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EditorialEditorial

In every disadvantage there is an advantage

Drug shortages and other challenges in family medicine

Nicholas Pimlott
Canadian Family Physician February 2024; 70 (2) 79; DOI: https://doi.org/10.46747/cfp.700279
Nicholas Pimlott
MD PhD CCFP FCFP
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In challenging times, I look for inspiration and advice about my work from many sources, frequently non-medical ones. Legendary Dutch footballer Johan Cruyff1 was a brilliant player, but he was also famous for his aphorisms and insights, many of which can be applied to life in general. One of my favourite “Cruyffian” aphorisms is the source of the title of this article.

One of the recent disadvantages that family physicians in Canada have had to contend with has been shortages of medications ranging from commonly prescribed pain medication1 to the “blockbuster” drug semaglutide, developed for the treatment of type 2 diabetes mellitus but widely used off label for weight loss.2 In the autumn and winter of 2022—peak season for conditions like acute otitis media, streptococcal tonsillitis, and pneumonia—the antibiotic amoxicillin was in short supply.3 But is the shortage of commonly prescribed drugs new, and is it primarily due to supply issues caused by the COVID-19 pandemic? Recent research by Lau and colleagues reveals that the problem has been around for much longer, across multiple drug classes, and is not exclusively owing to the impact of COVID-19.4

In response to these drug shortages and to support physicians and patients in managing them, the federal government5 and many provincial governments6 have established easily accessible online monitoring and reporting systems.

In this month’s issue of Canadian Family Physician, a commentary by pharmacist Huyghebaert and colleagues (page 85) focuses on the “advantage of the disadvantage” of these medication shortages, seeing in them the opportunity to consider deprescribing, to consider less expensive but equally effective alternatives, or to reduce doses.7 Their practice tips are timely and practical.

Much other content in this issue focuses on challenges in rural and remote health care, including a clinical review on burn care by Tremblay and colleagues from NOSM University8 (page 95), and 2 research articles—the first on the use of point-of-care ultrasound imaging by family doctors in rural and remote British Columbia9 (page 109) and the second, from Sioux Lookout, Ont, a rich qualitative exploration of the healing journey of First Nations individuals dealing with opioid use disorders (page 117).10

For those both living and practising family medicine in rural and remote communities, there is a tendency to think of the challenges as mainly disadvantages. The problems of recruiting and retaining family physicians in such communities are real and long-standing, but there are also opportunities to practise to the fullest scope and to make a meaningful difference in people’s lives. Poorer health outcomes and lack of access to certain types of care in rural and remote communities are similarly real and long-standing, but the advantages of living closer to family, community, and the natural world may outweigh the disadvantages for some.

As family physicians, wherever we live and practise, we are used to living in that duality, and it is that ability to see both the disadvantage and the advantage in many situations that allows us to look at problems differently and that can inspire creativity and growth.

Footnotes

  • The opinions expressed in editorials are those of the authors. Publication does not imply endorsement by the College of Family Physicians of Canada.

  • Cet article se trouve aussi en français à la page 80.

  • Copyright © 2024 the College of Family Physicians of Canada

References

  1. 1.↵
    WIkipedia [encyclopedia online]. Johan Cruyff. San Francisco, CA: Wikimedia Foundation Inc; 2024. Available from: https://en.wikipedia.org/wiki/Johan_Cruyff. Accessed 2024 Jan 4.
  2. 2.↵
    1. Dangerfield K.
    Canada’s pharmacies grapple with shortages. These drugs are facing the pinch. Global News 2023 Nov 17. Available from: https://globalnews.ca/news/10098307/drug-shortages-canada-ozempic-generic-tylenol-4/. Accessed 2024 Jan 5.
  3. 3.↵
    1. Lee J.
    Antibiotic shortage still a worry, Alberta doctors and pharmacists say. Amoxicillin and a number of other medications are in short supply. CBC News 2023 Feb 8. Available from: https://www.cbc.ca/news/canada/calgary/antibiotic-shortage-alberta-1.6741395. Accessed 2024 Jan 4.
  4. 4.↵
    1. Lau B,
    2. Tadrous M,
    3. Chu C,
    4. Hardcastle L,
    5. Beall RF.
    COVID-19 and the prevalence of drug shortages in Canada: a cross-sectional time-series analysis from April 2017 to April 2022. CMAJ 2022;194(23):E801-6.
    OpenUrlAbstract/FREE Full Text
  5. 5.↵
    Drug shortages homepage [website]. Ottawa, ON: Drug Shortages Canada; 2024. Available from: https://www.drugshortagescanada.ca/. Accessed 2024 Jan 5.
  6. 6.↵
    Drug shortages. Victoria, BC: Government of British Columbia; 2024. Available from: https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/pharmacare/pharmacies/drug-shortage-information. Accessed 2024 Jan 5.
  7. 7.↵
    1. Huyghebaert T,
    2. Svrcek C,
    3. Perry TL.
    How to navigate drug shortages with patients in primary care. Beneficial opportunities may exist beyond initial frustrations. Can Fam Physician 2024;70:85-6 (Eng), 89-90 (Fr).
    OpenUrlFREE Full Text
  8. 8.↵
    1. Tremblay C,
    2. Albrecht KA,
    3. Sonke CC,
    4. Azad S.
    Approach to burn treatment in the rural emergency department. Can Fam Physician 2024;70:95-9 (Eng), e31-6 (Fr).
    OpenUrlAbstract/FREE Full Text
  9. 9.↵
    1. Morton T,
    2. Kim DJ,
    3. Deleeuw T,
    4. Curran J,
    5. Olszynski P,
    6. Robinson VW.
    Use of point-of-care ultrasound in rural British Columbia. Scale, training, and barriers. Can Fam Physician 2024;70:109-16.
    OpenUrlAbstract/FREE Full Text
  10. 10.↵
    1. Madden S,
    2. Root A,
    3. Suganaqueb MC,
    4. Sofea L,
    5. Duncan C,
    6. Gordon J, et al.
    Healing journey. Experiences of First Nations individuals with recovery from opioid use. Can Fam Physician 2024;70:117-25.
    OpenUrlAbstract/FREE Full Text
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Canadian Family Physician: 70 (2)
Canadian Family Physician
Vol. 70, Issue 2
1 Feb 2024
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In every disadvantage there is an advantage
Nicholas Pimlott
Canadian Family Physician Feb 2024, 70 (2) 79; DOI: 10.46747/cfp.700279

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