A day in the life of a family doctor

Every weekday morning at 8:15, Dr. Brian Ritchie starts his day at the Ermineskin Medical Clinic in southwest Edmonton. By the time his first patient arrives 45 minutes later, Dr. Ritchie has met with the clinic staff, studied his list of patients, and is ready to take on any surprises a new day can bring.

On this typical day in mid-October, his schedule looks fast-paced and fairly normal, he says. Patients will come through the door with a variety of issues, starting with a check-up at 9 a.m. and running the gamut from knee pain, ear ache and stomach ache, to a couple of medication refills, a birth control follow-up and a vasectomy consultation. One patient has been doing well on her seizure medication, but due to a shortage of the drug, the prescription was changed. Her follow-up would ensure that she was still doing well. Another patient with diabetes also required screening because recent blood work caused some concern.

Dr. Ritchie has been practicing family medicine for 30 years and he has experienced a considerable shift in his workload during that time. In the early days, he saw his patients in hospital as well as in office hours, and was called to deliver babies at all hours. Today, he primarily keeps a regular office schedule. “Now, most urban family physicians are looking after a sicker, more elderly clientele,” he said. “Patients can’t stay long-term in hospital, so the workload for the office has increased.”

Family doctors handle all the basic care that patients expect from the cradle to the grave, he adds. “A fair number of family doctors go out to extended care centres, some do surgeries, some look after psychotherapy. Most of us have a sub specialty. I do vasectomies a half day each week, so I get referrals for vasectomies from other family physicians. Now with the primary care networks, all the services we need to provide are there.”

The Ermineskin Medical Clinic is affiliated with the Edmonton Southside Primary Care Network (PCN), which ensures an efficient team approach to family medicine. “We have an registered nurse here and a nurse practitioner, and both are trained in diabetic and hypertension follow-up. We work as a team. Once we diagnose a problem, the other health professionals assist me in following or monitoring chronic care patients. The nurses communicate with me, share their concerns and keep me informed. They can also do triage, providing advice by phone or on the spot, much like emergency room nurses at the hospital.”

The Edmonton Southside PCN’s model is based on decentralization, allowing the clinics to have the resources they need. Dr. Ritchie is one of 10 doctors working on two teams at the Ermineskin Medical Clinic. Five doctors are affiliated with one nurse and five with the other. A licensed practical nurse is on staff to help with pre-checkup work, such as height, weight, vision test and blood pressure. She can also remove stitches and apply dressings. A medical office assistant accesses patient records from the Netcare website as the doctors require it, and sets up ultrasound appointments or changes scheduling. Each team has its own receptionist as well.

A respiratory therapist, an exercise therapist and a dietitian make regular visits to the clinic, and a psychiatrist visits once a week, as does a physiatrist who specializes in musculo-skeletal issues and pain control. It’s convenient for patients and a valuable resource for the 10 doctors.

“By design, patients are getting more efficient care through the PCNs and we’re freeing up the doctors’ time,” said Dr. Ritchie. “The PCN makes sure you have a physician doing only what physicians do.”

Dr. Ritchie sees this as improved efficiency in the delivery of care. “If we can free up the family physician by taking 20 per cent off their plate, and still have patient care managed very well, then we’ll have more time and be able to take on more patients.”

This is one step toward addressing the shortage of family physicians and the common complaint that it’s so difficult to find a doctor who’s still accepting new patients. Ultimately, Dr. Ritchie believes this team approach to health care will bring more doctors into family medicine. “There are shortages of all physicians, not just family doctors,” he said. “But if you can make family medicine more appealing, then more medical students in their third year will consider it.”

While he may not deliver babies anymore and his hospital visits are rare, Dr. Ritchie is still enjoying his family medical practice. He is confident that everybody who walks into his office on this October day will receive the best care he can provide.