Attitudes toward medical cannabis among family physicians practising in Ontario, Canada: a qualitative research study.

BACKGROUND: Medical cannabis has been legally available in Canada since 2001, but its benefits and harms remain uncertain. We explored attitudes toward medical cannabis among family physicians practising in Ontario. METHODS: Between January and October 2019, we conducted a qualitative study of Ontario family physicians using semistructured telephone interviews. We applied thematic analysis to interview transcripts and identified representative quotes. RESULTS: Eleven physicians agreed to be interviewed, and 3 themes regarding medical cannabis emerged: reluctance to authorize use, concern over harms and lack of practical knowledge. Participants raised concerns about the limited evidence for, and their lack of education regarding, the therapeutic use of cannabis, particularly the harms associated with neurocognitive development, exacerbation of mental illness and drug interactions in older adults. Some participants thought medical cannabis was overly accessible and questioned their role following legalization of recreational cannabis. INTERPRETATION: Despite the increasing availability of medical cannabis, family physicians expressed reluctance to authorize its use because of lack of knowledge and concerns regarding harms. Family physicians may benefit from guidance and education that address concerns they have surrounding medical cannabis.

Ensayos clínicos y consentimiento informado: visión de investigadores, pacientes y médicos de familia / Informed consent process in clinical trials: Insights of researchers, patients and general practitioners

OBJETIVO: En investigación es fundamental informar adecuadamente a los pacientes y respetar el principio de autonomía. El objetivo de este estudio fue explorar la percepción de médicos de familia, investigadores y pacientes sobre el proceso del consentimiento informado (CI) en los ensayos clínicos (EC), y el papel que desempeña el médico de familia. DISEÑO: Estudio transversal mediante 3 cuestionarios y revisión de CI, historias clínicas e informes de alta hospitalaria. Emplazamiento: Médicos de familia, investigadores y pacientes involucrados en EC. PARTICIPANTES: Quinientos cuatro médicos de familia, 108 investigadores y 71 pacientes. RESULTADOS: En el 50% de los CI se recomendaba consultar con el médico de familia. Constaba la participación en un EC en el 33% de las historias clínicas de atención primaria y en el 3% de informes de alta hospitalaria. Los médicos de familia suspendieron, con 3,54 puntos, la información recibida a través del investigador principal. La legibilidad del CI fue puntuada con 8,03 puntos por los investigadores y con 7,68 por los pacientes (rango: 1-10 puntos). La satisfacción de los pacientes se relacionó positivamente con el tiempo de reflexión concedido. CONCLUSIONES: Los médicos de familia mostraron insatisfacción con la información que reciben sobre la participación de los pacientes de su cupo en EC. Los investigadores son conscientes de la necesidad de mejorar la información que reciben los médicos de familia, aunque están satisfechos con la información ofrecida a los pacientes. Los pacientes se mostraron colaboradores y satisfechos con la investigación biomédica y minimizaron los inconvenientes relacionados con la participación

OBJECTIVE: Adequate information for patients and respect for their autonomy are mandatory in research. This article examined insights of researchers, patients and general practitioners (GPs) on the informed consent process in clinical trials, and the role of the GP. DESIGN: A cross-sectional study using three questionnaires, informed consent reviews, medical records, and hospital discharge reports. SETTING: GPs, researchers and patients involved in clinical trials. PARTICIPANTS: Included, 504 GPs, 108 researchers, and 71 patients. RESULTS: Consulting the GP was recommended in 50% of the informed consents. Participation in clinical trials was shown in 33% of the medical records and 3% of the hospital discharge reports. GPs scored 3.54 points (on a 1-10 scale) on the assessment of the information received by the principal investigator. The readability of the informed consent sheet was rated 8.03 points by researchers, and the understanding was rated 7.68 points by patients. Patient satisfaction was positively associated with more time for reflection. CONCLUSIONS: GPs were not satisfied with the information received on the participation of patients under their in clinical trials. Researchers were satisfied with the information they offered to patients, and were aware of the need to improve the information GPs received. Patients collaborated greatly towards biomedical research, expressed satisfaction with the overall process, and minimised the difficulties associated with participation

Social Justice as the Moral Core of Family Medicine: A Perspective from the Keystone IV Conference.

A recurring conference theme was the essential place of social justice within family medicine, especially the need to focus on denominator populations, exalt the personal and caring qualities of doctoring, and address social determinants of health. Many expressed solidarity with "community," but it is not always easy to define community in our large and diverse nation. Exhortations for health advocacy were frequently voiced, but putting these into meaningful action agendas is a challenge. There was general agreement that medicine is in flux and that the many expressions of "commodity-centered consumerism" have altered organization and financing. The increasing demands by "consumers", who want low cost, instant availability, and shared decision-making, and yet change doctors when health plans alter coverage also differentially impact high-volume, low-margin specialties such as family medicine. Additional challenges were the electronic health record and calibrating an appropriate work/life balance. Five action steps are recommended: 1) speak out on the important social and moral issues; 2) be the experts on personal care; 3) make common cause with potential allies; 4) help institutions perceive the value of generalism; and 5) help find ways to enrich generalist disciplines to increase the joy of medicine and decrease the threat of burn out.

Coaching: ¿Una herramienta útil para el médico de familia? / Coaching: A useful tool for the family doctor?

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Risk factors for child abuse: levels of knowledge and difficulties in family medicine. A mixed method study.

BACKGROUND: Family physicians (FPs) have a central role in the detection and management of child abuse. According to the literature, only 2-5% of initial reports of child abuse come from the medical profession. METHODS: The objective of this study was to assess levels of knowledge of risk factors for child abuse by Family Physicians (FPs) and the attention that the physicians pay to these risk factors. We conducted a mixed-method survey based on semi-structured interviews. 50 FPs practicing in the Somme County (northern France) were interviewed with closed and open questions. The FPs' level of knowledge of risk factors for child abuse and obstacles in the detection of child abuse were assessed. RESULTS: The FPs' level of knowledge of risk factors for child abuse was similar to that reported in the literature. However, FPs knew little about the significant role of prematurity. Likewise, the FP's training did not seem to influence their knowledge of risk factors. Fear of an incorrect diagnosis was the main obstacle to reporting a suspected case. The FPs considered that they were often alone in dealing with a difficult situation and considered that the judicial system and the social services were not sufficiently active. CONCLUSIONS: Few FPs had actually received specific training in the detection and management of child abuse but many stated their need for this type of training. FPs encounter many obstacles in the detection of child abuse, which sometimes make the FP reluctant to report a suspected or potential case. Medical education need to be improved in this field.