Northern medical perspective ‘valuable and unique,’ says Dr. Sarah Cook

“It’s important to advocate for yourself, and if you’re worried about your health, making sure that you speak up about that.”

 – Dr. Sarah Cook

A doctor from the territories will lead the College of Family Physicians of Canada for the first time in its 71-year history.

Dr. Sarah Cook, who lives in Yellowknife, became more broadly known when she was appointed the NWT’s first Territorial Medical Director in 2016, playing a significant role during the early part of the COVID-19 pandemic.

But now the professional organization that represents more than 47,000 members across the country will get to know Dr. Cook, who says she brings the perspective of rural and Indigenous communities top of mind, “to every conversation that I have; every meeting I’m in.”

“It’s a real honor, actually, to be selected to be in the role of President of College of Family Physicians of Canada, because it’s the first time that there’s ever been a family doctor from any of the territories who has held this role,” she told CKLB in a recent interview.

“And I think that that really speaks to the recognition of how important the rural and remote issues are to understanding some of the healthcare issues that are really present everywhere in Canada.

“They’re just really easy to see sometimes when we’re working in rural and remote contexts.”

“The perspective that I bring from working in the North for the last 17 years is valuable and unique in that working in a rural and remote context really highlights some of the some of the health inequities that we need to pay attention to in the Canadian health care system

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“It’s definitely very, very challenging to have the same access to care that someone may have in a big city.”

Cook said it’s important to highlight the inequities in health outcomes for Indigenous people.

She said the College is working hard to improve the training of family doctors, “in terms of cultural safety and humility,” which is key for someone working in the territories.

Cook said a significant healthcare issue in the NWT — particularly in remote communities in the Northwest Territories — is delayed presentations of disease.

The lack of “continuity of care with a family physician,” meaning when a patient could see a different healthcare provider every time they go in, presenting with the same complaint, and a diagnosis can be delayed as a result.

“We often hear the story of, somebody’s diagnosed with cancer (after) they were told that they were fine,” she said.

“They were given Tylenol and then eventually they were diagnosed with cancer.

“And there is some truth to that. I’ve seen this myself, and I think when you look at what’s happening, it’s not that there’s any problem with any one individual health-care provider — they’re probably all providing excellent care — it’s because those patients don’t have the benefit of seeing the same person over time.

“When there’s a different person seeing them each visit, they’re not having the benefit of seeing a progression of symptoms over time, or developing that trust and relationship, and that’s what leads sometimes, to these delayed diagnoses that we hear people talk about in remote communities.”

It comes down to attracting and retaining health-care providers, something Cook has first-hand knowledge of.

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“The thing that that brought me here initially, it was actually I came in my residency training — that’s a part of training after medical school, when you pick a specialty, I picked Family Medicine in that residency training, I came to Yellowknife.

“I also went to Nunavut because I was really interested in rural, remote, Indigenous health, and I had a really amazing experience there.

“And we know that’s something that’s really important in recruitment of health-care providers, is the experiences they have in training, which is why it’s so great.

“So, I had an excellent experience then. And then we decided to come here — initially, like many people, we thought, ‘Oh well, we’ll go for a couple of years’ — of course, we loved it, stayed, raised our kids here and remain here.”

There are two family medicine residency spots available each year in Yellowknife through a partnership with the University of Alberta.

Originally from Nova Scotia, Cook earned her medical degree from Dalhousie University. She now provides comprehensive community-based primary care, including general practitioner oncology and maternity care.

Said Cook: “We have a wonderful place to live and raise kids and a wonderful medical community as well. All that said, it is still challenging to recruit enough people here. We still definitely do not have anywhere near the number of family doctors that we need to serve the population here.”

But more doctors are needed, as Cook explains there are 25 family physicians, but they don’t all work full time, so there are 18.6 full-time equivalents of 25 bodies.

Those are people who live in the territory, not counting the temporary professionals who travel here, called locums.

“We are definitely very locum dependent,” said Cook, who will continue to see patients while serving as College president.

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“We have many, many, many locums who come here. There are different types of locums … the types of locums that I think are really of value to us, are what we would call our long-term recurrent locums. These are people who may not live here, but they come back over and over and over again.

“And so, they know our communities, they know our health-care system, they know our patients that they’re able to even provide some continuity to our patients in primary care.

“We also do have locums who come, you know, once and never come again, and that that may fill a need, for sure, and we appreciate that, but it’s certainly not quite the same as having someone who is providing care over a long period of time.”

THE FINAL QUESTION

James O’Connor: “Okay, last question, what is some general advice, for people living in remote communities, smaller communities? What are a couple of measures they can do to make sure they stay healthier?”

Yellowknife’s Dr. Sarah Cook. (Photo: Choosing Wisely Canada)

Dr. Sarah Cook: “Well, I think that some of the most important things are what we would call the social determinants of health. So upstream of showing up to see your nurse or doctor, would be making sure that you’re staying active. I’m a huge proponent of exercise (she’s a certified fitness instructor) and staying active every day and eating very healthy food. That depends on where you’re living … often that means country food in remote communities, and how important that is for people’s health, rather than eating a lot of processed food. Also, making sure that you’re having screening done, so preventative health care. That would be the types of cancer screening that we do at certain ages, and depending on people’s risk factors, so going into their health center to make sure that they’re getting that kind of preventative care taken care of.

“And also, I would say, advocating for yourself. Given all of the things that I’ve mentioned about challenges in our system, that we don’t have enough resources, we don’t have enough doctors and nurses, and so sometimes that leads to not having been seen by the same person every time. It’s important to advocate for yourself, and if you’re worried about your health, making sure that you speak up about that.

“One of the things that we struggle with in the Northwest Territories is fractured health information, when patients need to travel outside of the Northwest Territories to Alberta, it’s a completely different electronic system. And I think some people, sometimes people don’t know that.

“And so even though in the Northwest Territories, our electronic record is all attached, depending on all of the communities are attached, so the information is intact. When you travel to Alberta to see a specialist, for example, they don’t have access to your electronic record. So, advocating for your information, to make sure you have access to your information, to make sure your information is being conveyed to all of the health-care providers in your circle of care is really important.”

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