It might not be the first word that comes to mind when you think of family doctors these days. The profession has been beset by grim headlines over a Canada-wide shortage, with patients growing increasingly frustrated in their search for primary care and overworked physicians battling burnout. Many older family doctors are delaying retirement because they cannot find anyone to take over their practice, as younger MDs gravitate to specialties with more appealing pay and hours.
And yet. For Dr. Karen Fleming, family medicine is one of the great joys of her life.
The Chief of Sunnybrook’s Department of Family and Community Medicine knows the challenges facing her field are profound. But, she says, so are the rewards. After all, family medicine is the only field that allows you to tend to a person from the beginning of life to the end – with all the ups, downs, and moments of human connection that come along the way.
“That journey is important to me,” Dr. Fleming says. “It’s about relationships, that is where the joy comes from.”
Dr. Fleming, who also maintains her own private practice not far from Sunnybrook, is a passionate advocate for systemic change that will help attract and retain family doctors. From the scarcity of affordable office space in cities like Toronto to the long hours spent on administrative duties, she knows the pain points are complex and require a multipronged approach.
“There’s a lot of things that could be done differently in family medicine that we need to address,” she says. “But at the core, care across the lifespan and the importance of relationships is what keeps me here.”
For several of Dr. Fleming’s patients, those relationships have been a lifetime in the making.
A large part of her practice is devoted to caring for women going through pregnancy and childbirth. And after more than twenty-five years of obstetrics work – first at Women’s College Hospital and later at Sunnybrook – some of the babies she delivered at the outset of her career are now having children themselves.
That’s the case with Jade Allison, a 27-year-old mother of three.
When Allison was born, it was Dr. Fleming and a young trainee who delivered her. That former trainee, Dr. Leslie Beyers, now works alongside Dr. Fleming in their shared family practice where they both care for Allison and her growing family.
“We’ve always had a really great relationship,” says Allison. “They treat me like I’m family, not like I’m a patient. It’s just so personal and easygoing. They’re lovely.”
The ease and familiarity Allison describes are on clear display during a recent checkup for her newborn baby, Greyson, who was delivered at Sunnybrook as were her two older children. Both doctors take turns holding the infant, clearly proud of being part of Allison’s story.
Asked what caring for patients like Allison feels like, Dr. Fleming pauses to find the right words.
“When you have followed people and looked after them as kids, given them their vaccine for kindergarten, their booster in middle school, seen them off to university, and then one day you’re following them through pregnancy – it’s really special.”
Dr. Fleming’s patients say it’s plain to see how much she loves the obstetrics part of her work.
“She’s got all the time in the world for your questions even though she’s probably been through them with people many times before,” says Jennifer Morrison, who is expecting her first child. “There is comfort in knowing I could get a very quick appointment at her office if I needed it.”
Being on call for patients who go into labour and delivery is something that still hasn’t gotten old for Dr. Fleming.
“I am always in awe of being present for that,” she says. “It’s such a gift and it certainly gets me out of bed at three in the morning. It’s joyful.”
Trusting relationships that are built over time not only make patients and doctors happy – they also lead to better health outcomes.
“The evidence suggests that longitudinal care makes a difference to outcomes and that’s where relationships matter,” Dr. Fleming says. “You’ve learned about their medical history but also their social history and family. You’re primed to be more aware of their individual risks, and if challenging diagnoses come along, you understand the impact and are better able to talk through the best options.”
Jennifer Morrison says having a family doctor who has gotten to know her over the years spells better care.
“Dr. Fleming knows some points about my personality that a new doctor wouldn’t,” she laughs. “She knows I might be a bit stubborn, and if we ever found ourselves in a delivery room where she had to tell me not to be so stubborn, I might have a better chance of listening to her.”
A recent national survey, led by Dr. Tara Kiran at Unity Health Toronto, confirmed that patients value a strong relationship with their healthcare provider. Sixty-five percent of respondents said having a provider who knew them as a person and was aware of all the factors affecting their health was very important.
Still, the life of a family doctor – juggling everything from obstetrics to chronic disease management or palliative care, not to mention administrative tasks – can seem daunting. Especially for younger doctors who are not only starting a career but families of their own.
Dr. Leslie Beyers says having a mentor like Dr. Fleming helped her realize that finding a good work-life balance is possible. Dr. Fleming is a mother herself and an accomplished masters’ swimmer in her spare time.
“She shows you how to actually make it work in life, when you’re also having children and working in a busy city like Toronto,” she says. “When you see someone joyfully doing it, it shows you that it’s possible.”
Thankfully, Dr. Beyers is not the only one to benefit from Dr. Fleming’s expertise.
As an assistant professor with the department of family and community medicine at the University of Toronto, Dr. Fleming is helping to train the next generation of comprehensive primary care physicians.
And at Sunnybrook, she is a passionate supporter of the Department of Family and Community Medicine’s Academic Family Health Team, which cares for some 10,000 patients in the area.
While most people associate Sunnybrook with its trauma centre or other specialized programs such as cancer or brain sciences, they might not realize it is also a community hospital with a strong family medicine department.
Sunnybrook is also a teaching hospital, and Dr. Fleming believes that residents who rotate through the Academic Family Health Team learn invaluable skills that will serve them well in their future paths. For instance, the team sees many patients with complex health needs and is made up not only of doctors but also nurses, dieticians, and social workers who collaborate to offer holistic care.
“It’s important they see it doesn’t need to be one doctor who does that womb to tomb care,” Dr. Fleming says. “It’s an interprofessional team with shared accountability. You know what they say: it takes a village.”
For Jade Allison and her growing family, that village includes Dr. Fleming. Something for which she is very grateful.
“Karen is just a really spectacular doctor,” she says.
You can read more about Dr. Fleming and her pregnancy care in two new books: Full Circle: A Collection of Family Medicine Birth Stories and Teaching Perinatal Care: A Practical Guide, by Dr. Mira Shuman, a member of Sunnybrook’s Academic Family Health Team. Both books were supported by the College of Family Physicians.