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In a scrum room without walls, specialists connect to help patients

In what’s called the scrum room of a new publicly funded health-care clinic in Saanich, a hip replacement specialist asks a spinal surgeon for his opinion on an MRI scan — he’s wondering whether the patient’s hip problem might be related to her spine
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Physiotherapist Chris May, left, works with client Devin Frampton at a new publicly funded health-clinic in Saanich.

In what’s called the scrum room of a new publicly funded health-care clinic in Saanich, a hip replacement specialist asks a spinal surgeon for his opinion on an MRI scan — he’s wondering whether the patient’s hip problem might be related to her spine.

The two orthopedic surgeons — Dr. James Stone and Dr. Adalbert Wahl — chat and pore over the scan, reaching an answer in about five minutes. That same collaboration might have taken three or more months if the patient had to be referred to another specialist.

“People don’t have isolated issues,” Stone said. “They have complex issues that affect different parts of the body.”

That’s the genius, doctors say, of putting about 30 musculoskeletal experts in the same clinic — all of Vancouver Island south’s 16 orthopedic surgeons; five physiotherapists; five sports medicine physicians and two rehabilitation medicine specialists known as physiatrists.

The 10,000-square-foot Rebalance MD musculoskeletal clinic in Uptown centre in Saanich is serving patients with a range of joint, bone and ligament problems.

Because there are no walls in the clinic’s open-concept scrum room — where all of the specialists have a computer station — a second, third or even fourth opinion is as easy as “a tap on the shoulder,” said Dr. Colin Landells, an orthopedic surgeon.

“This room really represents what it’s all about,” he said. It’s a place that allows for direct communication and collaboration that leaves no room for miscommunication or delays, he said.

Landells has been practising in Victoria for 17 years — about the same amount of time he has been planning just this kind of clinic with colleagues.

In the past, if a patient visited their general practitioner with a problem, they may have waited six months, for example, to see a specialist. If that specialist determined the patient should see another specialist, or another doctor for a non-surgical treatment, that could mean several more wait-lists. If surgery was required, the patient would be added to a final wait-list.

The system created stress for patients and doctors, who both have vastly different benchmarks for wait times than the Vancouver Island Health Authority.

Under a new pilot model, the referred patient arrives at Rebalance MD to be immediately assessed by a specialist. Based on that diagnosis, the patient is scheduled to see the first available surgeon, physiotherapist or sports medicine specialist.

“The goal is to reduce wait times and have patients go to only one location for all of their care, except for surgery,” said Stefan Fletcher, CEO of the clinic. “People will come to Rebalance MD right from their first referral from their doctor through to their post-operative physiotherapy in cases such as joint replacements.”

Landells said the doctors took it upon themselves to try to improve the system while acting within the existing funding envelope and the Canada Health Act.

Like other publicly funded clinics, care by doctors is covered by a patient’s B.C. Medical Services Plan, while physiotherapy, splinting or bracing or othotics are not covered.

The clinic houses orthopedic surgeons, as well as doctors in physical medicine and rehabilitation, sports medicine and osteoporosis medicine. There are also physiotherapists and physiatrists and services for splinting bracing and orthotics.

Open just weeks, the clinic is working out the inevitable kinks, Landells said, “but I have to say so far the model is flowing quite well.”

The clinic’s surgeon group is also negotiating with the Vancouver Island Health Authority to provide all pre- and post-operative services for people who have had joint replacements.

“We hope to have [the contract] finalized in the next few weeks,” said VIHA spokeswoman Sarah Plank. “On-site availability of the orthopedic surgeons during pre- and post-operative outpatient care will provide invaluable opportunities to address patient concerns and complications more readily, and increase collaboration between professions.”

ceharnett@timescolonist.com