June 2020: 62:5 Pages 153–184 An unusual finding from fecal immunochemical testing: A case report IN THIS ISSUE Novel website connects general surgeons during COVID-19 crisis Epidemiology of COVID-19 in BC Medical education during COVID-19 Obesity: A risk factor for severe infection with coronavirus bcmj.org BC MEDICAL JOURNAL VOL. 62 NO. 5 | JUNE 2020 153 You can now use Dr. Bill absolutely free. Use our powerful billing software to submit as many claims as you want at no charge. Focus on patient care. Let us handle your billing for you. Register today for FREE at dr-bill.ca 154 JUNE 2020 VOLUME 62 | NO. 5 PAGES 153–184 “Medical education during COVID-19: Lessons from a pandemic” by Dr Roger Wong begins on page 170. n 157 Editorials Corporatization of family medicine 170 Special Feature A conversation from sometime in the in BC, Robert H. Brown, MD Medical education during n future, David R. Richardson, MD Search engine to identify the most COVID-19: Lessons from a Is there a new, better normal? affordable drug, coverage availability, pandemic, Roger Y. Wong, MD Cynthia Verchere, MD and special authority resources, Anthony Chiam, RPh 172 Special Feature 160 President’s Comment UBC Reticulum: A novel website 165 BCCDC Forever changed, Kathleen Ross, MD connecting general surgeons in BC Epidemiology of COVID-19 in during the COVID-19 crisis, Hamish 161 Letters BC: The first 3 months, Caren Rose, Hwang, MD, Shiana Manoharan, n COVID-19 pharmacologic therapy PhD, BCCDC Surveillance Team, MD, Taryn Zabolotniuk, BSc, guidance for BC, British Columbia Kate Smolina, PhD S. Morad Hameed, MD COVID-19 Therapeutics Committee n COVID-19 pandemic and CLINICAL 174 College Library adolescents’ vaping epidemic, Thank you, and a helping . email? Aki Nilanga Bandara, BSc, Mehara 167 An unusual finding from fecal Niki Baumann Seneviratne, Senara Wanniarachchi, immunochemical testing: Contents continued on page 156 BSc, Ricky Jhauj, BKin, Vahid A case report, David Sanders, Mehrnoush, MD MD, Hui-Min Yang, MD, S. Ian Gan, 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, 2020. 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. 62 NO. 5 | JUNE 2020 155 ON THE coVER An unusual finding from fecal immunochemical testing: A case report This case report peels back the layers of endoscopic and histologic investigations following a positive fecal immunochemical test result, eventually leading to the detection of a rare mucosa-associated lymphoid tissue lymphoma. Art materials: toilet paper, cardboard. 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, along with debate on medicine and medical politics in editorials, letters, and In addition to providing medical care to the entire Skeena Valley, Dr Horace Wrinch (pictured here) built two essays; BC medical news; career and CME listings; hospitals, created a farm to supply the hospitals, and established a nursing school. A new book about him, physician profiles; and regular columns. Service on the Skeena: Horace Wrinch, Frontier Physician by Geoff Mynett, is reviewed on page 176. Print: The BCMJ is distributed monthly, other than in January and August. Web: Each issue is available at www.bcmj.org. Contents continued from page 155 Subscribe to print: Email [email protected]. Single issue: $8.00 175 COHP n Canada per year: $60.00 Research to address impact of Foreign (surface mail): $75.00 Obesity: A risk factor for severe COVID-19 on medication use Subscribe to notifications: infection with coronavirus and mental health for people with To receive the table of contents by email, visit www.bcmj.org and click on “Free e-subscription.” SARS-CoV-2, Priya Manjoo, MD, arthritis n Prospective authors: Consult the Katie Bowers, MPP Research to better diagnose “Guidelines for Authors” at www.bcmj.org COVID-19 n for submission requirements. 176 News Virtual stroke-recovery sessions n n Book review: Service on the Skeena: Ontario researchers join global Horace Wrinch, Frontier Physician initiative to study loss of smell in n 2020 Family Physicians’ Awards COVID-19 patients n n Editor Web and social media 2020 Rural Awards, BC recipients How to embed AI and digital David R. Richardson, MD coordinator n Amy Haagsma MSP coverage relating to technology into physicians’ training Editorial Board COVID-19 and practices Jeevyn Chahal, MD Cover concept and n n David B. Chapman, MBChB art direction, Jerry Wong, Health data coalition expands Remote surgery: Exploring Brian Day, MB Peaceful Warrior Arts data-sharing application emergency care at a distance Caitlin Dunne, MD Design and production n David J. Esler, MD Website for Canadians to ask Laura Redmond, Yvonne Sin, MD 180 CME Calendar Scout Creative COVID-19 questions and get Cynthia Verchere, MD Printing answers Managing editor n 181 Classifieds Mitchell Press Jay Draper BC PharmaCare COVID-19 Advertising Associate editor information for prescribers Tara Lyon Joanne Jablkowski 604 638-2815 Editorial and production or [email protected] coordinator ISSN: 0007-0556 Tara Lyon Established 1959 Copy editor Barbara Tomlin Proofreader Ruth Wilson 156 BC MEDICAL JOURNAL VOL. 62 NO. 5 | JUNE 2020 EDITORIALS A conversation from sometime in the future “ ey, great-grandpa, how did you sur- protective equipment (PPE), such as dental The people of BC have been asked to physi- vive the COVID-19 pandemic?” offices, have been sharing with those who need cally distance themselves, self-isolate, and avoid “Mostly, I just sat around and them. All manner of organizations in unrelated gatherings. I have been beyond impressed by the Hsent funny memes to my social media contacts.” fields have asked what they could produce and general response to these measures, despite the Back in February, I wrote an editorial about are now manufacturing gowns, masks, gloves, significant financial and social losses incurred. the novel coronavirus and my hope that if it face shields, and more. Some companies are The general population is being respectful yet became a global pandemic even designing and look- kind while doing their part to flatten the curve. humanity would respond ing to make ventilators if My spirits have been lifted, as has my belief with kindness and grace Despite fear of need be. in the basic goodness of people. Despite fear (published in the April physical illness and I have been touched to of physical illness and financial ruin, so many issue). As I now sit in financial ruin, so many my core by the 7:00 p.m. are reaching out to others less fortunate than front of my computer in are reaching out to shout-out to health care themselves. I am confident we will get through early April and reflect on workers and first respond- this pandemic together with perhaps a kinder the staggering spread of others less fortunate ers. The banging of pots and gentler world waiting on the other side. n COVID-19 and the re- than themselves. and clapping of hands —David R. Richardson, MD sulting unheard of soci- brings a tear to my eye etal adjustments, I am every time. Restaurants pleasantly surprised by the positive response that might be forced to close due to a drastic to this pandemic. Sure, there have been cases reduction in their business have been selflessly of people fighting over toilet paper or gouging providing much-needed meals to health care Doctors their neighbors by reselling medical supplies at workers at local hospitals. The outpouring of Helping ridiculous markups. But these are exceptions. support and gratitude has been truly amazing Doctors I have been impressed by how the majority of during this difficult time. 24 hrs/day, people are reacting. There are numerous reports People’s creativity has also been on display. 7 days/week of individuals reaching out to the vulnerable in Window decorations with hearts and positive their communities by picking up their groceries, messages adorn many neighborhoods. Colorful prescriptions, and other necessities. Others are decorated rocks now line pedestrian paths and The Physician Health trying to ease the social isolation many elderly walkways. Social media is providing a constant Program of British are experiencing by sharing music and conver- stream of funny memes to lighten the load Columbia offers help 24/7 sation.