What it means to take leave in medicine -

As we continue to see the decimation of healthcare in AB, we should anticipate more and more physicians needing to take leaves due to stress and burn out. Every week, we hear about family physicians closing their practice, due to burn out, unsustainability of keeping up with the cost of practice, and the moral injury that we all feel of "failing our patients."

For the first time in my own career as an internal med doc, I've seen the day where my colleagues can no longer safely admit patients from the ER. We've talked about healthcare collapse a number of times over the years and I think it's important that collapse looks and feels different depending on where in the puzzle your piece fits.

I've been pretty quiet on here for many reasons - self-preservation, trying to regain control in areas of my life, and simply put - healthcare still is in crisis and posting about it felt a bit like Groundhog's Day. But I think it's time to speak up again as the hospital system has hit a tipping point. As we head into a long weekend in the middle of a respiratory virus surge after 3 years of absolutely no meaningful help from our leaders, brace for a collapse of epic proportions.

It's been a minute since I've posted and I'm not entirely sure if I'll fully be back. But something happened today that restored faith in humanity. I was at the grocery store, last minute shopping before school starts, and when it comes time to pay, I realize my wallet isn't in my purse. The worst feeling ever, especially with a big line forming.

Incredible piece by my colleague, @gabefabreau on the healthcare crisis. The frustration we feel knowing there is no hope or solution on the horizon, when we are told to do more, provide more. In my career, I've never felt so ready to move on from a profession I love. calgaryherald.com/opinion/column…

It's been a week since we heard the healthcare crisis is under control in Alberta.

In that week, we have SIGNIFICANTLY surpassed our capacity each day, with no space on our wards to admit patients to. We continue to have significant EIPs (admitted patients stuck in ED since no beds upstairs), patients in over capacity spaces (read: hallways, extra "beds" in the corners of already crowded rooms) with no plan to reabsorb into funded spaces.

Patriarchy in medicine. Let's discuss.

I recently had an unnerving interaction with another healthcare provider not from my local medical community. We had a mutual patient, one that I was seeing for Long COVID. Now, I should point out, that on best of days, I have severe imposter syndrome when it comes to LC, knowing that I'm not an expert but simply a "willing to learn and try" physician for a condition that doesn't necessarily have "best practices guidelines" yet.

To my physician colleagues - I say this with the utmost empathy.. but...

Can we please (PLEASE) stop labeling disease entities that we don't understand or have enough evidence for as psychosomatic? I'm not suggesting that emotional and mental health do not play a role in our overall health, because trust me, I know they do. We are not simply organ systems. Our bodies are a complex unit.

I have reached the point in my outpatient clinic where 90% of the patients I now see are Long COVID patients. And while every patient is unique with their own story to tell, there is one incredibly powerful point in every initial consultation that remains the same no matter the circumstance.

A very long - Long COVID thread.

Our Long COVID program has been open 10 months now. I've seen over 150 patients in that time, with new referrals booking well into February 2023. I've had to stop accepting other internal medicine referrals, just so I can keep up with the demand, the follow ups, the downstream effect.

Day in the life of a medical clinic. (N.B.: family docs have been living this reality for decades, with less and less resources, and more and more overhead. They truly are the heroes of our healthcare system). I will start by noting that I am not a family physician. I am an internal medicine doc, who sees new consults, follow ups, works inpatient and administrative work. Context is key, as all of us have our own sets of challenges dictated by our individual circumstance.

Since there is so much distrust and paranoia about information being shared by HCW who are seeing collapse happen within the walls of our clinics and hospitals- /1 read: "you're being paid by xyz party to say that" "you must be working for big pharma"- I thought I'd talk about publicly available facts that simply cannot be disputed. /2

I spent better part of my weekend (first two days off in 30 days) as I do every weekend. Managing acute care crisis of overcapacity that I have no meaningful solution for. We remain at 130-180% overcapacity for medicine patients across the city (remain. It's NEVER gotten better, despite "covid being over"🙄).

This is where I grew up. A home filled with so much love, memory, support. That still houses my family. A home 2100 miles away from where I live now. I begin my journey back to reality today, after almost four weeks surrounded by so much love. Reconnecting with friends I haven't seen in decades. Watching my kids be kids... Grass stained clothes, sticky ice cream faces, playing with the deer every morning in our backyard.

Burn out -- it's not a surprise nor uncommon amongst myself and my physician colleagues. It is always one of the topics of conversations when we meet, see each other in the hallways, at events. Chronic burnout is a decades old problem in medicine, with alarmingly high rates of occurrence over the last 3 years within in this pandemic. With no tangible solution in sight.

Recently, my colleagues and I at my clinic had to make a difficult decision to temporarily stop accepting new internal medicine referrals until 2023.. which is where are currently booking into. Between the demand for Long COVID referrals, the volume of complex other internal medicine consultations, and increasing inpatient demand on our time, the situation hit a breaking point.

Why is the healthcare system collapsing?

You've heard many HCW talking about the system at the "brink of collapse." But what does that mean and how did we get here? People and System. Let's explore. Firstly, the system. And when I say system, I am going to speak specifically to medicine (internal medicine/hospital medicine), the literal safety net of any hospital.

Dear patient,
I know you are scared, worried, and even frustrated. You either have a diagnosis and are waiting critical treatment, or you are still waiting for the specialist/tests/procedures that can give you those answers. The wait is excruciating. 6-12 months. Of uncertainty. You call us...upset at us, the system, all of it. I get it.

I hear you, see you, and want to expedite everything I can... But I can't. The system is broken. I am only one human. I cannot fix this.

Post call delirium is setting in, so while I'm still slightly coherent, I wanted to share my observations of the last 24-36 hrs-- much of which isn't going to be new information, but definitely underscores the ongoing slow decay of our healthcare. Internal medicine call, especially in Edmonton, is busy. All. The. Time. We are the default admitting service 24-7, with no caps to number of patients we can accept or admit, even when our teams are overflowing with patient volumes some might consider approaching on unsafe.

Another Wednesday, another conference filled with misinformation.

@JasonCoppingAB says not all hospitals are overcapacity. Only some in #yyc and #yeg ... And okay, perhaps that true. But that should not be reassuring to anyone, and here's why.

https://twitter.com/jasonfherring/status/1516893719584120832

#YYC and #YEG contain the main tertiary car centers for AB, where specialized surgeries, procedures and transplant medicine occurs. It's where resources such as telemetry beds, specialized equipment exists as single point access for all Albertans.

I just finished my 24th week of COVID unit over the last two years.

For context.... That's A. Lot. Of. COVID. At this stage of the pandemic (yup, we are still in a pandemic), we have far more tools to manage severe COVID, we know more about the disease course, and I've been able to fine tune my clinical gestalt.