May 2021: 63:4 Self-poisoning among Pages 145–192 British Columbian children and youth Demographic and geographic characteristics IN THIS ISSUE Endometriosis: An update on diagnosis and medical management Systemic racism and medicine: A commentary Intergenerational housing as a model for improving older- adult health Potent sedatives in opioids in BC: Implications for resuscitation, and benzodiazepine and etizolam withdrawal bcmj.org May 2021 Volume 63 | No. 4 Pages 145–192 Beyond the direct effects of improving the health of older adults, intergenerational housing can lead to beneficial outcomes for society as a whole. Article begins on page 171. The BCMJ is published by Doctors of BC. The journal provides peer-reviewed clinical and review articles written primarily by BC physicians, for BC physicians, 148 Editorials 151 President’s Comment along with debate on medicine and medical politics in editorials, letters, and essays; BC medical news; career Pandemic musings Mass disruption: A time of great pain and CME listings; physician profiles; and regular columns. David R. Richardson, MD and great hope, Matthew C. Chow, Print: The BCMJ is distributed monthly, Research ethics board approval: MD other than in January and August. What, why, when, how? Web: Each issue is available at www.bcmj.org. 152 Premise Subscribe to print: Email [email protected]. Caitlin Dunne, MD Single issue: $8.00 Systemic racism and medicine: Canada per year: $60.00 150 Letters A commentary, Christopher O.Y. 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Chapman, MBChB Amy Haagsma 604 638-2815 rates among females age 10 to 19 Editorial and production Brian Day, MB [email protected] are striking, which is consistent coordinator Cover concept and Caitlin Dunne, MD with research that has found Tara Lyon art direction, Jerry Wong, ISSN: 0007-0556 David J. Esler, MD higher self-poisoning rates among Peaceful Warrior Arts Established 1959 Yvonne Sin, MD Copy editor female youth compared with Cynthia Verchere, MD Tracey D. Hooper Design and production males. Article begins on page 164. Laura Redmond, Scout Creative 146 BC MEDICAL JOURNAL VOL. 63 NO. 4 | MAY 2021 CLINICAL 158 Endometriosis: An update on diagnosis and medical management, Giselle Hunt, BSc, Catherine Allaire, MD, Paul J. Young, MD, Caitlin Dunne, MD 164 Self-poisoning among British Columbian children and youth: Demographic and geographic characteristics, Samantha Pawer, BSc, Fahra Rajabali, MSc, Jennifer Smith, BFA, Alex Zheng, MSc, Anand Dhatt, Roy Purssell, MD, Ian Pike, PhD 171 BCMD2B Intergenerational housing as a model for improving older-adult health Raiya Suleman, BHSc, Racism and discrimination are deeply ingrained in our society and represent significant social determinants of health— Faizan Bhatia, BHSc a truth that is backed by a growing body of evidence that highlights disparate health outcomes in racial minorities. Article begins on page 152. 176 Joint Clinical Committees A first-of-its-kind Canadian 179 WorkSafeBC n partnership for a stronger health care Learn about potential billing issues Medical advisors reaching out to early; check out your mini profile system, Ahmer Karimuddin, MD, n Anthon Meyer, MD community physicians: A new Improvements to Rural Retention WorkSafeBC initiative, Janice Program encouraging physicians to 177 BCCDC Mason, MD, Alfredo Tura, MD, practise in rural communities n Potent sedatives in opioids in BC: Peter Rothfels, MD Fast-tracked vaccinations for the Implications for resuscitation, vulnerable: Communicating with 180 News patients and benzodiazepine and etizolam n 2020 MacDermot writing prize withdrawal, Roy Purssell, MD, 184 CME Calendar winners Jane Buxton, MBBS, Jesse Godwin, n Doctors of BC insurance team MD, Jessica Moe, MD 186 Guidelines for Authors working remotely to support your needs, Kerri Farrell 188 Classifieds Environmental impact Postage paid at Vancouver, BC. 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BC MEDICAL JOURNAL VOL. 63 NO. 4 | MAY 2021 147 EDITORIALS Pandemic musings 6 April 2021 s this pandemic continues into its learned that gunshot deaths climbed during The coronavirus pandemic has drawn sig- second year, it is hard to be cheerful 2020. nificant attention and effort to fight it. Measures and optimistic. In terms of silver lin- According to the Gun Violence Archive, include regular briefings from the provincial ings,A 2020 was likely a far better year for the about 45 000 Americans died of gun violence health officer and health minister along with a environment. Climate change shifted into a in 2020 compared to roughly 40 000 in 2019. mobilization of public health and health region lower gear and nature was able to take a deep In fact, shooting deaths in resources. The population breath. Many large industrial centres noted 2020 outpaced the next About 45 000 has tolerated previously less smog with improved views, and many wa- highest recent year (2017) Americans died of gun unheard of restrictions terways were blessed with the reappearance of by more than 3600. Last with minimal complaint. fish and whales. year, the United States violence in 2020. I wonder what could be The recent run of mass shootings in the noted the highest 1-year accomplished if similar ef- United States reminded me that these previ- increase in homicides forts were directed toward ously common events were seldom spoken of since they started keeping records. the often-marginalized population of people in 2020. I took comfort, thinking that per- Some claim that this is not a gun problem who use drugs and the overdose crisis. haps the pandemic has also led to reduced gun but a mental health issue. However, recently a Forgive me for my pandemic musings, but violence for our southern neighbors. Imagine man went on a rampage with a knife in North this challenging time lends itself to reflection, my surprise when I researched the topic and Vancouver, stabbing multiple victims and end- and with that a desire for seeking hope amid the ing one woman’s life. I would argue that if this ruin. Sadly, we won’t find any uplifting change obviously disturbed individual had access to when it comes to gun violence and illicit drug an assault rifle the toll would have been much deaths. n Secure cloud-based clinical higher. —David R. Richardson, MD COVID-19 mobilized the world, and the speech recognition United States has been a leader in developing a vaccine to combat the pandemic. Imagine Doctors Dictate into your EMR from what could be accomplished if a fraction of the almost anywhere resources devoted to combating a virus were Helping directed toward ending gun violence. Doctors Install within minutes across One fact that is often overlooked is that 24 hrs/day, unlimited computers gun violence is a male problem. When was the last time you heard about a woman going 7 days/week One synchronized user on a shooting rampage with a semiautomatic profile weapon? Mass shooters are predominantly men If something is on your mind, Stunningly accurate with who turn to violence as a means of solving some internal strife. Men must do better and learn give us a call at accents to control their emotions without resorting to 1-800-663-6729. Or for more acts of aggression. information about our services, Contact us today for a free trial! Lastly, before we feel too smug here in Can- visit www.physicianhealth.com. 604-264-9109 | 1-888-964-9109 ada, and specifically in our home province, we should look at another local epidemic. In 2020 SO speakeasysolutions.com ASY LU E T there were approximately 1000 deaths in BC K IO A N E P S Professional Speech S 21 due to COVID-19.