Originally published in The Medical Post, VOLUME 36, NO. 35, October 17, 2000
Eight years ago, two Ottawa doctors went back to high school to start the first in-school medical centre of its kind in Canada
Adolescents are an under-serviced population — and there are several factors that contribute to this phenomenon.
The most trusted source of information among teens is their friends; next, the Internet; finally, an adult such as a guidance counsellor, teacher or parent. Most adolescents have a family doctor but few feel comfortable speaking with that doctor about their most important health concerns (more on this later). While adolescent health care is one of the areas identified by the College of Family Physicians of Canada where residents require more training, the realities of budget cuts have led to a low level of prioritization for this discipline. Adolescents will continue to obtain care in a haphazard manner through different walk-in clinics, the ER, their friends, or not at all if we do not give them better options.
As physicians there is a tendency to be less comfortable when dealing with the sensitive issues of our adolescent patients. How does one approach the adolescent patient? How do we prepare ourselves to talk to a 13-year-old versus a 16-year-old? How do we sit in our chair? Do we take notes while they are speaking? Do we glance at our watches? Although these questions may seem superfluous, they embody an approach that can contribute to either a strong or weak doctor-patient relationship.
The information I will present is based upon eight years of experience running the only full-service high school medical clinic in Canada. Eight years ago, Dr. Peter Cote and I established a high school-based medical centre that was incorporated into the family medicine program at the University of Ottawa, Elisabeth Bruyere campus. It provides residents with the opportunity to deal with adolescent issues on the students’ own turf.
Canterbury High School is an arts and science school with 1,200 students from around Ottawa. The male/female ratio is 30/70. The program there includes the medical centre and classroom visits. The hours of operation are Monday afternoons and Thursday mornings for 2.5 hours and three hours respectively.
Classroom visits are scheduled on Monday afternoons. Students are given the opportunity to ask questions written on slips of paper. Anonymity is preserved. Most questions are answered, but we usually run out of time. The visits give us more exposure to the students and increase their level of comfort with us. In fact, one of the first questions we ask the class is how many have their own family doctor. Most will raise their hands. The followup question is: “How many of you feel completely comfortable talking to your doctor about any subject?” Few if any hands remain raised. This response is universal for the hundreds of classes we have attended. This lack of trust is one of the greatest obstacles to providing effective preventive care.
The classroom visits invariably attract the students to the medical centre. We have become a recognizable fixture at the school. Students can come to the clinic with their friends for support. They have brought friends who have been in crisis. Even though we are not employed by the school board, we interact with teachers and guidance counsellors who bring their concerns about particular students. Clearly, teachers are already strained for time and classroom sizes are increasing. This year, there will be 2.5 guidance counsellors for 1,200 students at Canterbury. Underfunding of the education system is similar to underfunding of the health-care system. Health or social problems cannot easily be noticed and dealt with as early as possible. The overall cost to society is greatly increased as a result of our ignorance.
Trust and confidentiality are of paramount importance. This is the challenge of adolescent medicine. Adolescents are concerned their family doctor will speak with their parents about their problems. Right or wrong, that is their consistent impression. We need to develop a means to reverse this trend.
In future articles I will focus on the formula we have used to make our centre a success, our experiences with the clinic, case histories, the issues brought forth by the family medicine residents, and the moral and ethical dilemmas encountered at the centre. We have compiled and collected all the questions asked over the eight years. I will present them to you with our responses. Stay tuned.