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Captcha
12-31-2010, 01:59 AM
Set in Ontario, Canada - the terms might be a bit different, and I'd appreciate Canadian content if possible, but I think the general system of doctor training and hospital organization is pretty similar to the US, so insight from south of the border would be great.

I have a character who was in a car accident. I want her life to hang in the balance for about a week, and then for her to need a lot of rehab afterward (I'm thinking head injury plus some broken bones, but I'm open to suggestions). I want one of her doctors to be an old friend of my MC. The doctor character should be about 30 years old, and not Doogie Howser. So, with 12 years since high school - where would he fit in?

I figure she'd have come into the hospital and been seen by a trauma team. Would she then get a more permanent doctor to supervise her during her coma/intensive care period? Ideally, if she would, I'd like that doctor to be the old friend - is that realistic, or is he too young? Would he maybe be a resident working on the case, with a supervising doctor who is rarely around?

I am fortunate enough to have had very little experience with medical emergencies, so any help would be great. Thanks!

Spiral
12-31-2010, 02:22 AM
My husband and I got a new doctor when we moved to a different city in Ontario. He was right out of med school and about 28 or 29. (And he was amazing.)

lbender
12-31-2010, 02:41 AM
The age thing may be realistic, but it might be tough for someone to work on an old friend. I'm a veterinarian, and when I work on my own dogs and cats, especially for something serious, I'm told that I snap at everybody. I usually prefer to have a friend of mine, another vet, handle that stuff with my pets.

If you want him to do it, be ready for emotional complications in her treatment. If the hospital knows, they may or may not allow it. Does anyone know that?

Captcha
12-31-2010, 02:45 AM
That's a good point - it's my MC's sister, not the MC himself, but the doctor would certainly know the sister quite well. Maybe he could be on the initial trauma team, because then they wouldn't have a chance to sort out a different doctor.

Or - do doctor's really do ambulance ride-alongs, like they used to do on 'ER'? That would work...

backslashbaby
12-31-2010, 07:08 AM
Rehab? I'd think a rehab doctor could treat someone they knew. It could be regular physical rehab or brain-trauma related rehab, btw. So the amount of training might vary, but I'm sure 30 would cover any of it.

Or did you need it to be an earlier doc? Depending on her injuries, she might have a respiratory therapist working with her a lot (punctured a lung, maybe?). I have a friend who does that, and it doesn't take too many years to learn.

I'm sure there are lots of others. I'm just not sure what they all do or how long the schooling takes, lol.

Spiral
12-31-2010, 07:26 AM
If the hospital knows, they may or may not allow it.

Good point. Their code of ethics says they can't work on anyone they have a significant relationship with. So family members are definitely out, but you might get away with an old friend. Sorry, not much help!

GeorgeK
12-31-2010, 07:25 PM
The US and Canada have reciprocity (that's not the right term, but I can't remember it right now) such that a graduate of an accredited med school in either country can apply for a residency in the other. Due to that, I assume that Canadian average years for med school and residency are the same. If so, after HS (assuming no time off to do other things and the person passes all their exams on the first go), there will be a minimum of 4 years college, then 4 years med school, leaving four years for residency. Some residencies are only 3 years like family practice, so if they are a FP, then the friend cound be an attending physician. If Internal Medicine, then they'd be a chief resident. For any surgical residency, they'd be at most a senior resident with 1-4 years to go.

shadowwalker
12-31-2010, 07:42 PM
Or - do doctor's really do ambulance ride-alongs, like they used to do on 'ER'? That would work...

I don't know of any EMS service that has doctors along. Or do you mean just a "ride with them one night to see what it's like"? But if that happened and then it just happened to be the night this accident occurred it would be awfully 'convenient'.

profen4
12-31-2010, 08:22 PM
In Canada doctors do 4 years of university, then 4 years of medical school, then depending on the specialty between 2 or 3 (for family medicine - 3 if the family doc sub-specializes) or 5 (for most other specialties). That 5 years isn't the end, though, many specialists get a fellowship and sub specialize. eg, pediatric cardiology. That said, you could be a physician, with a fellowship by the time you're 30. (FYI- family medicine is a specialty.)

The ER doc she sees when she comes in would not continue with her care. She'd likely see a Hospitalist, or members of the internal medicine team (sometimes the hospitalist is an internal med doc, sometimes they're a family doc. depends on the size of the center - and some centres have both). She wouldn't just see one doc. She'd see the team. One doc would be assigned to her for that doctors shift, but what ever doc was on-call that night would see her too.

ETA: All patients in hospitals are seen by a doctor at least once a day.

profen4
12-31-2010, 08:36 PM
If Internal Medicine, then they'd be a chief resident. For any surgical residency, they'd be at most a senior resident with 1-4 years to go.

In Canada the Chief Resident is just someone who is elected by the class. Each year has a chief resident. Eg, if you're a family med. resident, doing your residency in Calgary (along with the few dozen other first year Family Medicine residents) you'd elect a member from that group to take issues to the attending physicians and management. It is not a reflection of skill (other than perhaps organizational).

Senior residents are, more-or-less, residents in their 3rd year or above of their program. Attending physicians are those physicians that have completed their specialties and are on service that day.

profen4
12-31-2010, 08:46 PM
Or - do doctor's really do ambulance ride-alongs, like they used to do on 'ER'? That would work...

No. Doctor's really wouldn't be any better on an ambulance than an ambulance attendant. They'd probably just get in the way :). EMT's are the best people to snatch and grab and keep a person alive while they get to a hospital. Docs need their tools and those tools are at a hospital.

ETA: Doctors are often on an air ambulance though (eg, STARS).

GeorgeK
01-01-2011, 03:05 AM
In Canada the Chief Resident is just someone who is elected by the class. Each year has a chief resident. Eg, if you're a family med. resident, doing your residency in Calgary (along with the few dozen other first year Family Medicine residents) you'd elect a member from that group to take issues to the attending physicians and management. It is not a reflection of skill (other than perhaps organizational).

Senior residents are, more-or-less, residents in their 3rd year or above of their program. Attending physicians are those physicians that have completed their specialties and are on service that day.

So then chief resident for FP is not an extra year in Canada? Here it's an extra year for most of the medicine branches, but not for the surgical branches which are already longer. It sounds like most of ours are about a year longer anyway.

profen4
01-01-2011, 04:11 AM
So then chief resident for FP is not an extra year in Canada? Here it's an extra year for most of the medicine branches, but not for the surgical branches which are already longer. It sounds like most of ours are about a year longer anyway.

No - it's not a longer residency. But, technically the "chief resident" in FP is a second year resident, but the first year group have a "representative" that works with the second year "chief" and basically acts like a chief resident for first years and then becomes "chief resident" in the second year. You go to them if you have questions about the contract, or if you're getting harrassed by the nurses.. lol....seriously

GeorgeK
01-01-2011, 04:18 AM
well, technically the "chief resident" in FP is a second year resident, but the first year group have a "representative" that works with the second year "chief" and basically acts like a chief resident for first years and then becomes "chief resident" in the second year.

I'm a surgeon, but worked with other residents of other specialties and where I did my residency FP was a 3 year program and one person a year was selected by the attendings to do an optional extra year as a chief. So I don't know how much is a Canadian vs American thing and how much is institution vs institution. AFAIK in America, anything under three years only qualifies someone as a General Practicioner, to whom few if any hospitals would grant admitting privileges.

profen4
01-01-2011, 05:46 AM
I'm a surgeon, but worked with other residents of other specialties and where I did my residency FP was a 3 year program and one person a year was selected by the attendings to do an optional extra year as a chief. So I don't know how much is a Canadian vs American thing and how much is institution vs institution. AFAIK in America, anything under three years only qualifies someone as a General Practicioner, to whom few if any hospitals would grant admitting privileges.

AFAIK there are no GP's anymore in Canada ... I should say, there are no "new" GP's. Here you apply to your specialty out of medical school. It is a very competitive process and spaces are limited. If you go into Family Medicine, you have a 2 year residency, but after those two years you can apply to do a 3rd year in a sub-specialty (R3), in things like ER, OBS/GYN .... and a couple others. Other specialties are 5 years (with a couple 4 year exceptions--internal, general pediatrics).

I'm not entirely sure how it works in other specialties, the chief may be 'assigned' rather than 'elected' but there is no added medical-related skill level that a "chief" has over their counterparts. Strictly administrative. And the 'residency' is not longer. Here earnings for residents varies only from province to province and by what year you're in. First year surgical resident gets the same as a first year FP resident (if they're in the same prov). But each year it goes up.

ETA: GP's used to exist, back in the day, but I believe their residency was only 1 year.

BillTrain
01-02-2011, 10:36 AM
Here's how it would definitely work in Ontario:
-no Drs do 'ride-alongs' - her trauma team would be made up of the ER group - there are ER docs and nurses each shift that are designated 'trauma', so in case a big car accident, like your MC comes in, they would be called for her...
-once your MC is stabilized in the ER by the trauma team (if she's in a coma) - they would call the ICU doc, who could be your 30-year-old
-MC would get moved to ICU where she's kept while she improves, comes out of coma etc etc...once she's medically strong enough, she'd be moved to a medical ward
-re your 30-year-old...in Ontario you'd be looking at high school (17 or 18 yo), then undergrad (3-4yrs), then med school (usually 4 years, unless they're McMaster, which is 3), then specialty...for intensivists (the guys who usually run the ICU) that would be 3 yrs internal med, then 2 years as an ICU fellow...so your 30 year old could have finished high school at 17, finished his BSc at 21, finished med school at 25, IM at 28, and intensive care at 30...take a year off his BSc and maybe med school to have him finish at 28 or 29...give him a year or two of experience....
anyway, that's how it would be.
cheers,
BT