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Women in Leadership - Kootenay Boundary key attraction is the collaboration and cooperation4/19/2021
 Dr Nattana Dixon-Warren BSc, PBDip, MD, FCCFP Dr. Nattana Dixon-Warren wears many hats including KBRH Senior Medical Director, Primary Care Physician in Salmo, and KBRH hospitalist. She shares her experiences while keeping an eye on the weather and the snow conditions at Red Mountain in Rossland, where she lives with her family. She wanted a balanced lifestyle and she got it. Although Dr. Dixon-Warren didn’t get into medicine on her first try, she continued her studies in premedical training, biochemistry, environmental toxicology and English literature, later graduating from UBC medical school. She and her husband, ready for a move, put a list of career options on their fridge in their Ontario home. They chose KB over places like Churchill, Manitoba. Dr Dixon-Warren and a colleague set up their family practice at the Salmo Wellness Centre, established with help from the town, the regional government, and the Health Authority, filling a long-time community void. “I’ve always enjoyed the variety of longitudinal care. It is unbelievably satisfying,” said Dr. Dixon-Warren about her role as a family doctor. The longer she stayed, the more roles she took on. 'Nimbleness’ needed for today’s services She describes the four bundles of family medicine as running a clinic, delivering babies, helping out with hospital/facility services, and using special skills in the community. It’s not as simple as it used to be, but KB’s collaborative and collective teamwork across a complex system and service delivery impressed her. The model is one of its biggest strengths and played a major role in Dr. Dixon-Warren coming, staying, and expanding her roles. “There has to be a nimbleness to the way services are developed,” she adds, using the COVID crisis as an example. “A respiratory assessment clinic was needed here, which involved setting up, running, staffing and planning.” They did just that; another example of KB medical services in motion.  The town of Rossland Photo: Dave Heath Blending family and work
Having grown up in a large family with professional parents, one being a doctor, she learned first-hand about the accommodation required by family to make a medical professional’s work life possible. It asks everyone to be flexible, so the community benefits. Her family, including four children, accepted this lifestyle and she looks back at a busy 20 years as ‘fun and happy’. They took advantage of all KB offers: sports, arts, fitness, outdoors, and nearby urban culture. Her husband, a teacher at the time of their move, later switched to ski instructing, running a guest cabin, and domestic roles. They wanted to move to be closer to my family, who live at the coast, and have access to skiing. The work-life balance was struck. “KB is quite family oriented,” she adds “What’s important to me is that family life is supported throughout this journey.” In true Kootenay style she blends activities into her daily routine, doing a 1950s military fitness program, yoga with her daughter via Zoom, and walk and talk meetings, to take indoor tasks outdoors. “I’m happy the offerings here make for a sustainable lifestyle.” Taking the lead Not only is Dr. Dixon-Warren KB's Senior Medical Director, a family doctor to the residents of Salmo, and a KBRH hospitalist, she's also Assistant Clinical professor for UBC medical program and serves as admin lead for distributed post graduate medical education. She is instrumental in helping drive the region’s medical education programs. In her role as KB’s Senior Medical Director, Dr. Dixon-Warren strives to ensure resources are planned for and distributed as needed throughout the region. She describes the job as a resource for chiefs of staff across the region, working to plan and recruit the resources needed to ensure nodes of acute care are functioning, supporting community service delivery, and that the region's specialty care centre is strong enough to do its job. It’s about keeping it all working smoothly and efficiently. “The discipline needs to keep an eye on the ball and ensure everyone is cared for. It’s our social contract.” Her reach is broad, her jobs varied, her vision expansive, but that’s how she likes it! Dr Nattana Dixon-Warren BSc, PBDip, MD, FCCFP KB Senior Medical Director Primary Care Physician- Salmo Wellness Centre Member of KBRH Hospitalist Group If you want to learn more about living and working as a physician in Kootenay Boundary, please get in touch with Sylvain Turgeon, Head of the KB Doctors Recruitment Team. Like, Share and Follow us @kbdoctors.ca Facebook l Instagram l LinkedIn l Youtube Video Health Choices - Dr. Nattana Dixon-Warren  Justin Dragoman (Medical student), Chi Zhang MD (Chief of Nephrology and the Department of Medicine), Marlene Johnson RN (Dialysis Nurse), and Dharma Paul L. Raju MD (Nephrologist and Project Coordinator) Even established medical practices like dialysis can benefit from new approaches. A Kootenay Boundary Regional Hospital team pooled their skills to search for a safe way to remove lung fluids during dialysis treatment. The team followed their hypothesis and analyzed the side effects of fluid retention on hemodialysis patients. Their goal was to see what benefits lung ultrasounds could provide for patients experiencing hypertension during treatment. The Lung Ultrasonographic Assessment of Volume Status in Hemodialysis team was keen to test Point of Care Ultrasound (POCUS) to identify extravascular lung water volume overload. It requires care and accuracy before taking action. “If you remove fluid too excessively, it can precipitate low blood pressure, loss of consciousness, heart attacks,” said DharmaPaul L. Raju MD (Nephrologist and Project Coordinator). “It can be quite dangerous.” Results give new insights and options The team members represented the variety of service providers a dialysis patient might come in touch with during treatment. This Physician Quality Improvement project was conducted by Justin Dragoman (Medical student), Chi Zhang MD (Chief of Nephrology and the Department of Medicine), Marlene Johnson RN (Dialysis Nurse), and Dharma Paul L. Raju MD (Nephrologist and Project Coordinator) at KBRH. The lung ultrasound results demonstrated a statistical decrease in the overall time patients were hypertensive while on dialysis. Also, the ultrasound allowed the researchers to identify patients with sub-clinical congestive heart failure (those without signs or symptoms of heart failure) who benefited from additional fluid removal. Most of the test patients were asymptomatic, leading to improved targeted ultrafiltration (UF) for patients with subclinical volume overload. UBC Medical student Justin Dragoman explained how the first step was to assess how often patients were becoming hypotensive during treatment. “We determined patients spent about 40 percent of their time in hypotension when they are undergoing a dialysis session.” Using lung ultrasound technology helped reduce the patient’s time in hypotension by 12 percent and deal with low blood pressure issues. Looking to the future “As physicians, we want to make sure we improve patient outcomes,” said Chi Zhang MD, Chief of Nephrology and the Department of Medicine. “But also we want to improve their physical well-being and experience with dialysis.” Lung ultrasonography has already been utilized by ICU and Emergency Room physicians. The project plans to expand throughout Interior Health and engage students and nurses throughout the region. Using this simple invaluable bedside tool can enhance patient safety in rural areas without easy access to hospital services. Review this project report here If you want to learn more about this initiative or anything else about living and working as a physician in Kootenay Boundary, please get in touch with Sylvain Turgeon, Head of the KB Doctors Recruitment Team. Like, Share and Follow us @kbdoctors.ca Facebook l Instagram l LinkedIn l Youtube  Guided by their shared desire to return to their mountain roots, in 2020 Dr. Aaron Krenkel and his family packed up and moved from urban Portland, Oregon to the rural Kootenay Boundary region, where Dr. Krenkel hoped to build on a career foundation in psychotherapy-centered psychiatry. “While I love individual psychotherapy work,” says Krenkel, “I wanted to explore translating those interests into smaller community psychiatry. I also wanted to work collaboratively with folks in allied fields, such as nursing and social work, to extend the benefits to an entire clinic and community.”  Of course, patient services in rural areas can face many challenges, communications being one of them. Mix in COVID best practices restricting travel and the need for creative solutions increases. For the Kootenay Boundary region, designing and implementing a tailored tele-psychiatry initiative to help patients and overcome access issues became the best solution. Pandemic increases tele-psychiatry need “The pandemic accelerated many clinician's adaptation of telemedicine,” adds Dr. Krenkel. “In the space of a few days in March, I went from never having done any, to providing 100% virtual care. I quickly became ready to take on some new adventures with telemedicine.” Kootenay Boundary’s tele-psychiatry project was initiated by forward-thinking psychiatrist Dr. Karen Trueman, reacting to the changing needs in rural communities made more critical by the COVID pandemic protocols. The program caught psychiatrist Dr. Aaron Krenkel’s attention and he joined shortly after moving to Nelson, British Columbia. He describes Dr Trueman as a generous mentor and trail-blazer. “Dr Trueman’s commitment to and understanding of the region's needs, including the way smaller and isolated communities need psychiatric services, put the focus on how different specialities could help each other and our communities.” Technology bridges a service and distance gap Before formally joining the Tele-Psychiatry initiative, Dr. Krenkel had been providing telemedicine services during the pandemic, connecting with patients in outlying areas like Crawford Bay, Balfour and Kaslo. Consulting with staff at Kootenay Lake Hospital, Nelson, could be just the tip of the telemedicine iceberg as this service grows. “There's a saying that 90 percent of communication is non-verbal. We can tend to devalue the importance of the non-verbal and non-symbolic forms of experiencing,” he adds, referring to body language, sharing space and experiences. “The challenge of tele-psychiatry, for me, will lie in balancing access to care with preserving embodied experiences; our nervous systems are not just those brains up there!” Krenkel says. With psychiatrists a call away, doctors can now book a tele-consultation for their patients. Protocols are in place to respect the privacy of the patient and the practitioner. It is a short-term answer that may have a long-term impact. “In some form or another, I think telemedicine will be here to stay after COVID restrictions ease,” says Dr. Krenkel. “I envision a future where I meet with patients occasionally via telemedicine, but where we'll also have some in-person experiences, and the two will complement each other.” Would you like more information on Specialist Positions available in the Kootenay Boundary in beautiful British Columbia? Contact Sylvain Turgeon, Head of KB Doctors Recruitment directly. Like, Share and Follow us @kbdoctors.ca Facebook l Instagram l LinkedIn l Youtube  Dr. Sue Babensee, KBRH Physician and Project Lead. Kootenay Boundary Regional Hospital (KBRH) Project Spotlight One thing that was a standard normal for our profession and services became a new normal for our patients in 2020. Masks. But, while many of us are comfortable with masks, and find them necessary and often preferable, for others it is uncomfortable and un-welcome. Wearing masks for safety may have grown in acceptance and practice but at the same time so did an increased desire to see people’s faces. Patients want to see their doctors’ faces. The solution: the Kootenay Boundary Physicians Association (KBPA) Face Button Project. KBPA’s goal is to supply all physicians, nurses, admin staff—anyone working at KBRHs—with their own smiling face button to wear for the public, patients, and colleagues. We are committed to this ‘face time’ project and participation is growing. It's a simple solution to the complex COVID protection protocols. The US National Centre for Biotechnology Information (NCBI) recently reported on the severe affects and challenges wearing face coverings are producing during the pandemic. They explore how “…the face mask can hinder interpersonal communication…”, an important component of our services. A key side-effect of masks is blocking facial expressions critical in comprehension. The facial muscles that create expressions, predominantly moving our nose and mouth, are important when conveying emotions and information. As communication is a two-way street, we are experiencing even more congestion as both parties communicating are wearing masks. The smooth flow of information is prone to being blocked. The KBPA are supporting the #KBRHSmiles to provide a face button with a head and shoulders photo so everyone can see the smile behind your mask. Dr. Sue Babensee, KBRH physician and Project Lead, wears hers with pride, loving the positive response she gets when others see her happy face. We’ve made it easy for KBRH IH Staff and physicians to join in. Take a selfie or chose a photo and contact your department head or our Project Co-Ordinator: kpegg@kbpa.ca. The rest is up to us. We’ll send your button and you can join the growing number of project supporters.
Get your smile out from behind your mask. Let’s face it. Putting our real face forward is a prescription for better connections, so important at this time. Date: January 2021
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