Prioritizing pain management during IUD insertions and other gynecologic procedures

10/07/24 • 36 min

On this episode of the CMAJ Podcast, Dr. Blair Bigham and Dr. Mojola Omole explore effective ways to manage pain during intrauterine device (IUD) insertions. They also address a broader issue: how women’s pain is often neglected during gynecologic procedures, and the failure of physicians to adequately seek consent. They are joined by Dr. Kristina Arion, an obstetrician and gynecologist at the Children's Hospital of Eastern Ontario, and Dr. Nadia Von Benzon, a lecturer and social geographer at Lancaster University.

The episode begins with Dr. Arion discussing the CMAJ article she co-authored, which outlines strategies for better management of pain during IUD insertions. She explains that the IUD is recommended as the first-line therapy for birth control and period management by the Canadian Pediatric Society and the Society of Obstetricians and Gynaecologists of Canada. Dr. Arion highlights how patient anxiety, lack of sedation options, and inconsistent practices contribute to unnecessary pain.Her key advice to doctors: listen to patients, explain each step of the procedure, and provide adequate pain management options.

Dr. Von Benzon broadens the discussion beyond IUD pain management to the neglect of women’s pain and autonomy during other gynecologic and obstetrical procedures. Her research article "My doctor just called me a good girl, and I died a bit inside: From everyday misogyny to obstetric violence in UK fertility and maternity services," illustrates how women’s pain is frequently dismissed and their consent overlooked. She discusses the long-term impact of these practices, with some women opting out of future pregnancies due to trauma. She advises healthcare professionals to clearly explain procedures, seek consent, and prioritize patient comfort and autonomy.

Dr. Omole and Dr. Bigham reflect on how patriarchal structures and time constraints within healthcare systems often lead to the failure to prioritize women’s pain and autonomy. The episode closes with a powerful call for healthcare providers to take the time to listen to their patients, ask questions, and ensure that consent and comfort are prioritized at every stage of care.

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AI versus physicians: who’s better at spotting high-risk patients?

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On this episode of the CMAJ Podcast, Dr. Blair Bigham and Dr. Mojola Omole discuss how artificial intelligence (AI) significantly improves the identification of hospital patients at risk of clinical deterioration compared to physician assessments alone. They are joined by Dr. Amol Verma, a general internist at St. Michael’s Hospital in Toronto, an associate professor at the University of Toronto, and the holder of the Temerty Professorship in AI Research and Education, who shares findings from his recent CMAJ article, “Clinical evaluation of a machine learning-based early warning system for patient deterioration”.

Dr. Verma explains how the AI system, ChartWatch, analyzes over 100 variables from a patient’s electronic medical record to predict deterioration more accurately than traditional early warning scores like the NEWS score. He discusses how the integration of AI into clinical workflows improves patient outcomes by complementing human decision-making, leading to better results than relying on physicians or AI alone.

The episode also looks at the potential future of AI in medicine, with Dr. Verma sharing insights on how AI tools should be thoughtfully integrated to support clinicians without overwhelming them. He stresses the need for AI systems to fit seamlessly into clinical workflows, ensuring patient care remains the priority. While AI is currently a tool to assist clinicians, Dr. Verma argues that the full extent of AI's role in healthcare—and its impact on the physician's place within it—remains ultimately unknowable.
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Breaking the mold: embracing neurodiversity in medicine

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On this episode of the CMAJ Podcast, Dr. Kirsten Patrick speaks with Dr. Shane Neilson, the author of a CMAJ Encounters article entitled, “Professional stigmatizations.” Dr. Neilson is a physician, writer, and academic, who shares his experiences navigating medical school and practice as a neurodiverse physician with bipolar disorder and autism.

Dr. Neilson reflects on the challenges he faced during medical school, including a moment when a preceptor told him, "There’s something wrong with you," without offering any support or guidance. He shares how this, along with the pressure to conform to normative expectations in medicine, made his training difficult, especially without any accommodations for neurodiverse students.

Dr. Patrick relates to these struggles, recounting her own experiences of feeling out of place in medical school. Together, they discuss how the culture of medical education at the time did not accommodate students who did not fit the traditional mold.

Dr. Neilson notes that while there are "little teeny, tiny occasional tales of change" happening now, such as program directors becoming more aware of neurodiversity and making small accommodations for students, these changes are still incremental. He expresses hope that this will continue to evolve, leading to broader acceptance and support for neurodiverse individuals in the medical profession.

He further argues that including neurodiverse physicians enriches the profession in several ways. By challenging rigid norms in medicine, neurodiverse individuals push the profession to be more inclusive and compassionate. They also provide care that is uniquely attuned to the needs of neurodiverse patients, offering identity-aligned support that can enhance patient satisfaction and outcomes. Dr. Neilson stresses that by fostering diversity, the profession not only lives up to its values but also improves care for all patients.