A lifetime of change

Dr. Don Stefiuk reflects on the evolution of health care during his 40 years in practice

By Girard Hengen

Despite all of the advances Dr. Don Stefiuk witnessed during his 40 years practising medicine – new drug therapies, practice models, surgical procedures, training, equipment, and technological change – he believes physicians have lost something along the way.

“To a degree, because of technology and different ways of communicating, collegiality among physicians has, I think, gradually lessened,” Dr. Stefiuk said. “It’s still there, but not in the same way that it used to be. That is something that’s sort of sad.”

Dr. Stefiuk retired on June 28, 2019, after 40 years with City Centre Family Physicians of Saskatoon. He joined the original practice – Drs. Doig, Golumbia, and Associates – in 1979, when it was located in the Canada Building in downtown Saskatoon. He had just graduated from the University of Saskatchewan’s College of Medicine in 1977 and completed a two-year family medicine residency at the U of S.

Dr. Stefiuk sat down with the SMA recently to reflect on a lifetime in health care.

I’ve had a chance to think about it and, my God, everything has changed,” he said. “Everything from technology to treatments have evolved and changed. It’s been quite amazing when you think about it.

When Dr. Stefiuk started his career in the late 1970s, a typical day would see the practice’s four physicians doing hospital rounds first thing in the morning. They usually finished early, but didn’t have to start at the office until 10 a.m.

“We’d go to the physicians’ lounge and talk with the other physicians there. It was a great opportunity to ask questions and get information, discuss your patients, and just socialize.”

On Mondays, Dr. Stefiuk would work as the roster physician in the emergency department from noon to midnight. There were no emergency room physicians at the time. Family physicians in his group – and others in Saskatoon – often assisted in their own patients’ surgeries in hospital. Gradually, emergency room physicians took over ER shifts from family physicians and specialists performed the surgeries.

“Family physicians have lost their position in the hospital,” said Dr. Stefiuk. “We used to visit our patients in emergency, we used to assist with surgery on our own patients. Physicians used to make rounds on their own patients, we used to care for patients in the hospital in all areas. I’m speaking mainly from our group perspective, but there were a lot of other groups that did the same thing.”

Physician groups have grown, and with the emergence of internists and specialists in hospitals, the burdens on family physicians might have lessened, but this has come at a cost in terms of continuity and collegiality, Dr. Stefiuk believes.

“One of the things is you don’t get to know your colleagues like you used to,” he said. “You knew the surgeons, you knew the orthopedic people, the pediatricians. You knew them almost on a personal basis. Now you don’t.

“The old physicians’ lounges were filled with smoke and specialists and family physicians and administrators … Elmer Schwartz, for example, used to talk to physicians all the time, and that helped in relationships between physicians and administration. And so over the years sometimes I felt there was a lack of communication between administration and physicians. Sometimes you felt like administration didn’t really understand what was actually happening.” Dr. Stefiuk uses an analogy to illustrate the rapid march of progress. The Wright brothers’ first flight was in 1903, and by 1939, a pilot in Germany had tested the first jet airplane. The difference is 36 years.

“I was in practice longer than that period of time, so there’s been time for a lot of changes to go on in medicine. It’s been amazing, from technology to the way we communicate between physicians,” he said.

Computers, of course, changed everything. His practice switched from paper to electronic records in 2000, one of the first in Saskatoon to do so.

“I don’t know how people can practice without the computer,” Dr. Stefiuk said. “When we decided to computerize in 2000, we were being eaten up by files. We had two rooms full of files, and we had a file clerk. When a report came in, she had to pull the file, look at the report, refile it. If you needed to send a referral or to look at something, she had to pull the chart and give it to you and then she filed it.”

The practice partners decided that the computer system – at a cost of $200,000 – would pay for itself within five years by eliminating the file rooms and adding a physician. At that time, the practice had about 10,000 patients.

“Can you imagine today, with 21 physicians, how much space those files would take up?” Dr. Stefiuk said. “Computerization has really made life much easier.”

First came computers, then pagers, and now cellphones for communications. All have “improved life immensely” for physicians, he said.

Patients have benefited from improved treatment techniques since he started practice four decades ago. For example, people who had heart attacks were put into coronary care.

This might be an oversimplification, but you were given nitroglycerin and maybe a couple of other drugs and sent home and, you’re like California – waiting for the big one,” Dr. Stefiuk said. Now, an angiogram will show blocked arteries, and a patient can have artery bypass surgery.

“That’s amazing when you think about it,” Dr. Stefiuk said. The first heart transplant was done in 1967. Dr. Stefiuk notes a patient of his has had a new heart for 20 years. “He’s done amazingly well.”

Dr. Stefiuk also cites a host of other “quite amazing” advancements in medical care that changed the way he practised. These include stroke treatment, investigative procedures in radiology, organ transplants, and medications – especially in the area of cancer care.

The emergence of primary health care in many practices, with its multidisciplinary approach, is a positive step, he added. Working alongside nurses, social services staff, pharmacists and home-care workers has greatly aided patient care.

Along with all of the advances, patients’ expectations have evolved too, he said. “People see things on the Internet. They see things on television. There’s dozens of doctor shows and they see all kinds of stuff. I think people expect more, they think more can be done than sometimes really can be.”

Dr. Stefiuk was a member of the Saskatchewan Medical Association Board of Directors from 2011 to 2015, and received an Honorary Lifetime Membership from the Canadian Medical Association in 2014. When he announced his retirement, many patients booked appointments just to talk or say goodbye.

One thing that didn’t change over Dr. Stefiuk’s 40 years in medicine is his belief that physicians need to take the time to talk to their patients.

MED 1 - Class of ‘77, 1972-73 Back row: M.Trew, Elizabeth Ueberschar, V. Von Kampen, C. Walker, D. Warden, B. Wiebe, W. Wells, L. Worobetz, R. Yeske Second row: Toby Rose, Nan Schuurmans, D. Sheridan, Linda Smith, A. Stadnyk, D. Stefiuk, J. Sunstrum, D. Surkan, G. Taylor, Katie Tihanyi Front row: Doris Nelson, Mary Ann Parker, L. Poulin, A. Raff, D. Read, J. Reggin, J. Rice, J. Road, N. Rooke

Patients today, they want to talk, they want to tell you about what’s going on, and that’s important, because you can pick up a lot of things in medicine from just talking to your patient, getting to know them.

“People want to build a trust between themselves and their physician,” he continued. “Before I retired I was sitting at my desk and a patient came in, he didn’t have an appointment, and he stood in the doorway and he said, ‘I just wanted to come by and thank you.’ Tears were rolling down his face and he said, ‘You saved my life.’ I couldn’t remember what I did, but when I retired there was a lot of emotion between me and my patients. I didn’t realize how much they trusted me or depended on me.” ◆