Lost together: Experiences of family physicians with emerging adult mental health.

OBJECTIVE: To explore the perceptions and experiences of FPs with emerging adult (EA) mental health to inform opportunities for improvement in EA mental health care. DESIGN: Constructivist grounded theory methodology, including theoretical sampling and constant comparative analysis of data to synthesize results. SETTING: Southwestern Ontario. PARTICIPANTS: Twenty practising FPs. METHODS: In-depth, semistructured, in-person interviews, which were audiorecorded and transcribed verbatim. MAIN FINDINGS: Family physicians recognized the unique situation of EAs being between adolescence and adulthood, having heavy psychosocial needs, and lacking a connection to the health care system. Experience and confidence are needed to treat the EA population, but provision of mental health care to EAs is influenced by resources, knowledge, and communication. Family physicians noted that they are the default physician while EAs wait for specialized care, and are often the physicians that the patient is referred back to after specialized care. Often, the FP knows and treats the EA's entire family, which participants described as enabling them to understand the EA's unique context. CONCLUSION: Family physicians and EAs are "lost together" in a fragmented health care system. Family physicians have the unique potential to assist EAs with their mental health needs, but that is not being actualized. Family physicians can support mental health outcomes for EAs through an improvement in knowledge and skills, and through forming family practice teams.

Canadian national survey of family medicine residents on point-of-care ultrasound training.

OBJECTIVE: To assess the quality of point-of-care ultrasound (POCUS) training in family medicine residency programs and to obtain the opinions of current family medicine residents on the role of ultrasound in primary care. DESIGN: A 23-question online survey conducted using SurveyMonkey between March 15 and June 30, 2017. SETTING: Canada. PARTICIPANTS: All family medicine residents of the 17 Canadian family medicine residency programs were included in the study but all enhanced skills residents were excluded. MAIN OUTCOME MEASURES: The quality and relevance of POCUS to primary care as perceived by residents and reported in the survey. RESULTS: A total of 854 Canadian family medicine residents responded, for a national response rate of 32.3%. Most respondents (94.3%) believe that POCUS training should be included in family medicine residency programs; however, only 18.4% of respondents currently receive formal training within their residency. Among those without POCUS training, 91.7% are interested in receiving formal training and 29.7% resorted to taking external POCUS courses. Most (77.5%) would consider using ultrasound in their future practice if they were competent in POCUS. The most useful applications for family medicine were considered to be the FAST (Focused Assessment with Sonography in Trauma) examination for free fluid and ascites (95.1%), procedural guidance (92.4%), and identifying an intrauterine pregnancy (88.6%). CONCLUSION: This is the largest survey identifying the perceived needs of family medicine residents for POCUS. Very few Canadian family medicine residents currently receive POCUS training. Consistent with our recent family medicine program director survey, there is overwhelming interest by family medicine residents to begin incorporating POCUS training into the family medicine curriculum.

Views of physicians on the establishment of a department of family medicine in South India: A qualitative study.

OBJECTIVE: To explore the experiences and perceptions of physicians involved in establishing a department of Family Medicine in South India. METHODS: In this study, descriptive qualitative methodology was used. Nine family physicians and one community medicine physician were interviewed. The data were subjected to thematic analysis. FINDINGS: The establishment of a department of Family Medicine in South India in response to the local health-care demands needed support from the institution, visionary leaders and alumni of the institution. The key challenges perceived were lack of mentorship, lack of identity and misunderstanding of the work of family physicians. CONCLUSION: This study replicates earlier studies on the role of local health-care needs and visionary leaders in striving towards family medicine-based clinical services that further evolved into training and research opportunities in family medicine. The study identified the challenges and supportive forces behind the initiation of a department of Family Medicine and the role of family physicians in strengthening primary health care.

Compound palmar ganglion with carpal tunnel syndrome.

Compound palmer ganglion is an uncommon condition characterized by a swelling in the distal part of volar aspect of wrist and communicating with another swelling over palm across the flexor retinaculum. It commonly results from tuberculous tenosynovitis. It may lead to carpal tunnel syndrome and need surgical excision with division of flexor retinaculum.