News for — and about — members of the Thompson Region Division of Family Practice.

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Clinic emergency management plan responds to patients under wildfire threat

NP suspends mat leave to help patients in wildfire emergency

When wildfires struck the North Shuswap area this summer, about half of the Chase Medical Clinic’s 10,000 patients were evacuated while another 45 per cent were put on alert. Clinic providers met to discuss their emergency management plan.

Schedules were rearranged to ensure medical staff coverage in the Chase Emergency Room, and clinic phones were rerouted to Salmon Arm so that office staff could provide support from east of the Highway 1 closure.

Doctors Cornel Barnard and Ben Robinson were able to keep the Chase clinic open, and nurse practitioner Keltin Everett was evacuated to Salmon Arm but wanted to provide care from that side of the wildfires.

Caring for her infant son at the time, Keltin approached Interior Health and requested that her maternity leave be temporarily suspended so that she could support evacuated patients in Salmon Arm.

“Keltin reached out to me as she wanted to support her patients, community, and primary care practice by offering a few hours daily in an alternate clinic,” said Dr. Louanne Janicki, DNP MSN NP (Family) Director, Professional Practice Office, Interior Health. “This demonstrates her strong commitment to patient-centered care and her resilience and willingness to help patients access health care during the wildfire crisis, especially when she herself was also affected by evacuation orders and alerts.”

The Thompson Region Division of Family Practice connected with the Shuswap North Okanagan Division and found a physician, Dr. Helen Imolele, who was willing to share extra clinic space in Salmon Arm to accommodate Ketlin and Medical Office Assistant Doreen Kirby, also evacuated from her home in Scotch Creek.
 

"The effectiveness of the Incident Command structure allowed the Thompson Division staff to quickly escalate Keltin’s request amongst IC members,” said Katherine Brown, the Division’s Executive Director. “Our proactive outreaches to members, interdivisional collaboration, and support from Interior Health resulted in a satellite clinic being up and running within 48 hours.”

The satellite clinic saw patients mostly for prescription refills since they had to leave their homes so quickly, and there were also minor injuries sustained in the evacuation and a few primary care visits moved from colleagues in Chase to help keep the Chase ER open.

“We were evacuated, and my own community was affected with 90 per cent under order in our catchment,” Everett said. “It was an all-hands-on-deck situation, and since I have no firefighting skills, I wanted to help how I could by offering consistent health care in a crisis.”

 

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Impassioned to navigate changes in primary care

A message from the Executive Director

The last few years have been full of change — from the COVID-19 pandemic and wildfires to the development of Primary Care Networks (PCN) and introduction of the new Longitudinal Family Physician payment model.

While we collectively faced many challenges, the relationships that were established and now sustained are invaluable. We now collaborate across the system to innovate, implement, and iterate together.

To say that I am excited to join the Division as the new Executive Director is an understatement. I am passionate about improving access for patients. I am passionate about supporting members. I am passionate about removing barriers to enable system collaboration and innovation. I am passionate about primary care.

In the coming months, we will receive approval of our PCN Service Plan, which means that we will have access to funding for many new clinical resources, including physicians, nurse practitioners, and allied health professionals in the Thompson Region. Recruitment is a challenge across the province. We warmly welcome new members, and their families, to the community by supporting them to make meaningful connections and participate in system change initiatives. We will continue to collaborate at regional and provincial levels to address the root causes of issues, while also working to keep members in community long-term through a multitude of retention initiatives.

The primary care landscape is evolving and seeing much needed change. I am grateful to work with our members, a passionate and dedicated board of directors, and a talented team. I am optimistic about the future of primary care and am excited to lead the way through this transformation in our region in support of our members and the communities we serve.
— Katherine Brown

 

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New early pregnancy clinic welcomes all patients

First Steps Early Pregnancy Triage Clinic

When First Steps Early Pregnancy Triage Clinic opened its doors in September, the clinic was an immediate ‘one-stop-shop’ for initial maternity care for both unattached patients and those who are attached to providers who do not provide maternity care.

“Patients don’t require a referral from a physician or nurse practitioner,” says Joanna Norman, Registered Midwife and Clinic Lead for First Steps Early Pregnancy Clinic. “The clinic will be a first point of contact, offering accessible pregnancy care within the first and early second trimester.”

Virtual and in-person visits provide prompt access to prenatal investigations, including routine bloodwork, ultrasound, genetic screening, as well as opportunities to identify and triage high-risk pregnancies with timely referrals to specialists.

Norman says, “The triage clinic will receive patients at their earliest stage of pregnancy, which leads to better health outcomes and provides reassurance and timely access for families seeking care. This clinic will also help reduce the burden on other services, such as the Royal Inland Hospital Emergency Department and the Urgent Primary Care and Learning Centre.”

“The clinic helps fill a significant gap in care for unattached patients in our community,” says family physician lead Dr. Justyne Morrow. “Not having a primary care provider during pregnancy is a very stressful experience as it requires one to navigate and advocate for oneself in a complex, opaque system. I am very proud of the work this clinic is doing to provide team-based interdisciplinary care to unattached pregnant patients to help alleviate this stress and ensure good prenatal care.”

The team of family physicians, nurse practitioners, and registered midwives includes Indigenous care providers, and provides support and referrals for early miscarriage care, contraception counselling, and termination care. All staff receive training to provide culturally safe care, connecting patients to appropriate resources, programs, and services while also seeking input from patients, families, and caregivers to inform patient needs and support decisions.

“We live in a multicultural place,” says Nurse Practitioner Natalie Manhard. “Providers have completed the San’yas Indigenous Cultural Safety Training, and the clinic has access to provincial translation services to ensure we are being respectful and providing a safe space for all pregnant people needing access to health care services.”

After providing initial treatment in two to three antenatal visits, the team packages the patient record and transitions care to the Thompson Region Family Obstetrics (TRFO) clinic for ongoing antenatal care, delivery, and postpartum care. This new streamlined approach aims to reduce the workload on TRFO and decrease stress for patients who would previously have sought care through the Emergency Department, the Urgent Primary Care and Learning Centre (UPCLC), or the Kinetic Energy walk-in clinic.

“We are already seeing the impact at the UPCLC. In the past, we would have provided an initial assessment prior to referring patients to the TRFO, but with this new clinic, people can go straight to them. It will reduce the impact on the UPCLC significantly,” says Matt Stubbings, Interior Health Manager of Urgent and Primary Care in Kamloops.

A grant from the Foundation for Advancing Family Medicine for Workplace Integrated Demonstration Project funding supports clinic development and is going toward optimizing the comprehensive primary care team as well as funding those who cannot be compensated in a fee-for service model (e.g., nurse practitioners and medical office assistants).

“Funding ensures the clinic will function until mid-March 2024,” says Shelley Breen, Project Lead. “Conversations have started with health care partners to explore further innovative health care grants to plan for the clinic’s sustainability.”

 

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Stories from a life in family medicine

Yukon Jack and Buddy

He was a burly, furry man with a thick beard, a flannel shirt and big winter boots, his faced etched with lines carved out by years spent in the cold winter sun. We lovingly called him Yukon Jack.

His affect was low. My husband was his family doctor and, after the usual clinical history, made a diagnosis of depression. Yukon Jack’s response: “Of course I’m depressed. Look at my life. But I don’t want no pills. And I am not going to no counselor.”

He used to have a purpose. He spent all his life training sled dogs and running teams of huskies up in the wild North. Then his wife died, and he found himself in warm, metropolitan Kamloops, living in an apartment by himself, staring at four walls with only the city noise for a companion. He went from being mesmerized by the Northern Lights to being blinded by the traffic lights on Columbia Street.

“What’s the point of living, doc?” he cried in anguish.

In a moment of complete helplessness, my husband did the only thing he could do to ease this man’s suffering. He pulled out the paper prescription pad and wrote, “One dog,” and signed it.

“Gosh, darn it,” Yukon Jack said, and slapped his knee. “That’s what I’ll doggone do.”

Orley (aka Yukon Jack) came back the following week, his eyes bright and his smile huge. He was a changed man. He took the prescription to the SPCA.

“Doc, they saw your signature and they said it was legit, so they waived the adoption fee. I have a dog.”

Buddy was a docile fluffball with soulful eyes and crooked teeth. It was a match made in heaven. Over the years, Orley trained Buddy to sit quietly in the scooter basket beside Orley’s oxygen tank. The two of them would ride around town, sit in Lansdowne Mall, and talk to everyone. Orley would come into the clinic and tell us tales of Buddy being his wingman as ladies would vie for a chance to pet Orley’s obedient and furry companion.

Buddy was trained so well that the duo was eventually invited to visit pediatric patients in the hospital. There, a little girl with cerebral palsy took a huge liking to Buddy. We didn’t see Orley and Buddy much in the office after that because they were busy visiting sick patients and making their rounds around town.

When they did come in, Buddy would sit and wait quietly in the basket while Orley had his doctor’s appointment. One day, a rude man came in and demanded to be taken on as a patient. To our surprise, Buddy barked and showed his teeth. Up until then, we didn’t even know Buddy could bark.

The pair of them became so famous that they even made the front page of the newspaper.

In Orley’s final days on the medical ward, we were able to bring Buddy to be with his human. No one batted an eye when Buddy became part of Orley’s palliative care team. 

After Orley passed, Buddy went to live with that little girl from the hospital. He retired as a therapy dog and became a family dog. It has been many years now. I keep thinking about the reunion between Buddy and Orley. I am sure Buddy would have been barking and showing his teeth for an entirely different reason at the end of the Rainbow Bridge.

— Dr. Allison Chung

 

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Local Care Home On-Call Group Improves Work-Life Balance

CHOC: Kamloops Care Home On-Call Group

Almost a year after being developed, an on-call group for long-term care (LTC) patients is giving providers some much-needed relief. The Kamloops care home on-call (choc) group launched in January 2023 to provide coverage for the long-term care patients of member physicians. The call group’s primary purpose is to improve work-life balance for physicians being pulled in many different directions while ensuring 24/7 care for their patients.

"It has been a great achievement to get this process started,” says Dr. Cristina Liciu, a founding member of the CHOC group. “The group provides better work-life balance for physicians with long-term care patients. Last year, I only got 10 days off. The rest of the time, I was available 24/7.”

The hope is to attract more providers to take on LTC patients now that the group has been created and is functioning well. Currently, there are five members in the on-call group. More members could enable the group to expand coverage to include weekday evenings if desired, further supporting physicians in our community.

An evaluation conducted after the first three months indicates positive outcomes: improvement in work-life balance for physicians, fewer calls from care homes due to the new formalized process, and more appropriate calls. Care home staff say it will take time to iron out some kinks, but overall, the staff have voiced satisfaction.

“It’s so great to know that it’s there, and that we can access a most responsible provider in a timely manner without exhausting anyone,” says Ailie Kerr, IH Manager Clinical Operations, Short Stay Programs Ponderosa Lodge.

Calls are for urgent matters only on weekends, from Friday at 5 p.m. to Monday at 8 a.m., and during the week CHOC members act as back-up if the most responsible provider cannot be contacted between 5 p.m. and 8 a.m.

“Each Division has different call models,” says sue Lissel, Senior Network Lead, Thompson Region Division of Family Practice. “This is a small group, and if we can grow the membership, it will provide greater coverage for more patients and better balance for physicians who then spend fewer weekends on call.”

Join the on-call group. Contact Melanie Todd, Senior Project Manager.
Email: mtodd@thompsondivision.ca

 

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Reclaim the camaraderie of the physicians lounge

A message from the Board Chair

As I reflect on my journey as a Board Member of our Division of Family Practice, and now the Chair, I want to share the reasons that led me to join this vital community of health care professionals.

At the heart of my commitment lies a nostalgic yearning for the camaraderie that once flourished in the physicians lounges and the sense of community that accompanied family physicians working closely in hospitals.

In the past, physicians lounges were more than just physical spaces — they were the epicenter of collaboration, knowledge exchange, and shared experiences. The camaraderie fostered in these lounges extended beyond professional discussions, creating a tight-knit community of practitioners.

However, with the changing landscape of health care we witnessed a shift, and family physicians found themselves working less frequently in hospital settings, leading to the gradual erosion of this sense of community.

Recognizing the need for a new gathering point, our Division has emerged as a hub for community-based family doctors. I hope that we will reclaim and redefine the essence of community by providing a platform for connection, collaboration, and shared purpose.

While the physicians lounge may no longer be a physical space within hospital walls, our Division is becoming a lounge of sorts. Through our collective efforts we are reigniting the spirit of community that has been integral to our profession.

As we navigate the evolving landscape of health care, let us embrace the opportunities that come with change. The Divisions of Family Practice are not just adapting; we are leading the way in revitalizing the sense of community among family physicians.

Together, let us continue to build a strong and supportive network that enhances the practice of family medicine and ensures the well-being of both our practitioners and the communities we serve.
— Dr. Cornel Barnard