New Health Care Technician: Sarath Ekanayake

We'd like to welcome the newest member of our clinical team, Sarath Ekanayake.

Sarath is a physician who moved to Canada last year from Sri Lanka with his wife and children.  He is an experienced General Practitioner (Family Physician) who also worked as a Health Care Manager in Sri Lanka before moving to PEI.  Sri Lanka is a Commonwealth country which used to be called Ceylon until 1972.  It's health care training is based on the British model and physicians such as Sarath trained entirely in English.

Sarath will be starting today as one of our Health Care Technicians.

Although Sarath would be most likely be eligible for immediate medical licensing in the United Kingdom (and possibly some Canadian Provinces), due to the licensing requirements in PEI for doctors, Sarath needs to take three licensing exams before he is able to practice as a physician in PEI.

This will take him about two years.  Sarath is an experienced and capable physician who will be a significant asset to the Island when he has his license.  Thousands of very talented and highly experienced doctors and nurses in this situation in Canada are working as taxi drivers and in fast food outlets, which is a disaster for them and for our health care system. (It's not as if we have too many doctors and short waiting times for patients!)

We created the Health Care Technician posts specifically to allow doctors and nurses in this position to:
- continue to contribute to patients in the community
- earn a decent income while they wait for their license
- keep their skills fresh
- learn about the Canadian medical system.
- make our medical practice more efficient and allow us to see more patients in the same amount of time, which means we can take on more patients who do not currently have a family doctor.

Although Sarath is a physician, because he is not currently licensed in PEI, he is not allowed to:

- make diagnoses
- give medical advice
- sign prescriptions

However, he will be able to:

- perform simple technical procedures under the supervision* of a physician, such as taking blood pressures or doing simple blood tests.
- enter medical data into our computer system.
- prepare referral letters, medication data at the instruction of the physician.
- organize medical data, such as test results, for the physician.

I'm sure all of our patients will join me in welcoming Sarath to the practice and will wish him good luck in his new post.



* Supervision means that he has been assessed by the physician as being competent, has been given a protocol and guideline to follow strictly for the procedure, and has access to the physician in person, by telephone, or electronically, during the procedure.

We're Hiring! Third LPN post now open to applications

We are looking for a dynamic Licensed Practical Nurse to join our Primary Care Team as a Practice Nurse.

We have a busy, exciting, paperless practice with over 3,000 patients in brand new premises in the Sherwood Medical Center in Charlottetown. The three Practice Nurses have their own clinics seeing patients in conjunction with or under the supervision of the Family Physician. They also implement our computerized Annual Health Checks, run Initial Appointment clinics for new patients, and staff a daily Walk In Nurse Clinic for procedures and investigations.

Duties include: 

• General measurements
• Use of electronic medical record
• Spirometry
• 12 lead ECGs
• Chronic disease monitoring
• Overnight oximetry
• Health screening
• 24 hour BP machine
• Taking blood
• INR near patient testing
• i.m. injections
• Audiometry
• Syringing ears
• PAP smear tests
• Travel advice
• Wound care
• Preparing investigations and organizing referrals
• Health promotion

The Practice Nurse will work within her or his scope of practice to the protocols in our Practice Nurse Procedures manual and will receive in-house training and competencies certification where appropriate from the R.N. and Family Physician.

The rate of pay is $22.50 per hour with excellent contract terms including an annual study budget and generous paid vacation time. The post is initially for 9 months with the possibility of permanent employment after that. The start date is March 2010.

The successful candidate will have excellent people skills, a positive outlook, good computer skills, a love of learning, a desire to embrace positive change, and a personality that will fit in well with our close, informal team.

Please download an application form and job description and return your completed application by email, fax, or post.  The closing date for applications is 1st March 2010.

New Members of Staff

We'd like to welcome our new Practice Nurse, Dawn Rodd, and our new receptionist, Margaret Pippy, who have recently joined the practice.  They are an excellent addition to our growing team, and we are delighted to have them in the team.

Oxycodone and Hydromorphone

We don't prescribe oxycodone and hydromorphone.

Virtually all the patients who have joined the clinic taking one of these drugs will be moved over to safer alternatives over the next six months.

Chronic pain is a common problem for primary care doctors - disabling arthritis, back pain, nerve pain.  When choosing a medication that will treat long term pain, it is important to choose ones that are effective and continue to work over long periods of time.

The best choices are a combination of acetaminophen, anti-inflammatories, gabapentin (an anti-epileptic), and amitriptylline (an antidepressant).  It is also very important to treat depression in chronic pain patients, as virtually all such patients will become depressed over time which makes their pain worse.

The worst choices are hydromorphone and oxycodone.  These are extremely dangerous drugs, and a very poor choice for long term pain.  The reasons are 1. they produce a 'buzz' or 'high' which is extremely addictive, and 2. patients become rapidly tolerant to them and need higher and higher doses for the same effect.

The street value for these drugs is very high as a result, and they are now the most common drug of addiction in Canada.  They now cause far more damage than heroin or cocain and because the dangers are not widely known they are addicting a wide range of people who would not normally be exposed to dangerous drugs.  Once exposed to these drugs, the less dangerous drugs are less effective because the 'buzz' is missing.

It is rare to see oxycodone prescribed in Scotland.  I've only seen them used in terminal care of dying patients.  There are two reasons for this:  1. the heavy marketing of the drug in the US by the manufacturers, and 2. the widespread use of pharmacy advisors who monitor the prescribing of drugs in the UK.   Yet, I see far more chronic pain problems here than I do in Scotland.   It could be that the use of these drugs is actually increasing the chronic pain problem by addicting patients rather than treating them.

If an opiate drug is required, then it is vital to use one that produces less 'buzz' or 'high' as these are less addictive.  For example, tramadol.

Sadly, PEI Medicare currently covers the dangerous opiates but does not cover the less dangerous ones, although the prices are similar.   I would encourage the PEI Department of Health to review this decision.

For terminal care patients addiction is obviously not an issue and we will continue to use all the drugs available to us to relieve pain in these patients.

Patients bringing lists of problems to the clinic

We have been experiencing long waits in our clinics recently, which have been running over an hour behind frequently.

There are lots of reasons why doctors run behind - for example, they may receive an urgent phone call, an emergency may occur, or a patient may be much sicker than they realised and may require a lot of time.

However, the main cause of our clinics running late just now is patients bringing long lists of problems with them to their appointments.  Quite a few patients have been attending with lists of between 5 and 10 problems that they want to discuss!

This is understandable - many of our patients have been without a family doctor for years.  They have many issues they wish to discuss.  We are very busy, and they may not want to wait again to discuss those issues. 

We don't want to impose a 'one visit, one problem' limit on our patients.  And we have several nurses/technicians helping with each clinic to make sure we deal with as much as possible in the time available.

But, we only have between 5 and 20 minutes per patient, and it really just is not possible to deal with more than one or two problems in that time.

To avoid long waits, and to provide safe care, we will now be prioritizing the problems when there is more than one.  Patients bringing long lists will find that simply organizing the list will take up the first appointment, and they will then be advised how many appointments we think will be required to work through their list.

Merry Christmas and a Happy New Year

We'd like to wish all of our patients a Merry Christmas and a Happy New Year.

We will be closed over Christmas and New Year and we will re-open on Monday the 4th of January.

Dr Ashby's Patients Joining Our Clinic

Dr. Ashby has asked us to take over the care for some of her patients, as she will be returning to work next year part time.

We're delighted to have her patients join us.

If you have received a letter in the mail from Dr. Ashby asking you to register with us, then please use our online registration page.

Don't forget to print out and return your Patient Access Form to us - unless we receive that form we will not be able to register you.

Dr. Ashby's office has already sent a list of patients who are joining our clinic to the Provincial Register, so you don't need to call them yourself.

Welcome to our clinic - we look forward to seeing you.

Seasonal Flu

We are not currently planning another seasonal flu clinic.  We will be holding one later in the year, but we don't know when yet.

This is because we are waiting for further advice on which patients should receive the seasonal flu.

Currently the advice is that only those patients over 65 years should receive the seasonal flu.  There has been some (unpublished) data that getting the seasonal flu vaccine will increase your risk of getting H1N1.  But, the data is that the extra cases are only mild.  The risk of dying from H1N1 or being admitted to hospital does not go up.

We will be contacting our at risk groups over the next few weeks to advise them when to get the seasonal flu.  We do not charge for our at risk patients (those with chronic disease or over 65 years).

Sherwood Drug Mart is planning a seasonal flu clinic in the near future.  We will announce the dates here when we get them.

More spaces for new patients

We've made good progress with the first batch of new patients, and so I've released the second batch of spaces.  You can see the number of spaces available at the top of the page. 

This second batch is likely to be our last set of spaces for new patients.  Spaces are being taken rapidly, so please do make sure you tell any friends or family who need a family doctor.

H1N1 Vaccination

PEI Public Health are now offering the H1N1 vaccine.

The vaccine is being provided free of charge at Public Health sites.

They have decided not to issue any of the family doctors with the vaccine, so we are not able to provide it directly to patients.

If you would like to be vaccinated for H1N1 please do not call us.  Instead, call public health on 1-888-748-5454 or visit their website.

Our clinical system on the news

We use the OSCAR Electronic Medical Record. This allows us to provide much more organized and efficient care for our patients.

OSCAR was developed by the family practice team at McMaster University, Ontario. It is 'free' software designed by doctors for doctors in Canada and is, in my opinion, the best electronic record available today.

It's creator, Dr Chan, has been in the news a lot over the last week spreading the word about this fantastic Canadian product that is available free to any doctor in Canada (and beyond).

Quality and Outcomes Framework (QoF) points 2008/9

We use the Quality of Outcomes Framework (QoF) points system to measure the quality of the care that we provide to our patients.

This gives a score out of 1000 possible points, with points being scored for providing evidence based care across a range of chronic diseases and preventions. Also, points are scored for good quality clinic management and easy access to care for patients. It is the scoring system used nationally in the UK National Health Service, where the score for all family practice clinics are available online.

Dr Coull is using this score to compare how we are doing in the Sherwood Clinic, Canada, compared with how his staff are doing in his Strachur clinic in Scotland, where the same scoring system is being applied.

Currently, the scores are as follows:


Strachur 2008/9 998.5 quality points out of 1,000
Sherwood 2008/9 172.0 quality points out of 1,000


You can download a breakdown of the scoring system here.

As you can see, the quality score in the Sherwood clinic is very low compared with our Scottish clinic. This is because we inherited paper charts without any computerized system of disease registers which make providing and scoring good care difficult. We've been improving our score in Strachur for several years now.

We have been working very hard over the last few months to get the quality systems up and running, and we expect to have a much improved score for 2009/10.

Seasonal Flu Vaccination Clinic Friday 9th October

We will be running our first Seasonal Flu vaccination clinic on Friday 9th October at 8.30am.

Please note that in accordance with PEI Dept. of Health guidance, we are ONLY VACCINATING THOSE AGED 65 YEARS OR OVER at this time.

Anyone aged 65 years or over should attend on Friday at 8.30am.

Please not that this clinic is free of charge.

We will be running other clinics over the next two months - please keep checking this site or add it to your RSS feed.

Season Flu and H1N1 Vaccination

There is a lot of confusion over this year's influenza vaccination program.

We have just received our guidance for this year's vaccinations.

1. We are going to vaccinate over 65s as usual with the season flu vaccine. We will be arranging days to hold vaccination walk in clinics once we receive our supplies.

2. We are going to vaccinate all age groups for H1N1 in November when supplies become available.

3. We are going to vaccinate other at risk groups (children and those with chronic diseases under the age of 65) after the H1N1 vaccinations are completed.



Bear in mind that:

- the last time we had an H1N1 pandemic was 1956, so people over the age of 65 are at high risk from seasonal flu and lower risk from H1N1 as they will likely have had previous exposure when they were younger.

- children and younger adults are at higher risk of H1N1 as they will not have encountered it before, but are at lower risk from seasonal flu.

- there are unconfirmed reports that people who have had seasonal flu vaccination are at higher risk of becoming ill from H1N1.

We're Hiring!

Edit: we have now filled these posts - thank you to everyone who applied, and welcome to our new staff!

We are expanding and we are looking to hire two new staff - a clinic nurse, and a receptionist / secretary.

We are a state-of-the art, fully computerized, paperless clinic concentrating on chronic disease prevention and management. We emphasize a collegiate style of work and practice based on the biopsychosocial model of medicine.

We're looking for a nurse and a receptionist who are interested in helping us to provide top quality care to our patients.

If you are interested in either of these posts, or you know someone who might be, then download an application form and job description using the links below.

The closing date for applications is Tuesday 20th October.


Nurse job description
Nurse application form

Receptionist / Secretary job description
Receptionist / Secretary application form

Waiting times

As with other physicians, our clinics can often run late for various reasons. For example, a patient may require more time than usual or an urgent problem may crop up that needs to be dealt with straight away.

This can be frustrating for patients who are waiting past their appointment time.

To help, we now have a Waiting TIme Display. You can see this online on our website (either at the top right of the site under 'Today's Clinics' or by visiting the page directly), on a display in our waiting room. It will also be available upstairs in the walk in clinic when Dr Coull is seeing patients.

The display lists all the staff who have booked appointments for that day and whether they are running on time or late. This can help patients plan when the clinic is running behind.

In our main clinic we can catch up quickly sometimes, so to avoid being bumped please do let the staff know if you are going to be stepping out.

If you are a family physician and would like to implement this Waiting Room Display in your clinic it can be downloaded for free from the tech.oscarpei.net website.

My new clinic is now open

I've now have my new clinic open in the Sherwood Family Medical Practice.

The clinic is downstairs in the modern Sherwood clinic and is completely paperless. It uses the OSCAR Electronic Medical Record to keep track of patient consults, prescriptions, letters, and results.

The contact details for the clinic are:

Sherwood Family Medical Center
15 Brackley Point Road
Charlottetown
PE C1A 6Y1

Tel. 1 (902) 894-7369
Fax. 1 (902) 894-8164