Difficult pill to swallow?

In answering the PDQ, patients are being asked how they want to be seen or understood as a person by their healthcare team. These conversations are summarized into a few paragraphs, and with the patient’s approval, placed on their medical chart.

While mostly used in patients with serious illness, the PDQ is relevant across all of medicine.

Whether you are being seen for routine medical care, or find yourself moving towards the end of life, or somewhere in between, who you are and acknowledgement of who you are as a person, matters. And the things that people disclose by way of the PDQ profoundly change the way healthcare providers see them. I’m a survivor of childhood abuse. My son is battling cancer. I am afraid to die alone. I am a former department head of medicine.

During the COVID-19 pandemic, the daughter of a women on a ventilator in intensive care shared that her

• Ontario’s nursing profession is in jeopardy

– One in five nurses (19%) are considering moving outside of Ontario to practice nursing. This trend is in line with recent data that shows a yearover-year increase in Ontario nurses not renewing their license.

– More than half of all nurses surveyed (54%) are considering leaving their current role to work for a private agency

– Compensation is top of mind for both agency (95%) and out of province considerations (83%).

• Pride in nursing has dramatically eroded since the pandemic

– 91 per cent of nurses say their daily experiences in the workplace have become significantly more stressful, and almost all (97%) say working short staffed has negatively impacted their workplace culture.

– In 2020, 67 per cent of nurses in Ontario said they had never been more proud to be an RPN. Sadly, three years later, pride in nursing has plummeted to a mere 31 per cent. n H

Prescribing psychostimulants for people at risk of overdose

Growing evidence supports prescribing psychostimulant medications to help reduce use of illegal stimulants such as methamphetamine, authors write in a CMAJ (Canadian Medical Association Journal) commentary.

Illegal stimulant use is rising, judging by the presence of these drugs in at least half of all opioid deaths in Canada in 2022.

Following evidence from clinical trials in Australia, Europe and the United States, physicians and nurse practitioners in Canada and other countries are increasingly prescribing psychostimulants as harm reduction for stimulant use disorder.

“This emerging evidence can support prescribers’ level of confidence in off-label prescribing of psychostimulants to patients with stimulant use disorder (and particularly for patients with attention-deficit/hyperactivity disorder and stimulant use disorder),” write Drs. Heather Palis, University of British Columbia and Scott MacDonald, Providence Health Care, Vancouver, BC.

In 2020, Canada’s Federal Minister of Health issued a letter to the provinces and territories to encourage increasing access to safer pharmaceutical-grade drugs as an alternative to contaminated illegal drugs. Only BC has issued guidance on prescribing psychostimulants to people at risk of overdose.

mother had survived the likely murder of her first child and was a spiritual leader in her community. She said that responding to the PDQ gave her a way of letting the healthcare team know that her mother “was no ordinary person.”

These kind of disclosures profoundly and forever change the healthcare provider’s lens, bringing an appreciation of who patients are as persons, above and beyond whatever ailment brought them to medical attention.

This is good for healthcare providers, helping stave off emotional indifference that can lead to professional burnout, while restoring human connection with the potential for them to be more whole themselves.

It is also good for patients and families, ensuring that patienthood doesn’t overshadow personhood.

Being a patient is hard, especially when it undermines your feeling that you are still you. That, it turns out, is the hardest pill to swallow of all. n H