Shifting Gears: The Doctor Who Rewrote Her Own Practice

When the System Isn't Enough: One Physician's Case for Preventive, Personalized Care

A geriatric care specialist and founder of SageMD on functional medicine, the limits of traditional practice, and what patients are asking for that the system isn't delivering

There is a particular kind of frustration that comes from seeing a patient too late. For Dr. Katarina Lakovic, a family physician with additional training in care of the elderly, it became a recurring experience - patients arriving in hospital or long-term care with advanced, complex disease that might have looked different if they had been seen years earlier.

“I wish that I saw that patient years prior and had been able to actually advise them on how to delay progression or sometimes even prevent many diseases”

Dr. Lakovic has practised across settings that few physicians navigate simultaneously: acute care hospitalist work, long-term care attending and medical director roles, academic program direction at TMU's new School of Medicine, and advocacy through her role as Vice President of Ontario Long-Term Care Clinicians. Across these roles, she observed recurring structural gaps in preventive care and continuity, where patients often present at advanced stages of disease that may have been avoidable with earlier intervention.

A different kind of falling through the cracks

The conventional framing of patients 'falling through the cracks' involves delayed diagnoses, missed referrals, and failures of clinical follow-through. Dr. Lakovic describes a broader issue: disease trajectories that reflect cumulative gaps in preventive engagement rather than isolated clinical errors. She described a patient presenting at 52 with advanced metastatic cancer whose early symptoms were minimized, whose investigations were delayed, and who arrived in hospital past the point where outcomes could be meaningfully altered.

“We know that we could have done so much more to actually prevent and alter the course of their health”

This perspective led her to establish SageMD, a practice focused on functional medicine and preventative care, aiming to intervene earlier in disease development rather than responding primarily once conditions are established.

What functional medicine actually is

Functional medicine is often misunderstood as alternative practice, but she defines it as a clinical approach focused on identifying root causes of disease, optimizing physiological systems, and preventing progression before damage becomes irreversible. The emphasis is on earlier, deeper, and more continuous engagement with patient health rather than episodic treatment.

The differences, she argues, are not ideological but operational: how extensively patients are assessed, how frequently follow-up occurs, and how care is structured within system constraints that often prioritize volume over depth.

What patients are asking for

Across her practice, she consistently sees demand for care that is more continuous, personalized, and attentive than what episodic systems typically provide. Patients want time, context, and a physician who can engage with their concerns in full rather than within constrained appointment windows.

This creates a structural mismatch between patient expectations and system design, particularly in publicly funded models built around high-volume, short-duration encounters.

What surprised her

One consistent observation is that patients often report improvement even before any formal intervention begins. The experience of being listened to and taken seriously appears to have measurable impact on perceived wellbeing.

“They feel like they’re finally being heard. Someone’s finally actually taking them seriously. They’re not dismissing their symptoms”

She also notes that patients frequently discover improvements in areas they had normalized as part of aging or chronic illness, once a more holistic evaluation is undertaken.

What getting it right would look like

Her vision for Canadian family and geriatric care is not replacement of the existing system but expansion of its capacity to support prevention, continuity, and individualized care across the lifespan. This requires structural investment in time, access, and care continuity.

SageMD represents an attempt to operate within the current system while addressing gaps that limit preventive and longitudinal care. It is built around the premise that many outcomes could be improved with earlier, more sustained clinical engagement.