Marathon

Orientation for Locum Physicians at Marathon Family Health Team

Welcome to Marathon and to the Marathon Family Health Team. We have prepared this package to help orient you to the town and the practice. You should have received a separate package entitled “Orientation for Locum Physicians at Wilson Memorial General Hospital” that will orient you to the hospital.

Marathon Family Health Team:

This group practice evolved in August of 1996 and became a Family Health Team in December 2005. Please see other areas of this website for more information about MFHT.

If you could arrive approximately 15 minutes before your first scheduled clinic, Janice will show you around and orient you to the clinic. This person will also let you know which desk you will be sitting at and if you are covering for any particular physician(s). (See Covering Paperwork below).

The family physicians currently in the practice (and their home phone numbers) are: Peter Cunniffe (229-8662), Nancy Fitch (229-8275), Sarah Newbery (229-1777), Eliseo Orrantia (229-1777), Scott Wilson (229-8359), Mary Wilson (229-8359) and Barb Zelek (229-1402). We all prefer first names be used. Hopefully you will have a chance to meet each of us and discuss our particular interests and roles. For more information about our practice, please see: http://www.cfpc.ca/cfp/2005/Sep/vol51-sep-cme-1.asp

Clinic related issues should be discussed with the Family Health Team Director, Joanne Berube, home phone number 229-8216.

Working with the physicians are several contracted employees and staff listed in the MFHT Staff area of this website.

Clinic phone numbers – Area Code always 807:

Main Clinic Line #1 and #2: 229-3243 Clinic Fax: #229-2672
Clinic Line for Hospital use #5: 229-1246
Private Line #3: 229-0609
Private Line #4: 229-2068
Private Line #6: 229-1541

*We ask that you use Lines #3, 4, or 6 for calling patients, specialists or the hospital. If you are using lines #3-6 for outgoing calls to patients, please always dial *67. By doing so, ‘private number’ comes up if patients have call display and these numbers are not disclosed to the general public. You may give out Lines #4 and #6 to specialists if you are requesting a call back.

Hospital phone numbers:

Main Phone Line: #229-1740
Administration Office Fax: #229-1721
Medical Records Fax: #229-3242

Your hospital orientation package contains a list of extensions within the hospital.

Clinic/On Call Schedule

Prior to beginning your locum, you should have received a schedule for your approval. You will also receive a copy when you arrive in Marathon. This highlights when you are in clinic or when you are on call.

On Call coverage begins at 8:00 a.m. at Wilson Memorial General Hospital. Details regarding on call coverage and scheduling are found in the ‘Orientation for Locum Physicians at Wilson Memorial General Hospital’.

Full Day Clinics are schedule from 9:00 a.m. until 5:00 p.m. with lunch from 12:00 pm until 2:00 pm. Morning only clinics are scheduled from 9:00 am to 1:00 pm and afternoon only clinics are scheduled from 1:00 pm until 5:00 pm.

We have tried to accommodate your requests about how much you would like to work during your locum in Marathon. If you find that the schedule is either too light or too heavy, please speak directly with Joanne the MFHT Director. If Joanne is away, you may speak with Janice. We will try to accommodate your request for change.

Appointments
In July 2009 we moved to an Advanced Access or Open Access booking system where we try to accommodate patient requests for appointments within 3 days of calling, ideally with their regular physician. Our regular physician group will be informed if it would be helpful to add clinic time to accommodate patient demand. Each day there is also a designate physician, highlighted in bold on the schedule who is expected to add clinic time if the demand is there. If the demand on a particular day is low, then they will often be in clinic doing paperwork or will be available within 10 minutes to return to the clinic to support the RN and RPN staff as well as see patients if necessary. Approximately 30% of appointments are prebooked for DM follow ups, prenatal visits, well babies and PHRs.

If you would like a patient to book a follow up appointment, please use the yellow slips in the exam rooms. Please indicate the number of follow-up units, 1 unit = 10mins, 2 units = 20mins, etc., with whom the follow-up should be booked (using the MDs initials or indicating RN/RPN), and when you would like the appointment booked (e.g. 1 month, 2 weeks, next available etc.)

Please reserve these for the above type appointments.

EMR We began using the Clinicare EMR in November 2008. Please see the separate EMR orientation section on this website. We are still transitioning between paper charts and a full EMR. All recent information except for lab results will be on the EMR. Older consults and reports are still found on the paper dhart.

Coloured Charts
We use a coloured folder system for our day-to-day office procedures. You will be shown where the all charts go that are completed or have tasks attached that need to be completed.

Orange Folder – INR folders. We have an INR program where the nurses use medical directives to provide patients with instructions. You are unlikely to see one of these folders.

Purple Folder – Chart Requests from the Doctors. These folders are also of high importance. Please place the piece of information you have received e.g. lab result or consult in the folder and put in the front staff pile and the staff will pull the chart for you and return it to your desk. If you only have a patient’s name, put the name on a piece of paper and the chart will be brought to your desk.

Blue Folder – Used to flag charts that are attached to messages sent electronically to the Dr.’s In-Box.
Red Folder – Emergency Folders. These folders are of highest importance and require immediate attention. If you receive one of these folders on your desk you should attend to it immediately and then direct the staff accordingly. In some instances you may have to call the patient or the hospital or write an urgent prescription request.

Green Folder – This is your daily mail folder. You will find labwork, consult notes, general mail, and magazines in this folder. You must sign off all the lab work which will be filed in the patient’s paper chart and consult notes which will be scanned into the EMR. Once the filing is signed, the entire folder may be placed in the filing pile and it will come to the front and be filed or scanned.

Booking Procedures at the Hospital
Each exam room has a white out-patient booking form that should be completed and attached to the front of the patient’s chart. These will be sent directly to the hospital. Please try to book procedures on your call days. If the procedure needs to be done sooner, you can book it on someone else’s call day with their approval.

Referrals
These may be typed directly into the EMR or dictated. There is an Olympus Dictaphone that is on Elana’s desk in the administration area that is directly connected to the computer. She can orient you to it if you have any questions. Once you have completed the dictation, please complete a pink dictating slip found on the bookshelf next to Elana’s desk. This goes on top of the patient chart and it indicates to whom the dictation is to and the urgency with which it needs to get transcribed. If the transcription needs to done immediately, please let Elana or Jackie know. If the dictation is urgent it will be done within 24 hours. If a dictation is non-urgent it will be done within 7 working days. These will be returned to your desk for signing when they are completed. If you require copies of reports or lab results to be sent with the dictated letter, please mark these in the chart with matching colored paper clips (e.g. all red, blue etc) and indicate on the front of the chart that you would like them sent with the letter.
We have a copy of our current specialist list on each computer and you should have a hard copy of the names and phone numbers of consultants on your desk. To access the address list on our computers you must open the Microsoft Inbox and click on Clinic Address List. You will also find some computers have Contact addresses as well (this is for a more personal use to each computer and is not shared with the network.) If you are unsure about who to refer to, please ask one of the physicians and we will provide a suggestion for you.

Covering Paperwork
You will likely be covering for one or more of the physicians while you are here. There should be a Departing MD Sheet for any physicians not in the clinic. The staff orienting you should let you know which physician(s) you are covering for and we would ask that you check their paperwork daily at their desk.

You will be given a “patient issues / findings sheet”. Please use this sheet to mark down any patients that will need follow-up or attention by their family physician after your locum is complete. This sheet will be attached to the Locum Assignment Evaluation form, which you will complete at the end of your locum assignment. There is also a flow sheet on which you can keep track of abnormal results or interesting consultation notes and the actions taken as an FYI for physicians who are away. Alternately, these can be sent to the physician’s pending box.

Billing
We primarily do shadow billing as we are on an alternate payment plan. Any out of province billing is fee for service (FFS), as are WSIB billings and private billings. You will be paid these amounts on top your daily locum rate.
Clinic day sheets: please indicate the fee code and diagnostic code on these sheets. Please also indicate if it is a WSIB case.

ER patients: please collect stickers with the patient names on one piece of paper. These are submitted in the billing office.

Hospital admissions: There is a separate white billing sheet that is in every admission package. You may complete this and simply indicate on the sticker sheet that the patient was admitted. In patient weekend rounds are also tracked on this same piece of paper.

If you have any patients from Quebec, please get them to complete the OUT OF PROVINCE CLAIMS FORM; it must be completed fully by the patient. We would like you to do this regardless of whether they have their Health Card on them or not, more often than not the wrong information is collected from their cards. You are also required to sign this form.

For initial WSIB visit, please complete a Form 8 and try to get as much information from the patient as possible, especially SIN and employer’s name and contract phone numbers.

Payment
You will be mailed a cheque from HFO for your locum days. Sessional and extra billings will be mailed to you directly from MFHT at the end of the calendar month. You may continue to receive cheques for extra billings that are received in the months after you leave.
You will receive an invoice from the practice for the locum house accommodations. We do this to pay for the upkeep of the houses as we are directly responsible for this. This invoice can be submitted to the OMA directly for reimbursement. You have the option to pay this invoice directly to the practice or to have the amount deducted from your sessional payment. It will be clearly marked as such on the ledger you receive.

Other Services and Providers

NURSING

NURSE PRACTITIONER AT MFHT

Currently, the Nurse Practitioner is doing some acute care clinics, high school clinics and general appointment clinics. She is also working on some chronic care program development including diabetes management and COPD.

PROGRAMS PROVIDED BY RNS AT MFHT

• Travel Medicine and Travel Vaccines
• Smoking Cessation
• Reproductive Health Care including pregnancy tests and counseling, prenatal counseling (first visit with RN then sees MD at 10 to 12 weeks gestation), well woman exams, emergency contraception counseling and administration, abortion counseling, hormonal contraception counseling and follow-up
• Asthma Education and Spirometry
• INR Monitoring and Warfarin Therapy Program
• Hypertension Program medication adjustment

SERVICES PROVIDED BY RNS AT MFHT

• Compression stocking measurements for fitting for Rx. (for those patients unable to travel to Thunder Bay only)
• Injections: vaccines, TB skin testing, B12, DepoProvera, Lupron, Zoladex
• Teaching self administration of injections
• Allergy serum injections. (emergency epinephrine available on site, & anaphylaxis policy in place)
• Telephone triage of more complicated patients requesting appointments
• Telephone patients with more complicated results

PROGRAMS PROVIDED BY RPNS AT MFHT

• Hypertension including monitoring, home monitor verification, counseling and healthy life style counseling
• Wound Care including staple and suture removal
• Foot care and wart treatments

SERVICES PROVIDED BY RPNs AT MFHT

1. Injections: Vaccines (all except travel vaccines), TB skin tests, Depo Provera, B12
2. Ear Syringing
3. Calling patients with normal results and uncomplicated abnormal results.

There are Nursing Medical Directives in place for the following:

• Td vaccine booster
• MMR vaccine
• Pneumococcal Polysaccharide Vaccine
• Influenza Vaccine
• Hepatitis A and B vaccines
• Typhoid vaccine
• 2 – 18 mo. routine vaccines – Pediacel, Prevnar, MMR, Meningitis C, Varicella
• School age vaccines – Quadracel, Adacel (dTaP), Hepatitis B, Meningitis C
• PAP testing
• Screening swabs for STDs
• Management for anaphylaxis
• Warfarin dose adjustment
• Glucagon/Dextrose for Hypoglycemia
• Emergency Contraception
• TB skin testing for screening
• Wart and skin treatments
• Spirometry and Salbutamol administration for post spirometry

Please feel free to review the RN /RPN policy and procedure manual for specifics regarding these duties.
Please note that wart treatments, other than feet and genitals, skin tags and non-medically necessary skin treatments are not covered by OHIP and patients will be charged $20 per visit. Also travel consults ($30 single and $60 family) and travel vaccine administration ($15) are not covered by OHIP.

SOCIAL WORKER AT MFHT

PROGRAMS OFFERED BY THE SOCIAL WORKER

• Reproductive Health Care
• Smoking Cessation Group Therapy
• General Social Work including access and referral to all community social service programs
• CBT for Mood Disorders
• Urgent Care Program for urgent same day referrals – booked daily 2-3pm
• Hospital visitation
• Geriatric programming including performing the MMSE
• Coordination of telepsychiatry referrals, sitting in on appts and follow ups

You can refer by using the EMR. Please ask patients to book their appointment before before they leave the clinic.

DIETITIAN AT MFHT

The Registered Dietitian’s role is to provide nutrition assessments, counseling and care plans in collaboration with individuals and families referred for dietitian services. Referrals to the Registered Dietitian are made by all health care providers for a variety of conditions and diseases, including but not limited to:

• Diabetes (includes management and prevention strategy)
• Cardiovascular Disease (includes heart disease and stroke)
• Hypertension
• Anemia
• Celiac Disease
• IBS (Irritable Bowel Syndrome)
• High Risk Pregnancy
• Eating Disorders
• Weight Management

The Registered Dietitian collaborates with the physicians and all other health providers on already established programs such as:

• Hypertension
• Diabetes
• Smoking Cessation
• INR
• COPD
• Geriatrics

Upon Departure
Thank you so much for working with us. Prior to leaving if you could ensure that you:
____ return your pager
____ return your hospital ID
____ return the house and clinic keys
____ complete the ‘patient issues / findings sheet’
____ complete the Locum Assignment Evaluation sheet
Please return all these to Janice and have a safe trip home.

If you have any feedback for us, we would love to hear from you. You can provide this to any of the physicians or e-mail our locum contacts Nancy Fitch at nfitch@mfht.org or Barb Zelek bzelek@mfht.org