Dr. Janet Tootoosis knows what it’s like to be a patient in Saskatchewan’s health care system.
In 2007, she was diagnosed with thyroid cancer.
That same year, she received surgery to remove the cancer, followed by radiation treatments at the Saskatchewan Cancer Centre in Saskatoon.
As a family physician, wife and mother of an 18-month-old son at the time, she says she would often consider how much more difficult her situation would have been if she were a single mother in the same position.
“Having this experience highlighted that not everybody has all of the things I’m fortunate to have,” says Dr. Tootoosis. “It made me pause and consider how I provide support to patients, and how I can make their care more seamless by going the extra mile and advocating for them if, for example, child care is an issue and they need a different appointment date. Prior to my experience, I might have thought, ‘I’m so busy, it’s not really my job to be playing with dates,’ but my experience in the system highlighted that patients may require support outside of medical care.
“It really gave me an understanding of the importance of considering the resources which are available to specific individuals and making the system function in a manner that supports them to achieve health in whatever form that looks like,” she adds.
Dr. Tootoosis has been in remission for more than a decade, and in that time she gave birth to another son.
“My boys are the reason I do everything,” she says affectionately of her 13-year-old and nine-year-old boys. “They’re my greatest success because they’re Indigenous males being raised in a community where they don’t necessarily have a profile that is deemed privileged or positive. My husband and I are raising them in opposition of the stereotypes and building young men who are proud of themselves, who know where they come from and what they’re capable of.”
Dr. Tootoosis and her youngest son, Anthony, at Yellowstone National Park
Bringing her health care experience to the board
In addition to being a mother and family physician, Dr. Tootoosis is the owner and operator of the North Battleford Medical Clinic, a clinical professor at the University of Saskatchewan and one of two practicing physicians on the 10-member Saskatchewan Health Authority Board of Directors.
As a practicing physician who works in rural Saskatchewan and has Indigenous roots, Dr. Tootoosis brings a unique perspective to the board.
“I get to deliberate with the board, and the next day, see patients in my clinic and train new physicians. My vantage point gives me a very broad perspective of the entire system,” she says. “My role is to ensure that the patient and provider voice is central to the organization going forward.”
Dr. Tootoosis also serves on the board hearing committee and the quality and safety committee, and she was part of the CEO selection committee.
“My fellow board members are exceptional, committed individuals who bring incredible energy and dedication to their roles on the board. They are all busy professionals, yet they are committed to take time out to contribute. It’s really inspiring to see this group of individuals come through and really want to better the system.”
Improved integration of services
Within the new provincial health system, Dr. Tootoosis says she wants to see improved integration of services that result in a better experience for both patients and health care providers, especially in regard to primary health care.
“Whether you are ill or well, young or old, we all need primary health care,” she explains. “I truly believe that patient-centred, comprehensive primary care can support people to lead healthy lives, and that is why I feel that improving and advancing primary health care is an extremely worthwhile endeavor.
“We also need to consider how we reconfigure services for specific groups and communities like our Indigenous population to ensure health equity, so that all residents in Saskatchewan receive access to appropriate and timely community services,” she adds.
For many of Dr. Tootoosis’s patients, reconfiguring care has meant moving her on-reserve clinics, which she provided to four communities for half a day every two weeks, to the North Battleford Medical Clinic.
“After a number of years of providing on-reserve clinics, it became apparent that many of the people I was looking after on reserve were opting to travel to North Battleford to see me in my clinic,” Dr. Tootoosis says. “They preferred improved access over convenience closer to home because they wanted to be able to see me any day of the week, morning or afternoon. If I was centralized at the clinic they had that opportunity, so I welcomed everybody to the clinic and started providing services from there.”
The pull of a rural lifestyle
Dr. Tootoosis grew up on the Poundmaker Cree Nation, a First Nations reserve northwest of North Battleford.
“I have a large extended family and it’s my family who keep me in the Battlefords. That’s a big reason why I choose to live where I live,” she says. “I practiced in North Battleford initially because it was close enough to home that I could reacquaint with my family after having been away for 10 years going to school.”
Although Dr. Tootoosis has always known she would live in rural Saskatchewan, she wasn’t always so sure about her chosen profession.
“In Grade 12, I wanted to be a veterinarian but soon realized that my plan for rural living would mean conducting semen samples on cattle for a good portion of my career, so I decided to shift to people medicine,” she says with a mischievous gleam in her eye.
What she loves most about living a rural lifestyle is the community.
“It’s that small-town vibe where you’re seen as you and not just as the cover of a book; people get an opportunity to read the book. That part’s nice.”
Being close to the north also provides Dr. Tootoosis and her family with the opportunity to get away together for adventures, most often to Meadow Lake Provincial Park.
“My husband and boys love to fish, so any northern lake with great fishing will do!” she exclaims. “I love the boat and can spend all day out on the water reading while the boys get their fish on.”
Dr. Tootoosis with her husband Jamie Couillonneur
A generalist at heart
Dr. Tootoosis says she’s a generalist at heart and that’s why she chose to specialize in family medicine.
“I chose family medicine because I didn’t want to feel restricted in my attempts to support people to achieve health, which is incredibly broad and different for many people,” she explains. “I like being able to support patients in identifying their health concerns and to direct them through the care they need, which changes throughout their life span.”
As the owner and operator of a clinic, Dr. Tootoosis says she has learned that the business side of medicine is equally as important as the clinical side when considering the patient experience.
“Your experience with the health system starts when you pick up the phone or you enter into a clinic or hospital,” she says. “The lighting, the environment, the cleanliness and the safety of the facility – all of those things play a part in the patient experience and can’t be overlooked. Also, the people providing health care need to be trained, protected and supported in their work, and all of that is the business side of medicine.”
The team at North Battleford Medical Clinic
Dr. Tootoosis has worked hard to create a seamless care experience for patients, as well as a good working environment for her staff, which includes eight physicians (soon to be 10), a registered nurse, clinical pharmacist and clinical dietician, as well as medical office assistants and transcriptionists. The clinic also has private laboratory and X-ray facilities.
“None of us can do this by ourselves,” she says of her work family. “As the largest primary care facility in the community, we provide care to 13,000 people in the area.”
The physicians in her practice also work in the hospital as anesthetists and emergency room doctors, as well as sit on committees. To minimize any gaps in care that patients might experience when one or more physicians are out of the office, they’ve created two teams of four physicians. The physicians on each team provide coverage for each other to ensure that their patients are seen and that paperwork is completed when they are out of the office.
“The reason for the team within the team is for continuity,” explains Dr. Tootoosis, “so that patients get to know their providers. We try to surround patients with the same team, which builds that comfort level and helps them feel more secure. It’s about building capacity through team-based care and getting patients comfortable with the team.
“Distributing this responsibility of care can be challenging, but I know it’s being done effectively in a number of places across the province. Supporting all physicians to have this approach to care would be wonderful,” she adds.
Quality improvement at the forefront of care
This drive for quality improvement can be seen throughout Dr. Tootoosis’s practice.
“We engage in quality improvement initiatives to our hearts content,” she says proudly of her staff, “whether it’s changing how we fax prescriptions to pharmacies or how we better integrate patients from hospital back into the community. We also contribute to a lot of quality initiatives through surveys, interviews and working groups, and many of the research projects required by our medical residents focus on quality.
“It’s all day, every day,” she says with a chuckle, adding that she’s always been motivated by continual improvement, even in her personal life.
“It drives my husband crazy!” she says with an impish grin. “His to-do list is continually growing. We never quite get the house or yard to a point where we can just coast. I’m always coming up with ways we can better ourselves.”
Their current project: making their yard aesthetically pleasing again after having to take down two ageing trees for safety reasons.
Finding work-life balance
Not surprisingly, Dr. Tootoosis says her greatest challenge is work-life balance.
“I just have to ensure that I’m not too hard on myself with regard to priorities, because some days my foundational priorities have to take a backseat. Career may come to the forefront and consume a lot of my time, but it’s not forever. Recognizing that and leaving some capacity for life is huge.”
Even so, there is nothing she would rather be doing.
“I don’t know of anything as rewarding as contributing to the health of other human beings,” she says.