SooToday received the following letter from a family physician at the Group Health Centre. Last week, the province announced $2.8 million in funding to open a new nurse practitioner clinic at the centre to treat thousands of recently de-rostered patients.
I am a family doctor and I really like my job — most of the time. Lately, the media is inundated with news about family medicine and yet more could be done to inform the public about the day-to-day experiences of family doctors. My typical day at the Group Health Centre is fast-paced, demanding, frustrating, and also very rewarding. I hope my account might provide perspective into the family medicine crisis in Sault Ste. Marie.
A typical day starts with a fully booked clinic with one patient every 15 minutes. That means for each visit, I have 10 minutes to listen to the patient, make a diagnosis, and develop a treatment plan. I then have five minutes to order all the required tests and document each visit in an electronic medical system. Three people call at 8 a.m., all desperate to see me that day. Suddenly, that 15-minute appointment slot at 10 a.m. has two patients in it. The first patient of the day arrives five minutes late, putting me behind schedule right from the start. Luckily, the first four appointments go smoothly. One patient has high blood pressure requiring an adjustment of their medication. One patient has arthritic knees and wants to talk about surgery. Another has shoulder pain from a baseball injury and we discuss treatment options. The fourth has a cough, which turns out to be a pneumonia urgently requiring antibiotics.
SEE: Sault’s newest walk-in clinic and family practice now open
The next patient at 9 a.m. is very unwell. They have depression and it is really bad. So bad they can’t work. I don’t tell them when their appointment is over. I sit down and talk to them determining whether they are safe to leave the office. We set up a plan. They leave a little more hopeful. I am now an hour behind. I sense the frustration of the people in the waiting room. I take a deep breath. I’ve got this. Then my pager starts to beep — a nurse needs to talk to me about a sick patient who is at home. My cell phone rings — a surgeon returning my call about a patient I saw the other day with a new cancer. Important interruptions, but more reasons I am behind schedule.
As a family doctor, my days are filled with trying to help people. I am a detective of human biology, but my job involves so much more than investigation. Each hour, I find time between patients to review staggering amounts of blood work, imaging, notes from specialists, and reports from every test imaginable ordered by other doctors; these all get copied to me, and I have to read them so I know what’s going on with my patients. The prehistoric fax machine continually spits out refill requests from pharmacies. Every interaction with a patient must be recorded in an electronic medical record which takes a huge amount of time. The system is difficult to navigate and I have to click numerous times to accomplish simple tasks like ordering blood work. Referring patients to specialists is an important but challenging task as it includes writing a comprehensive explanation and providing all relevant information from the chart. This is essential so specialists can figure out how best to help my patients, but it takes time. Sadly, there aren’t enough specialists in the north and that means I spend extra time searching for them all over Ontario.
At times, my job can be scary, like when I have to calm a very angry patient. In other instances, I risk exposing myself to contagious diseases. Lengthy forms pile up on my desk that take up more and more time each day to complete. The work is relentless, often starting at 6 a.m. and ending at 11 p.m., or even later when urgent phone calls from Lifelabs or nurses wake me up in the middle of the night. I miss social events, my kids’ sporting activities, family movie-nights, and it is no surprise when I am called during a special Mother’s Day dinner.
My job is emotionally and physically exhausting. And yet, it is totally worth it. Days can feel like roller coasters filled with moments of wonderful highs and tragic lows. Welcoming a new baby into the world and reassuring the parents about the infant’s weight gain. Finding a way to settle a scared 4-year-old to determine whether their stomach pain is a surgical emergency. Treating an attention disorder in a student so they can reach their true potential. Connecting with four generations in a family as a great grandmother shows me the picture of the baby just born, who is also in my practice. Congratulating a patient on quitting smoking after having a massive, life-changing heart attack. Reassuring a patient with type II diabetes that the blood work shows improvement after starting a new medication. Treating all sorts of pain from an ankle sprain to severe shingles. Discovering an early, treatable lung cancer and saving a person’s life. Holding the hand of a patient as I share the news of their recently identified terminal illness. These are the moments that are inspiring about family medicine and bolster me in the job.
My job allows me to connect with people on a basic, human level. As a family doctor, I have the privilege of helping patients during times of incredible vulnerability, pain, and trauma. Patients turn to me for guidance which is a humbling responsibility; sometimes an overwhelming one. This job is not for the faint of heart as patients can show up at the office in all manner of emotional, physical, or financial distress.
The family medicine profession can be heart-wrenching; I have watched colleagues burn out under the weight of our workload and the emotional burden placed on us. I have watched sadly, as patients are left without a family doctor. Like many of my colleagues, I want to help but I know I can’t. I work right at the limit of what I can handle.
I write about my day to explain why being a family doctor can be very challenging. Many of my colleagues experience similar days but we continue to work under difficult conditions with the hope that one day the workload might ease and new family doctors will come to Sault Ste. Marie. Optimism and my determination to help my patients is what motivates me to go to work each day.
On a typical day, I am running late almost from the start. I miss lunch. I am late picking up my daughter from school and I miss my son’s soccer game. I return to work at 5:30 to finish reviewing the labs for the day. I eat a late dinner. I log into the computer system from home before heading to bed so I can get ready for what feels like another marathon the next day. The next morning, I put on my running shoes and try to help as many patients as possible.
Dr. Adrianna Schamp
Family and Palliative Medicine
Group Health Centre
Sault Ste. Marie