Fall 2017 (Volume 27, Number 3)

Updates from the Yukon and Northwest Territories

Update from Yukon

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The Yukon has rheumatology services provided by a visiting rheumatologist, Dr. B. Daniel McLeod and rheumatology nurse, Ms. Lee Ash. Previously Dr. Graham Reid was the visiting rheumatologist. He negotiated the addition of the rheumatology nurse to the clinics. This has been extremely valuable and I would say indispensable.

The clinics are held in the visiting specialist clinic area in the Whitehorse General Hospital guided by the Outpatient services office manager, Jason Durand.

Mrs. Mary Gottshall provides us with clerical support. Clinics are scheduled every two months.

Additional support clinically is provided through referrals to rheumatologists in British Columbia and Alberta, because we are unable to meet the demand. A visiting consultant internist, Dr Kevin McLeod, also helps with decompressing the demand for rheumatology services. There are visiting specialist clinics in physiatry, orthopedics, dermatology, gastroenterology, neurology and nephrology. Access to echocardiography locally is very limited. Pulmonary function testing and bone densitometry are not available in the territory and patients need to be referred out for these services

– Dr. B. Daniel McLeod

Dr. B. Daniel McLeod and rheumatology nurse, Lee Ash, are pictured in front of Whitehorse General Hospital.

Update from Northwest Territories

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This summer marks the 20th year I have been traveling to the Northwest Territories to do the rheumatology outreach clinic. Back in 1997, merely a week out of residency, I started what has turned out to be the most challenging and rewarding aspect of my practice. It continues to amaze me that with a population of less than 50,000 I manage to still see such fascinating pathology. I have continued to do a four-day clinic four times per year, sometimes accompanied by one of our rheumatology trainees from Edmonton.

Over time the waitlist for routine appointments has increased to unacceptable levels. I have had productive meetings with senior administration to look at solutions to bring down waiting times. I have drafted a referral guideline document that should help reduce unnecessary referrals and allow for early identification and treatment of inflammatory arthritis at the primary care level. We are examining expanding the role of physical therapy (PT) and occupational therapy (OT) as well as nurse practitioners who already play a large role in providing services in the NWT. The territory-wide electronic medical record (EMR) has been a great help in improving efficiency, both in triage and case management.

I was very pleased when one of our new rheumatology grads, Dr. Carrie Ye, expressed interest in doing a couple of clinics this year to help shorten the waitlist. She had enjoyed her time up in Yellowknife with me as a resident that she wanted more. Our waitlist for routine referrals went from 2.5 years at the beginning of 2017 to a manageable 3-6 months now.

Moving forward the challenge will be to continue to provide timely access not only to new referrals, but also adequate follow up and support for the primary care providers looking after our arthritis patients. Access to echocardiography locally is very limited. Pulmonary function testing and bone densitometry are not available in the territory and patients need to be referred out for these services.

– Dr. Dale Sholter

Stanton Medical Centre with the new hospital under construction in the background

The mesmerizing Northern Highlights. (Photo credit: Carrie Ye)