Surrey Memorial Hospital Foundation Magazine by Surrey Leader

MEDICAL A Surrey Memorial HOSPITAL Foundation Magazine

Spring 2011

generation next Dr. Janakie Singham is part of a new group of specialists coming to Surrey. THE FUTURE OF MEDICINE

Surrey’s newest health care centre opens in June

SUSPICION TO DIAGNOSIS

Breast Health program aims to provide answers soon

DEVELOPING DOCTORS

How the Jim Pattison Outpatient Care and Surgery Centre will help train tomorrow’s doctors MEDICAL PULSE • VOLUME 1 • ISSUE 1 • SPRING 2011

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A COMMUNITY EFFORT The City of Surrey and neighbouring communities have seen such tremendous growth and development in recent years. The rising population along with expanding health care facilities mean there is a need to recruit more doctors in order to meet the demand. By bringing the community together in support of this effort, we can help attract new physicians to the region by purchasing innovative medical equipment and putting the right tools in the hands of those who choose to come here. I am delighted to join the Surrey Memorial Hospital Foundation in raising $10 million for the medical requirements of this growing community. Together, we can attract the best and brightest doctors to Surrey. Sincerely, Jim Pattison Managing Director, Chief Executive Officer and Chairman The Jim Pattison Group

As a Director of Surrey Memorial Hospital Foundation’s Board, I offer our sincere thanks to Jim Pattison for launching the Foundation’s ‘100 Days to Give’ campaign with a generous gift. The campaign coincides with the period leading up to the opening of Fraser Health’s newest facility – the Jim Pattison Outpatient Care and Surgery Centre. In this magazine, you can learn more about how the Centre is driving innovation in health care in our community. The Centre will open on June 1. The competition for top physicians is international. Surrey is a vibrant, fast growing community in need of more doctors. The Foundation’s new campaign will help attract the best and brightest to this region by providing the leading edge equipment these medical specialists need to do their work. With this new facility and a Critical Care Tower scheduled for completion at Surrey Memorial Hospital by 2014, we are moving in the right direction to address the immediate and long-term health care needs of Fraser Valley residents. As CEO and President of Coast Capital Savings, I am also delighted to announce that we are giving half a million dollars to the campaign. Our gift aligns with our commitment to help build a richer future for our communities. I encourage everyone, including other business leaders, to join this important community effort and ensure we have the best health care available for the people who mean the most to us - our families and employees. Regards, Tracy Redies President & CEO Coast Capital Savings Credit Union 2 VOLUME 1 • ISSUE 1 • SPRING 2011 MEDICAL PULSE

MEDICAL

FEATURES

insidestories

4 GENERATION NEXT

SPRING 2011 VOLUME 1 | ISSUE 1

Dr. Janakie Singham is among the new recruits coming to Surrey

5 THE FUTURE OF MEDICINE

EDITOR Jason Howe

The Jim Pattison Outpatient Care and Surgery Centre opens in June

CONTRIBUTING WRITERS Karin Mark, Jason Howe

6 DEVELOPING DOCTORS

CONTRIBUTING PHOTOGRAPHERS Jerald Walliser, Bjorn Ewart

7 SOUND WAVES AND LASERS

LAYOUT & DESIGN Creative Services Department The Leader PUBLISHED BY

Outpatient Centre boosts medical education in Surrey

High-tech urology care, close to home

8 SUSPICION TO DIAGNOSIS

Surrey-based breast health program shortens the time between suspected breast cancer and diagnosis

9 RECONSTRUCTING OUTPATIENTS

Plastic surgery is more than just cosmetic touch-ups

10 CHRONIC CONTROL

New centre’s 3rd floor sets up coordinated effort to care for chronic disease and chronic pain patients We welcome your comments on Medical Pulse magazine. Please email info@smhfoundation.com or write to us c/o Surrey Memorial Hospital Foundation, 13750 96 Avenue, Surrey, British Columbia, V3V 1Z2. Established in 1992, Surrey Memorial Hospital Foundation has raised more than $55 million to purchase medical equipment, fund innovative programs, and support training and research. Visit www.smhfoundation.com for more information.

12 PREGNANCY’S FOCAL POINT

Bringing high-risk pregnancy services under one roof

13 QUARTERBACKS OF CARE

New primary care clinic supports patients who don’t have a family doctor

15 A FIRST LOOK INSIDE

Get a glimpse inside the new Jim Pattison Outpatient Care and Surgery Centre MEDICAL PULSE • VOLUME 1 • ISSUE 1 • SPRING 2011 3

interviewdiscussion

GENERATION NEXT Newly settled in Surrey, Dr. Janakie Singham is an example of the new generation of physicians being recruited to meet the needs of our growing population. The number of gastroenterologists practicing in Surrey is doubling from two to four with Dr. Singham’s arrival and that of Dr. Albert Chang. Dr. Singham: I was born in Sri Lanka, and I moved to Canada when I was seven because of the war. I grew up in Coquitlam. Foundation: Do you remember much about your time in Sri Lanka? Dr. Singham: I do actually. Lots of happy memories, but I do remember the war as well. I was very young. I think the gravity of it all didn’t quite hit me as much as it did my older sister, who was, I think, 15 at the time, and my parents. Foundation: What is gastroenterology? Dr. Singham: It’s the medicine behind the GI tract, so the mouth, the oesophagus, the stomach, the small intestine, the colon and the rectum. But it’s also the liver and the pancreas. Foundation: How long does it take to become a gastroenterologist? Dr. Singham: In my case, 16 years total. I did an undergraduate degree at Simon Fraser University in biology for four years. Then I actually went to Emily Carr and did training in art for two. Foundation: That’s a different direction. Dr. Singham: I always wanted to be a doctor and go to medical school, but I knew that if I did, it’s such a straight track that I would never get a formal education in art, which I really wanted as well. So that’s two additional years that most others don’t do. And then I did four years of medical school at Queen’s University, a year of general surgery training, then I switched into internal medicine, so three years of internal medicine training and two years of GI fellowship. Foundation: What attracted you to this specialized field of medicine? Dr. Singham: I think we’re all a product of our mentors, and Queen’s University where I 4 VOLUME 1 • ISSUE 1 • SPRING 2011 MEDICAL PULSE

went to school has a strong surgical program. Straight out of first year, I was taken under the wing of some amazing surgeons, so that’s what I thought I wanted to do. But I always enjoyed internal medicine. I found that I didn’t just want to use my hands. I wanted to provide treatment plans as well. I really enjoy thinking through a difficult diagnosis. Gastroenterology, or GI, is a good amalgamation of both. We get to do endoscopy, which is a procedure, but there are also a lot of really difficult diagnoses and treatment plans. I find it’s a good marriage of the two – the thinking sciences and procedural medicine. Foundation: What types of symptoms would lead someone to see you? Dr. Singham: In an emergency basis, what we mostly deal with is bleeding. Ulcers can bleed in the stomach, and there are different things that can bleed in the small intestine and colon as well. Obviously that’s an emergency because these people are actively losing blood, and we do have the ability to stop the bleeding a lot of the time, allowing the patient to avoid surgery or other procedures. Foundation: These are people who would arrive in the ER? Dr. Singham: That’s right. Then on an outpatient basis, we see a lot of inflammatory bowel disease, so Crohn’s disease and ulcerative colitis disease. There’s a myriad of other diseases that involve the GI tract. We commonly see what we call irritable bowel syndrome as well, which is a nervous disorder. When it comes to the liver and pancreas, we see a lot of the hepatitis, the viral hepatitides, alcohol, genetic liver disease, and then inflammation of the pancreas, that’s called pancreatitis. We deal with a lot of colon cancer

Gastroenterologist Dr. Janakie Singham opened her Surrey-based practice in February.

as well, and a lot of patients we see we’ll be screening for colon cancer. I really think that preventative medicine is the wave of the future. Foundation: Is there something you would see a lot because of the aging population? Dr. Singham: Certainly colon cancer is one of them. The recommendation is that when you turn 50 you need to have colon cancer screening of some sort, whether it’s testing your stool for blood or going straight to colonoscopy. Certainly with the aging population, there’s going to be an increased need for screening colonoscopies. Foundation: Why did you choose to work in Surrey? Dr. Singham: It was based on the advice of a lot of my mentors. Particularly from my research, Surrey seems to be an under-served community right now. Unfortunately I don’t think there are enough medical services to go around for such a growing population. I think fortunately that’s being recognized, and so it is one of the few hospitals that’s really growing and has the potential for change and improvement. I like the fact that I am perhaps starting at the right time when it is growing and becoming the hospital it needs to be for its community.

newcentre

THE FUTURE OF MEDICINE The Jim Pattison Outpatient Care and Surgery Centre opens in June

tep inside the new jim pattison outpatient care and surgery centre

Mahony, the project’s physician lead, what makes the centre truly unique is how it will deliver those services. “All aspects of the centre are designed with the patient in mind,” Dr. Mahony noted.

shop” approach, which means if patients need to access several clinics or programs, efforts will be made to coordinate appointments, when it opens in June, and you’ll know share records and reduce duplication. instantly you’re in a unique health care “A lot of time people work in silos and facility. aren’t patient-centred,” Dr. People can check in at highDoris explained. “We’re trying tech kiosks, like those at the to develop this high functioning airport. Natural light floods in team concept, and we’re getting through large windows. Colours better and better all the time.” and themes make it easier to find The teams will include your way around. A sacred space hundreds of staff and about welcomes all faiths. Interior 190 doctors – including 28 design inspired by trees adds to new positions, several of them the feeling of peace and healing. “DTF” (difficult to fill) positions Named after Jim Pattison to such as neurologists, infectious celebrate his $5 million donation disease specialists and foot/ankle to Surrey Memorial Hospital orthopedic surgeons. Foundation, the new centre is Physician support for the physically only three blocks away project has been strong from from Surrey Memorial but feels the start. In the past two years, miles away from an acute care Fraser Health has made an effort setting. And that’s intentional, to include physicians like never because Fraser Health’s newest before. building will be delivering care “It means no surprises. in a different way. Doctors have been engaged Outpatients are the focus of and collaborated with from the this modern building. These ground up,” Dr. Mahony said. are people who don’t need “From the patient point of view, emergency care or an overnight it means they’re going to get care hospital stay. that’s more thorough.” Approximately 450,000 patient The 188,000-square-foot visits are expected each year, building features six operating including most of the 134,000 rooms, 10 procedure rooms, outpatient clinic visits and 94,000 an atrium with retail space outpatient diagnostic procedures including a pharmacy and food that now take place each year at services, and 600 underground Surrey Memorial Hospital. and surface parking spaces. The Dr. Chris Mahony says patient care will be delivered in a unique building also meets the highest Residents from Surrey and beyond will come for diagnostic way at the new Jim Pattison Outpatient Care and Surgery Centre. environmental standards. scans and assessments, to help “It’s going to be completely manage an illness, and to receive a variety of SMH head of surgery Dr. Peter Doris different, but not just because it looks treatments. explained the philosophy underlying the pretty. Our mandate is to ensure the patient More than 50 clinics and programs – many Outpatient Centre is to help people better experience is very different than what it was of them firsts in Fraser Health – will be offered. manage their health when they’re not in the before,” Dr. Mahony said. It’s the first facility in Fraser Health and hospital in order to help them stay out of the “The goal is for patients to walk out of there B.C. to bring together such a wide array of hospital. feeling reassured, happy, and that they’ve been outpatient services. But according to Dr. Chris Care will be delivered through a “one-stopcared in a comprehensive way.” MEDICAL PULSE • VOLUME 1 • ISSUE 1 • SPRING 2011 5

teaching

DEVELOPING DOCTORS Outpatient Centre boosts medical education in Surrey

r. john diggle can barely contain his enthusiasm. “It’s huge and i’m excited!”

he exclaims while discussing the role the Jim Pattison Outpatient Care and Surgery Centre will play in training future doctors. The new facility will be ground zero for the general practice residency program starting July 1 that will bring a dozen GPs-in-training to Surrey each year, noted Dr. Diggle, Site Director for Medical Education at Surrey Memorial Hospital and the new Outpatient Centre. “It’s a perfect storm for us – we have a deep need for GPs in the community, we have an active training program for students at our hospital, and we now have the development of the Outpatient Centre that allows us to give them access to the whole spectrum of care,” said Dr. Diggle, a neurologist. “We’ll be training GPs right here in this community. If we repatriate 20 per cent of these doctors, it will have a profound effect on the general health of the community.” SMH’s status as a teaching hospital has become increasingly formalized over the years. Recognition in 2008 as an Affiliated Regional Centre for the University of BC medical school has meant residents and interns are a permanent fixture at the hospital. When the new tower is complete in 2014, a full Clinical Academic Campus will be established. To this point, most of the training has been centred around acute or emergency care. But with its focus on outpatient care and long-term health management, the Outpatient Centre will enhance Surrey’s academic landscape by offering completely new types of training opportunities, Dr. Diggle said. “We’re very good as doctors at teaching how to approach a problem, such as chest pain. We know what causes it, the tests we should do, etc. in the acute (hospital) setting,” he said. 6 VOLUME 1 • ISSUE 1 • SPRING 2011 MEDICAL PULSE

“What we’re not as adept at teaching is how to care for patients over the course of their illness. That’s the kind of knowledge you usually acquire over the course of your practice. In an acute setting you don’t get that longitudinal experience, and that’s one of the things we’ll be able to offer.” The new facility essentially takes the training out of the ivory tower and into the real world, he said. “We need to disperse this education, because most of health care does not take place in a hospital. Most of what we do as doctors is deal with ambulatory people who are coming in for prevention or maybe complications from acute care.” On any given day now, there may be 80 to 90 residents and students on the hospital grounds. Once the Outpatient Centre opens, they’ll flow back and forth between the two sites. From the patient’s perspective, Dr. Diggle noted there are some definite benefits. “It educates the patient as well as the resident and trainee you’re with,” he said. “They’ll be in the middle of all that communication.” Patient care also benefits because an academic focus tends to help keep everyone’s skill levels sharp. “Having that trainee at your side peppering you with questions makes you a more precise, rigourous clinician,” he said. Not to be underestimated is the value brought by the students and residents themselves, he said. “They’re closer to the basic science of medicine, closer to the medical training. It enriches the entire medical team when you have these people on board. They are current, they are writing their exams, they are at the top of their game,” he said. “They may be learning the art and style of patient care, but these people are very current in their knowledge and skills. They make us all better doctors.”

Dr. John Diggle says a medical school affiliation will help bring new doctors to the region.

Ultimately, Dr. Diggle said, the Outpatient Centre will ensure that students and residents who train in Surrey will receive a uniquely comprehensive academic experience, while also benefiting from some of the innovative approaches being explored there, such as the breast health program. Surrey can also look forward to a steady supply of new family doctors and specialists, because statistics show that people tend to stay where they trained. “The opportunities here will range from hyper acute to outpatient care. It’s going to be a tremendous opportunity for those people,” Dr. Diggle said. “With Surrey as the hub of that training, the community will also benefit.”

urology

SOUND WAVES AND LASERS L

High-tech urology care, close to home

asers that treat enlarged prostates and a machine that blasts kidney stones

with sound waves will be among the leadingedge urology equipment featured in the Jim Pattison Outpatient Care and Surgery Centre. New technology and services at the facility’s urology clinic will make the treatment of kidney, prostate, bladder and urinary tract problems faster, easier and more convenient for patients – and further cement Surrey’s place as one of the leading centres for urologic care in B.C. “Ultimately the new clinics will reduce our waiting lists, so we can see patients more promptly, more effectively and closer to home,” said urologist Dr. Cal Andreou. Urology services being offered at the Outpatient Centre include Extracorporeal Shock Wave Lithotripsy to treat kidney stones a brand new service for Fraser Health. Currently, Surrey patients must drive to Vancouver for the lithotripsy procedure, which blasts kidney stones into sand that is later passed with the patients’ urine. This allows patients to go home the same day rather than undergo stone-removal surgery, followed by a hospital stay of two to three days and several weeks’ recovery. “It’s a much easier treatment for the patient,” Dr. Andreou said. “Being able to do these treatments closer to home will be a fantastic benefit for our patients.” The clinic can’t open fast enough for Cornelia Reinsma. In the last six years, the 77-year-old Surrey resident has undergone three operations for kidney stones and has received lithotripsy treatment twice in Vancouver. “They found two more stones but I’m not going back to Vancouver,” she said. “Travelling to Vancouver is for the birds. My sister went with me but we had to leave very early in the morning.” Reinsma hopes the new stone prevention clinic will also help keep her away from Surrey Memorial Hospital’s busy emergency department, which she visited three times last year.

New in-house urodynamics testing – which diagnoses bladder malfunction and helps identify treatment options – will also eliminate the need for patients to travel elsewhere. As well, the clinic will house Surrey’s second GreenLight Laser, used for the treatment of

Dr. Cal Andreou stands inside one of the Outpatient Centre’s new operating rooms.

enlarged prostates, a common condition in older men and one that represents about 15 to 20 per cent of local urology cases. The laser allows enlarged prostates to be treated as a day procedure, rather than a surgery followed by a hospital stay of one or two days and several weeks’ recovery. The addition of a second laser will reduce wait times while also making this non-invasive procedure available to patients whose prostates are too large to be treated by laser now, Dr. Andreou noted.

Prostate patients will also receive follow-up care, education and support. For example, those dealing with incontinence or sexual dysfunction following treatment may be referred to the physiotherapist, incontinence clinic, counseling or other services in the Outpatient Centre, in addition to a community support group. This one-stop, full-service approach to patient care will be evident in all areas of the practice. For example, along with improved treatment of kidney stones, a new stone management clinic – Fraser Health’s first – will be working to reduce the 50 per cent recurrence rate through monitoring, diet and lifestyle education, and medications. The care of incontinence will be another significant focus. One of the most common procedures will address female incontinence, a widespread problem among older women. Women who urinate when they laugh, cry, sneeze or jump may be helped by a 10-minute procedure in which a sling or mesh is implanted. Diagnosis and treatment of these and other incontinence issues will be augmented by a focus on education and prevention through a new incontinence management clinic. A new nurse incontinence adviser position has been created to provide diet and lifestyle counseling and other support for patients. The incontinence and other urology care offered will drastically improve the health and quality of life of many Surrey residents. Incontinence affects about 15 per cent of the population and is the leading reason that seniors are placed in long-term care. Enlarged prostates are common in older men. Kidney stones affect about 10 per cent of Dr. Andreou’s practice and are more common in the South Asian population. “Patients are always very appreciative of what we do for them,” Dr. Andreou said. “Now they’ll be able to get the best care in the world close to home.”

MEDICAL PULSE • VOLUME 1 • ISSUE 1 • SPRING 2011 7

Suspicion to Diagnosis Surrey-based breast health program shortens the time between suspected breast cancer and diagnosis

Dr. Peter Doris says the new breast health program will provide quicker diagnosis.

New breast health program based on European model of care

8 VOLUME 1 • ISSUE 1 • SPRING 2011 MEDICAL PULSE

or Heidi Kerr, the waiting was the worst part.

Now undergoing chemotherapy following a bilateral mastectomy and lymph node removal in January, Kerr waited six agonizing weeks from the day she learned her mammogram was abnormal to receiving a definitive diagnosis of breast cancer. “The waiting just plays on your mind. You have too much time to think and stress. I seriously thought at times that I would need some psychiatric help,” Kerr said frankly. “It could have been even longer. When I was getting the second imaging they had a cancellation for the ultrasound, so I was lucky to get it done in the same day.” Weighing on Kerr was the fact that her mother had lost her battle with breast cancer. “I’m feeling better about the cancer now because it’s out,” she said. “The waiting is definitely the worst part. The fact that you don’t know: do you have cancer or do you not have cancer?” The new Breast Health Clinic in the Jim Pattison Outpatient Care and Surgery Centre will put an end to long, distressing waits for women with suspected breast cancer. Based on the model developed by the European Society of Mastology (Eusoma), the program’s goal is to reduce diagnosis times to a maximum of 21 days from the time of referral, compared to an average of three months now. “I have always had great compassion for the women who are going through the diagnostic cascade for months and all they want to know is, do I or don’t I?”, said Dr. Peter Doris, head of surgery at Surrey Memorial Hospital. “When the opportunity arose for the Outpatient Centre, we said we need to set up a system like they have in Europe, and we need to do it based on a standard.” The lack of North American standards prompted Fraser Health breast health specialists to look abroad for inspiration and

best practices. Surrey’s model will focus on the suspicionto-diagnosis phase, while treatment and advanced disease care will be done outside the Outpatient Centre in another setting. Like Eusoma, the program will provide same-day access to the three key means of diagnosis – physical exam, medical imaging (mammogram and/or ultrasound) and tissue sample (biopsy) – and ensures coordination between specialists to provide a faster, accurate diagnosis. Not to be forgotten are the many women who wait for weeks and months envisioning the worst-case scenario, only to learn they worried for nothing. “The experience of these clinics is 85 per cent of women don’t have cancer,” Dr. Doris said. “It takes months for somebody to say, ‘No, it’s not cancer.’ That’s terrible.” Weeks if not months of delays are built into the current diagnosis sequence, he noted. Some delays are caused by a lack of coordination between the different pieces of the diagnostic puzzle. Another contributor is the fact that the imaging and procedures take place within hospital settings and so can sometimes be bumped for more emergent cases. Dr. Dennis Janzen, the diagnostic imaging lead for the Jim Pattison Outpatient Care and Surgery Centre, said many women will get a definite benign result on the same day through the new program. A large segment will get a definite diagnosis within 72 hours, and only a small percentage of cases will be complicated enough to require 21 days for diagnosis, he said. From a logistical point of view, he added, the one-stop approach of the new program is not only less stressful and more convenient for patients, but will also save the system time and resources in trying to organize multiple appointments with different specialists. A typical diagnosis now may go something

like this: • A woman or her doctor finds a lump, or she has an abnormal mammogram and the results are sent to her family doctor. • Her family doctor makes an ultrasound appointment; the earliest available date is several weeks away. • Following the ultrasound, the radiologist needs more information so recommends an appointment with a surgeon. It takes two weeks to get the appointment. • A biopsy is scheduled; there is another twoweek delay as the date is coordinated with the x-ray department. • The biopsy results confirm the presence of cancer, three months after the suspicion of cancer. • The woman is referred for treatment, which begins within two weeks. A typical diagnosis through the new Breast Health Clinic may go something like this: • A woman or her doctor finds a lump, or she has an abnormal mammogram and the results are sent to her family doctor. • An appointment is made with the Breast Health Clinic the following week. • At her appointment, the woman could receive a physical examination from a surgeon, an ultrasound and a biopsy, all on the same day. • The specialists confer over the results and come back with a diagnosis of breast cancer within 72 hours of the appointment. • The woman is referred for treatment, which begins within two weeks. Faster diagnosis is just one aspect of the new model. The new “triple assessment” approach is expected to reduce false negative diagnoses (when the cancer is not detected by the tests) and provide a definitive diagnosis 99 per cent of the time. The current false negative diagnosis rate varies, but is significantly higher for younger women, due to their denser breast tissue and more subtle and infiltrative tumours.

In the new program, clinical and imaging specialists will compare notes on each patient’s test results; their assessments must correspond before a diagnosis is provided. They’ll also have more data to work from than before, thanks to a new digital mammogram unit – the first in Surrey – that produces more detailed images that can be easily shared online. The digital mammogram also enables the use of new biopsy equipment that can more quickly and accurately identify a greater range of legions. “It’s a new concept to have the surgeons on site. The fact that they’re right next door will allow the imagers and surgeons to collaborate on a patient,” Dr. Janzen said. “The more collaboration and the more thorough the investigation, the smaller and smaller the miss rate becomes.” While the Surrey program won’t meet the official Eusoma accreditation standards to begin with, Dr. Doris said the intent is to act as if accreditation is the goal. In part, this will mean introducing a new focus on collecting and analyzing clinical data – data that could be used to create a business case for more Eusoma-type clinics in Fraser Health. Looking further ahead, Dr. Doris envisions the program expanding its multi-disciplinary approach to include disease treatment and management, similar to the European clinics. “My own view is that this is the way things need to be done, but of course there are reasons why this hasn’t occurred in North America yet,” he said. “If we can show proof of concept, that’s very important.” For Kerr, the mother of two daughters in their 30s, there is some comfort in knowing that diagnosis could come more quickly if they ever have an abnormal mammogram. “The biggest scare for me is that they will end up going through this too.”

Reconstructing outpatients PLASTIC SURGERY IS MORE THAN JUST COSMETIC TOUCH-UPS Dr. Adrian Lee is forever coming across people who are surprised to hear that plastic surgery is a lot more than just cosmetic procedures. Dr. Lee and the rest of the plastics team at Surrey Memorial Hospital perform reconstructive surgeries all over the body on all types of tissue, including skin, muscle, tendon, nerves, blood vessels and even bone. Many of the people treated by this department qualify as outpatients, which make them well suited for the Jim Pattison Outpatient Care and Surgery Centre. “In plastic surgery, approximately 50% of all our cases are daycare surgeries appropriate for the new centre,” says Dr. Lee. “We will be seeing 5000-6000 patients a year in this new centre for conditions of the hand, skin cancers and other plastic surgical ailments.” Dr. Lee says major cases like 1st stage breast reconstructions following mastectomies and complex hand and facial fractures will continue to be performed at Surrey Memorial. But in anticipation of an increased focus on outpatient care, Dr. Jennifer Prince was recruited last year. “She is a huge addition and specializes in microsurgery and hand & wrist surgery,” says Dr. Lee. “The latter is almost exclusively outpatient work.” MEDICAL PULSE • VOLUME 1 • ISSUE 1 • SPRING 2011 9

chronicconditions

chronic CONTROL New centre’s third floor oversees care of chronic conditions

any people who have a chronic disease don’t have just one.

They may have asthma, diabetes and hypertension. Or maybe chronic pain along with depression. In Surrey and North Delta, thousands of people live with multiple chronic diseases. It doesn’t take much for something to go wrong – the wrong combination of drugs, for example, or a bout of unbearable pain – for the individual to end up in the emergency department. This is the target audience for a group of clinics on the 3rd floor of the Jim Pattison Outpatient Care and Surgery Centre that will offer care to people with chronic illnesses. Even for people with less complex conditions, chronic disease support can make a big difference in health and quality of life. For example, Sarabjeet Charchun was very concerned when she was diagnosed with Type 2 diabetes nine years ago at age 31, just before she and her husband were planning to start a family. Diabetes is a risk factor for pregnancies. As an occupational therapist at Surrey Memorial Hospital, Charchun was already comfortable within the health care environment. But even so, she relied on the diabetes clinic to support her through her two pregnancies and other stressful times in her life. “It can sometimes be paralyzing, and I see people every day who don’t deal with their diabetes. But with support, it is possible to learn how to live a healthy and fulfilling life and deal with your disease,” she said. “I had two healthy pregnancies and have two beautiful children, and it’s because of their support. That’s the bottom line.” 10 VOLUME 1 • ISSUE 1 • SPRING 2011 MEDICAL PULSE

The new Outpatient Centre will bring together a number of services in one location. “(There are) seven services, but the philosophy is to run it as one integrated clinic,” explained Dr. Urbain Ip. “What the patient will see is smooth delivery of care.” Other innovations will include better information sharing by having all care providers use the same patient record, and a new chronic care coordinator to oversee patients with complex conditions and prevent gaps or overlaps. “The care coordinators know the latest in best practices. It’s a very effective way of managing the patient,” Dr. Ip said. One of the primary aims is to improve the health of patients with Dr. Urbain Ip says several programs on the 3rd chronic diseases to keep them out of floor of the new Outpatient Centre will work the emergency room and hospital together to improve the health of people with beds. Almost 40 per cent of the chronic illnesses. population has a chronic disease, but this segment consumes more than 80 per cent of health care resources. services is recognition that chronic pain – New services include Positive Health, Fraser afflicting as many as 300,000 people across Health’s first comprehensive HIV/AIDS/ Fraser Health - must be treated with the same Hepatitis C program, along with a new primary multi-disciplinary approach as other chronic care clinic that will provide hospital follow-up, diseases. referrals and care management to patients “Chronic pain is involved in every chronic without a family doctor. disease aspect. It begins with acute pain, when Other clinics that existed elsewhere and will patients show up in doctors’ offices and ERs. be expanded in the new space include diabetes, Some forms of pain transition into chronic heart, lung and seniors’ health programs. pain,” explained Dr. Lau, who recently handed The chronic pain clinic will be moving over the pain clinic’s directorship to Dr. David from two rooms at SMH into about four Twist in order to take on a new regional role. times the space at the new centre. Dr. Brenda continued... Lau said the expansion of the pain clinic’s

chronicconditions

The Pain Management team on the 3rd floor of the Jim Pattison Outpatient Care and Surgery Centre.

“With early recognition and intervention, many of the pain-related disabilities negatively impacting the person and their family can be reduced.” Fraser Health’s only chronic pain clinic and B.C.’s first fully integrated pain clinic, the program helps patients manage their pain through medication, medical interventions, counseling, education, or non-medical therapies such as physiotherapy and occupational therapy. The goal is to help patients improve function, return to work and reduce their need for health care services. Typical chronic pain types include low back pain, lumbar spine pain, persistent migraines, pelvic pain, neuropathic pain and rheumatologic pain. Fibromyalgia, which produces chronic widespread pain, is becoming more common. “Pain is disabling because of physical, emotional and psychological factors,” Dr. Lau said. “There are people who have major physical abnormalities but if they have a coordinated network of providers and family support, that makes a difference in a person’s quality of life and coping. Pain conditions are worsened through lost relationships, lost jobs

and lost sense of purpose.” Before she first visited Dr. Lau in 2009, Lisa Armstrong was often bedridden with debilitating pain from a previous car accident and surgeries for endometriosis and complex intestinal problems. “I always say the pain is like having the flu and having a pickaxe in every joint and abdominally. And it never goes away,” explained the 35-year-old photographer. “I went to several doctors while I was waiting for Dr. Lau. I actually had doctors say, ‘I don’t know how to help you.’ At the pain clinic they listened and spent the time to assess my complex medical issues. They refer you to specialists they think can help. Within a couple of months they had figured it out.” Now, Armstrong must still monitor her “energy piggy bank” and visits the clinic weekly for medication infusions, but her pain is manageable. “I’m out four days a week doing things, and when I can, I take pictures. I’m living my life. It may not be the eight-hour days other people have, but it’s so much better than what it used to be. They’ve given me my life back,” she said. “And they still haven’t given up on me. They’re

still referring me to other doctors and doing other tests to help me progress in getting better.” The clinic’s team of five clinicians include four anesthesiologist/pain specialists, B.C.’s first nurse practitioner specializing in chronic pain, a physiotherapist and an occupational therapist. Along with the extra space and direct access to related disciplines, the clinic team is expanding with the addition of a psychiatrist, nurse, physiotherapist and two new pain specialists. Dr. Lau hopes the additional capacity will reduce the waiting list that can now run into two or three years. But with the large volumes of people who need help – an estimated 40,000 to 50,000 people in Fraser Health suffer from severe disabling pain – the new clinic space will also be leveraged to build capacity through education of clinicians and improved support for the family doctor community at large. “We have to increase the education at the GP level,” she said. “By improving access to team-based approaches in managing complex pain problems, we have a huge opportunity to reduce the disabilities of those suffering from chronic pain sooner rather than later.” MEDICAL PULSE • VOLUME 1 • ISSUE 1 • SPRING 2011 11

prenatalservices

preGNANCY’S FOCAL POINT Bringing high-risk pregnancy services under one roof

new baby immediately becomes the focal point in a home.

In the same way, pregnant women will be the focal point in the new Maternity clinic at the Jim Pattison Outpatient Care and Surgery Centre. The clinic will bring together a wide range of services to support mothers with high-risk pregnancies, while also providing prenatal care to mothers with uncomplicated pregnancies. “These are stressful pregnancies for patients,” noted Dr. Keith Still, physician lead for the clinic. “If we can normalize certain parts of that pregnancy, that makes a huge difference. Women can deal with things if they know what it is they are dealing with.” That approach was certainly appreciated by Gerrilyn Alexander when she was pregnant with her daughter Audrey. Alexander was referred to the existing Maternal Fetal Medicine and Antepartum Care programs for monitoring because she suffered a loss during an earlier pregnancy. “The anxiety can be huge, especially if you’re worried about loss,” she said. “For me, it was very reassuring to know that things were plugging along as they should be.” The key Maternity services will be: • Antepartum Care at Home – allowing women with certain types of complications to remain at home rather than be hospitalized. • Nausea and Vomiting of Pregnancy – care, counseling and education of women experiencing severe nausea and vomiting. • Outpatient fetal monitoring – diagnostic testing and assessment. • Maternal Fetal Medicine – delivering the provincial program, with services including ultrasound, genetic screening, pre- and postnatal care, and consultation for women with high-risk pregnancies. • Surrey Prenatal Clinic – primary prenatal and post-natal care for low-risk pregnancies. • Diabetes in Pregnancy – assessment and management of pregnant women who are diabetic or have gestational diabetes. 12 VOLUME 1 • ISSUE 1 • SPRING 2011 MEDICAL PULSE

• Reproductive Mental Health – assessment and management of patients with mental health concerns. These services will be delivered by a group that includes nurses, dieticians, social workers, family physicians, endocrinologists

Dr. Keith Still says the Outpatient Centre will help structure the care of women with high-risk pregnancies.

and perinatologists, along with a psychiatrist and counselors in reproductive mental health. A geneticist and an expert in medical complications in pregnancy will be added in the near future. “So many of the patients we see are very complex, and in this setting there will be more opportunity to structure their care. So many of

the patients require so many services,” Dr. Still said. “It’s like going to a big box store where you can find everything in one place, but with boutique service.” New technology coming with the new space includes a third ultrasound unit and a new electronic archive of fetal monitoring results. Digital imaging results will also improve coordination between the sites. But what Dr. Still is most excited about is how the care providers will work as a team. “I don’t have to be the coach or manager – I can be the quarterback,” he said. “I ultimately have to make the call, but we’ll be drawing on all of the resources we have.” Bringing together more eyes and minds will produce healthier babies, he predicts. “If we are assessing these babies in a timely way and are triggering delivery in a more appropriate way, we’ll have less long-term issues with these babies, less learning disability and other complications,” Dr. Still said. While the core services will focus on high-risk pregnancies – such as twins or women with diabetes or other health conditions – women with low-risk pregnancies will be able to receive prenatal care on site through family doctors, or visit the nausea and vomiting clinic. Ultimately, the Maternity clinic will put the patient at the centre and make sure she understands what’s happening with her care each step of the way. The Antepartum Care at Home Program was particularly convenient when Gerrilyn Alexander was on bedrest. Because of the support she received, she didn’t go to the hospital once during her pregnancy. She also learned a lot about how her body reacts to being pregnant. “They basically train you what to look for and you learn to monitor yourself. You get to know your own normal,” she said. “I have no pain when I go into labour, so if I hadn’t learned how to monitor myself, I would have been a nervous wreck. The education was really valuable.”

primarycare

QUARTERBACKS OF CARE New Primary Care clinic supports patients who don’t have a family doctor

HEY’RE OFTEN CALLED “ORPHANED” OR “UNATTACHED” PATIENTS:

people who don’t have a family doctor. There are a lot of them in Surrey – an estimated 15 per cent of the population – and they’re the focus of the new primary care clinic at the Jim Pattison Outpatient Care and Surgery Centre. The new clinic will offer the kind of care usually provided by family doctors to people who need more care than a walk-in clinic can provide – those who have been discharged from hospital, for example, or the 40 per cent of the population who have one or more chronic diseases. “Other primary care clinics exist, but what’s innovative about this one is its integration with the other services at the centre,” said Dr. Art Willms, the physician lead for the clinic. “The idea is there will be coordination and support for the family doctors at the clinic through mental health, home health, addictions and the various chronic disease clinics.” The primary care clinic is intentionally located within the Third Floor Centre, the name that has been given to the collection of clinics on the Outpatient Centre’s third floor that will provide care to patients with complex conditions. Specialty programs for diabetes, heart health, lung health, chronic pain, HIV/ AIDs and Hepatitis C and seniors will be located there. Most of the patients coming to the primary care clinic will be referred by Surrey Memorial Hospital. Several factors make the primary care clinic a necessity, Dr. Willms noted, including the shortage of family doctors, the high rate of diabetes in the South Asian community, the aging population, and the large number of people who have two or more chronic diseases. Hospitals and ERs are overwhelmed, but the community lacks family doctors and other resources for patients who need follow-up care.

Issues are bound to arise, sending the patients back to the hospital and ER. Research has showed that more than 19.5 per cent of patients showing up at SMH’s emergency room don’t have a family doctor. The hope is that by providing follow-up care to patients who don’t have access to a family doctor, the primary care clinic will reduce congestion at Surrey Memorial’s emergency department, help people avoid the need to return to the hospital after having been discharged, and connect with those who have complex medical needs. “There are some very solid studies that say if you have a primary care provider, you end up in the hospital less and you cost the system less,” Dr. Willms said. “This will improve the capacity of the whole system. At one level it’s good care, but on another level it’s stewardship for the entire system.” The clinic will serve four main types of patients: • Patients from SMH who have difficulty accessing a regular family doctor, including: patients discharged from the emergency department, admitted patients discharged from the hospitalist program, and new mothers who delivered at the hospital (along with their babies). • Patients from other outpatient clinics at the Jim Pattison Outpatient Care and Surgery Centre. • Patients who require urgent follow-up care to allow for discharge from hospital or to prevent admission to hospital. These would usually be unattached patients but would also include those who have a regular physician who is unavailable or distant. • Patients with unusually complex needs who require the support, input and time of a health care team. While the primary care team will oversee the health needs of these patients, the clinic will also search for ways to transfer them to other providers in the community for ongoing care as soon as possible.

Dr. Art Willms says primary care physicians can help reduce the number of hospital visits for patients who don’t have family doctors.

Since August, the primary care clinic has been operating from the Charles Barham building at Surrey Memorial Hospital. continued... MEDICAL PULSE • VOLUME 1 • ISSUE 1 • SPRING 2011 13

primarycare

Recruitment drive It didn’t take long for Surrey Memorial Hospital Foundation’s latest fundraiser to start getting results.

Dr. Hala Ahmed and Dr. Laila Bhimani are new recruits who have chosen to work in Surrey as primary care physicians.

Dr. Laila Bhimani, who was recruited to the primary care clinic last year after completing her residency in Edmonton, is one of the doctors working at the interim clinic. She was drawn to the clinic by its teambased approach to care – something she had been looking for after working in a similar environment in Edmonton. “It’s easier for patients when you provide all the care in the same place. All the services and information they need is available,” Bhimani said. “By a team-based approach, we can offer more complete care for complex patients under one umbrella.” In particular, she noted, the team-based approach (involving a physician, nurse practitioner and Care Coordinator nurse) ensures that a patient’s complete needs are met while allowing doctors to move on to the next patient. Bhimani has found Surrey’s healthcare professionals to be welcoming to newcomers and helpful in linking her up with local resources and contacts. And because Surrey is a multicultural community, she hopes her South Asian heritage will enabled her to assist the clinic with overcoming any cultural obstacles that may prevent some residents from seeking medical care. Once the new Outpatient Centre opens in June, Bhimani will be among eight to 10 14 VOLUME 1 • ISSUE 1 • SPRING 2011 MEDICAL PULSE

doctors who will run the primary clinic with the assistance of a steady supply of general practice residents. Dr. Willms said Surrey’s new general practice residency program starting in July is considered an important part of the primary clinic, in that it will provide resources to the clinic while helping to train future doctors. The hope, he said, is to not only promote this integrated primary care model with the next generation of doctors, but also that some of the residents will fall in love with Surrey and eventually decide to set up their practice here – helping to address the community’s doctor shortage. Ultimately, the goal of the primary care clinic is to build capacity within patients so that they know what they need to know to manage their own health, Dr. Willms said. “We want to educate patients, we want them to learn to self-manage, we want them to make good decisions about their health,” he said. “This is exciting for us as physicians, because it will simplify our life, but for the patient, it should really help them both to understand their condition and take better control of it, and enhance their health in the long term. “The mantra is really to build a strong primary care program that will, in an ideal world, keep more people healthy and out of the hospital.”

A new neurologist is coming to Surrey, making the doctor the Foundation’s first success in a campaign to bring new specialists to the region. The 100 Days to Give campaign was launched February 21st to help attract new doctors by purchasing innovative equipment with donations. Even before the campaign was publicly announced, Surrey Memorial Hospital neurologist Dr. John Diggle had passed along details to some of his colleagues from outside of the region. Dr. Diggle says this generated new interest in Surrey among neurologists and resulted in the recruitment of Dr. Martin SuttonBrown. The Foundation will purchase some specialized neuroophthalmology equipment for him. That’s where the 100 Days to Give campaign can be effective – by putting the right tools in the hands of those who choose to come to Surrey.

Get a glimpse inside the new Jim Pattison Outpatient Care and Surgery Centre

A FIRST LOOK

inside

MEDICAL PULSE • VOLUME 1 • ISSUE 1 • SPRING 2011 15

The Future of Medicine Opening June 2011

Jim Pattison believes Surrey deserves the best health care. Give to Surrey Memorial Hospital Foundation today, and he will generously match your gift. Your donation will be doubled by the Jim Pattison Foundation up to $5,000,000. The Jim Pattison Outpatient Care and Surgery Centre is a first of its kind in BC and opens June 1st in Surrey. Your donation will help to purchase state-of-the-art equipment which will help attract the very best doctors to our region.

Please visit www.smhfoundation.com today!

Feb 21–June 1 Featured Donor

Coast Capital Savings Credit Union has generously pledged $500,000. You can also make your cash donation at any Coast Capital Savings branch. For a complete list of branches, visit www.coastcapitalsavings.com. 16 VOLUME 1 • ISSUE 1 • SPRING 2011 MEDICAL PULSE