Maija Robinson, Tim Miao and Colin Way
University of Ottawa
Class of 2017
As medical students, we tend to focus on the physiological consequences of disease. However, what really drives us, and makes the study of medicine captivating, is the patient story.
As part of the "SIM: Society, the Individual and Medicine" curriculum at the University of Ottawa Faculty of Medicine, first year students choose a community service learning placement. Three of us selected the Dave Smith Youth Treatment Centre (DSYTC), a non-profit, residential addiction treatment program for youth and their families. This placement allowed us to explore physicians' relationships with youth struggling with addiction, and ways in which these relationships can be improved.
We each came to our placement with preconceived notions about youth struggling with addiction – a mixture of stereotypes cultivated from newspaper headings, TV dramas, and high school interactions. Perhaps we had expected youth at the DSYTC to be reserved and unwilling to share their experiences. We might have thought they were angry with their situation, displeased with our presence. We feared that they would not want us to be there. How could we possibly understand what they were going through?
But what happened when we arrived was very different. We immediately found our expectations to be misplaced and our assumptions challenged. The youth were incredibly welcoming and open to our presence. They were kind, generous in sharing their experiences, humble and positive. They allowed us to become a part of their world, if only for a few hours. We learned not only about youth with addiction, but also about ourselves – how we label, marginalize, and make assumptions about those suffering from addiction. We learned about the preconceptions that we hold and the impediments they pose to patient care. More importantly, we learned about how youth would like to see physicians break barriers down.
Through our discussions, interesting themes emerged from both the male and female groups. One was the overwhelming consensus that the physician needs to be positive. They told us to smile. Smiling can make the difference between an individual opening up or leaving without having shared his or her greatest concerns. It became clear that, while ultimately it is the patient who dictates disclosure of information, there is a great onus on the physician to provide an environment in which disclosure feels like a safe and effective choice. A need for assurance of confidentiality was of particular concern amongst the boys.
Many youth expressed fears about the legal and familial consequences of sharing their substance abuse struggles. They informed us that even presenting to a doctor should be recognized and validated as a sign that they want or need help in some capacity. It became evident that they developed the strongest bonds with physicians who acknowledged their progress each step of the way, never doubting their effort even in times of relapse.
When asked what they hoped to leave with following a visit with their physician, they all agreed: a plan. They wanted a list of steps outlining how they could begin to get help or to help themselves. Again, the onus is on the physician to be an advocate and to take initiative in providing further care or further knowledge. The youth explained that this involves creating a treatment plan which addresses the changes they are ready to make. While they may not currently feel ready to access further treatment for their substance use, they may be open to general health advice and information on harm reduction such as safer practices, reducing the number of substances used, and reducing frequency or dose of use.
Through our experience with youth at the Dave Smith Youth Treatment Centre, we learned that providing exemplary primary care to youth struggling with addiction does not require a thorough understanding of pathophysiology, neurobiology or psychiatry. Meeting the needs of these youth requires time, effort, and compassion above all. Getting outside the walls of the medical school to learn about community agencies and the clients they serve was an invaluable experience. We encourage future physicians to spend some time at community agencies such as the Dave Smith Youth Treatment Centre. We were challenged and shaped as individuals and are confident this experience will improve the way we work with youth throughout our careers.