You really can’t be scared of tackling the thorny issues if you’re working with this population,” says Dr. Natasha Johnson (Photo below). The population she works with is teens. “We deal with a variety of issues that are relevant to teenagers,” she says, including pubertal development, mental health issues, eating disorders, chronic illness, transition into adult care, and sexual health issues.
Johnson accepted the role of head of the Division of Adolescent Medicine in 2013, becoming the second after Dr. Sheri Findlay, who was a founder of the specialty. Part of Johnson’s role is raising awesomeness of specific health concerns affecting teens, including information based on new research being generated within the department. A recent example is working be done on conversion disorders, disorders in which a patient experiences neurological symptoms like seizures or paralysis without a physical cause. Division members Dr. Christina Grant and Dr. Catherine Kranisk, a researcher from McMaster’s Department of Psychiatry and Behavioural neurosciences, ar leading a national Canadian Pediatric Surveillance Program study on pediatric conversion disorders. Now published, the study results (Conversion Disorder in Children and Youth) is of interest to patients, parents, and physicians across Canada and abroad.
Advocating for Teens
That work belies the guiding principle within the division, which is to get the right information into the right hands. Part of the role of adolescent medicine specialists, says Johnson, is raising awareness of specific health concerns affecting teens. Dissemination of information to teens, their parents, the medical community, and the community-at-large is an important task. Through involvement with the Canadian Pediatric Society (Adolescent Health Committee and Section), the division participates in the publication of position statements and practice points on adolescent health topics.
It also means reaching out to undergraduates and post-graduate students, building an understanding of adolescent medicine and equipping them with the skills necessary to provide optimal health care to teens. “Whatever speciality they go into, notes Johnson, residents are going to see teens.” That means not only interacting with teens, but interacting with health issues specific to teens.
“We’re setting the stage about how you have a conversation with people out the things that are important to them in a way that makes them feel comfortable.” Over the past year that has included a presentation with Dr. Jan Willem Gorter, Director of the CanChild Centre for Childhood Disability Research, on issues surrounding sexuality in young people with developmental delay, an initial presentation of their joint research.
Finding New Teaching Tools
“Pelvic exam simulation for pediatric residents is a novel teaching method,” says Johnson, and has proven to be a very effective one. The division now has a simulator for pelvic examination to help teach this skill in the face of reduced clinical opportunities. Simulation will be regularly incorporated into the adolescent medicine rotation for trainees of all levels.
Simulation is invaluable in part due to the success of non-invasive screening methods for sexually-transmitted diseases. It has meant a decline in opportunities for pediatric residents to practise pelvic exams, something which nevertheless remains an essential skill. To provide training, Johnson incorporated pelvic exam simulation as part of a clinical skills curriculum for pediatric residents in 2011.
Family Based Therapy
The most public face of adolescent medicine is the treatment of eating disorders. When the division opened a dedicated eating disorder unit, one of the intentions of the newly expanded ward–which includes in-patient and day-treatment beds–is to keep the complex patients close to home and to reduce the number of teens who are sent elsewhere, including treatment facilities outside of Canada, for intensive services.
The main approach to treatment used by the eating disorder program is Family Based Therapy (FBT), a treatment that is based on what Johnson calls an “agnostic approach,” one that doesn’t seek to place blame on the patient or their parents for the illness and does not attempt to search for the cause of an eating disorder. Instead, the focus is to work with the family, and to encourage the family in partnership with the clinic, to bring the patent back to a point of physical and psychological health.