Rapid Rounds: 5 Minutes with Dr. Nadia Alam
Written By The Rounds
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Dr. Nadia Alam is a family physician and anesthetist who works out of Georgetown, Ontario. With just over 10 years of experience in these roles, her spare time is just as busy as her professional life. She shares her passion for writing on her personal website that houses many blog posts, her opinions on healthcare, and her own personal stories. We are delighted to highlight such a prominent voice in Canadian healthcare for our fourth article in our “Rapid Rounds” blog series!
Continue reading the rest of our post to hear about what attracted Dr. Nadia to her specialty, how online networking can enhance clinical decision making, and what she believes Canada’s healthcare system will look like in 20 years’ time.
1. What is your job and speciality? What attracted you to this specialty?
I’m a family physician and anesthetist who works out of Georgetown, Ontario. I love being a small-town doctor who provides cradle-to-the-grave care, working both in the community and the local hospital, and doing house-calls. I was attracted to family medicine because of the breadth and scope of practice. You never knew what would walk through the door. You got to follow patients as their stories began, through the ups and downs, and all the way to the end. Your relationship with the patient was a fundamental part of the work – they invited you into the most vulnerable and meaningful moments in their lives. Your role would be to be the medical expert in their care for the vast majority of their care. In one day, I will advise patients on anxiety, heart failure, multi-morbidity, dementia, well-baby visits, adolescent health, acne, end-of-life care, cancer, weakness, domestic violence, sexual health, enlarged prostates, liver failure, Crohn’s and so on. Anesthesia is similar in some respects; though it doesn’t have the continuity of care, the breadth and scope of knowledge required to do your job mirror the breadth and scope of family medicine. Anesthesia satisfies the adrenaline junkie in me – it requires quick decision-making, multi-tasking, teamwork, and deep expertise in human physiology, clinical pharmacology and probability. The two fields are complementary in many aspects.
2. How do you believe technology and online networking can enhance clinical decision making?
While the breadth and scope of family medicine are what attracted me to the specialty in the first place, keeping up with evolving medical knowledge is challenging. Decision-making for diabetes has been completely transformed in the past few years with the advent of new pharmaceuticals. Decision-making for osteoporosis has totally shifted. Ditto for menopause treatment and so many other illnesses. Frailty and multi-morbidity are new disease frameworks. Trying to keep up with changing disease patterns and clinical practice guidelines, technology can provide decision-support tools to help juggle the now-vast amount of information required in the daily family physician office. Technology in the form of phones, video conferencing and asynchronous messaging can also increase access between a family doctor and their patients – especially as patients juggle competing demands on their time. Technology in the form of artificial intelligence like Khure Health can also tease out symptomatology that is suggestive of rare illnesses. We all have those patients whose symptoms do not conform to the common disease pattern; diagnosing rare illnesses often takes years because these illnesses are not top of mind. AIl can help bridge the gap.
3. What do you think is the most pressing issue for physicians in Canadian healthcare today?
How to care for the multi-morbid patient through continuity of care. Data around the world shows that multi-morbidity, or the presence of two or more chronic illnesses that impact a patient’s global health status, is affecting younger and younger patients and overall is growing at an extraordinary rate. 1 in 3 Canadians is multi-morbid. Unfortunately, disease-specific clinical practice guidelines do not often address multi-morbidity. Patients end up in a prescribing cascade of medications to manage their illnesses and medications to manage iatrogenic side effects. Studies have also shown that the one that does decrease the impact of multi-morbidity is continuity of care. We need to shift our mindset – Canada is very hospital-centric. Funding for healthcare is very hospital-centric. The best thing for patients however is to keep them out of hospitals through continuous, coordinated, comprehensive community-based care through family doctors. That means a paradigm shift in medical training up to government decision-makers to refocus the priorities towards primary care and towards community-based services, including social care, that enable primary care to do its job well.
4. Where do you see Canada’s healthcare system in 20 years time?
I think more and more care will need to move out of the acute care sector. We need to focus our attention on managing complexity – complexity of care, the complexity of illness, the complexity of our siloed healthcare system. Healthcare systems, where primary care takes the lead in making decisions, including funding allocations, tend to provide better patient value and outcomes. This means reprioritizing everything required to keep patients well at home instead of trying to fix them in hospitals – valuing education, income security, housing security, and so on above hospital-based services. It means bringing allied health out of the hospitals into the communities so that patients don’t just receive care closer to home, they receive care in their homes. It means taking a family doctor’s perspective of the patient – the holistic perspective of the patient with all their medical and psychosocial needs – and delivering care in a culturally-relevant patient-centred way.