Best Possible Chance, Best Possible Care

Dr. Nicole Laferriere (audio clip included)

Council Award Recipient: Dr. Nicole Laferriere

For cancer patients, what’s a good outcome? Dr. Nicole Laferriere thinks about that a lot. The obvious answers are effective therapy, surgery, remission and survival. But there are other definitions, like management of symptoms and quality of life.

“We never give up hope, and what we hope for can change over time,” says Dr. Laferriere, Chief of Oncology at the Thunder Bay Regional Health Sciences Centre (TBRHSC), Regional Cancer Care Northwest.

Dr. Laferriere, who was presented with September’s Council Award, was raised in the Ottawa area but spent summers in northwestern Ontario. When she was a child, her grandparents moved to Red Lake. Her frequent visits there sparked a lifelong love for the region.

“The beauty and the strong sense of community that exists here were part of life growing up,” she says.

She holds a Bachelor of Science in medical laboratory science from Lakehead University (1990), a PhD in cell biology from the University of Ottawa (1995), and a Doctor of Medicine from McMaster University (1999).

Dr. Laferriere did her residency in Ottawa, and when her children were young decided to practise in Thunder Bay. The lifestyle suited her, and the opportunity to serve a community need — a relatively small population spread over a vast geography — was also appealing. “Everything seemed to fit,” she says.

Beyond her hospital role, Dr. Laferriere teaches at the Northern Ontario School of Medicine, and is president of the Canadian Hematology Society. She’s the hospital’s systemic therapy quality lead for Cancer Care Ontario, and serves on several of that body’s committees (Systemic Treatment Program Committee, Systemic Therapy Funding Model Advisory Committee, Acute Leukemia Advisory Committee, Complex Malignant Hematology Steering Committee). On the research side, she’s involved in clinical trials for patients in northwestern Ontario for all hematologic diseases.

She and her husband have a son, 25, who completed a mechanical engineering degree, and a daughter, 23, who’s studying environmental sciences. In her off hours, she enjoys cooking (back in university, she had a summer job as a chef) and running.

“Running outside for an hour every morning, regardless of the season, is the most powerful way for me to be connected to the community in which I live,” she says.

We recently spoke to Dr. Laferriere about the rewards of oncology, serving in Thunder Bay, and her best leadership lessons. We also have an audio clip 🔊 of her remarks when she accepted the award at the September meeting of Council.

What led you to hematology as a speciality?
One day in grade 11 biology, my teacher was talking about red blood cells, and how the shapes are different across species. It was a totally visual image. In medical laboratory sciences, my favourite area was hematology. Under the microscope, I was able to see and think of blood in a whole new way. Seeing different shapes was so intellectually intriguing. I still feel the same kind of joy looking at a blood cell. It’s so full of information.

What kind of environment do you try to cultivate in your cancer centre?
A culture of kindness and respect. When we recruit physicians, the most important thing to me is that we agree on how we treat each other. Part of our philosophy is accessibility and awareness of the diversity of needs of our patient population.

You’ve emphasized that patients and families are the first and main concern. What does that mean in practice? How do you reinforce that?
We start every meeting of our physician and chemotherapy staff with a patient story, one that gives us insight into the patient experience. We also have a patient join us. When we end, I remind the group that the only reason we have meetings is to improve the care we deliver to patients.

What’s the satisfaction of serving a smaller, more remote and vast community?
We serve a geographic area larger than France, with about 270,000 people scattered across. The rewards are clear: helping to provide care to people who need to have specialized services. There’s a richness to practicing here. Beyond the medicine piece, it’s an idea that in the north we all need each other. To me as a physician and a leader, the focus is on trying to bring as many services to the north so patients can remain as close to their communities as possible.

That includes a regional outreach program, which you lead, where rural patients receive chemotherapy in their home community. How has that worked?
We’ve trained and supervise 11 regional chemotherapy sites. All the nurses have the same training as the nurses here in Thunder Bay. We share an electronic medical record, and can communicate in real time. I approve chemotherapy orders as if the patients were here, and physicians in the community are available for any acute issues.

You’re also the driving force in creating the Complex Malignant Hematology clinic, which allows for outpatient hematology chemotherapy delivery. What kind of impact has that had?
It’s part of the process of sustaining complex care in a small community, so patients can have specialized attention. They have diseases that need close monitoring. The clinic helps people to be out of hospital more. It has opened up this whole circle of care, from diagnosis to transplant, if they need one, to the home community.

What drew you to become so involved in the Canadian Hematology Society, now as president?
I thought it was important to have the voice of a clinical hematologist from a more isolated region. Sometimes in speciality medicine, it can seem like if you don’t stay in larger centres, there’s less legitimacy.

You’ve taken many courses on leadership. What are the most important traits of a leader in medicine?
Putting the patient in the centre of the conversation. All of us come to work to have the very best outcomes for our patients. If we can keep that at the core, we’re going to be on the right path. I’ve always felt that empathy is an important value. That has been a good compass for me.

How has that evolved over your career?
When someone has a new diagnosis, and they’re most frightened, the most important thing I can do is have a moment to let them know that we’re going to look after them.

What impact do you want to have for patients?
We want people to have an experience where they feel cared for and valued, that the whole team is doing their very best. When people feel that, regardless of the outcomes, they can be assured they have best possible chance and best possible care.

Dr. Laferriere’s acceptance remarks

On September 11, 2020, the CPSO Council Award was presented to Dr. Nicole Laferriere, an oncologist from Thunder Bay, Ontario, at the College’s meeting of Council. The following were her remarks upon receiving the award.