A Passion for Primary Care — at Home and Abroad
Council Award Recipient: Dr. Katherine Rouleau
By Mark Sampson
If the future of primary care and family medicine needs an enthusiastic champion, we don’t need to look any further than our latest CPSO Council Award recipient, Dr. Katherine Rouleau of Toronto. Dr. Rouleau speaks with an unbridled passion about the importance of primary care, not just for her own patients, but for patients all over the world.
Below we talk to Dr. Rouleau. We also have a video of her remarks 🎥 when she accepted the award at the September meeting of Council at the end of the article.
Dr. Rouleau is the Global Lead for the Office of Health System Partnership and director of the WHO Collaborating Centre on Family Medicine and Primary Care at the Department of Family and Community Medicine, University of Toronto. Dr. Rouleau says her role has only cemented her belief that family medicine is integral to the very fabric of communities and societies.
In fact, she can’t imagine having any other career — being a family physician has always been her calling. “It’s an amazing job, an amazing way to spend your life,” she says. “It’s fun. It’s galvanizing. It’s humanizing. It’s science and the humanities all wrapped into one career. It truly is great.”
Indeed, there has never been a time when Dr. Rouleau didn’t want to be a doctor. Born and raised in Montreal, the second of three girls, she was always an “academic geek” who was drawn to leadership positions from an early age — she was class president for all five years of high school. But it was her paternal grandfather who provided the inspiration for her future career. He worked for decades as a general practitioner, a job he loved and was deeply passionate about. Dr. Rouleau found a similar passion in herself, wanting to become a family physician even before she could fully grasp what that would entail. “I’ve always been a generalist at heart,” she says. “I’ve liked a lot of different things and liked being in the middle of things. Watching how happy being a GP made my grandfather, I always believed that a career in family medicine was what I wanted to do.”
Yet, the road to that career wasn’t exactly a smooth one. Dr. Rouleau readily admits that it took three attempts before she got accepted into medical school. In the meantime, she completed a BSc in human biology at the University of Toronto before beginning a master’s degree in public health sciences. That degree was interrupted when she got accepted into medical school at McGill University. She completed her medical training in 1993 before doing her residency in family medicine at the University of Ottawa. She returned to Toronto in 1996, where she became a staff member in family and community medicine at the Wellesley Hospital (and later St. Michael’s Hospital after the two institutions merged). She was promoted to the rank of full professor at U of T’s Faculty of Medicine in July 2023.
Her time working at a downtown clinic gave Dr. Rouleau the opportunity to treat patients from the 2SLGBTQIA+ community, and people newly arriving to Toronto as immigrants and refugees. Working with a remarkable team to deliver comprehensive care to patients of all ages, her work also involved providing care to HIV-positive patients, methadone treatment for those struggling with addiction, and treating patients suffering from poverty and displacement, including Francophone refugees from Africa. She found the work absorbing and fulfilling. “These stories, the ribbons of these people’s lives just have a way of weaving their way into your career,” she says.
By the end of the 1990s, Dr. Rouleau completed her master’s degree and took on an additional role as a family physician at Toronto’s Seaton House, a homeless shelter for men. Her time there helped cement a prevailing reality she saw in the patients she was treating: that poverty, addiction, trauma and other social determinants are intricately linked to health outcomes, and that primary care and family medicine — and the human connection they entail — are key to improving those health outcomes. “In Seaton House, there was all this trauma: incarceration, lack of love, the abuse,” she says. “But right underneath were these commonalities of humanity. We can learn so much about what it means to be human by listening to these patients’ stories.Physicians who do this kind of work are there to give, but we also receive so much. If you do this long enough, you realize there is a challenging but rich symbiosis between you and your patients.”
A key ingredient to Dr. Rouleau’s success as a clinician has been her exceptional communication skills. She is a natural talker and listener. She says most patients she treats want to connect with a human being who is going to listen to their stories. While the solution to whatever health issue they’re struggling with is important, they mainly want to connect with someone who will understand their problems. “Family medicine is just an excuse to be curious and nosy about people’s stories,” she says in jest, “to unwrap people’s stories and get at the heart of what they’re dealing with. Finding common ground with those we treat is so important.”
Dr. Rouleau’s communication skills are not limited to her work with patients. She is also adept at connecting with colleagues, decision makers, policy players and other stakeholders in the health care space.
“Her skills as a communicator are evident in the relationships she has built cross-culturally with family medicine leaders around the world,” says colleague Dr. Praseedha Janakiram. “She has a way of making others feel at ease, bringing expertise and data to discussions in a way that is highly accessible, and always being culturally humble in her approach,” she explains.
It’s a talent that serves Dr. Rouleau well in her current role with Global Health at U of T. There, she and her colleagues have highlighted the importance of primary care on a worldwide scale, and to make social accountability the cornerstone of family medicine for future generations of physicians. “When I started 27 years ago, primary care in low-income countries often meant vaccinations and weighing babies. But today, we’re getting to a version of family medicine that corresponds with patients’ cultures, their beliefs, their ways of living that may be very different from ours.”
For Dr. Rouleau, patient-centred care has always been what it’s all about. It’s what defines primary care and family medicine; it’s the lens through which we can see what health equity and social accountability really mean. She’s under no delusions: the current crisis in family medicine is a crisis in patient-centred care. Yet, she rings a note of true optimism when she speaks of the specialty area she has loved since childhood, the same cornerstone of medicine that meant so much to her grandfather.
“Yes. I am optimistic about the future of family medicine, about the role of the generalist, and about the profession of medicine in Ontario and elsewhere,” she says. “We need to be purposeful, of course, but I see people every day who are so dedicated to the practice, to the teaching, to the research, the innovation, that I have to believe that we’re going to get to the right place with primary care, not just in Ontario or Canada, but around the world.”
Video from Council
Dr. Katherine Rouleau was honoured with the CPSO Council Award on September 22, 2023. Here are her remarks:
Thank you. Thank you, everyone. I really want to thank the Council and the College for this incredible honour, which is for me, equal measures of delight and surprise. And surprise, largely because I know the richness of the community to which I belong. Awards, of course, make you think about your own reality. But really, the full delight of this recognition really is linked to the fact that it makes me feel like I am indeed a thread in an incredibly rich fabric and a member of the medical community in Ontario, and, as Madhu has said, in the world. But my roots are here in Ontario on the medical front, and my home and my community is here, and so therefore, I really want to thank you. As I’ve been reflecting on this award and what it means, and really wanting to sort of extend the richness of this experience beyond today — which is already so fabulous, thank you.
I was reminded of a custom that I learned about which I think is rooted somewhere in Africa, although I must admit to forgetting the details, and the custom consists in when you receive a precious gift giving back to the person who gave it to you, a small token that belongs to you. It could be a part of your clothing or something that is cherished in your house. And the reason to do this is to convey to the giver that you take on the responsibility of the gift and you commit to carrying that gift in all that you do onward after that day. And so maybe riffing off that theme, I’ve been thinking about how I want to invest and extend this wonderful honour in the various parts of my life and the various parts of the incredibly rich fabric of I would say not only of the medical community, but of the healthcare community globally.
So, the first place I will do this, and I hope this doesn’t sound too presumptuous, but since Madhu mentioned this in the text, is at the WHO, I’m very privileged and fortunate to work alongside incredible people who truly work hard to bring health and health care to people around the world. I’ll be in Kazakhstan, the exotic Kazakhstan, in October to talk about primary health care and what you’ve given to me today, you here, and all of the many people who worked so hard to pull together a nomination and to review them and to select. I will bring all of this to my work at the who to carry on this important work. And I want you to know that it’s apropos that I bring the WHO first, because I will confess with some modesty that my appreciation of governance was a little lacking until I started working with the WHO. And you, of course, would know this, but what usually featured in my world as diplomas and letters and formal things really takes life when you interact with the world. And I know you know this, but I have now been in touch with so many people who would pay to have the kind of governance we have in Ontario, the kind of quality, dedication, the expertise that you all bring to this. And so, I will carry a little fiber of this with me in my work at the WHO.
I will carry another fiber of this to the University [of Toronto], which has been my home for many years. But again, the importance, the nuances of the work that you do and of this recognition will carry through in what I teach, but also very much how I continue to learn at the university. And thirdly, to state the obvious, I will carry this in my clinical work with those amazing patients that you mentioned, Madhu. And this is what gets me tearful because there are so many wonderful ones. I see in the room some of my colleagues from my professional family at St. Michael’s Hospital, which has provided such an incredibly fertile ground for me to grow as a physician, to learn, to teach, and to care for really uniquely fabulous people. And so for all of that, thank you.
I want to end, since I’ve mentioned my professional family, to mention my family family, and to acknowledge my husband who’s hiding somewhere behind us, I hardly see him. My husband, Jamie [James] Meuser, who like me, is a family physician and has been a leader and an inspiration much to sometimes the exasperation of our daughter medicine in all of its sides, the good, the bad, and sometimes, the ugly, make their way to our dinner table on a regular basis. I want to thank you, Jamie, for all of your contributions, companionship, wisdom along the way over those many, many years. And I want to, of course, bring to mind my own family, who’s in Montreal, and in particular today, my mother, who passed away last week and who was not a doctor, but who certainly conveyed to me how to take care of people, something that I think is really at the heart of this award.
Thank you again, everybody, for this incredible privilege. Thank you.