons nos services. Grâce à une démarche à six volets (être, savoir, ressentir, faire, promouvoir et agir), nous pouvons donner aux personnes les moyens de devenir des alliées dans la lutte contre le racisme de façon générale et dans l'enseignement médical en particulier. La création d'espaces psychologiquement sûrs, la sensibilisation aux vécus complexes et à leur influence sur le présent des individus, la reconnaissance du racisme et le plaidoyer pour le changement contribuent à une prise de conscience qui permet d'orienter le dialogue. La croissance personnelle, aussi difficile que nécessaire, passe par la reconnaissance des sentiments de honte et de culpabilité et par la renonciation au privilège. Enfin, le démantèlement des structures racistes présentes dans le monde médical permettra de s'attaquer à la nature systémique du racisme dans le milieu de la santé, au-delà des interventions au cas par cas. Tout un chacun trouvera un point de départ dans ce guide, car ce sont les actions simples et cohérentes qui favorisent le changement dans les sphères d'influence; l'effet d'entraînement que produisent les actions individuelles se traduira par un changement général des mentalités et des comportements.

Medical education leadership: from diversity to inclusivity.

Both in Canada and globally, medical schools are prioritizing diversity in medical education. The ensuing development of innovative approaches to augmenting the representation, comfort, and success of students from under-represented groups has been increasing. Curricula have also expanded to better prepare graduates for the realities of effectively meeting the needs of a diverse patient population. Leadership has however, not kept up with this progress. Evidence shows that diverse leadership teams develop innovative solutions to complex problems, recruit and retain the best talent, and remain relevant to the communities they serve. Our international conference workshop included a literature review on the current state of diversity in medical education and in leadership for medical educators, and case-based models of lived experiences to initiate conversations in three different facets of diversity to stimulate reflection, engagement and discussion. The oft-forgotten side of the conversation in conference offerings, the audience's perspective, was purposefully included in planning the workshop and presenters adhered to this principle throughout the session. Participants recognized the importance of addressing diversity with leadership in medical education. Themes included the need for communication training, cultural education, sharing these data more broadly with faculty in medical education and continuing these conversations. A final theme "we will never represent all minorities", led us to a conclusion that a culture of inclusivity and not diversity would be required to successfully meet this challenge.

Systematic review and meta-analysis of second-generation antidepressants for the treatment of older adults with depression: questionable benefit and considerations for frailty.

BACKGROUND: Frail older adults are commonly prescribed antidepressants. Yet, there is little evidence to determine the efficacy and safety of antidepressants to treat depression with concomitant frailty. To better understand this issue, we examined the efficacy and safety of second-generation antidepressants for the treatment of older adults with depression and then considered implications for frailty. METHODS: Due to the absence of therapeutic studies of frail older adults with depression, we conducted a systematic review and meta-analysis of double-blind, randomized controlled trials that compared antidepressants versus placebo for adults with depression, age 65 years or older. We searched PubMed/MEDLINE, Cochrane Library, reference lists from meta-analyses/studies, hand searches of publication lists, and related articles on PubMed. Outcomes included rates of response, remission, and adverse events. After evaluating the data, we applied a frailty-informed framework to consider how the evidence could be applied to frailty. RESULTS: Nine trials were included in the meta-analysis (n = 2704). Subjects had moderate to severe depression. For older adults with depression, there was no statistically significant difference in response or remission to second-generation antidepressants compared to placebo. Response occurred in 45.3% of subjects receiving an antidepressant compared to 40.5% receiving placebo (RR 1.15, 95% CI: 0.96 - 1.37, p = 0.12, I2 = 71%). Remission occurred in 33.1% with antidepressant versus 31.3% with placebo (RR 1.10, 95% CI: 0.92 - 1.31, p = 0.30, I2 = 56%) (Figure 2 and 3). There were more withdrawals due to adverse events with antidepressants, 13% versus 5.8% (RR 2.30, 95% CI: 1.45-3.63; p < 0.001; I2 = 61%; NNH 14, 95% CI:10-28). IMPLICATIONS FOR FRAILTY: Subjects in the meta-analysis did not have obvious characteristics of frailty. Using framework questions to consider the implications of frailty, we hypothesize that, like older adults, frail individuals with depression may not respond to antidepressants. Further, observational studies suggest that those who are frail may be less responsive to antidepressants compared to the non-frail. Given the vulnerability of frailty, adverse events may be more burdensome. CONCLUSIONS: Second-generation antidepressants have uncertain benefit for older adults with depression and cause more adverse events compared to placebo. Until further research clarifies benefit, careful consideration of antidepressant prescribing with frailty is warranted.

Review of emergency preparedness in the office setting: How best to prepare based on your practice and patient demographic characteristics.

OBJECTIVE: To outline an approach to assessing the risk of emergencies in one's medical practice and determining the equipment and medications required for emergencies and the necessary staff training to meet this important facet of patient care. SOURCES OF INFORMATION: The emergency preparedness recommendations presented in this article are based on data collected from family physicians' current preparedness plans, formal physician evaluation and informal feedback provided after 2 large group presentations, and the authors' expertise in areas including family medicine, emergency medicine, prehospital care, and pharmacology. MAIN MESSAGE: Delineating risk based on practice profile, location, and demographic characteristics will inform the development of an appropriate plan to meet both public expectations and professional obligations. Reviewing the plan or having a practice drill of the plan once developed will improve the process in the event of an emergency. It is also essential to have medication and equipment checked periodically for expiry dates and proper functioning. CONCLUSION: Physicians will encounter office emergencies at some time in their practice. Appropriate risk assessment, planning, and preparedness will allow the provision of high-quality care, safety for staff members, the best patient outcomes, and the reward of having managed a time-sensitive problem in an efficient and effective manner.

Revue de la préparation aux situations d'urgence à la clinique: Comment mieux se préparer en fonction de votre pratique et des caractéristiques démographiques de vos patients.

OBJECTIF: Présenter une approche pour évaluer les risques d'urgences dans sa propre clinique médicale, et déterminer le matériel et les médicaments nécessaires pour de telles urgences, de même que la formation du personnel requise pour aborder cette importante facette des soins aux patients. SOURCES DE L'INFORMATION: Les recommandations sur la préparation aux urgences dans cet article se fondent sur des données colligées à partir de plans de préparation aux urgences déjà existants chez les médecins de famille, d'une évaluation formelle faite par des médecins et d'une rétroaction informelle fournie à la suite de 2 présentations à de grands groupes, de même que sur l'expertise des auteurs dans des domaines comme la médecine familiale, la médecine d'urgence, les soins préhospitaliers et la pharmacologie. MESSAGE PRINCIPAL: La définition des risques en fonction du profil, de l'emplacement et des caractéristiques démographiques de la pratique éclairera l'élaboration d'un plan approprié pour répondre à la fois aux attentes de la population et aux obligations professionnelles. La révision du plan ou un exercice d'entraînement une fois qu'il est élaboré améliorera le processus dans l'éventualité d'une urgence. Il est aussi essentiel de vérifier périodiquement les dates de péremption des médicaments et le bon fonctionnement du matériel. CONCLUSION: À un moment ou l'autre, les médecins auront à faire face à des urgences à leur clinique. Une évaluation des risques, une planification et un état de préparation appropriés leur permettront de fournir des soins de grande qualité, d'assurer la sécurité de leur personnel, d'obtenir les meilleurs résultats pour les patients et de ressentir la satisfaction d'avoir géré un problème urgent d'une manière efficiente et efficace.

A Case of Ophthalmic Branch Trigeminal Neuralgia in the Emergency Department.

This case report describes a middle-aged patient with a past history of migraine headaches, who presented to the emergency department with a new onset of headaches around his left eye that were different from the pattern and character of his usual migraine headaches. The pain was severe, brief, and stabbing in nature, lasting only seconds, and occurring over intervals of a few minutes. His vital signs, including glucose, were normal. He had no constitutional symptoms, a normal neurological examination, and a normal head, eyes, ears, nose, and throat examination. The painful paroxysms could not be elicited on palpation of his face, head, or oral mucosa. His blood investigations were reported as within normal limits. He was not using alcohol or any illicit drugs and was not taking any medication. A diagnosis, with supportive imaging, of ophthalmic branch trigeminal neuralgia (TN) was made. His pain responded well to treatment with carbamazepine. TN is characterized by brief and intermittent lancinating pain with or without a constant background level of pain in the sensory distribution of one or more branches of the trigeminal nerve. There are three main causes for TN: idiopathic, the classical type resulting from neurovascular compression, and the secondary type typically due to multiple sclerosis, a space-occupying lesion, or a skull base abnormality. The mandibular and maxillary branches are most affected and can often be affected simultaneously. Ophthalmic branch TN is relatively rare. Virtually all of TN cases are unilateral and most are the classical type. Distinguishing TN from other cephalalgias, ocular pain, dental pain, or other pathology is critical to a proper diagnosis and initiation of effective therapy. Identifying trigger zones is important and carries a high diagnostic yield; however, they may be anatomically difficult to access, or in a refractory period during a physical examination. Physicians should be aware of several red flags associated with a suspected case of TN. Carbamazepine is the first-line treatment for TN, capable of reducing pain in 90% of patients. Failure to respond to medication requires further investigation and/or specialist referral. Untreated or unrecognized TN can have significant impacts on a patient's quality of life.