McMaster University

McMaster University

Dr. Sheri Findlay, Founder of Adolescent Medicine, Department of Pediatrics

Extending Family-Centered Care

When Dr. Sheri Findlay came to McMaster, it had no division for adolescent medicine, nor was adolescent medicine recognized as a specialy by the Royal College.

Now there is, and it does.

“It’s a branch of pediatrics that sort of speaks for itself,” says Dr. Sheri Findlay of adolescent medicine, the division she heads within the Department of Pediatrics. “It’s not a specialty that focuses on an organ system.... We focus on the illness that occurs within a certain age group: growth and development and puberty issues and also mental health issues.” As a specialty, it’s also exceedingly new, something Findlay knows better than anyone, principally because she was part of the team that founded the specialty in Ontario.

When she came to the University in 1999, it was her intention to begin an adolescent medicine division, despite the fact that it had never existed at McMaster or any other university before, and that the Royal College of Physicians and Surgeons didn’t recognize it. She recalls that when she proposed the idea to then-chair Dr. Jack Holland, he responded pluckily, “You know what? That sounds really neat.”

“He was really open to it,” recalls Findlay, “and [he] said, ‘If you want to come here, we’ll support you to build the program.’ So it’s been 12 years building a service that didn’t exist. It’s been a lot of fun and a lot of headaches — all the things that come along with changing the way that people do things.”

More than anything, she saw developing the service as an opportunity to further define the transition of care from childhood to adulthood, something that she felt was an essential element in ongoing care that was lacking from most clinical practice.

“It’s easy to forget that teenagers grow up....When you’re nine and you’ve got asthma, the parents come in and you’re teaching the parents. But when they get to be 13, we should be doing some education with the teenager, and teaching them about asthma, what it means to have asthma, and how to avoid triggers. And by the time they are 17, the parents shouldn’t be coming into the room at all.”

Findlay was aware that that’s not an approach that all pediatricians and family doctors were comfortable with, which is something that persists to a lesser degree today. Teens aren’t always the easiest people to speak with, and that’s especially true of those with lifestyle issues. Teens with health issues relating to sex, substance abuse or depression — in short, those who can benefit most from early intervention — may be less likely to open up to a doctor, and that’s infinitely more true when a parent is in the room. Allowing teens to participate more directly in the management of their care, and the management of their overall health, is beneficial both in the short and the long term. “As pediatricians we forget that. We go out to the waiting room and call for Johnny, and Johnny and his parents stand up and we don’t stop and say ‘You know what, guys, why don’t you have a seat and I’m going to meet with Johnny and when we’re done we’ll fill you in on the plan that we’ve come up with.’”

“It doesn’t come naturally,” Findlay says. “The role that adolescent medicine plays is to remind people of that.”

Reaching out

The overall context of adolescent care in Hamilton when Findlay arrived was also a bit bare. There were no services specifically geared toward adolescents and there were no eating disorder services, despite a recognition that work was needed in that area. Given that, she began laying the groundwork. The fact that she is still strikingly young — you’d be forgiven, on passing her in the hall, for mistaking her for a resident — is a reminder of how far Findlay has brought the program in a short period of time.

“Mac has always been a bit more holistic in its provision of care,” she says, noting that this context has helped and supported the work that she has done.

That context has also given her the time and the financial support to drive the Mac Kids Grow Up conferences that have grown out of the adolescent medicine program. The conferences include full-day professional development events open to caregivers in the Hamilton region, including physicians, nurses, dieticians and other health care professionals. The conferences present topics related to encouraging teen-friendly clinical work and educating teens on how to take responsibility for their care, and topics specific to the age group, including maturation, nutrition, sex and social issues. Because the hospital and fundraising funds the program, attendees pay no fees.

“It’s meant to be completely interdisciplinary,” says Findlay, “because we work in teams. Having just the doctors on the team tuned into what’s going on with teens isn’t going to be nearly as helpful as having the nurses and the social worker” all the others who contribute all together tuned is as well.

“Overall we’ve made huge progress,” Findlay says. Although adolescent medicine programs are more common today than they were in the past, the work being done at McMaster continues to set the bar. In addition to providing clinical care, the division members work closely with other pediatric clinics to provide adolescent services to youth with chronic illnesses and disabilities. The Eating Disorder Program is the largest of its kind in Ontario and offers interdisciplinary assessment for children and teenagers who have, or may have, eating disorders.

Findlay and others, after establishing an adolescent medicine department at McMaster, successfully advocated with the Royal College to have adolescent medicine designated as a recognized discipline. When it was, they then set the Royal College exam. In recognition of that pioneering role, Findlay was given the Founders Designation in Adolescent Medicine at the Royal College in November 2011. That designation recognizes fellows who have been instrumental in the creation of a new discipline approved by the Royal College.

“Yes, that’s something I’m proud of,” Findlay says. “Though being called a founder makes me sound like somebody’s grandmother. Really, I’m not.”

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