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Post-test: Green Nail Syndrome

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

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I have spent the summer trying to avoid working, a noble endeavour. However, in 34 years of medicine I have never before been as successful in work avoidance as I have been this summer. Most people would assume that the reason is that I am becoming smarter (or sneakier) with advancing age; after all, doctors are like wine, they improve with age (or so I like to believe).

The reason I was able to take so much time off was much simpler and more straightforward than that. We have hired two new geriatricians on top of our recent hire from a couple of years ago! As well, one young geriatrician who did not want a permanent position (she is waiting to see where her cardiologist husband will get a job), worked as a locum. We have even been able to recruit a young American trained geriatrician who will start in 2014. She apparently prefers Canadian ‘socialized medicine’ to ‘Obama-care’. I now know that my eventual retirement will not leave a gaping hole in the attending schedule. Even better, there will be geriatricians to take care of me when I become frail! This ability to recruit new trainees into the field is happening across the country. Trainees realize there are excellent job prospects in geriatric medicine, and recent reimbursement hikes for geriatric consultations have made outpatient clinics in geriatric medicine an economically viable practice style. As well it is not just the numbers of trainees that is increasing. The quality of trainees is incredibly high, and most could qualify for any subspecialty program they chose. This trend to quality has been accentuated in Toronto where our program director (Barb Liu) and our division director (Sharon Straus) are both great mentors and role models.

We still have a long way to go in Canada both to train enough generalist health care providers in care of the elderly and to ensure an adequate specialist work force, but for the first time in my long career, I am not worried about the future health of my specialty, Geriatric Medicine.

Regards,
Barry Goldlist

The Cost of Dementia in the United States

Teaser:

Dr.Michael Gordon Michael Gordon, MD, MSc, FRCPC, Medical Program Director, Palliative Care, Baycrest Geriatric Health Care System, Professor of Medicine, University of Toronto, Toronto, ON.

The prevalence of dementia appears to be increasing in most western countries. That when coupled with the increased average age of the older population has leads to an expectation that projections of financial costs to individuals, families and to society will grow over the next few decades. The current study, out of the United States, based on a number of robust data bases coupled with in-depth interviews has resulted in projections of the current true costs of caring for elderly people living with dementia. It also allowed for the projection of future costs over the next three decades. The results are quite mind-boggling: "We found that dementia leads to total annual societal costs of $41,000 to $56,000 per case, with a total cost of $159 billion to $215 billion nationwide in 2010. Our calculations suggest that the aging of the U.S. population will result in an increase of nearly 80% in total societal costs per adult by 2040."

Something is Wrong with Her Back

Members of the College of Family Physicians of Canada may claim one non-certified credit per hour for this non-certified educational program.
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Pre-test CME Quiz Post-test CME Quiz

Teaser:

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

Abstract
Erythema ab igne (EAI) is a localized hypermelanosis with erythema in a reticulated pattern. It is triggered from repeated exposure to heat and infrared radiation. Actinic keratosis, squamous cell carcinoma, and Merkel cell carcinoma have been reported in patients after chronic exposure to infrared radiation. EAI is diagnosed based on clinical symptoms. If the diagnosis is uncertain, a skin biopsy may be performed. Early in the disease process, elimination of the heat source may lead to complete resolution of the symptoms.