A day in the life of a family doctor

It's just after six o'clock on a frigid Ottawa morning. 

The sun won't rise for another hour, but Dr. Alykhan Abdulla is already racing against the clock.

He's been studying his patient's charts throughout the weekend, preparing for some very long days at his small family practice in Manotick in the city's south end.

"I'm contemplating all the things where I'm going to potentially have problems with. And that always makes me feel a little worried and anxious," said Abdulla. 

He worries he might miss something that could have grave health consequences. That fear has changed the way he feels driving to a job he's done for three decades. 

"It's a sense of dread in some ways. I've been working all weekend to prepare for this week, the opportunity to get a bit of a break hasn't really happened," he says. 

On his busier days, Abdulla could have between 25 and 40 patients go through his office, each with problems he's following, new problems they bring and a medical trajectory he needs to put them on.

Tuesdays can be overwhelming, in particular.

"It's important to know what they're coming for. Collect the data, pre-prepare the charts if possible, make sure we're not missing anything so we can be as efficient as possible."

He used to see 50 or so patients a day, but now he can barely manage half of that. He sets aside 20 minutes tops for each patient and their paperwork. 

Any longer than that and it will become near impossible to complete the day's work.

So much paperwork

His first patient arrives slightly ahead of schedule, with an injured shoulder and some unfinished business from his last visit.

Abdulla recommends a series of tests and a plan for a colonoscopy. He spends seven minutes on his patient, leaving him another 13 minutes to fire off the paperwork.

It's the administrative stuff that drowns you.- Dr. Alykhan Abdulla

"I'm gonna do a couple of things. I'm gonna send the referral along that he requires. I'm going to make sure that, if there's any messages in my system, that I deal with them."

Abdulla has been practising family medicine for three decades. Gone are the days when he used to go to the hospital to do obstetrical care, deliver babies and assist in surgeries. That variety of work has given way to piles of paperwork and an endless stream of aging patients with complex conditions, desperate for care. 

He's learned how to make this work, but the demands of the job have changed. 

"It's the administrative stuff that drowns you," said Abdulla. 

The paperwork is a huge responsibility — it takes up one-third of his day.— and the doctor is liable if anything is wrong. 

"It almost seems like you're patching holes of a dam that's gonna burst over," Abdulla said of trying to catch up while treating other patients. "That is not a good feeling."

Abdulla shares his workload with a team: a nurse practitioner, a secretary and a few other family doctors. Abdulla is responsible for 5,000 patients.

"If you're looking for a cause to burnout that happens for doctors on a day-to-day basis. It's the fact that we probably feel that we lose more battles than we win. That's a serious problem."

Working extra hours

As patient after patient files in, Abdulla greets them cordially, but wastes no time getting to the issue at hand. 

A man named Jonathan has been struggling with mental and physical health challenges. He has a family relying on him to pay the bills, but can't return to work. His employer wants him back at work but he doesn't feel ready.

Jonathan and Abdulla have been working on these issues for some time. They discuss changing medication dosages, psychotherapeutic counselling, and how much longer the family can make it through without a paycheque. 

Getting Jonathan back on his feet is a delicate balance, and it's going to take up a lot of the doctor's time. 

"I know the child, I know the parents of this man, and I know the wife. And so if I didn't understand the whole context of that, he would be coming into a walk-in clinic asking for a form to be filled out, which will probably be declined because they wouldn't have any information or background or context for it, and he would struggle."

Abdulla wants to see Jonathan more frequently than other patients.

"There are no spots for me over the next four weeks. I'm going to have to figure out when to see him. So it'll be a lunch hour, it will be in the evening. I'll see him on a weekend or something like that."

It's harder now than it ever used to be, but I couldn't be anything else except a family doctor.- Dr. Alykhan Abdulla

Some patients require complex care and attention and Abdulla fears many aren't getting that. 

By his own account, his dedication to these patients cost him his first marriage, and took him away from his family. 

"It's gonna make it very hard for me to sell this to young people, to say come and be a family doctor like me. Because you're going to end up getting burnt out and washed up and stretched and pushed on, and you're going to have the challenges that I have and not have the work-life balance. Do you really want this?" 

Yet, it's a job he says he wouldn't trade for anything else.

"I love the people. I love the relationships. I love the opportunity to be able to make a difference in people's lives," he said.

"It's harder now than it ever used to be, but I couldn't be anything else except a family doctor."