Rapid Rounds: 5 Minutes with Dr. Ramjeesingh

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Have you met Dr. Ravi Ramjeesingh? Currently residing in Halifax, NS and spending his time working as a staff physician and Associate Professor in the Division of Medical Oncology at Dalhousie University, he is best known for his clinical expertise in the areas of hepatobiliary cancers including pancreatic and hepatocellular carcinoma, and breast cancer.

Continue reading to find out more about Dr. Ramjeesingh’s opinions on the positives that have come out of COVID-19 and what he feels is the most pressing issue facing Canadian physicians today.

1. Tell us a bit about yourself!

I joined the Division of Medical Oncology at Dalhousie University in May 2015 as a staff physician and Associate Professor. Previously, I completed my Ph.D. in cancer research in 2004, and my doctor of medicine in 2008 at the University of Toronto. I then completed my Internal Medicine and Medical Oncology residencies at Queen’s University before completing a clinical trials methodology fellowship at the Canadian Clinical Trials Group (CCTG) in Kingston, Ontario where I received a CAMO-CIHR fellowship. My main clinical expertise is in the areas of hepatobiliary cancers including pancreatic and hepatocellular carcinoma, and breast cancer. Currently, I am the chair of the HPB Disease site group in Nova Scotia and more recently took on the role of the Director of Research in the division of medical oncology. My research activities and interests are in the fields of health service delivery, and translational research in oncology.

2. What inspired you to get involved in Craigs Cause Pancreatic Cancer Society?

As I traditionally see the bulk of pancreatic cancer in the province, I have seen the pitfalls and the hurdles our patients go through leading up to their diagnosis and treatment. I wanted to do more for our patients in Nova Scotia. One of our surgeons introduced me to Stephanie Condon-Oldreive from Craig’s Cause and we really hit it off. Knowing how poorly the outcomes were for pancreatic cancer patients in the province historically, we both knew there were vast improvements that could be done to improve the care of pancreatic cancer patients which could lead to better outcomes. Working with Craig’s Cause has allowed for my education and awareness about pancreatic cancer, and has allowed us to get the word out that there are treatments for this disease. As well, I have always had a vision of what we could achieve in cancer care in the province. There was no reason why we could not become a center of excellence for pancreatic cancer treatment in Canada.

3. How has the COVID-19 pandemic impacted your career? What are the positives that you have seen come from the pandemic?

I always like to say, cancer does not care if there is a pandemic going on. When the pandemic began, we were one of the few services that did not de-escalate care. In fact, we had to increase our workload as other services closed down. When ORs were being closed, we had to see those cancer patients and start them on neoadjuvant treatment. When services could not see patients for whatever reason, we still continued to manage their cancer care. Clinic schedules were still maintained. Vacations were cancelled. While there was some conversion to virtual care, for those who were on systemic treatment, we still had to assess them in person to assess for tolerability of the treatment. Noticing a discoloration to a patient’s skin tone due to anemia or jaundice is very difficult to assess over a phone or zoom. Seeing a patient walk into the clinic and assess their strength is something you cannot get on a virtual assessment. So we were seeing patients in person, even at the height of the pandemic, which means the potential exposure risk was anxiety-provoking at the beginning of the pandemic when little was known about COVID-19. And with the PPE shortages, all of the meetings about what to do if cases increase, and modifications to treatment protocols, all lead to more anxiety and stress. Research and teaching were set to the side, and we are only just starting to get back to it, meaning we are a year behind in our plans, which of course is a setback. So COVID-19 has definitely impacted us in a number of ways. The only positive is that it forced technology into the system to allow for virtual clinics. Before COVID-19, it was not being utilized efficiently and now care can be done easier around the province due to the virtual care model.

4. How do you believe online networking can enhance clinical decision-making? 

Everyone has experience in something. You may have that one rare case that you really are not sure what to do. By having a network of go-to individuals that you can ask questions, they can either provide you with the guidance needed to assist the patient or direct you to the proper people who can help. On top of that, it allows you to keep up to date on decision guidance, treatment algorithms and other hot topics from not just your region but across the country. This can allow you to better advocate for your patient.

5. What do you think is the most pressing issue for physicians in Canadian healthcare today?

Burnout. Hands down. For so many years, the system has been built on the backs of health care professionals (HCP) wanting to do the best for their patients. They see holes and have plugged these holes where they can to limit the potential harm from getting to the patient. However, for some time, there has been little investment into supporting the system by the government. Despite the outcries from the HCP, little was done to try and fix the system. Then the pandemic happened, and those holes blew wide open. We have seen more HCP leave, retire or just change/augment what they do, due to the pandemic. The trickle-down effect is those remaining are dealing with more patients, more diagnoses leading to more stress and burnout. Couple that with the skepticism about medicine online, whether we are speaking about COVID-19, vaccines, cancer care or whatever, the exhaustion of spending so much time trying to convince patients to do what science is telling them is best in their situation, it can be too much. And we are now beginning to see the cancer tsunami occur. Those patients who stayed home due to the pandemic, had their cancer screening tests cancelled and did not see an HCP with that new or progressively worsening symptom, are now presenting with an incurable disease. I feel this has led to more patients on systemic treatment than I have ever seen, and I am not sure if the system can handle it. Thus I am fearful that we will see more and more HCP burnout and leave, which will lead to an even more fragile system.