Department of Neurology
With the support from the leaders of the hospital and the International Affairs Office, I went to Canada as an observer to receive a 3-month training from March to May 2016. During these three months, I learnt a lot about the Canadian medical system and practice.
I studied at the Foothills Medical Centre (FMC). FMC is the largest hospital in Calgary, Alberta. It is one of Canada's most recognized medical facilities as well as one of the leading hospitals in Canada, providing advanced healthcare services to over two million people from Calgary, North Western United States, Southern Alberta, southeastern British Columbia and southern Saskatchewan. Formerly operated by the Calgary Health Region, it is now under the authority of Alberta Health Services and part of the University of Calgary Medical Centre.The main building of the hospital was opened in June 1966. It was originally named ‘Foothills Provincial General Hospital’ and later known as Foothills Hospital. With the addition of other medical facilities, it became known by its present name. Foothills Medical Centre is an accredited Level 1 trauma centre by the Trauma Association of Canada and is the largest regional trauma centre in Southern Alberta. In addition, FMC is accredited by Accreditation Canada for stroke rehabilitation. FMC works in conjunction with the nearby University of Calgary for the purposes of educating students as well as providing facilities for medical research. FMC imported the world’s first and most powerful movable MRI machine, which was introduced in January 2009. It provides patients the world’s safest, most accurate surgery. In addition, the world’s first robotic surgery was also performed on a patient at the FMC for removal of a brain tumor, which also created a landmark in Canadian medical history. During the 3-month observership, I followed the Supervisor Dr. Andrew Demchuk, who is a professor in the Department of Clinical Neurosciences for the Cumming School of Medicine, University of Calgary. He is also a stroke neurologist and the Director of the Calgary Stroke Program, Alberta Health Services. His primary research interests focus on vascular imaging, where he is trying to establish target populations for new stroke treatments by selecting patients based on imaging tests performed in the emergency setting. I mainly studied in the stroke department of Foothill Hospital. I was arranged to follow Andrew Demchuk to observe the clinic every Tuesday, and the rest of the time in the ward, and participated in 2 academic meetings on Thursday. Through the 3 months of study, my experience and understanding about the medical system, medical environment, relations between physicians and patients are reported as follows:
Medical system: the Canadian health care policy is set by the federal government, the pursue is national preferential policies, whether you are wrapped around the waist of a million of your rich, or destitute vagrant, through the public health insurance plan, to all eligible persons (including citizens, immigrants and refugees) provide medical services. People who are eligible to have the health card show it to the physicians before they receive treatment. According to the Canadian medical insurance system, the cost of these services is paid by the government’s tax income. However, dental services and vision care are not covered by the health insurance. Although the medical insurance is a national service system, provinces manage medical insurance plan independently. OTC medication is paid personally, and pharmaceutical medications are covered by public funds. Canadian surgeons are basically divided into two categories, family physicians and specialist. Generally, every family has a family physician, who provides health care for individuals and families across all ages and diseases. Patients can discuss the plan with the family doctor about fertility, nutrition and psychological problems. So family physicians are also general practice doctors. In Canada, family doctor can only provide health care to a certain number of individuals. Every citizen chooses their own family doctor, and family doctor manages their health records. The files would be saved in the databases of the province. If people get sick, they will go to their family doctor first, if they need a specialist, family doctor will make a reservation for them. In case of an emergency, they will dial 911 directly, and the ambulance will send you to the corresponding hospital emergency departments.
Advanced information systems: Canadian medical information system is very powerful, and sharing, the hospital has two information systems, one is hospital information systems and hospital records of the patient’s own information. The other one is throughout Alberta (AHS) information system; you can check all Alberta resident health information and do the examination. All the patients’ medical information is shared, which can effectively avoid repeated examination and patient information is quite abundant and completed.
3. Professional team: neurology doctors are professional, the research direction is mainly Parkinson’ s disease, movement disorders, intracranial infection, headache, stroke, memory impairment and so on; I was mainly in a stroke department, the outpatient service, emergency wards.
(1) Clinic: family doctors make appointments for outpatients; all the data reached the hospital through the information system. A specialist will divide them into 4 categories, A, B, C and D, A file for a 1 week treatment, B file for a 2- week treatment, C file for 1-month treatment, and D file for 3-month treatment. Two specialists guide a few fellows in the clinic, giving treatment to the cerebral vascular disease patients. The patients and the physicians respect and trust each other. The physician is patient and careful when inquiring and interpreting the illness, and often goes up to a computer to check the medical history of the patient. Outpatients are very quiet when they are waiting. When the patient completes the treatment, physicians use the phone to explain the patient’s condition and diagnosis, treatment advice, written materials formed by third parties. These data will be sent to family doctors, and also saved in the AHS health management system. If you need further examination, the doctor will provide the form, and the specialized staff will make appointments for the patient, also make another appointment for the next visit. Due to the relatively fewer reservations, the outpatient order is good, and nobody makes loud noise. Although the efficiency is not high, staffs have enough time to do their work perfectly.
(2) Sickroom: sickroom is managed by a specialized doctor with 4-5 fellows. There are one and a half wards divided into unit 100 and unit112. Unit 100 is a stroke unit. Unit 112 is ICU, shared with neurosurgery. Hospitalized patients are mainly having cerebral vascular disease. The average length of stay is around 5-7 days. The patient does not need family to accompany. The hospital provides health care and food. Every Monday and Thursday is the day for hospitalized patient summary. The nurses, physiotherapists and the doctors introduce the patient's condition and plan the next process. Patients at discharge must give the viability assessment, such as independent walking and cooking.
(3) Emergency: emergency is very strong; there are about 100 beds, emergency patients transported by EMS (emergency medicine service). The specialists check the wards and give medical advice. Nurses provide care, according to the medical advice. If a patient has acute stroke, first aid person in the ambulance send the patient’s information through the system to the hospital. The doctors and nurses will arrive at the emergency department, waiting for the patient and learning the patient’s information (including history, inspection, etc.) They will never waste any time to give a preliminary diagnosis and assessment in the CT room to give intravenous thrombolysis with RT PA. For interventional therapy, they will contact the Department of Intervention to give stent thrombectomy with mutual cooperation.
4. A harmonious relationship between doctors and patients: during my study in Canada, the harmonious relationship, mutual trust and respect between doctors and patients impressed me deeply. No matter in the clinic or ward, doctors’ greetings and farewells are heard anytime. The doctors take the protection of patient privacy seriously. In clinic and ward, I need to do the self-introduction to the patients. I have to introduce that I am from China as an observer, following to see patients until I got their permission. In my opinion, this has a big relationship with their health care system.
Free medical system: doctors and patients do not have a direct interest relationship. All patients are treated fairly; diagnosis and treatment ate in full accordance with the disease, following the guidelines, which helps to protect the doctor-patient relationship.
Excellent medical environment: due to the full implementation of the clinic appointment, every doctor will not have more than 10 appointments, ensuring that the doctor has enough time to communicate and check with the patients. Waiting area does not have too many people, and it is clean.
5. Rigorous style of work, positive learning attitude: all doctors, nurses are very strict, the clinical diagnosis and treatment of each medical personnel are based on the guide. I had 2 meetings every Thursdays in which we participated and discussed actively.
6. The unity and cooperation of departments: first aid, emergency department, Department of Radiology, cerebrovascular diseases and interventional radiology physicians, staff from various departments cooperate together, never shirk. Before arriving at the hospital, first aid escorts the patient. In this way, they ensure the patients with thrombolytic therapy when they arrive at the hospital within 20 minutes; their stroke thrombolysis rate can reach 30%.
In Canada, this 3-month study is a very valuable experience to me. I got a huge benefit from it, with which I improved my professional skills and broadened my horizon.
At the end of my report, I want to extend my thanks again to the hospital leaders for providing me this opportunity to study in Canada. In turn, I will work harder during the clinical work and try to make greater contributions for the development of Binzhou Medical University Hospital!
