St. Paul’s Hospital in downtown Vancouver, Canada.
Our clinical service delivery areas are multidisciplinary and span the entire province of British Columbia.
Most Division members participate in inpatient GIM services, either on the CTU at St. Paul’s Hospital or at Vancouver General Hospital. This includes ED Triage service and Medicine Consult Service, and at St. Paul’s Hospital. We also participate with other Internal Medicine specialists in the Acute Internal Medicine Service (AIMS) with a nurse practitioner to care for medial patients requiring hospital admission. The Division also provides ambulatory care through active clinics for CTU patient follow-up, pre-operative assessment, post-operative follow-up, ED referrals, and urgent referrals from primary care.
Below is a comprehensive list of our clinical service delivery areas.
St. Paul’s Hospital Rapid Access Specialty Clinic
Located at St. Paul’s Hospital in downtown Vancouver, non-emergency patients are discharged and referred to the Rapid Access Clinic until the end of treatment. The clinic also takes in referrals from doctor’s offices or walk-in clinics.
Referral Form (PDF)
VCH Internal Medicine Outpatient Clinic
Located at Vancouver General Hospital, the Internal Medicine Rapid Access Clinic provides consultation with an internal medicine physician to diagnose a variety of complex medical conditions. After diagnosis, patients can be referred to other specialist services. Appointments must be arranged through a physician.
Referral Form (PDF)
Rapid Access Consultative Expertise (RACE) Line:
The RACE Line is part of the provincial Shared Care Initiative. The Division also participates in the eCASE, which is the new non-urgent complement to the RACE Line. Through the dr2dr Secure Messaging platform, family physicians can send an email message to a specialist for an answer back within one week.
Bridge Clinic (Refugee Health):
Dr. Trudy Nasmith is providing a weekly clinic for this patient population who frequently have undiagnosed and unmanaged medical conditions.
Chronic and Complex Disease Clinic (Ambulatory):
Division members participate in this multidisciplinary clinic that provides care for patients with Chronic Lyme-Like Syndrome, Fibromyalgia, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Multiple Chemical Sensitivities. Treatment choice takes patient preferences into account, and treatment plans strive to incorporate components of self-care. Vital to the process is development of a partnership with the patient, and facilitation of patient involvement in assessment and treatment decisions.
Division Members: Ric Arseneau, Jane McKay
Eating Disorders (Inpatient and Ambulatory):
GIM faculty members have expertise in managing the medical complications of patients at the Eating Disorders Program, a tertiary province-wide program housed in Mental Health at Providence Health Care. These patients are very complicated medically and challenging to manage.
Division Members: Ric Arseneau, Jane McKay, and Debbie Rosenbaum
Division members, who are Hypertension specialists with American Board Certification, operate clinics for resistant hypertension at both St. Paul’s Hospital and Vancouver General Hospital to optimize blood pressure measurement and management for patients whose blood pressure has been challenging to treat. Poorly controlled hypertension is associated with substantial morbidity (renal, cardiac, stroke), acute care use with ED visits and hospital admission for hypertensive emergency and urgency, and premature mortality. Hypertension specialists in the Division employ motivational interviewing techniques to improve adherence to medications and focus on lifestyle interventions in addition to pharmacologic treatments.
Division Members: Nadia Khan, Biri Mangat, Laura Kuyper, Jane McKay, Debbie Rosenbaum, and Karen Tran, Jesse Bittman
Perioperative Medicine (Inpatient and Ambulatory):
With their advanced training in Perioperative Medicine, Division members are working with Anaesthesia to implement a standardized approach to better identify and manage patients with myocardial injury after non-cardiac surgery (MINS). MINS occurs in 8% of patients (only 16% symptomatic) and is associated with a ~10% mortality rate at 30 days and 20% composite endpoint (mortality, CHF~9%, stroke). Members are also working with Cardiology and Anaesthesia regarding the best monitoring strategy and follow-up—in-hospital and as outpatients—to improve patient outcomes.
Division Members: Iain Mackie, Erin Morley, Zach Schwartz, Erin Sloan, Terence Yung, Steve Ham
Obstetric Medicine (Inpatient and Ambulatory):
Faculty work at BC Children and Women’s Hospital as well as in the CTU at St. Paul’s Hospital and in an OB Internal Medicine Clinic at the Rapid Access Clinic at St. Paul’s Hospital. Members also provide outreach clinics at Surrey Memorial Hospital (SMH) weekly.
Division Members: Tessa Chaworth-Musters, Sue Purkiss, Wee-Shian Chan (BCWH, SMH), and Jayson Potts (BCWH and SPH)
Palliative Care (Inpatient and Ambulatory):
Dr. Gil Kimel, Physician Program Director of Palliative Care at PHC, attends on the Palliative Care ward at St. Paul’s Hospital, where he has been successful in building a healthy relationship with the CTU.
Rural and Remote Outreach:
A number of Division members regularly do outreach to underserved communities in northern BC (Hazelton, Bella Coola, Smithers, Terrace) and in Yellowknife, NWT. Dr. Marie Pierre Dallaire has worked closely with Dr. John Pawlovich (Family Medicine) and Dr. Terri Aldred to build relationships with First Nations communities. She and others are using telehealth to communicate and follow up with the patients and the staff in these places. Dr. Denise Jaworsky, recent GIM graduate, was recently hired in Terrace (Mills Memorial Hospital) where she will continue to collaborate with the group on providing outreach and longitudinal care to these patients.
Division Members: Marie Pierre Dallaire, Trudy Nasmith, Dave Sohi, Stephane Voyer, James Tessaro
Two Division members with advanced training in thrombosis developed the Thrombosis Clinic at St. Paul’s Hospital. The vision is to provide exceptional and readily accessible patient care that improves the quality of life for people with thromboembolic disease. The clinic provides urgent assessment and follow-up to patients discharged from the emergency department, urgent primary care centre and inpatient wards. The clinic also accepts referrals from family physicians and nurse practitioners in the community. Common reasons for referral include long term management of deep vein thrombosis (DVT)/pulmonary embolism (PE), treatment of venous thromboembolism in unusual sites, bridging anticoagulation for procedure and management of post-thrombotic syndrome.
Division Members: Anna Rahmani and Tony Wan
Urban Clinic Outreach:
Division members from Vancouver General Hospital participated in the Ravensong Community Health Centre pilot and continue to spend a half day per week seeing patients and doing case conferences with complex patients and the primary care team (sessional payment). Dr. Debbie Rosenbaum has regular clinics at the Portland Hotel and the Pennsylvania Hotel with family physician Dr. Christie Sutherland—which has been successful in terms of providing access to specialist care to patients who are hard to reach. Division members also provide Internal Medicine outreach ½ day every 2 weeks to Three Bridges Community Health Centre.
Division Members: Cary Cuncic, Harp Nagi, Marie Pierre Dallaire, Trudy Nasmith, Debbie Rosenbaum, Penny Tam, and Peter Weerasinghe