Are You Due for a Screening Test?

What tests do you need . . . and when?

by Davidicus Wong, MD

With the nationwide crisis in primary care and the pandemic-spurred changes in the virtual and in person availability of family doctors to their patients, healthcare has shifted further to reactive rather than proactive care. 

Screening tests are the procedures and other investigations recommended to detect health problems – including diabetes, cancer and high blood pressure – early enough to improve patients’ outcomes with these conditions. They are regularly revised according to the best medical evidence and based on gender and age. 

It’s not unusual for a patient not to have seen their family physician since the start of the pandemic – now over four years ago! The unfortunate reality is that most of your healthcare encounters are reactive rather than proactive and preventive. 

You usually make an appointment to your primary care provider when you have a problem such as a respiratory infection or bothersome symptoms such as fatigue, chest pain or weight changes. If you’re lucky enough to have a family doctor, get an appointment and the doctor is not in a rush, he or she will take the time to review your chart and in addition to addressing your presenting concerns, remind you if you are due for any screening tests, such as a blood pressure check, pap smear, mammogram or screen for diabetes. 

But in the majority of your medical visits, this doesn’t happen, and you may have no way of knowing what screening tests you need and when. 

Here’s a quick quiz to test your knowledge of screening tests. 

1. When should you check for high blood pressure? 

High blood pressure (over 140/90 in a medical setting or over 135/85 at home) is a silent and usually asymptomatic risk factor that can increase your risk for arterial disease including strokes, kidney failure and heart disease (angina, heart attacks and heart failure). 

Adults 18 and over should check their blood pressure by a doctor or nurse at least annually. 

2. When does a woman need a pap smear? 

The pap test is a sampling of cells from the cervix to detect cancer at an early stage while it is treatable. This test starts at age 25 and if normal, repeated every 3 years. When a woman is 70 and has had three successive normal paps over the prior 10 years, she can stop screening. 

3. Do you need a test for diabetes? 

People with diabetes have impaired glucose tolerance. It is a metabolic condition that if untreated can increased your risk for kidney disease, blindness, nerve damage and vascular disease. 

Those at high risk based on the FINDRISC or CANRISK calculators (available online) should have a fasting glucose or Hb a1c blood test every 3 to 5 years. Those at very high risk require an annual blood test. 

4. When are screening mammograms recommended? 

Breast cancers are more easily treated and often curable when detected by mammograms before a woman can even feel a lump. The current recommendation is to start at age 50 and continue every two years until the age of 69. However, women between 40 and 49 and over age 70, should discuss the risks and benefits of screening with their physician. If my 72-year-old patient is in good health and has a long life expectancy, I will recommend continued screening mammograms because the risk of breast cancer increases with age. 

5. How do we screen for colon cancer? 

Colon cancer usually starts with a polyp in the large bowel that may bleed, and that blood may not be visible in your stools. The screening test in BC is the FIT (fecal immunochemical test) requiring a tiny amount of stool. It is recommended for all adults over age 50 every two to three years until the age of 70. In other provinces and countries, colonoscopies are publicly funded as screening tests every 10 years. 

6. When should a man start screening for prostate cancer? 

As men age, testosterone stimulates the growth of the prostate gland that sits at the neck of the bladder. With benign enlargement of the prostate, most men will notice a gradual reduction of the urine stream, incomplete bladder emptying and dribbling after they think they’re done. 

If peeing from a dock were an Olympic sport, the world record for an 80 year old would not be more than a few inches. 

Men over 50 should have a discussion with their family physician about their prostate health and ask about a digital rectal exam. Don’t expect a high-tech noninvasive scan. Digital refers to your doctor’s lubed gloved finger. Don’t ask for a second opinion, or your doctor may use two fingers. The PSA blood test is not covered by MSP as a screening test. However, this approximately $40 lab test may detect prostate cancer before it can be felt by a digital rectal exam. Men should discuss the value of this test with their personal physicians. 

All screening tests are intended for individuals who have no symptoms and are at average risk for these conditions. A family history of breast, prostate or colon cancer can put you at a higher risk, and screening is recommended at earlier ages than for the general population. 

If a woman has breast pain or feels a lump, she should see her physician immediately as an expedited diagnostic mammogram may be the more appropriate investigation after a physical examination. If you see blood in your stool, consistent changes in the shape of your stools or persistent changes in your pattern of bowel movements, you should see your physician for a physical examination and possibly an expedited colonoscopy.

If you’re not sure if a new symptom warrants a visit to the doctor or you don’t know which screening tests you or your loved ones need, on Thursday, February 29^th, 2024, I’ll be giving a free online talk from 7 to 8:30 pm. The topic: Making Sense of Symptoms and Screening Tests. I’ll review the screening tests recommended based on gender and age and how to determine which symptoms are normal and when you should see your doctor. It’s part of the Burnaby Division of Family Practice’s Empowering Patients health education program. To register, email Leona at lcullen@burnabydivision.ca, call (604) 259-4450 or use this link:  https://us06web.zoom.us/webinar/register/WN_Gk_DFYHmQU2iYoZ3VTt01g#/registration

Finding True Love by Redefining It

by Davidicus Wong, MD

We are all a part of the Love Cycle

60% of our bodies is water. It’s in each of our cells and in our circulation, but we don’t own that water. We consume it in our food and drink, we lose it through perspiration and elimination. 

In school, we studied the Water Cycle. Water evaporates, condenses into clouds, precipitates as snow or rain, freezes, thaws, flows into rivers, lakes and oceans, continuously cycling around the globe. It belongs to no one. It belongs to everyone.

I see ourselves as vessels of love and we are part of the Love Cycle. We receive love from many people throughout our lives – friends, family, teachers, coaches – and it comes in many forms including the random kindness of strangers; those who have come in and out of our lives; from those who have helped and inspired the people who would later help and inspire us; from those who have worked in big and small ways, with or without recognition to create the best of our institutions, clean water, electricity, our roads and bridges, the infrastructure we rely upon each day. 

It doesn’t always come unconditionally – it comes in many imperfect and human forms because we are imperfect and human, but still we receive love from infinite sources. 

Love is not a finite resource. It is in us to give, and the giving of love does not diminish us but connects us and makes us stronger.

Why are we here? What is the point? Where is the meaning?

To be born; to learn and to forget; to grow and to age; to see, to want, to crave, to pursue, to gain and to lose all we gain; to care, to worry, to suffer, to regret and not to care; to grow ill and to die?

There is one answer for each question. Why are we here? What is the point? Where is the meaning?

To learn to love. To love and be loved.

But we are confused by love. 

It can be an idea (that consumes our thoughts and preoccupies our minds); an emotion (that carries us away), or a spiritual experience (THE spiritual experience: the experience of the spirit and the discovery of your true self).

Love the idea or thought can be a concept, obsession or preoccupation. Everyone has a different idea of what love is and we forget that others, including those we love, may have vastly different ideas of just what love is, and our ideas about love can change with experience; they can expand or contract.

Love is also an emotion or a variety of emotions. It can be warm and fuzzy; faithful, full and abiding; passionate and possessive; wanting and craving.

But the big L Love is THE spiritual experience – the experience of the spirit; of our deeper, greater self; and of our deepest connection to another. This is the experience of your true self and the true self of another. This is the real thing. This is authentic love: metta, compassion, lovingkindness, lovingawareness, agape. 

This is why we are here. 

This is the point of it all. 

This is the meaning of life.

Without Love, we see ourselves as separate and competing in a win-lose world; what benefits others does not benefit you; to give to others takes away from you; to give strength to others diminishes you; we are always incomplete and searching.

Without Love, we pursue counterfeit happiness: the illusion of perfection, having everything we want; the delusion of permanence, the futile search for lasting satisfaction.

Without Love, all is ultimately empty, and we remain alone.

With Love, all is clear. Everything makes sense.

We see ourselves clearly. We see others as they are. The world and life start to make sense.

Without judgment, with understanding and compassion, with complete acceptance, with hope but without expectation, we see beauty in another, in our lives and in ourselves. 

We see our lives and every relationship as a gift.

Love creates a “new math”. Don’t use an economic model in your relationships. An accountant would tell you to give if you get a good return on your investment . . . or a tax credit. 

Money is the currency of economics. Love is the currency of relationships.

You no longer need to keep track. The more you give, the more you get. The less you keep, the more you are free. You give more than you get and you don’t keep track. You win by giving all you have; the winner gives it all. 

Being empty of self, you live fully.

At the end of each day and at the end of this life, you don’t want to regret not giving enough or loving enough. It is like leaving Denmark having spent your last Chrona because it is worth nothing when you leave. 

Life is lived fully by loving without limit, by giving all you’ve got and holding nothing back.

To experience Love is to awaken; to express Love is to be fully alive.

We can express love as we serve others: through our intention to do good (and not to harm), to be open to the suffering and the needs of another, and to help where we can; to seize each and every opportunity to make a positive difference; to share our own gifts; to see beauty in another, and bring out the best in them.

Love lifts us up. Our families can open us to connecting, letting go of self-interests and learning to love unconditionally. Loving my children has made me a better person. The love of my parents (who loved all that I was) brought out the best in me.

What I want most for those I love is that they each love themselves the way I love them: that they accept themselves and their lives just as they are, forgive themselves, let go of what they do not need, let go of what holds them back, see the beauty that I see in them, and share their gifts with the world.

Loving your life as it has unfolded is a challenge. There are events and experiences that are unpleasant, regretful and overwhelming: misfortune and trauma, negative situations, difficult relationships, harm we have experienced, harm that we have done, missed opportunities, words left unsaid and acts left undone.

To turn away, hide or fight against our nature and the reality of our world is to give greater power to the very things we push away. They continue to hold us back from fully loving, fully living and finding our true selves.

We can choose to let go, and we are freed to see more clearly: to see beauty, to love unconditionally ourselves, others and our lives.

We are all human and imperfect but still deserving of love, beautiful and able to love.

What I can do in my thoughts, words and actions to benefit another – or to benefit the world – benefits me.

We are all interconnected in the Cycle of Love. When more of us realize our interdependence and connection with the global community and all life on this planet, we will see the positive evolution of humanity and life on Earth. 

If you’re not sure if a new symptom warrants a visit to the doctor or you don’t know which screening tests you or your loved ones need, on Thursday, February 29^th, 2024, I’ll be giving a free online talk from 7 to 8:30 pm. The topic: Making Sense of Symptoms and Screening Tests. I’ll review the screening tests recommended based on gender and age and how to determine which symptoms are normal and when you should see your doctor. It’s part of the Burnaby Division of Family Practice’s Empowering Patients health education program. To register, email Leona at lcullen@burnabydivision.caor call (604) 259-4450. If you aren’t able to make it to my talk, you’ll find videos and my slides on this and my other sessions on health and wellbeing at https://divisionsbc.ca/burnaby/for-patients/empowering-patients

Dr. Davidicus Wong is a family physician serving the Burnaby community and writing for the Burnaby Now since 1991.

The Lonely Patient’s Guide to Hospital Land: How to Make the Most of Your Hospital Stay

Some day when you least expect it, you may find yourself in a strange place in clothes and a bed that are not yours. 

You see other visitors dressed like you, some with the front of their bodies covered better than their backs. Most of them are lying in similar beds, some with devices attached to their faces, arms and chests. 

Outside your room, you catch a glimpse of the inhabitants of this strange place all dressed the same in blue or green pajama-like outfits. They speak to each other in a different language that sounds a little like English but you don’t recognize many of the words. They are writing on the pages of binders or on computers. You’re not the paranoid type but you have a suspicion that they are talking and writing about you and there is a binder with your name on it. 

No. You’re not in a foreign country, and you haven’t been abducted by aliens.

You are a patient. Welcome to Hospital Land. 

Being a patient in the hospital can be a disorienting experience. The transient confusion or delirium that older patients may experience can be triggered by illness but is certainly exacerbated by being in a completely unfamiliar environment. 

But even younger patients can feel unsettled. You’re not quite sure what you’re allowed to do on your own and where you are free to go. When I was 11 years old, I stayed at Burnaby Hospital for a few weeks with a painful flare up of rheumatoid arthritis. It was at first a stressful experience but the kind care of my nurses and doctors inspired me to work in healthcare one day. 

To make sure you’re prepared for the day you become a hospital patient, here are some tips to maintain your independence and sense of control and get the information you need about your condition and its treatment. 

Like the Lonely Planet guides for travellers, consider this the Lonely Patient’s Guide to Hospital Land. 

Your “Travel” Documents 

You don’t need your passport – just your CareCard or PHN (personal health number) and some essential information. 

I encourage everyone to keep a one-page summary of your medical history. This will be invaluable if you ever have to go to the ER or an urgent care or walk-in clinic. It should include a list of your allergies, chronic conditions such as high blood pressure or diabetes, past illnesses and operations, and your family medical history. 

Bring a list of your medications, including the full name of each drug, the dose (i.e. 325 mg) and the directions (i.e. one tablet twice daily). 

What to Pack 

For comfort: ear plugs, music with earphones, reading material, word puzzles, an eye mask for sleeping, a toothbrush and toothpaste, warm socks, non-slip slippers and a sweater.

To keep you oriented: a calendar and a quiet, inexpensive clock. 

For communication: a pad of paper, pens, and if you need them, your glasses, hearing aids and teeth. 

What NOT to bring: expensive jewellery or electronic devices, wallets, purses, credit cards, your nicest clothes and shoes or other prized possessions. 

Don’t bother with perfume or cologne. Your neighbours may have allergies and respiratory problems, and you’re more likely to pick up an infection rather than your future romantic partner. 

Three Keys to a Better Hospital Stay 

1. Stay informed and in control. 

There are four things you need to know about every procedure or treatment (including surgery, medications and investigations): a. the purpose or reason for the procedure or treatment; b. common side effects or risks; c. serious side effects or risks; and d. alternatives or other treatment choices. 

2. Know your team. 

When they are all dressed in scrubs and lab coats, all health professionals and support staff look alike. Ask for each person’s name and role (e.g. nurse, respiratory technician, dietitian, physiotherapist, speech language therapist or specialty – family physician, hospitalist, surgeon or internist). 

Most importantly, ask who your attending or most responsible physician is. This is the quarterback who is overseeing your care in the hospital. 

Take a look at your wrist band now that you know you’re not vacationing at an all-inclusive resort. It usually has the name of your attending physician. This is the person to whom you should direct your questions. 

3. Set up a channel for communication. 

Prepare your list of questions. Key questions to ask your attending physician: What is the plan? What is the working diagnosis? What is the schedule of tests or procedures? What are the results of those tests? When is your expected date of discharge? 

This information could be shared on a white board in your room or a large pad of paper at your bedside. If you have a family physician, make sure he or she knows you are in hospital and that reports are sent to that office. He or she can provide important medical information to your hospital care team.

In an upcoming column, I’ll talk about advance medical directives including the MOST form used in all our hospitals to indicate what procedures and level of care you want and those you don’t want.

On Thursday, January 18^th, 2024, I’ll be giving a free online talk from 7 to 8:30 pm. The topic: The Lonely Patient’s Guide to Hospital Land: Making the Most of Your Hospital Visit. It’s part of the Burnaby Division of Family Practice’s Empowering Patients health education program. To register, email Leona at lcullen@burnabydivision.ca or call (604) 259-4450. If you aren’t able to make it to my talk, you’ll find videos and my slides on this and my other sessions on health and wellbeing at https://divisionsbc.ca/burnaby/for-patients/empowering-patients

Here’s a YouTube preview of what I’ll be covering:

A New Year Revolution Begins with Reflection on the Year Past

Davidicus Wong, MD January 1^st, 2024

A traditional annual ritual is our review our family calendar of events at the end of each year.

With each Christmas, my wife will find in her stocking the kitchen desk calendar in which every family member will record (in advance) our daily and weekly activities. I learned early in marriage that if it hasn’t been written in the family calendar a dinner, talk or other event has not officially been acknowledged. 

It was a great way to coordinate the activities of a busy family.

But before, we put away the past year’s calendar, we take the time to review it together with appreciation and reflection.

Although the year seems to have passed so quickly, when we recall holidays, birthdays and other special events celebrated together they seem to have happened long ago and we’re amazed how much we did in just one year. 

Together we reflect back on personal and family achievements – successfully completing another year of school, what my wife has accomplished with her kindergarten students and the patients I have assisted in my practice. We appreciate the challenges we navigated, what we have survived together and what we have learned.

A New Year comes with new promise – and promises we make to ourselves, often in the form of new activities and habits we’d like to try out or establish. 

I usually ask myself four questions.

1. What activities should I do more often in the New Year? What should I continue?

2. What activities should I do less often? What things should I reduce?

3. What activities should I stop? These take time, energy and attention but are neither necessary nor add value.

4. What can I create? What new activities will bring more value and enjoyment to my life?

We often identify resolutions – personal commitments to healthier new habits – or the elimination of old unhealthy ones, but when we frame our resolutions in the negative, we need to articulate positive alternatives.

I don’t recommend we start with a to do or self-improvement list. We all have someone in our lives who would be happy to provide a short or long list. If you need further suggestions, your family doctor would be happy to help. 

Goals should be consistent with your most important values and these should be considered from your long view – beyond even the span of one year. 

Consider starting with your mindset – the perspective with which we think of ourselves, our relationships and our world.

This doesn’t have to be a full-blown identity crisis. It’s just an honest assessment of the attitudes we bring to life. What approaches are not working so well? Can we consider more positive points of view?

I call this a New Year’s revolution. This is not a wholesale trashing of the status quo but an iterative cyclic review not unlike how scientists expand or revise their theories to accommodate new information and things that just don’t fit with our outdated narratives – the stories we tell ourselves.

Here are just a few provocative perspectives to fuel your potential New Year’s revolution.

1. The growth mindset (as opposed to the fixed mindset). If we believe our potential (our talent, skills and intelligence are fixed, we limit our personal growth. If we recognized that we are always learning and growing from experience, we’re more open to new experiences and willing to challenge ourselves to discover our undiscovered potentials.

2. Are you playing the traditional win-lose game at work, in school or in your relationships? The alternative is the infinite game, popularized by Simon Sinek. With this mindset, the point of the game is to keep the game going and not compete to be the sole winner. We lift each other up and work and play in ways that benefit whole of which we are an integral part.

3. Are you just one separate individual competing with all others in the rat race of life with the goal of gaining the most points in status, money or material things that no one gets to keep at the end of the race of life?. The alternative is recognizing that we are all connected and interdependent. Living my own life, raising a family with my wife, seeing my children grow up, losing my mother and supporting my patients through the evolution of their relationships and the vicissitudes of human life, I’ve come to recognize that we are all a part of the cycle of love. We receive love in many forms from innumerable benefactors, including family members, teachers, coaches, friends, neighbours and many others whom we will never know or be able to thank. We learn to accept love in all its human and imperfect forms, learn to love ourselves and learn to give that love forward to others.

Dr. Davidicus Wong is a family physician serving the Burnaby community and writing for the Burnaby Now since 1991. For more on achieving your positive potential for health, check his blog at davidicuswong.wordpress.com

Sunset off Waikiki Beach, Honolulu, Hawaii

Davidicus Wong

Four Mindsets for Happier Holidays

by Davidicus Wong, MD

Until my mother-in-law passed away last year, one of our family traditions was to have an advent dinner on the four Sundays leading up to Christmas. She would lead the readings and the lighting of the advent candles each week dedicated to a particular theme: hope, love, peace and joy. 

Finally, she would coax the unwilling group to sing a Christmas carol. It sounded bad. Really bad. Like karaoke without music loud enough to cover up the chorus of out of tune voices singing in different keys. Before we could finish, many of us would break down in laughter. 

One year, my niece brought a boyfriend to an advent dinner but begged for no singing. We sang anyway. They broke up, and she went on to marry a man who accepted that tone deafness can be hereditary. 

The holidays can be a stressful and unhappy time of the year for many other reasons. We can get caught up in big expectations, the busyness and cost of shopping, and even family conflicts.

To prepare for the season, we would all do well to reconnect to a healthier perspective of who we are in relation to one another. 

It is no coincidence that the four brahma viharas (or four divine abodes) of mindfulness practice for cultivating positive qualities of mind and heart are love, compassion, peace and joy. 

You will discover the same themes in all the great religions – which all agree on a deeper, esoteric level. It’s on the details of dogma that they differ.

In the centre of Michelangelo’s masterpiece on the ceiling of the Sistine Chapel is the image of God reaching out to touch the hand of Adam. Adam looks as unenthusiastic as our family advent singers while God seems to be making the bigger effort. 

Unless you’ve studied neuroanatomy, you may not recognize that the image of God is riding on the outline of the corpus collosum – the structure that connects the two hemispheres of the human brain.

We recognize that there are two ways of thinking about ourselves and the world, each associated with the functions of the two cerebral hemispheres.

The left hemisphere is associated with conceptual dualistic thinking. This is how we make sense of the world. We label and categorize everything. We make judgments. We set goals and get frustrated when we don’t achieve them. We create mental models or stories about the world, ourselves and our relationship with others, but our stories are just approximations of reality and they can limit our perception of others. Our thoughts can foster anxiety, sadness, anger and resentment. This conceptual dualistic way of thinking creates the illusory concept of your separate smaller self.

This conceptual way of thinking about ourselves and the world is where we function most of the day – at work, in school and at home. It can be the source of much of our misery at this time of the year.

The right hemisphere has been associated with a holistic, connected and mindful way of living in and seeing our world. It fosters the perspectives or mindsets of equanimity (peace and acceptance), compassion, unconditional love and joy. 

Both ways of thinking – the conceptual and the holistic – have been essential for human survival. The conceptual way of thinking helps detect danger, protect ourselves and plan for the future – but can make us miserable. The holistic, connected way of thinking encourages cooperation and human connection – and fosters greater happiness.

During this season, when you are feeling stressed, isolated or disappointed, let these feelings be a prompt to reconnect with the four healthy mindsets:

1. Peace or equanimity. Accept all that is rather than hoping that reality can be any different than it is. Be grateful for what you have today – the measure of health that you have at this moment and the people in your life today. 

2. Unconditional love. Everyone wants to be happy and everyone truly believes that they are right. We all live according to our own conscious and unconscious life stories. None of us is perfect but everyone deserves and needs to feel loved.

3. Compassion. Suffering is a part of every life, but there is always someone else who is in need of your help and compassion. What can you do today to make someone else’s day? Remember to practice self-compassion. The judging left brain can be very hard on ourselves.

4. Joy. The only time that you can be fully alive and happy is in the present moment. Enjoy what you can experience with the people in your life this day and recognize that our expanded connected selves can lift us up from the limitations of our smaller self-told stories.

There may be a thrill with a perfect present but it doesn’t match the joy of authentic presence.

Wishing all of my readers, peace, love and joy this season and always.

On Thursday, December 7^th, 2023, I’ll be giving a free online talk from 7 to 8:30 pm. The topic: The Positive Potential of Your Relationships. I’ll discuss how healthy relationship and social connections are essential to your happiness and wellbeing; the qualities of healthy relationships; recognizing and managing challenges, and how we can foster a sense of belonging and connectedness in our community. It’s part of the Burnaby Division of Family Practice’s Empowering Patients health education program. To register, email Leona at lcullen@burnabydivision.ca or call (604) 259-4450. If you aren’t able to make it to my talk, you’ll find videos and my slides on this and my other sessions on health and wellbeing at https://divisionsbc.ca/burnaby/for-patients/empowering-patients

Be Your Own Best Friend

Throughout her elementary school years, my daughter had a friend who was really a frenemy though she couldn’t see it at the time.

They would do all the same after school activities and of course, they were in the same classrooms in every grade.

Her friend would talk about her behind her back, put her down and sabotage her work.

It wasn’t until high school when she met new friends who appreciated her sweetness but didn’t take advantage of her that she let that frenemy drift into the background of her shifting social circle.

Most of us remain intimately connected with the frenemy of our youth even into adulthood. That false friend puts you down, diminishes your accomplishments and sets you up for failure. He or she reminds you of your painful past and makes you feel bad and small.

That frenemy of course is you.

A key to happiness is to BYOBF (and I don’t mean bring your own boyfriend).

Be your own best friend.

Think about your best friends. Though you may have met when you were both much younger, you’ve grown up and grown old together. Though you may now live in different cities or even different countries, you can call or text at any time and catch up where you left out.

Your best friend knows the authentic you, sees the best in you, accepts the worse and tells you what you need to know even when you’re not ready to hear it.

We carry throughout our lives both our inner frenemy and our best friend. The frenemy resides in the critical left hemisphere of your brain. It narrates a narrowed self-story. It is always comparing and finding fault in you and in your situation. It focuses on the superficial – status and appearances.

The frenemy within puts you down, tells you that you are too skinny or too heavy, too young or too old. It exaggerates the minor imperfections that make us unique and human and tells you that you are ugly. In the eyes of your frenemy, you are never good enough.

Your frenemy talks to you with words that a good parent would never say to a child. In fact, you may be saying things to yourself you would never dare to say to any other person.

I see the most caring mothers who look after everyone else in their family – ensuring they are getting enough sleep, eating well, engaged in healthy physical activities and feeling loved and supported. These same moms don’t look after themselves or treat themselves with the same loving attention – as if they thought they did not deserve this.

I remind them that they know how to be great mothers and all they need to do is to be good mothers to themselves. They deserve that same loving attention.

Whenever you are feeling bad or small, question the voice speaking to you.

Is it the voice of your inner frenemy?

Answer it with the best friend within. It resides in the right cerebral hemisphere with qualities we can foster with mindfulness: equanimity (acceptance), compassion, unconditional love and joy.

Listen to the voice of your best friend.

You are good enough and beautiful just the way you are. You are loved.

Live your best life and be your best self right now.

The frenemy within is stuck in the past and old narrowed narratives. The expansive inner best friend sees your real connected self. You are a part of a greater whole. You bring to this life unique talents and qualities. The discovery and engagement of these qualities in the living of your life is your gift to the world.

Every one of us has the potential each day to make the world a better place.

Healthcare is Self-Care

Everyone is welcome to my next public health talk on

the Four Foundations of Self-Care

My next public health talk will be by Zoom from 7 to 8:30 pm on Thursday, October 19th, 2023.

Though we usually think of healthcare as the services of healthcare professionals, 90% of your healthcare is the care you give yourself.

One of the best predictors of your future health is what you do every day.

I will provide practical suggestions addressing the four foundations of self-care:

What you eat (what you put into your body)

What you do (physical activity and rest)

How you feel (emotional wellbeing)

How you connect (healthy relationships)

He will offer practical tips to create healthy new habits and sustain positive changes in your life.

For more information, contact Leona at lcullen@burnabydivision.ca or call (604) 259-4450 or check out the Burnaby Division of Family Practice’s Empowering Patients webpage: https://divisionsbc.ca/burnaby/for-patients/empowering-patients

To register online: https://us06web.zoom.us/webinar/register/WN_0az0pTZdTviZnfyvKXluSA#/registration

#publichealtheducation #healthyeating #physicalactivity #emotionalhealth #wellbeing #health #empoweringpatients #burnabydivisionoffamilypractice #relationships #healthyrelationships

How Confidential Are Your Medical Records?

In the age of connected computers, just how confidential are your medical records?

Confidentiality is a cornerstone principle of medical ethics and it applies to every healthcare encounter in any clinic or hospital. 

For example, does a mother have a right to know that her teenage daughter had a doctor’s appointment and what was discussed? When celebrities are admitted to the hospital, since any healthcare provider unrelated to their care has access to the records, what keeps them from peaking? 

The assurance of confidentiality is essential for trust in the patient-doctor relationship. Your physician needs to know critical details in order to make the right diagnosis and recommend the most appropriate care. Without confidentiality, you would be reluctant to share personal information you would not want shared with anyone else. 

In nearly every medical office, the old paper file chart has been replaced by the EMR (electronic medical record). Everyone working in your doctor’s office (including other physicians and all staff) have access to your record. However, they are all trained not to access records that they have no business looking at. 

This situation also applies to hospitals where many more staff members have access to your records. We rely on the ethics of healthcare providers but one safeguard is that electronic medical records in private clinics and hospitals are able to track every time someone accesses an individual patient’s chart. 

Outside of the hospital, electronic medical record systems are carefully regulated to prevent your confidential data from being shared with others. The College of Physicians and Surgeons of BC also requires physicians to safeguard the security of their networks to minimize the risk of hacks and other breaches.

Who else has access to your records?

With your written consent, third parties including lawyers, WorkSafe BC, ICBC and other insurance companies may be granted access. I recommend that you read any consent carefully before signing to ensure that it is limited by a specific time period and only those portions of your record relevant to the third parties. 

Other healthcare providers involved in your care will also have limited access to your records. For example, if I refer a patient to a surgeon, along with my detailed referral letter, I will provide a relevant summary of the patient’s medical record including significant past illnesses, operations, allergies and medications. 

There are specific conditions where your confidentiality can be legally breached.

1. A court order. Physicians are compelled by law to provide records if there is a court order.

2. The duty to protect. An example would be a serious risk of harming others or committing suicide. We are also required to report to authorities unsafe drivers, child abuse or neglect and certain sexually transmitted infections. 

3. Minors and others who rely on others to provide informed consent. However, a mature minor who understands their condition and the risks and benefits of a treatment, can consent to that treatment and their confidentiality is respected.

At 7 pm on Thursday, April 13^th, 2023, I’ll be giving a free online talk on What You Should Know About Medical Ethics. I’ll cover the essential information you need to know in order to make informed decisions about your own health, how to ensure your wishes are respected if you are not able to speak for yourself and who has access to your confidential medical records

What You Should Know About Lung Disease

What You Should Know About Lung Disease

(presented by Dr. Davidicus Wong)

7 to 8:30 pm Thursday, March 9^th, 2023

In my next free online public health talk in the Burnaby Division of Family Practice’s Empowering Patients program, I’ll be sharing what you need to know about lung and respiratory disease.

• What you should know about the symptoms of asthma, chronic bronchitis and emphysema and how to manage them
• What is the difference between bronchitis and pneumonia, and do you need a pneumonia vaccine?
• Are you at risk for lung cancer and should you be screened?
• Do you nod off during the day after meals, during boring meetings, riding in a car or bus, or sitting on the couch? How to tell if you have sleep apnea

To register for this free talk: https://us06web.zoom.us/webinar/register/WN_fRaNoTWPQyyAPP4WvRGrbA

For questions or alternate registration details, email Leona at lcullen@burnabydivision.ca or call (604) 259-4450.

For access to all Empowering Patients program material, including slides, key points handouts and videos, go to https://divisionsbc.ca/burnaby/for-patients/empowering-patients

In case you missed them, you can find the videos and key information on my recent talks including:

What You Should Know About Heart Disease

Emotional Wellbeing

The Keys to Positive Change

With a fresh new year, our community centres are expecting an influx of new patrons. Lanes in the pools and stations in the gym are filled with the enthusiasm of New Year’s resolutions – to shed a few winter pounds and get back into shape. 

Are you inspired to start 2023 with a resolution? 

Or does your personal experience confirm the stats that over 90% of resolutions fail by the end of the month?

As a family physician supporting thousands of patients towards their personal goals, I’ve learned the pitfalls and pearls of supporting positive change. 

1.Choose wisely and start with why.

I learned early in practice that patients seldom follow “doctor’s orders.” 

They would politely agree to exercise more, consume less saturated fat, quit smoking or reduce their drinking, but three months later, few would have been successful. I soon learned that every patient must choose a goal that really matters to their priorities.

To sustain your motivation in well beyond the first month, your goal has to matter to you personally. 

Start with a reflection on the important areas of your life – family and social life, work and play, financial wellbeing and spiritual health, physical and emotional health. You might recognize some areas that have faded into the background over the past year while your attention was focused on the demands in one particular area. 

Once you’ve chosen your general goal, ask yourself, “Why?” 

Your goal must resonate with your most important values (e.g. family values, community, self-respect, your personal mission). 

For example, I want to get into a regular exercise routine because it will improve my mental and physical wellbeing and allow me to be more present in my relationships at home and at work. 

2.Fine tune your goal.

Most people choose goals that are too general and too grand.

To get back in shape or eat better are non-specific goals that can be hard to put into practice. 

To go from no exercise to running 10 km next month would be too ambitious and easily lead to procrastination, exhaustion, early injury and quitting. 

Scale down a mountain of a goal to an achievable mole hill. This will guarantee early success and fuel your confidence to set incremental weekly goals that will steadily bring you closer to your greater goals. 

Instead of running 30 minutes every day, you might choose to start with walking 5 minutes and lightly jogging 1 minute every other day for the first week. 

3.Write down your goal and share it with others.

Putting on paper the details of your goal will increase your odds of success.

So will sharing it with at least one other person. It makes us responsible to more than ourselves. 

Use the SMARTEST goals acronym. 

Make your goal Specific (What activity will you start? When? Where?).

Make it Measurable (How far or how long?).

Make it Achievable (Be confident that you can achieve that first mole hill of a goal. It’s just the first step.).

Make it Relevant (Connected to an important area of your life and your values).

What is your Time Frame (When will you start? When will you finish?).

Evaluate after the first week (How did you do? What did you learn?). Make it Enjoyable (Make it fun by doing it with someone you like to be with and linking it to a healthy reward).

Stepping Forward (What will you do next as a progression to your greater goal? What will you do differently?).

Together (Who can work with you as you move forward in your goals? With whom can you share your success?).

4.Turn lofty resolutions into new tiny habits. In his book, Tiny Habits, psychologist, B.J. Fogg describes three simple steps:

#1 Make the behaviour tiny . . . one easy step towards your goal (i.e. doing one push up);

#2 Hook it to an anchor . . . a routine that you already do automatically (i.e. going to the washroom); and

#3 Celebrate immediately (i.e. give yourself a thumbs up, applause, or say to yourself, “Nailed it!”). This may sound silly but it really works by releasing the feel good neurotransmitter, dopamine.

Within 10 days, you will have established a new habit, likely be doing more than a single push up and ready to calibrate to a slightly more ambitious goal.

At 7 pm on Thursday, January 12^th, 2023, I’ll be giving a free online talk on Emotional Wellbeing.

I’ll be sharing practical emotional health strategies to manage stress, difficult emotions and negative thoughts and important resources on emotional health and mental illness.

It’s part of the Burnaby Division of Family Practice’s Empowering Patients public health program. For more information: https://divisionsbc.ca/burnaby/for-patients/empowering-patients or contact Leona at lcullen@burnabydivision.ca or call (604) 259-4450.