Dear Editor:
I have been tempted for several months now, to do a write-up of actions that are taken behind the scenes in our emergency room in Stettler. I was prompted, in a way, to do so after reading a recent letter to the editor of the Stettler Independent. In response to the letter, I want to quote one of my favourite writers, Mark Twain, “It ain’t what you don’t know that gets you into trouble. It is what you know for sure that just ain’t so.”
First, let us start with a bit of background information, and I have to mention that this is all my own personal experience and opinion.
We are seven physicians working in a rotation of 24/7, year in, and year out. It doesn’t sound too bad if you say it fast, but believe me, it is taxing! During a typical weekday, approximately 48 to 65 patients will be served in the ER. An ER shift starts at 7 or 8 a.m., and will continue for 24 hours. The next day, after the 24-hour shift, is a normal work day at the clinic. Starting at 7:30 a.m. doing rounds, and ending around 5 and 6 o’clock in the afternoon, taking into consideration the paperwork that piled up at the clinic during the emergency room shift.
My math teacher would be proud of me for calculating that this is a 34-36 hour workday. It is a very frequent occurrence not to get any sleep. Due to the workload we are experiencing in Stettler, we cannot afford to take the next day off like it is done in other cities and towns in Alberta.
Please forgive me if my smile doesn’t extend as far as it usually does, after typically missing lunch, and sometimes supper on my on-call day, adding severe sleep deprivation to the concoction. I further have to ask for forgiveness if I have to perform a caesarean section while doing an ER shift, deliver a baby, perform a resuscitation on a patient in acute care, because it will take me away from the emergency room. This yet again, is not an uncommon occurrence as many of the young moms with newborns will testify to. I want to throw out an invitation to notify me of any other occupation the same gruelling schedule. Pilots, bus drivers, etc., are prevented by law to work extended hours. It always amuses me that emergency care workers are often exempt from these laws.
Furthermore, I will have to add that the emergency room physician is not only responsible for the emergency room, but for acute care with 32 beds, long-term care with 100 beds, and frequently for labour and delivery, epidurals, anaesthetics etc. As frustrating as it sometimes may be to patients waiting in the emergency room, I remain dedicated to my task at hand, which is NOT limited to the emergency room.
When an ER physician is absent, he/she is more likely than not, busy in the hospital somewhere else or perhaps there is a slim chance that he/she may be having lunch. It is therefore impossible for this ER to be physically manned by a physician for 24 hours on-site.
Next look at other hospitals, specifically Red Deer, since it was brought up in the letter written to the editor. I looked at the statistics compiled by Alberta Health Services throughout all healthcare facilities in the central zone.
Stettler emergency room, despite the fact that it’s in the so-called small community in rural Alberta, consistently sees 27% of the volume that is going through Red Deer emergency room. Thus, for every patient seen in the Stettler emergency room, 3.6 patients will be seen in Red Deer. This, despite the fact that Stettler has a population of 5500 people versus Red Deer with a population of 100,000 people.
Interesting, isn’t it?
The conclusion I have come to, is that the geographic area we are drawing is populated by 26,000 people, which correlates well with what businesses are experiencing. A second factor, is the shortages of physicians. Let’s look at the math again. Stettler has seven physicians working covering the ER 24/7 as an added service to the public, but first of all are family docs, doubling up obstetricians, anaesthesiologists and hospitalists. Red Deer has twenty dedicated ER docs, doing only ER shifts.
Now let’s have a look at Drumheller , a town with a population of almost one-third more than Stettler. We have seen almost 2700 patients more than Drumheller in the 2012-13 year.
If we had seen 990 patients more, a proverbial drop in the bucket, we would’ve seen exactly the same number of patients the Camrose emergency room have seen. Camrose is a city.
Enough said. I guess I’m trying to convey that we are desperately short of physicians, and it’s not for lack of trying, it’s a province wide phenomenon. It remains exceedingly challenging to recruit physicians for rural areas, especially with the irregular and extended hours that rural physicians have to contend with. It prevents family orientated physicians, in most cases, from going to small rural hospitals.
Now let’s go closer to home. When I first came to Stettler almost 12 years ago, we consulted approximately 4,000 to 5,000 patients a year in the ER. The emergency room was adequate for that. One RN and one LPN were allocated specifically to the emergency room. Let’s turn the clock 11 years forward. We still have only one RN and one LPN on duty in the ER. We remain at seven physicians. Three and a half times the volume of 11 years ago are going through the emergency room. It doesn’t take rocket science to do this math. We are precariously balancing this act. Hats off to our staff sharing this workload with us.
Despite the circumstances and volumes we have to contend with, patients are waiting half the time they do in Red Deer ER, contrary to belief. We, however, have to content with the “McDonald’s phenomenon,” where the “drive in, drive out” expectation is prevalent in the Western culture. I remember my dad saying to me, after I started attending medical school. “Phil,” he said, “remember that people believe the best doctor is in the neighbouring town.” My dad is profoundly wise.
Another fact I would like to bring to light, is that all patients presenting to the emergency room, are triaged. Serious cases are seen first, and not so serious, are seen last. The vast majority of complaints we have received, relate to wait times. Could there perhaps be a reason why you are waiting “too long”? I believe in order to keep the emergency room efficient, we have to limit walk-ins, and keep the emergency room for what it is intended to be-for emergencies. I do realize that non-urgent cases need to be seen as well, but this is an unfortunate circumstance that we are working on continuously to resolve. Anybody have a family member with a medical degree, who is willing to work in Stettler?
And, no, ma’am, nobody was handsomely paid for the care you didn’t receive.
Dr. Phil Vogel,
Stettler