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Q&A: Doctor of internal medicine Ed Etchells

This is part of The Globe's months-long series on the challenges facing Canadian hospitals. All of our published material has been reported with permission from staff.

Dr. Ed Etchells is a general internal medicine physician at Toronto's Sunnybrook Health Sciences Centre. While it doesn't get nearly as much attention as the emergency department or state-of-the-art specialty wings, internal medicine is the heart and soul of any hospital. It's home to a significant portion of the hospital's beds and encapsulates many of the major challenges many hospitals face: growing patient loads, increasingly complex cases and never enough resources.

Kevin Van Paassen

Do you find that many people don’t understand what ‘internal medicine’ means?

My mother isn’t even sure what I do, so there probably is a disconnect in that regard. An internal medicine specialist is good at diagnosis and treating conditions with medications, that’s what we do.
Our group specifically, we are for the group of hospitalized medical patients… We don’t do surgery. We’re the busiest inpatient service for unscheduled service, by far. That’s because if it’s not immediately clear what’s wrong with you, you’ll probably end up on an internal medicine service. The first step is always an accurate diagnosis. If it’s not obvious you have a surgical condition, you’re not going to go to surgery, you’re going to come to us. One of our challenges is the undifferentiated problem, figuring out what is actually wrong.
Kevin Van Paassen

How hard is that, figuring out what is wrong with a person?

That’s the hard part of the job and that’s the fun part of the job. I can’t emphasize enough that if you don’t get a good diagnosis, you won’t get good treatment because the treatment would be wrong. I think our other biggest challenge is the patients are very complicated and increasingly frail, so sorting out what’s a new problem….[and] sorting out a new treatment plan that won’t make the patient worse is a big challenge.
Kevin Van Paassen

From a hospital and health-care system perspective, what are the biggest challenges facing internal medicine?

I think it’s providing excellent care to an increasing number of complex patients, that’s our biggest problem.

Is it simply an issue of demographics [given that our population is aging so rapidly?]

That’s a major part of it. The median age of my patients is 80. That means half of them are over 80.
Kevin Van Paassen

Are there things we could be doing to better serve those people?

What I’ve seen is the biggest change that I really enjoy is teamwork and communications. In my view, doctors don’t take care of hospitalized patients, it’s a team of health professionals that take care of patients. We’re just part of the team. Teamwork, to me, is tremendously good and it’s essential to the care of giving excellent care to these complex patients. The other challenge is communication and transition. It’s one thing to get a good care plan when a patient is in the hospital. Transmitting that care plan in a timely fashion… that’s our other biggest challenge.
This interview has been condensed and edited.
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