Curiosity, Collaboration and Continuity: The Fine Points of Family Medicine

Before there was the Internet, and before coordinated local, and even global, efforts became the norm for frightening infectious diseases, there was Dr. Cheryl Wagner and a handful of her colleagues, who were serving, perhaps unknowingly, as role models for the power of collaboration in family medicine.
Dr. Cheryl Wagner with a patient

"We were all working in Toronto and what we had in common was that we had patients that were in the high-risk group … most of us were looking after gay men,” says Dr. Wagner.

“A lot of what we were seeing hadn’t really been described in the medical literature. The specialists would see five to 10 per cent of the patients, the sickest ones, but we were seeing the early stages of the disease.” 

The group of fewer than 10 doctors, initially brought together by Dr. Mary Fanning, an infectious disease specialist at Toronto General Hospital, went on to meet regularly for over a decade. In those early days of HIV/AIDS, they counted on the city’s Public Health team to collate and deliver monthly bundles of articles with the latest research evolved. “We would bring in our own resources, our own specialists to teach us,” she recalls. “We had to design our own education programs.”

Inspired by those early collaborations – including with other family doctors, public health partners, specialists, patients themselves and the wider community – Dr. Wagner went on to manage and advocate for the first HIV primary care model in Ontario, providing direction for so many family physicians to enhance patient care in the primary care setting.

As for what influenced her to pursue family medicine, Dr. Wagner says Dr. Carolyn Bennett – now a Member of Parliament and Canada’s Minister of Crown-Indigenous Relations and Northern Affairs – and Dr. Jean Marmoreo, another well-known Ontario family physician, figured prominently in her decision – after having initially put this option “on the shelf”. 

“I was an early patient in their office and, at the time – especially coming from the States and from Alabama – I really had not met a female physician until I met the two of them,” says Dr. Wagner. Her response to the disproportionate number of women being recognized for their outstanding work in family medicine? “I guess once we got our foot in the door, we took over,” she says with a quiet laugh.

Another key inspiration was Dr. Peter Newberry who, in the 1970s, led research in Northern Ontario to examine the effects of mercury pollution. “Here was a family doctor who was looking beyond just their office, looking out into the environment,” says Dr. Wagner.

Today, decades after her decision to follow a path in family medicine and her extraordinary, ongoing successes in caring for patients, Dr. Wagner points to collaboration and a desire for knowledge as important attributes for a family physician, including when caring for patients with an evolving and largely unknown disease.

“I think HIV, if anything, is the perfect metaphor for knowing something about everything – being able to be curious and follow leads,” she says. “HIV came along and everybody was going to die. Then, we figured out how to prevent some of the preventable, opportunistic diseases – so, if you’ve got the curiosity, the commitment to your patients, you’ll be able to problem solve and consult with colleagues until you get an answer for your patients.”

For Dr. Wagner, the reward is well worth the effort. “There’s wonderful continuity of being there when they face their crises, being there as they [patients] overcome their crises or through their illnesses,” she says. “And they give you their trust, so it’s a very special place to be.”