Joey Wahler (Host): This is Health Matters: Insights from WCH Medical Experts. Thanks so much for joining us. I'm Joey Wahler. Our guest, Dr. Gurpreet Nagra. She's a primary care physician with Wood County Hospital. Doctor, welcome.

Gurpreet Nagra, M.D.: Thank you. Pleased to be here.

Host: Great to have you aboard. So first, what would you say most of all inspired you to become a doctor?

Gurpreet Nagra, M.D.: Yeah, absolutely. So, great question to start this off. You know, I think I kind of knew that I wanted to be in the medical field from an early age. Growing up in a large family, I think caring was sort of engraved in us as kids. And so, you know, I gravitated towards biology in high school and then ultimately did my undergrad in that and Kinesiology.

But I think the defining moment was when my mom sort of scored me a job in my family physician's practice as a filer. So, this was before the EMR days. And so, I would come out of school, and I would sort of go to the practice and there's a stack about this big, ready for me to file.

So, you know, I went from there to kind of becoming an MOA and then sort of integrated myself into their practice, even became a Janitor at some point. But that was sort of a defining moment for me in that practice because, you know, I really got to sort of see what family medicine is all about. You know, I was around multiple family physicians and so, you know, really got to see their sort of responsibilities, their roles. And ultimately, that sort of consolidated what I wanted to do. And fast forward a few years, here I am. I'm super grateful to be here and so far loving what I chose to do as a career.

Host: Wow. That's great. That's an awesome story. So when you start out doing things like filing and janitorial work, it shows you right away that medicine isn't always glamorous, right?

Gurpreet Nagra, M.D.: No, not at all. I mean, it was pretty much my second home at that point, so... For sure.

Host: But something obviously that to work in, you have to be passionate about, and you certainly have that, right?

Gurpreet Nagra, M.D.: Absolutely.

Host: So, you've actually worked in both Canada and the U.S. What would you say are the biggest differences you've noticed between the two healthcare systems?

Gurpreet Nagra, M.D.: That's a loaded question, Joey. I think, you know, I don't want to really step on anybody's toes here in terms of countries. But I can't really speak too much to the U.S. healthcare system. I've only been here for four-ish months now. However, I could sort of allude to some of the challenges or barriers that I've noticed in both countries. 

Number one, as I'm sure most people would agree, insurances are definitely a bit of a headache. And so, having to deal with that in the States was something new for me. Canada, we didn't necessarily do that. In Canada, of course, everybody knows that it's publicly-funded healthcare system. And so, with that being said, just want to make a PSA here, that it's not that healthcare is free in Canada, we do definitely still pay in taxes. But it is one of those things where there's pros and cons to that as well. You know, number one, you're not worried about out-of-pocket costs at that time. And the cons would be then that there are some limitations to how many facilities are available to visit and how many physicians are working in a particular setting or city. So, that is absolutely not the case from what I've seen here in the States. Of course, there may be some rural cities that I haven't been to. But, so far, I feel like it's a little bit more saturated. Of course, the cost can be definitely a barrier. But the benefit of being here in the U.S., I found that the turnaround time for investigations and the time to see a specialist is, of course, cut in thirds compared to Canada. And again, I think it's just because of that sort of healthcare system that's a little different in both.

Host: So, you mentioned there that you just recently joined the Wood County community. What would you say brought you to it and what excites you most about joining it?

Gurpreet Nagra, M.D.: Yeah. So, I found it really nice to sort of move from a small community that I was working in to then join a smaller community as well. I haven't been able to find an opportunity to sort of integrate myself and introduce myself to the Wood County physicians, but, you know, I plan to do that soon enough here.

But I can speak to Falcon, is where I currently work, and I think having multiple healthcare providers under one roof is absolutely amazing. And that's something that's new to me for sure. We've got everyone from chiropractors to physiotherapists. And just underneath us, we've got Lab and X-ray, which is super convenient and we're all sort of able to communicate to one another. And then, last but not least, we've got pharmacy as well. So, I think it's sort of like a one-stop shop, is what I tell my patients. And I think that's so important to sort of provide the best kind of care, having sort of a multifactorial approach.

Host: Speaking of that, you've actually also had experience practicing in rural areas. What would you say are some of the unique challenges that patients face in those settings, and how do you go about addressing those?

Gurpreet Nagra, M.D.: The best answer for that would be just the lack of access to healthcare as I alluded to earlier. And with that comes investigations and specialists. So, because of this reasoning, multiple patients have sort of put off some of their medical issues or medical problems for several months, and sometimes up to years. And when they finally come in to seek care, it's pretty advanced at that point for some individuals and some folks.

The one thing that I really love though is that telehealth used to be huge in all countries, I think, during COVID, but Canada seems to have continued to utilize it, especially for rural communities. So, you know, a small example would be, you know, even rural hospitals where usually there's one provider kind of overseeing the ED department, let's say. If a person comes in that's a bit more sort of high acuity, say the individual's having a stroke, that physician doesn't need to feel that they're the only ones there. They're able to sort of hop on telehealth and sort of consult a neurologist to obtain some help. So, that's been really good.

But even speaking of hospitals, you know, some communities have hospitals that only have x-rays. They don't necessarily have CTs or even ultrasounds. And that's sort of one of the hospitals that have rotated in. And I admire the physicians that work there. I think that they're doing a fabulous job with as much as they have in that hospital. So yeah, I think ultimately, multiple different things, I guess, stem from that. But I think a lack of access in smaller rural communities is definitely a challenge.

Host: When you talk about that lack of access in Canada, rural doctors sometimes actually act as specialists due to the long wait times there. So, how did that scenario shape your approach to patient care, would you say?

Gurpreet Nagra, M.D.: Yeah, absolutely. I think not taking away from specialists, I mean, specialists do things that, of course, us family physicians cannot do. But I think there was a bit of a silver lining that I saw there, especially as a new grad fresh out of residency or med school for that matter, just kind of being able to sort of see what rural medicine is about and then work in a semi-rural area during my practice.

I think the biggest thing is that camaraderie is there. So, everyone knew that it was going to be a little bit of a wait time to see a specialist, may take several months to actually get a CT scan or an MRI done. So, to be able to pick up that phone anywhere in B.C. and to be able to call a specialist just to sort of run by a case by them in two to five minutes or so, pick their brain, and just kind of almost like laying up the patient before they're able to see the specialist was super helpful for both myself as well as the specialists themselves and getting the investigation started.

Sometimes having to think outside the box because, you know, your patients are coming to you, they need your help. You're not going have them wait nine months or so, you know, until they're getting sort of thoroughly investigated, but thinking outside the box, trialing certain things, and again collaborating with a bunch of physicians I think is very key. And that sort of added to my education on top of what I already had. And so, that was crucial for both myself and the patients.

Speaking about specialists and the diversity of family medicine and how that sort of goes together in Canada and B.C., and I'm sure maybe some places in the U.S. as well, family practice is one of those sort of fields where you're able to diversify what you want to do. So, for example, for myself, I made sure that I was an integral part of the Addiction Medicine Clinic, and then also in a clinic that was on First Nations Land, so on a reserve. But I did do some hospitalist work as well. And a lot of my colleagues have gotten extra training in Oncology and Emergency Medicine. they're able to surgically assist. And even to the point where I did rotate around with a GP surgeon, so she did surgery in rural areas. So again, that diversity is there for family practice, which is another obviously a big reason for why I love this field in the first place.

Host: As you alluded to there, you've worked in indigenous communities as well as with addiction patients as well. So, what would you say there's some misconceptions or maybe stigmas centering around addiction treatment and how can we as a society better support those seeking help, would you say?

Gurpreet Nagra, M.D.: . I think the main thing to sort of think about is the Oak Clinic patients, the addiction Medicine patients. You know, those individuals wouldn't come to the clinic if they didn't necessarily need help, right? That's the first thing to think about. And, you know, just like with any other pathology, like blood pressure or even weight management, it's a multifactorial approach. It's multiple things that are involved in this person's care. So, you don't know their background, you don't know their history. You know, there may be a lot of trauma involved, genetics are involved, abuse, mental health, education, resources. In order to sort of combat that, you also need to have a multifaceted approach. So, approaching it from all different angles. And it's kind of sad to think about.

I've definitely heard of patients coming to me and letting me know about their experience in, you know, hospital settings and healthcare facilities. I think when these individuals show up for help, oftentimes they feel like they're being judged, and the individuals that are approaching are maybe a little biased when it comes to the way they look, et cetera.

So, I think to answer your question, what can we do to support these individuals? I would say, being patient, being sort of, understanding and being open-minded, again, just knowing that, you know, they're there for seeking help. And unfortunately, that is something that, you know, I see in the field and needs to be changed, I think.

Host: In summary here, doctor, as someone who's had such an interesting and diverse background in the field, what's your best advice in a nutshell to patients joining us about taking charge of their health and working with really whatever may be available to them as we've discussed? 

Gurpreet Nagra, M.D.: I think one of the main things is-- and this may not resonate with everybody-- but I think I do kind of ask my patients to sort of treat their body or their health as if it was an investment, right? I mean, everybody focuses on, you know, 401(k)s and they're, you know, invested in their savings account. And why, right? Just because at the end of the day, you know, once you're retired, you want to sort of look back and count blessings pretty much, and kind of utilize that money that you worked so hard for. It's the same thing as your health. I always advise people to develop their habits early. You know, make sure they're getting their cardiovascular health and just kind of make sure you've developed just good habits in general, that you can thank yourself later for in the long run. And when you're 65, 70, looking back and you're healthy and you have good quality of life, you are going to thank yourself, I think that sort of resonated with me. And so, I do try to tell my younger patients and my older patients, I think, because it's never too late to quit smoking or what have you, so... absolutely.

Host: Sounds like an analogy as you point out that just about everyone can really relate to. Well. Folks, we trust you are now more familiar with primary care. Dr. Gupreet Nagra, sounds like you're already hitting the ground running, as they say. A great addition to the family. And so, best of luck to you and thanks so much again.

Gurpreet Nagra, M.D.: Thanks so much, Joey. Take care.

Host: Absolutely. And to make an appointment with Dr. Nagra, please call 419-728-0601. Now, if you found this podcast helpful, please do share it on your social media. And thanks again for being part of Health Matters: Insights from WCH Medical Experts.