June 2021: 63:5 Elective surgery Pages 193–228 without COVID-19 testing will lead to excess morbidity and mortality IN THIS ISSUE Delay in diagnosis and management of adolescent ACL injuries in patients with lower socioeconomic status Impacts of the COVID-19 pandemic on the health and well-being of young adults Obesity as chronic disease Dr Jenn Tranmer: Proust questionnaire bcmj.org June 2021 Volume 63 | No. 5 Pages 193–228 Emergency preparedness project in Kamloops. From left: Rhonda Eden, Graham Dodd, and Colin Swan. Article begins on page 220. The BCMJ is published by Doctors of BC. The journal n provides peer-reviewed clinical and review articles 196 Editorials Re: On the nature of being a written primarily by BC physicians, for BC physicians, professional, Brian S. Pound, MBBS along with debate on medicine and medical politics in Rights and freedoms n editorials, letters, and essays; BC medical news; career David R. Richardson, MD Re: Managing vulnerable patients and CME listings; physician profiles; and regular columns. Roger Seldon, MBChB, MD Restrictions on private health n Print: The BCMJ is distributed monthly, Authors reply, Jennifer Laidlaw, MD, other than in January and August. insurance, Brian Day, MB Leanne Lange, MPA, Web: Each issue is available at www.bcmj.org. 198 Letters Erin Henthorne, MSW Subscribe to print: Email [email protected]. n Single issue: $8.00 Compliments to the artist Canada per year: $60.00 200 President’s Comment Foreign (surface mail): $75.00 Paul Thiessen, MD n Keeping you informed Subscribe to notifications: Value of family physicians To receive the table of contents by email, visit Robert H. Brown, MD during negotiations www.bcmj.org and click on “Free e-subscription.” n Re: Lost art of physical examination Matthew C. Chow, MD Prospective authors: Consult the “Guidelines for Authors” at www.bcmj.org Neil Finnie, MD n for submission requirements. Re: The gender pay gap in medicine Brenda Hardie, MD Rita McCracken, MD ONC THE OVER Editor Managing editor Proofreader Printing Elective surgery without COVID-19 David R. Richardson, MD Jay Draper Ruth Wilson Mitchell Press testing will lead to excess Editorial Board Associate editor Web and social media Advertising morbidity and mortality Jeevyn Chahal, MD Joanne Jablkowski coordinator Tara Lyon Assuming 37 000 planned surgeries David B. Chapman, MBChB Amy Haagsma 604 638-2815 are conducted per week in Canada Editorial and production Brian Day, MB [email protected] (excluding Quebec), and the prevalence coordinator Cover concept and Caitlin Dunne, MD of COVID-19 infection cases is 0.20%, the Tara Lyon art direction, Jerry Wong, ISSN: 0007-0556 David J. Esler, MD number of avoidable deaths that could Peaceful Warrior Arts Established 1959 Yvonne Sin, MD Copy editor occur is estimated to be 11.7 but could Cynthia Verchere, MD Tracey D. Hooper Design and production exceed 17.0. Article begins on page 208. Laura Redmond, Scout Creative 194 BC MEDICAL JOURNAL VOL. 63 NO. 5 | JUNE 2021 ELECTIVE SURGERY WITHOUT COVID-19 TESTING 201 News WILL LEAD TO EXCESS MORBIDITY AND MORTALITY n Book review: Dreamers, Skeptics, and Healers: The story of BC’s medical school We are not routinely testing patients for COVID-19 prior to surgery. n There are known morbidity and mortality dangers What is critical illness insurance? n to performing surgery on infected people. Grant to offset costs of recruiting into team-based care practices n Preventing symptom escalation among mild COVID-19 patients 204 BCMD2B 0.20% 77% Assumed active Risk of operating on at least Clicks, tweets, and likes case prevalence 1 person with COVID-19 Faizan Bhatia, MD, Arman for every 500 surgeries Mojtabavi, BSc, Azim Ahmed, BSc, As well as increased risk to patients, operating on COVID-19 patients risks transmission to hospital staff. Vishal Varshney, MD, Alana M. The authors recommend mandatory preoperative COVID-19 testing for planned operations. Flexman, MD TheA.A. authors Karimuddin, argue thatJ.M. Sutherland,patients should S.M. Wiseman be tested for COVID-19 prior to planned operations to prevent avoidable surgical 207 WorkSafeBC complicationsBCMJ 2021;63:208-210 and mortality. Article begins on page 208. Workers Compensation Act amended to include COVID-19 Michelle Vukelic 217 BCCDC 220 Shared Care CLINICAL Last in line: Impacts of the Emergency preparedness project COVID-19 pandemic on the health rises to the challenge with pandemic 208 Elective surgery without and well-being of young adults in response, Graham Dodd, MD COVID-19 testing will lead BC, Hasina Samji, PhD, Naomi 221 CME Calendar to excess morbidity and Dove, MD, Megan Ames, PhD, Meridith Sones, MPH, Bonnie mortality, Ahmer A. Karimuddin, Obituaries Leadbeater, PhD 222 MD, Jason M. Sutherland, PhD, Dr Robert Lachlan MacLeod Coupe Sam M. Wiseman, MD 218 College Library 223 Classifieds 211 Delay in diagnosis and Hidden gems on the bookshelves Karen MacDonell management of adolescent 226 Proust anterior cruciate ligament 219 Council on Health Promotion Dr Jen Tranmer injuries in patients with lower Obesity as chronic disease socioeconomic status Ilona Hale, MD, Priya Manjoo, MD Lise Leveille, MD, Tessa Ladner, BSc, Christopher Reilly, MD Environmental impact Postage paid at Vancouver, BC. Canadian Publications Mail, Product Sales Agreement #40841036. Return undeliverable copies The BCMJ seeks to minimize its negative impact on the to BC Medical Journal, 115–1665 West Broadway, Vancouver, BC V6J 5A4; tel: 604 638-2815; email: [email protected]. environment by: Advertisements and enclosures carry no endorsement of Doctors of BC or BCMJ. • Supporting members who wish to read online with an e-subscription to bcmj.org © British Columbia Medical Journal, 2021. All rights reserved. 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Doctors of BC does not assume responsibility or liability for damages arising from errors or omis- • Using FSC-certified paper sions, or from the use of information or advice contained in the BCMJ. • Printing locally in British Columbia The BCMJ reserves the right to refuse advertising. BC MEDICAL JOURNAL VOL. 63 NO. 5 | JUNE 2021 195 EDITORIALS Rights and freedoms 4 May 2021 am writing this editorial as the provincial the powers that be made travel restrictions more receive increasingly suspicious glances thrown government just announced sweeping re- stringent with the threat of roadblocks and in my direction as the belief grows that maybe strictions preventing British Columbians fines. Tourism providers have been asked to I am part of “they.” Ifrom moving between three defined regions. cancel and refund customers who are from out- A quick evaluation of our elected officials Stuck between a rock and a hard place, the side their regions. All recreational vehicles have should be enough to doubt the government government made this difficult decision due to been banned on BC Ferries. conspiracy idea. In addition, if you have ever rising COVID-19 case numbers with hospi- As soon as these re- had to deal with any talizations and ICU admission levels reaching strictions were announced, government body, you’ll all-time pandemic highs. Despite pleas from angry comments began Despite pleas from recognize that the level our provincial health officer, people contin- to appear on social me- our provincial health of organization required ue to travel and are propagating viral spread dia about infringement of officer, people to form a secret agency through their actions, albeit often unknowingly. our basic rights and free- continue to travel seems an unobtainable Pandemic fatigue has led to the population doms. I even had some pa- goal. Furthermore, I am and are propagating craving some degree of normalcy and perhaps tients complain that this pretty sure Bill Gates has reducing their commitment to follow provin- was just another way that viral spread through enough money and access cial guidelines. “they” were trying to con- their actions, albeit without monitoring or re- Worried that this third viral wave has the trol us. These are often the often unknowingly. stricting the population’s potential to overwhelm our hospital resources, same individuals who are activities. against vaccines and mask Society already limits wearing. (I also suspect many of them have red many individual choices for the good of the MAGA hats hidden in their closets.) majority. For example, I’m not allowed to drive Secure cloud-based clinical I have often wondered who “they” are. I have drunk as a skunk without my seatbelt on at my even asked some of my patients, but I never chosen speed down the wrong side of the high- speech recognition seem to get a clear answer. As best as I can way with a baby smoking on my lap. tell, “they” is some secret level of government The current temporary travel restrictions are Dictate into your EMR from or a collection of sinister wealthy individuals no different and were created to buy time while almost anywhere (Bill Gates is often mentioned) who want to the vaccination process continues. track and control our movements. When I ask “They” are simply trying to save some Install within minutes across to what end would “they” want to restrict us, lives.