Winter 2020 (Volume 30, Number 4)
Regional News
News from Saskatchewan
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By Regan Arendse, MD, FRCPC
Our plans for rheumatology practice in 2020 in
Saskatoon were totally flipped by the COVID-19
pandemic. It started off on a high with a trip to
the beautiful city of Victoria, B.C. for the Canadian
Rheumatology Association (CRA) Scientific
Meeting in February 2020. No sooner had
we returned to the Prairies, we found ourselves
in complete lockdown.
With an increasing number of in-person consultation
cancellations in March 2020, it was
clear that our normal practice of rheumatology
was not going to be possible for much longer.
Our Ministry of Health’s early COVID-19
predictions were for 150K to 400K infections
in the province, and an anticipated 3,000 to
8,000 deaths. So, after a flurry of consultative
meetings with various stakeholders, many
rheumatologists in Saskatchewan agreed to a
pandemic agreement. This provided us with a
monthly salary for three months and allowed
us to practice virtual care while being available
to be redeployed as required by the province at
a time of need.
The learning curve with regard to providing
virtual care in rheumatology was steep.
From a predominantly tactile practice, examining
people up close, we had to transition to
assessing joint activity telephonically, which
was not without its challenges. We also had
to field many questions about this novel disease
and its unique implications for our immuno-compromised population. Fortunately,
there was excellent support from the CRA and
many pharmaceutical companies for extremely
informative WebEx learning sessions. These
allowed us to learn from the COVID-19 experiences
of rheumatologists in other parts of the
world that were further along the pandemic
curve. Much of the information was reassuring
when faced with the anxiety of prescribing immunosuppressive
therapy to immuno-compromised
individuals in the midst of a pandemic.
Many thanks to all those involved in making
these learning opportunities possible.
At least five rheumatologists were called
at various time periods during the pandemic
agreement to work in internal medicine.
During this time, we cancelled our community-
based office work and took up duty in internal
medicine. For rheumatologists with
less experience in internal medicine, this
was a humbling experience, with a return
to managing medical conditions we had not
seen in a while. Similar to the huge advances
in management in the field of rheumatology,
there were apparently similar advances in
the management of complex internal medical
conditions. Fortunately, the very competent
residents were there to guide us through this
adventure. However, their comments on our
evaluation sheets indicated that we should
keep our day jobs.
Our pandemic agreement ended with the
month of June 2020 and thereafter we slowly
saw a trickle of patients for in-person consultations.
Fortunately, the province has continued
to support our practices by maintaining the
virtual consultation billing codes. At present
we have approximately 60% in-person consultations
and provide virtual care to about 40%
of our patients. This split is driven purely by
patient preference. We found that many out-of-city patients and those with co-morbidities
prefer virtual care due to concerns about visiting
the city of Saskatoon, where we continue
to have a small but steady number of positive
COVID-19 cases. The fewer in-person contacts
have allowed us to stagger consultations and
provide the necessary disinfection between
patients. It also allows us the time required to
discuss the merits of wearing a mask or other
suitable face covering with some of our less
enthusiastic patients.
We undoubtedly live and practice rheumatology
in interesting times. With determined
Prairie optimism, we continue to be hopeful
that 2020 will end off on a better note than it
started.
Regan Arendse, MD, FRCPC
Assistant Clinical Professor,
University of Saskatchewan
Saskatoon, Saskatchewan
By Bindu Nair, MD, MSc, FRCPC
Greetings from Saskatchewan! 2020 has
certainly ushered in plenty of surprises for
all of us, and our rheumatology community
has banded together to meet the challenges.
There was a quick learning curve for some
of us, but now a hybrid of both virtual appointments
and safe in-person consultations
as needed are provided to Saskatchewan
patients. Earlier in the pandemic, our colleagues
on hospital services required help
and we had some amazing rheumatologists
answer the call by working as attending physicians
for the medicine inpatient teams.
This fall saw the successful delivery of our
undergraduate musculoskeletal foundations
course by virtual teaching, which was received
well by the medical students. Our provincial
rheumatology group continues to remain
connected and have lively discussions
with weekly videoconferenced grand rounds.
We are pleased to welcome our colleague,
Dr. Cairistin McDougall, who is practicing in
Regina, and now brings the number of rheumatologists
looking after adult patients in
Saskatchewan to fourteen. We are also very
excited to have Dr. Kate Neufeld and Dr. Hon
Yan Ng join the Division of Pediatric Rheumatology
at the Jim Pattison Children’s Hospital
in Saskatoon.
Bindu Nair, MD, MSc, FRCPC
Professor of Medicine, Division of Rheumatology
University of Saskatchewan, Saskatoon, Saskatchewan
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