It was early in her career when Dr. Anita Greig first identified a gap in preventive care resources for school-aged children and adolescents.

As a resident, she received a checklist of recommended physical examination manoeuvres for the adolescent; one item on the list was to check feet.

"I had no idea why and what I was to look for," Dr. Greig recalls. "Athlete's foot? Flat feet? Plantar warts?"

She searched for a guideline but found none. In fact, she could find no evidence at all for most items on that checklist.

Years later, although she saw many children and adolescents for 'annual physicals' at her North York practice, Dr. Greig still felt she had little idea what to include in her discussions or examinations with them. It occurred to her that an evidence-based preventive care checklist for the 6 to 17 age group would benefit all doctors.

A new tool for point of care: The Greig Health Record

Dr. Greig created her own tool in 2010 using information she found through research and collaboration with colleagues - who in turn, asked to use the tool.

The Greig Health Record helps practitioners structure their interactions with younger patients and teens to allow them to identify issues that they may need to revisit - for example, family, personal or mental health concerns. This helps ensure that doctors are building ongoing relationships with their younger patients.

Additionally, the tool helps patients build a level of comfort and trust with their doctors as they grow from children into adolescents and then adults.

"Using The Greig Health Record helps me give patients the comfort of knowing what to expect at a visit," Dr. Greig explains. "I start with a lot of questions early on. I ask the six-year-olds, 'How much do you smoke?' and 'Who are you dating?' and they'll laugh at me." She continues, "Then they get comfortable with those questions and know what to expect at their next visit. It allows us to build our relationship in a fun way."

Ongoing updates and a challenging case

Over the years, using the tool in her own practice and ongoing feedback from others have contributed to the tool's refinement, identifying areas for inclusion and revision.

One challenging case in particular stands out in Dr. Greig's mind.

"He came to me for help and I was at a loss as to how to assist him," she remembers.

A transgender adolescent who wanted to transition from female to male had come to Dr. Greig for help with hormone treatments. With no experience in prescribing these treatments, she referred him to a program with a long wait list but was unable to help further.

"He felt abandoned and I felt inadequate," she recalls. "I wished I had the experience, knowledge, and resources to help him."

In response to this experience as well as ongoing feedback, she updated The Greig Health Record in 2016 to incorporate suggestions from colleagues and her family medicine resident students. The next installment will include even more resources, including LGBTQ patient care resources, according to Dr. Greig.

Today, the tool is endorsed by the Canadian Paediatric Society and the College of Family Physicians Canada. It is recognized as a comprehensive and practical resource for family physicians working with younger patients and is central to the OCFP's Pediatric Preventive Care program.

Learning from the learners

As the developer and facilitator of the OCFP workshop since its inception in 2012, Dr. Greig considers the session's real strength to be the opportunity for family physicians to learn from each other.

"Not only can I give my expertise, but other participants will have ideas, suggestions or stories that stimulate, educate and inspire everyone."

During the workshop, she encourages participants to share their own stories from clinical practice, discuss challenging cases and talk about different approaches.

"The most interesting and lively discussions tend to be about cases of adolescents who are not thriving," says Dr. Greig. "There are so many possible scenarios and contributing factors that we all have a case we can bring from our own practice."

Workshop participants often raise difficult topics like how to talk about abuse with children, speaking with a reluctant teenager and approaching more sensitive portions of a young patient's history or physical exam.

"I always come away from these sessions with something new to read, look up or think about," says Dr. Greig. "So, I always have something new to pass on to the next group."

After these workshops, participants report feeling more comfortable with pediatric preventive care and more confident in using The Greig Health Record in their practices.

"Every session, participants talk about how excited they are to use The Greig Health Record," she adds. "This workshop and tool allow them to apply pediatric preventive care in a way that is more efficient, focused and evidence-based."

About Dr. Anita Greig

Born in Nelson, B.C., Dr. Greig's family moved around Western Canada and Ontario before settling in Wiarton, and then in nearby Owen Sound.

Growing up, she always expected to become a pediatrician, but found virtually every specialty fascinating in medical school; family medicine turned out to be the best fit. Raised to value service to her community, Dr. Greig believes there is a service component to being a physician and that family medicine is the perfect vehicle to give back.

In addition to delivering the workshop through the OCFP, Dr. Greig teaches family medicine at the University of Toronto and at Mount Sinai Hospital in Toronto. In 2018, she published The Greig Health Record for Young Adults to assist practitioners in providing preventive care for young adults aged 18 to 24 years. This new tool has also been endorsed by the College of Family Physicians of Canada.

In her spare time, Dr. Greig escapes to her cottage. Situated on a small quiet lake, she finds the time there to read, write, paint, swim and cross-country ski. A recipient of the OCFP Award of Excellence in 2015, she credits her teachers - from kindergarten through to residency - and her teacher parents for nurturing her curiosity, as well as her passion for learning and sharing knowledge.

Learn more about the OCFP's Pediatric Preventive Care workshop and upcoming sessions in regions near you.