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Make sure your Substitute Decision-Maker Understand the Rules of Engagement

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Ihave heard it many times, “ I am the POA"…
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I have heard it many times, “ I am the POA" (wrong use of the term—what they mean is the SDM-Substitute-Decision-Maker or as is often used in the United States Proxy: the POA is in fact the document outlining the substance of the decisions that are being referred to).

I have heard it many times, “ I am the POA (wrong use of the term—what they mean is the Substitute-Decision-Maker (SDM) or as is often used in the United States Proxy: the POA is in fact the document outlining the substance of the decisions that are being referred to).

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Any Reason to not Enjoy Sex if you are in a Nursing Home?

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A while back there was a headline in the New York Times about a well-known retired politician…
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A while back there was a headline in the New York Times about a well-known retired politician who was charged with rape for allegedly having sexual relations with his wife.

A while back there was a headline in the New York Times about a well-known retired politician who was charged with rape for allegedly having sexual relations with his wife. This would of course not have been a story were it not for the fact that his wife was at the time of the alleged event living in a nursing home and experiencing cognitive impairment to a significant degree.

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Why a Section on Ethics?

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At the time of my medical training, the term medical ethics was hardly used when discussing complex issues related to patients and families.
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For most of us in practice in the 1960’s when I attended and completed medical school, the main source and inspiration for medical ethics was Hippocrates…

At the time of my medical training, the term medical ethics was hardly used when discussing complex issues related to patients and families.

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Discussions with your Doctor about your Future Wishes

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There are days in my clinic where I seem to be having the same conversation over and over…
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There are days in my clinic where I seem to be having the same conversation over and over—but with a different patient and different family.

There are days in my clinic where I seem to be having the same conversation over and over—but with a different patient and different family. I have often thought that a model of care I once heard a presentation about might be worth doing—having the equivalent of a group therapy, but with a number of my patients and their families to discuss the common problems in aging and cognitive function.

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Digoxin for the Control of Congestive Heart Failure Symptoms in Palliative Care

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One of the great things about the history of medicine is how new ideas and approaches to care replace those that were previously the "gold standard" fall by the wayside and are replaced with newer and more effective treatments.
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One of the great things about the history of medicine is how new ideas and approaches to care replace those that were previously the "gold standard"…

One of the great things about the history of medicine is how new ideas and approaches to care replace those that were previously the "gold standard" fall by the wayside and are replaced with newer and more effective treatments. Sometimes what becomes the new "gold standard" appears so counter-intuitive or "off-the-wall" that it takes time until the evidence grows that demonstrates its new role in the hierarchy of medical treatments.

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Lecture in Dundee Scotland—Reviving Old Wonderful Memories

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When I graduated from medical school in 1966, geriatrics was already one of the medical subspecialties in Scotland...
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I was the honoured speaker for this lecture series endowed in the Name of Miriam Friedman ben-David...

First Inaugural Miriam Friedman Lecturer: Dundee Scotland May 5, 2015

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More Than Child’s Play: Ethics of Doll Therapy in Dementia

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If one is in medical practice long enough it sometimes seems like that sense one gets when sitting in a waiting room and picking up a years old copy of Time® magazine and not realize that it is years out of date, as many of the stories seem to be the same or very familiar.
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If one is in medical practice long enough it sometimes seems like that sense one gets when sitting in a waiting room and picking up a years old copy of Time® magazine and not realize that it is years out of date, as many of the stories seem to be the same or very familiar.

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When Enough is Enough: Musings on the End of Work and Life

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Elderly members of society face end of life struggles while acknowledging physical and mental difficulties associated with the coming of life's end.
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When I tell people that what I do professionally...

When I tell people that what I do professionally is “look after older people,” I often hear responses such as: “Oh, that must be so depressing;” or sometimes, “Isn’t that wonderful, you must be a special human being;” and on occasion, “there are so few of you—what will be in the future with so many old people using up health care resources?” When I add that I am also involved in palliative care, you can imagine the response, but usually permuta

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The Four Dr. Gordons: Connecting the Past with the Present

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I have for many years enjoyed my family name, Gordon, and all the connections I can make with it.
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I have for many years enjoyed my family name, Gordon, and all the connections I can make with it. I learned when I was quite young, from my paternal grandfather that the name had been ours for many generations and had not been changed as had those of my childhood friends. I had stored that knowledge deep into the recesses of my memory. When I decide to study medicine in Scotland, the name became a talking point, as everyone assumed that with that name I must in fact have Scottish ancestry. I could only explain that the name was genuine, unsullied by arbitrary or deliberate alteration by American immigration authorities when my grandfather arrived from a small village in Lithuania.

It was only some years later, during my first trip to Israel that I read a history of Russia by a Scottish historian. There I found a reference to the likely origin of the Jewish Lithuanian and by dint of migration Russian Gordons. It was Peter the Great's desire for territorial expansion that led him to hire a militarily brilliant Scottish mercenary general by the name of Patrick Gordon. It was General Gordon, who successful in many Russian expansionist battles ultimately became a close friend and confidant of the Tsar. A well detailed biography of Peter the Great by Robert Massie explains how Gordon's death was mourned by the Tsar as a loss to his empire. During the later emancipation process, when Russians adopted family names, it appears that my ancestors, in deference and regard to the Tsar's great friend took on the name Gordon. Although there are varying iterations on the origins of that name in Jewish Russian/Lithuanian history, this narrative has always seemed to me to be the most credible.

During the pogrom-dominated anti-Jewish period in Russia around the turn of the 20th century many Jews left Russia, including my ancestral village of Eysheshuk I near Vilna and made their way to the United States, then British Palestine and South Africa. When I was sitting my oral examination in Midwifery in Dundee Scotland, then still part of the University of St. Andrews, my examiner was the "prof" (professor and head of the department) himself. As I sat down he said, "You're the Yank" in his mellifluous Scottish dialect which by this time had become music to my Brooklyn English ears. "Surely" he continued, "with a name like Gordon, you must be Scottish." I responded with a "yes and no, but if you would like to hear the story, I would be happy to tell you." He nodded yes and with my eye on the clock above his head, ticking out the 10 minutes of oral examination time, I recounted the tale. With 30 seconds left, he interrupted with "Oh dear, Oh dear, we're running out of time, followed by 'give me three symptoms or signs of eclampsia'". I knew the answer "cold" as it was one we all prepared for knowing how important the subject was. As I turned to leave the room I saw him write a 10 and say, "very good, very good" in broad Scottish.

That event resulted in a prize in midwifery much to the shock and surprise of my classmates as it was not my "strong" subject. With the 500 pounds I spent 5 months doing midwifery and gynaecology at the Rambam Hospital in Haifa, which resulted in epiphany in my life which circuitously resulted in Aliyah some years later. My return to North America and settlement in Canada is complex but I have always responded to the name Gordon with the question to determine if the person was perhaps a landsman and if they are aware of the history of the name. This has resulted in many warm interactions and sharing of family histories.

This was personified on a recent invitation to Vancouver to attend a conference as a presenter. After the acceptance I received a request to attend a meeting of the newly established Vancouver chapter of the Israel Medical Association, having been involved in the Toronto chapter for many years. Once accepted I received an email form Dr. Paula Gordon, a Vancouver radiologist who trained at Mt. Sinai Hospital early on in my career as a clinical teacher.

At the IMA meeting, Dr. Marla Gordon, an elder-care focused primary care physician at whose house we were meeting introduced herself and reminded me that years earlier she had asked me via-email about my knowledge of the derivation of our name. Also at the meeting was Dr. Rhona Gordon, a family physician with a major focus in Obstetrics and newborn care, is married to the president of the Vancouver IMA. We spent much of the post-meeting time comparing our family histories and our understandings of the movements through Europe and North America of our respective Gordon families. We concluded the we were for sure Landsman (a Yiddish term for people of the same geographic area—which in 18th and 19th century Eastern Europe usually meant the same village or district. I could add these three to other Gordons living in Israel who also I knew as émigrés from Eyshoshuk or other parts of Lithuania.
This experience reminded me of the importance of keeping people with cognitive impairment as grounded as possible with ideas, events, people and associations that they can relate to and which are meaningful. The use of photographs is very important in helping those living with dementia relate to important people and events in their life. The nice thing about the use of photographs is that they can be shown and discussed time after time without the person getting bored as they may have little recollection of having looked at the pictures recently. (/article/photography-many-windows-memories). It has been shown that familiar and personal music is also useful to those living with dementia and the fact that the person can related to their music has been demonstrated to bring back important memories that may result in revitalization of the person even within the context of dementia and may also be useful when dealing with behavioural issues such as agitation (http://www.youtube.com/watch?v=Fw7Y78aqf_I).

What could be defined and an expansion of one's historical connections also resulted in a recognition of the importance of individual roots and relationships. As physicians dealing with dementia we should also try and explore and find those aspects of our patient's lives and experiences with which they can connect, and if we can add to or enhance that connection, all the better for a fulfilling and meaningful and ultimately more successful clinical experience—for the patient and for the physician.

I have for many years enjoyed my family name, Gordon, and all the connections I can make with it. I learned when I was quite young, from my paternal grandfather that the name had been ours for many generations and had not been changed as had those of my childhood friends. I had stored that knowledge deep into the recesses of my memory. When I decide to study medicine in Scotland, the name became a talking point, as everyone assumed that with that name I must in fact have Scottish ancestry.

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We've got your back: HealthPlexus and the Canadian Spine Society Announce the Launch of the Back Health CME Resource

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The Canadian Spine Society, as part of its educational mandate, is partnering with www.healthplexus.net and the Journal of Current Clinical Care…
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HealthPlexus.net
For immediate release:
January 7th 2014


The Canadian Spine Society (CSS), as part of its educational mandate, is partnering with www.healthplexus.net (HealthPlexus) and the Journal of Current Clinical Care (JCCC) to promote best practices and knowledge translation for fast and effective diagnosis and management of back pain.

As part of the multi-faceted collaboration, CSS and HealthPlexus will work on a comprehensive continuing education program aimed at healthcare professionals that will be delivered via www.healthplexus.net and the Journal of Current Clinical Care.

Dr. Hamilton Hall is a well-recognized key opinion leader both nationally and internationally on the subject of back pain. He has taken on the position of Editor-in-Chief for the Back Health Resource Center @HealthPlexus.

Dr. Hall and his colleagues from the CSS will present an ongoing series of Clinical Reviews and Case Studies, which will be available through the HealthPlexus channels. Their goal is to provide those healthcare professionals who are managing patients with back health issues with deeper knowledge and increased ability to address their patients' needs.

"Numerous population wide surveys have confirmed that arthritic disorders that limit mobility are the most important factors in impairing quality of life for older adults. Back pain is one of the key issues limiting mobility, and I applaud HealthPlexus for addressing this very important topic."

-Barry J. Goldlist, MD, FRCPC, FACP, AGSF, senior member of the advisory board for HealthPlexus.net [Geriatrics and Dementia] and the Journal of Current Clinical Care. Dr. Goldlist is a nationally recognized geriatrician with a long standing interest in medical education and medical journalism.

“For practitioners who look after the adult population, especially those in the middle and later years, disorders of musculo-skeletal mobility and acute and chronic pain is one of the most common challenges they face with their patients. There is enormous suffering and impairment of full function and ability to participate in normal activities much less those of a recreational nature when someone experiences back pain that is unrelieved by simple and safe methods. Having an additional means to learn about and find methods to address the issues of back pain with all its complexities of diagnosis and treatment, is an important addition to the HealthPlexus spectrum of clinical support for practicing physicians.”

-Michael Gordon, MD, MSc, FRCPC, FACP, the Editor-in-Chief of the Dementia Educational Resource. Dr. Gordon is the Medical Program Director of Palliative Care at Baycrest Geriatric Health Care System

"As a medical professional who has trained as both a Radiologist and a Family physician, I have seen many patients who suffer from the entire spectrum of lower back pain. I don't think that medical school and residency prepares you enough to adequately to deal with the complexity of this condition. A dedicated CME resource focusing on back health is a much needed tool for both students and practicing physicians who wish to acquire skills and keep their skills up to date on this subject. Dr. Hall is eminently qualified for such an endeavor. I still recall his teachings, some years ago now, in my medical school class at the University of Toronto vividly. As medical editor of the Journal of Current clinical Care, I encourage you to take advantage of this learning opportunity."

-D’Arcy Little, MD, CCFP, FRCPC, the editorial director of HealthPlexus.net and its sister publication, the Journal of Current Clinical Care. Dr. Little is a family physician, diagnostic radiologist and medical writer. He completed fellowships in Care of the Elderly and Academic Medicine


About Health Plexus:
Comprised of 1000s of clinical reviews, CMEs, bio-medical illustrations and animations and other resources, all organized in the 34 condition zones, our vision is to provide physicians and allied healthcare professionals with access to credible, timely and multi-disciplinary continuing medical education from anywhere and on any media consumption device. The Back Health Educational Resource is the compilation of high quality clinical reviews, online CME programs, library of original visual aids, interviews, roundtable discussions and related conference reports.


About The Canadian Spine Society:

The CSS is a collaborative body of Canadian neurosurgical and orthopaedic spine surgeons and other spine care professionals with a primary interest in advancing excellence in spine patient care, research and education.

Contact Person:
Mark Varnovitski
mark@healthplexus.net
www.healthplexus.net