Doctors should go into the schools

Originally published in The Ottawa Citizen September 17, 2002
Original Title: School Days

Despite numerous health advisory and information campaigns, inroads into curbing or modifying deleterious adolescent behaviours remain wanting. The reasons are multifactorial. There is competition from television and movies, advertising, peer-pressure, academic responsibilities, developing independent attitudes, rebelliousness and their own social calendar.

The messages and ideas that we try to impart to them are lost because of information overload. It is not that they do not want access to accurate and practical information. They certainly do. The problem is fitting it into their day. Adding more time to their day requiring them to pay attention to the message is not going to work.

If, as physicians, we are to have any influence on adolescent health, it must start from the ground floor. We have to get into the schools and talk to them in the classroom. In my nine years of classroom visits at Canterbury high school, I am consistently surprised by what the students want to know. Each class has its own focus and interests. This is yet another reason why single-message ad campaigns fail. It misses a great number of its intended audience.

Health information tends to be broadcast with a sense of urgency. “If the kids don’t hear this now we will have lost our chance”. Calssroom visits of an hour per week will deliver all these health messages, but it will be the students who set the tempo and the topics. Ceding this control to them makes them responsible for their health concerns and respects their interests. They always listen to what is being said. Their questions are relevant. They also force you to evaluate your own biases.

The student’s questions vary by grade. Each class can have a different area of interest that can include health and fitness, diet, STDs, contraception, abortion, depression, eating disorders, musculoskeletal complaints, cancer, smoking and drug abuse among others. Obviously it requires more than one visit to cover these topics in any detail. It also requires a consistent presence in the school. Students talk to each other. They will know who you are and if they like you, you will have a greater chance of success getting the message out.

In the course of one grade ten classroom visit I was asked the following anonymously written questions (verbatim):

Every woman in my family has been depressed at one point or another. My mother warns me about it. Is there anything I can do not to get it?

What is the average penis size? What is the biggest/ How long when erect? What is shrinkage?

Is breathing Helium bad for you and why?

How can I gain weight? I eat at least twice what normal people eat and weight-gain shakes and still never gain an ounce. If I occasionally miss a meal I tend to lose a lot of weight.

Why do some men go balder faster than others?

Can you have an abortion when you are 16 without letting your parents know?

Why do people shy away from people that have disabilities or physical disadvantages or limits?

I’ve heard that smoking pot does not harm you at all because it is a natural drug but all that is harmful is the smoke. Is this true?

What are the long-term effects of LSD?

I keep telling my doctor that I am depressed a lot but she just tells me it’s a phase. I don’t think it is. What should I do?

My joints crack and snap (painfully) ALL THE TIME. Is this something I should have looked at?

Is there any proof that steroids cause cancer?

Why is it that the Olympic Federation includes such things as aspirin and cold or cough suppressants on their banned substances list?

I find that I get excessively angry and violent at times. When I feel this way I feel like hurting or destroying someone or something. Is there something wrong with me?

What is the best diet to be on?

What is worse, smoking cigarettes or grass? If cigarettes are so bad for you why are they legal?

If anything these questions keep you on your toes. They are all answered in class. A common follow-up from the students is the rationale of our drug laws given that alcohol and cigarettes cause most of the morbidity and mortality of all recreational drugs.

I think the millions spent on ad campaigns could be put to better use establishing permanent teams of physicians and nurses in all of our high schools. School-based clinics complement classroom visits and provide a good follow-up for students who have expressed their concerns through their questions. A contract for trust grows and the students will seek us out for medical services. It is also one of the more enjoyable aspects of family medicine.

[Originally published in the Ottawa Citizen]

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