Saturday, April 26, 2008

It feels just like a vacation...

Since living here in Iqaluit I've taken up squash. Yes, I know, it's a strange sport to take up in the arctic but it's fun and a great workout. Imagine doing a few hundred lunges and a few dozen wind sprints and you have the game pretty much down. The worse you are the harder you work on the squash court (I, for instance, work my butt off). It's been a fun way to meet people and get out during the cold winter months when going outside is sometimes not terribly appealing.

When physician supply here in the arctic is lean (and it often is) it's left to the long term docs to pick up the slack. The emerg. needs to be covered, obstetrics needs to be covered, anesthesia needs to be covered, and when there aren't enough docs around that coverage can be tough to find. For the last few months we've been pretty understaffed and that has meant a lot of 7 day work weeks and lots of on call. A couple of months at that pace really eat into the rest of your life and for me squash games got put on hold. This month has been better staffed and we've even had a couple of weekends off! I've been back on the squash court a few times, though any skill I had has definitely atrophied.

Since I started playing again about 5 people have come up to me and asked how my vacation was. Vacation? What vacation? They react in disbelief when I tell them I have just been working every day for a couple of months, assuming I had been out of town since I hadn't been playing. It can be a tiring schedule up here sometimes, but luckily the work is usually enjoyable even when it's too busy. At the end of this week we're taking a real vacation. A bit of R&R should recharge the batteries, though I doubt it will do much for my squash game....

Thursday, April 10, 2008

Charts

Lets be honest, the paper medical chart is on the way out, and probably for good reason. Electronic charts have the capability of moving the chart from being mainly an archive of information to being a tool for communication and error prevention. Electronic medical records are slowly but surely supplanting paper charts. Here in Canada many provinces are offering incentives for physicians to adopt new technology, and physicians are slowly integrating electronic records into their practices. In the north the eventual disappearance of paper charts will mean better communications between nurses in remote stations, physicians in hospitals and specialists in the south. It will improve care planning, meds prescribing, and hopefully patient care.

Even though I see the benefits of electronic charts I remain attached to the paper versions. Here in the north many charts stretch over an entire lifetime. In the back of many charts I'll find thin typewriter paper from the 1950's and 60's with interesting notes from the past. Medical charting of yore was very different than the notes of today. Recently I stumbled across a note that read 'Hospitalized for bacterial meningitis. Fully recovered.' That was it, the full hospital admission, and discharge summary in one simple line. It probably wouldn't be considered particularly adequate these days.

Paper charts can be part of a tale of the ups and downs of a life well lived. One of the great thrills I get here in northern practice is to see a single volume chart on a 60ish year old patient. In the back there is a birth note on thin and fragile typewriter paper, lists of childhood immunizations, notes about hospitalizations for serious illnesses that still add weight to the conversation, delivery notes about the patients own children, office notes about the stress of raising teenagers, chronic diseases, aging. Then I look up from the chart, a story of a lifetime, and see the smiling face of a patient. Oolakoot!! (goodmorning!).

Sunday, April 6, 2008

Pics from Pangnirtung

Usually I am the only doctor providing support to the nursing station in Pangnirtung. It can be a big job, the population there is now 1350, which would be a pretty normal size for an urban family practice. Here in the north a community that size is cared for mainly by a nursing station, and with a doctor a phone call away for support. I visit the community about every 6 weeks for a 3 to 5 day visit where I see patients in clinic, do small procedures, review charts and make care plans for complex patients. I don't really get any other devoted time for community care, and manage phone calls, emails, x-rays, lab reports, prescription renewals and more of the side of my desk while I'm working in emerg. catching babies, or whatever duties I'm assigned to here at the hospital on any given day. Over the past couple of months we've been fairly short staffed (again) here at the hospital and a pretty substantial list of patients to be seen had built up in Pangnirtung. Luckily this month they were able to send up both Dr. H. and I to see almost all of the waiting patients.

We spent the week in Pang. and in addition to a few days of medical clinics managed to walk around town, out on the ice and generally enjoy the beautiful spring weather that has finally arrived (that's about a balmy -10C for those who've never been here). Here are a few pictures from the trip.

A family heads out to enjoy the spring day.


The Pangnirtung pass...


Dr. H and I with the pass in the background.


Sunset.


This is one of the old houses the govt. built to house Inuit families as they moved in off the land. It's now uninhabited, but you can imagine a large family living in that small cabin. It would have been a very different life. The housing sitation here remains grim, and though the houses are usually a little bigger than this now, they are still very overcrowded in many cases.