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General Internal Medicine La Revue Canadienne De Médecine Interne Générale Volume 10, Issue 4 • 2015 Canadian Journal of General Internal Medicine La Revue Canadienne De Médecine Interne Générale Publications Agreement Number 40025049 | 1911-1606 An Internist’s Journey with Behavioural Medicine Goldberg An Approach to “The Social Admission” ANDREW AND POWELL www.csim.ca Canadian Journal of General Internal Medicine Volume 10, Issue 4 • 2015 Publications Agreement Number 40025049 EDITOR-IN-CHIEF Mitchell Levine SENIOR ASSOCIATE EDITOR Peter Brindley Volume 10, Issue 4 • 2015 J UNIOR ASSOCIATE EDITOR CONTENTS Ben Wilson Message from the Editor-in-Chief/ 39 A Suspected Case of Endoscopic Ultra- RESIDENTS' VIEW EDITOR Andrew Appleton Message du rédacteur en chef sound Induced Pancreatitis, Without Fine Needle Aspirate EDITOR EMERITUS 4 Understanding the Biomedical - Hector Baillie Michael John Abunassar BSc, BA, MD, Loree Boyle, BN, Behavioural Continuum MD, Avijit Chaterjee, MSc, MDCM EDITORIAL BOARD Mitch Levine Ranjani Aiyar, Simona Bar, Hershl Berman, Peter Brindley, Kaberi Dasgupta, Don Echenberg, Donald Farquhar, 42 Spontaneous Four Limb Compartment Bert Govig, Luc Lanthier, Alex Leung, Suzanne Morin, 5 Pour une meilleure compréhension du Jock Murray, Kathryn Myers, Glen Pearson, Louise Pilote, Syndrome Linda Snell, Matthieu Touchette, Ben Wilson, continuum des volets biomédical et Giovanna Riolo MD, Danny Aurora MD, David Taylor MD, George Veenhuyzen comportemental Gavin CA Wood MBChB CSIM OFFICE Mitch Levine Tel: 613-422-5977; Toll-Free: 1-855-893-2746 45 Diagnostic Approaches: Images in GIM Email: [email protected] Clinical Medicine: Art and Science Acute Infectious Epiglottitis MANAGING EDITOR Jeff Shrum MD and Ben J. Wilson BJ Rose Simpson 6 An Internist’s Journey with Behavioural Medicine ARTDIRECTOR William Goldberg, MD, DSc (Hon), FRCPC, FACP 46 Deep Vein Thrombosis and Amanda Zylstra Pulmonary Embolism as a TRANSLATOR Julie Paradis 10 A Rose By Any Other Name? Complication of Traditional Richard Marlin, PhD Chinese Acupuncture and Cupping ADVERTISING John Birkby; 905-628-4309 ThucNhi T. Dang Bsc, Albert A.C. Yeung MSc, MD [email protected] 13 Seeing Wisely: The Pursuit of Clinical Expertise 50 Submucosal Lesions Presenting with CIRCULATION COORDINATOR Brenda Robinson Ben J. Wilson, MD Rectal Bleeding-Endometriosis in the [email protected] 15 Handover: The Fragile Lines of GI Tract ACCOUNTING Fahd Jowhari, MD, Pearl Behl, MD, PhD and Susan McClung Communication Sean Pritchett, MD, FRCPC GROUP PUBLISHER Andrew Smaggus MD, Adina S. Weinerman MD John D. Birkby 53 A 54 Year Old Female with Fever and _______________________________________ 20 An Approach to “The Social Admission” Melissa K. Andrew, MD, PhD, Ataxia Subscription Rates: Marie-Lie Cadieux-Simard MD, Laurence Green MD Colin Powell, MB, FRCP (Lond, Edin et Glas) __________________________________Per year: $15.00; per issue: $3.75 Canadian Journal of General Internal Medicine is published 23 Acute Care SINS: Surgical Insights for the Proceedings four times a year by Andrew John Publishing Inc., with Non-surgeon Chapter 13: Spine Surgery 55 McMaster University Department offices located at 115 King Street West, Suite 220, Dundas, th ON L9H 1V1. Aaron S. Robichaud MD, David B. Clarke MDCM PhD, of Medicine 26 Annual Residents’ Cian O’Kelly MD, Martin Beed DM, Peter G. Brindley MD We welcome editorial submissions but cannot assume Research Day in Medicine responsibility or commitment for unsolicited material.Any edi- torial material,including photographs that are accepted from Case Reports an unsolicited contributor, will become the property of Andrew John Publishing Inc. 33 Unilateral Adrenal Hemorrhage and the The publisher and the Canadian Society of Internal Medicine Challenge of Early Recognition shall not be liable for any of the views expressed by the Resheed Alkhiari MBBS, Dana Attar MBBS, authors published in Canadian Journal of General Internal Christian Kraeker, MD Medicine,nor shall these opinions necessarily reflect those of the publisher. 36 Severe Acute Cytomegalovirus ••••• Infection Complicated by Disseminated Every effort has been made to ensure that the information provided herein is accurate and in accord with standards Intravascular Coagulation and accepted at the time of printing. However, readers are Pneumonitis in a Healthy Female advised to check the most current product information pro- Zain Chagla MD, Deborah Siegal MD, Phillippe vided by the manufacturer of each drug to verify the recom- El-Helou MD, Wendy Lim MD, Jill Rudkowski, MD mended dose, the method and duration of administration, and contraindications. It is the responsibility of the licensed prescriber to determine the dosages and best treatment for each patient. Neither the publisher nor the editor assumes any liability for any injury and/or damage to persons or property arising from this publication. ABOUT THE COVER Return undeliverable Canadian Addresses to: Photography by Dr. Hector Baillie National Gallery of Canada, Ottawa Overlooking Major’s Hill Park 2013 115 King St W., Suite 220, Dundas, ON L9H 1V1 www.andrewjohnpublishing.com For Instructions to Authors, please visit www.andrewjohnpublishing.com/pcjim.html Canadian Journal of General Internal Medicine Volume 10, Issue 4, 2015 3 CSIMMessage Members from of Council the PresidentMessage from the Editor-in-Chief Dr. Stephen Hwang President | Toronto, ON Understanding the Biomedical - Behavioural Continuum Dr. Benjamin Chen Past President | Napanee, ON Patients referred to internal medicine physicians are often unusual in their clinical Dr. Neil Gibson presentation or have multiple clinical problems and co-morbidities. The complexity Secretary-Treasurer requires that the physician have a strong understanding of both pathophysiology and Western Region Representative | Sturgeon County, AB the behavioural sciences. The further challenge is knowing how to balance both of these Dr. Amy Hendricks Western Region Representative | Yellowknife, NT disciplines when managing difficult clinical presentations. In the current issue of the Dr. David Simpson Canadian Journal of General Internal Medicine there are three articles that highlight Eastern Region Representative | Halifax, NS this dilemma. Dr. Nadine Lahoud Quebec Region Representative | LaSalle, QC In the Goldberg and the Marlin articles, we are presented with the risks of over Dr. Donald Echenberg medicalizing patient symptoms with the subsequent peril of not helping the patient Chair, CPD Subcommittee to recover and eventually regaining function and quality of life. It is critical for the Quebec Region Representative | Sherbrooke, QC clinician to recognize that invoking a biomedical model as the foundation for a Dr. Bert Govig Quebec Region Representative patient’s presentation (e.g., symptoms, illness, disability) is not always appropriate nor Vice-President, Health Promotion Committee | Amos, QC beneficial. Rather in some circumstances, after acknowledging the patient’s suffering Dr. Tom Maniatis and loss, the physician needs to adopt or integrate a behavioural model of illness in 2016 Chair, Annual Meeting Committee Quebec Region Representative | Montreal, QC order to develop the optimal management strategy and to facilitate patient recovery. Dr. William Coke In the Andrew and Powell article we are advised of the importance of not ignoring Ontario Region Representative | Toronto, ON the biomedical contributions to what might appear to be a failure of the patient’s social Dr. Céline Léger-Nolet Ontario Region Representative | New Liskeard, ON support environment. The determinants of the “social admission” are multifactorial Dr. Stephen Duke and clearly involve many aspects of the patient’s environment, from family and friends, Eastern Region Representative | Dartmouth, NS to institutions and societal policies. But often the tipping point for failure includes Dr. Ameen Patel an important contribution arising from a biomedical problem, which studies have Ontario Region Representative | Hamilton, ON suggested are commonly overlooked. Dr. John MacFadyen Ontario Region Representative | Orillia, ON With the Goldberg and Marlin articles in this issue emphasizing the relative Dr. Maria Bacchus importance of one end of the biomedical-behavioural spectrum, and the Andrew and Western Region Representative | Calgary, AB Powell article emphasizing the other end, the message might be confusing. But the Dr. Glen Drobot goal of presenting these articles together was to communicate the need for physicians Western Region Representative | Winnipeg MB to consider in all new patient encounters the potential for both biomedical and Dr. Meghan Ho Resident Representative | Vancouver, BC behavioural components underpinning the patient’s presentation, and that a skilled Dr. Michel Sauvé and knowledgeable internist will be able to provide the appropriate balance to best Representative to the CMA Council Member-at-Large | Fort McMurray, AB manage the patient’s concerns. Other CSIM Positions Mitch Levine Dr. Pearl Behl Vice-President, Membership Affairs | Markham, ON Dr. Irfan Dhalla Vice-President, Research and Awards Committee | Toronto, ON Dr. Jim Nishikawa Vice-President, Education Committee Representative on the RCPSC Specialty Committee in Internal Medicine and to the GIM Subspecialty Committee | Ottawa, ON Dr. Mitch Levine CJGIM Editor-in-Chief l Hamilton, ON 4 Volume 10, Issue 4, 2015 Canadian Journal of General Internal Medicine Message du rédacteur en chef CSIM Mission Statement Mission Statement The CSIM is a non-profit professional
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