VCU news

By Laura Ingles
VCU School of Medicine

A 17-year-old with chronic kidney disease had been refusing treatment when Stephanie Crewe, M.D., a pediatric resident at the time, first entered her hospital room. The patient sat in bed, disheveled and scowling, with her glasses sliding down her nose.  

“Why are you looking at me that way?” she challenged Crewe, who responded, with a blend of concern and amusement, that her hair was standing straight up. “You gonna do something about it?” the teenager shot back. “Absolutely,” Crewe said, without missing a beat. “Give me a few minutes, I need to go get a comb and brush.”  

The young patient had been in and out of the hospital for most of her adolescent life, was being raised by a single dad, and, as Crewe recalled, was “just over it.” After returning with supplies, Crewe settled herself next to the girl’s bed and carefully tamed her unkempt hair into tidy cornrows. The two chatted as Crewe worked, and together they devised a new dialysis schedule that was both medically appropriate and less overwhelming.    

“Both of us wanted a good outcome for her, and it took the two of us coming up with a plan together,” Crewe said. “As doctors, we’re trained to give the order. But with teenagers and young adults, they’re trying to develop independence, and we need their buy-in to achieve whatever the goals are. She was my teacher in how to do that.”  

Now chief of the Division of Adolescent Medicine at VCU School of Medicine and the Children’s Hospital of Richmond at VCU, where she treats patients ages 12 to 22, Crewe has dedicated her career to “working with patients a lot of people don’t understand.” As a Richmond native herself, with a deep understanding of the social complexities surrounding the physical and mental health of underserved young patients, she strives to “meet patients where they are.” With credibility, humility and warmth, Crewe is a fierce advocate for patients, their families and their communities.  

‘I can be a voice for my community’ 

Crewe grew up with her sister and parents in Bellemeade, a working-class neighborhood in the Southside of Richmond. It was a part of town where “people judge you based on your zip code,” she said, though her street and surrounding area always felt safe to her. Her parents kept her busy outside of school with extracurricular activities like Girl Scouts and full, family-centric Sundays at church and her grandmother’s house, which she joked didn’t give her “time to get into much trouble.” On some level, she understood at an early age that the support of her two-parent household and strong faith community afforded her a stability many of her peers lacked. 

She began noticing inequities in high school, when her classmates “started getting pregnant and having babies.” It was so prevalent in the early 1990s that George Wythe High School (now known as Richmond High School for the Arts) opened a daycare on campus to help students with children stay on top of their classes. While Crewe said she didn’t necessarily perceive the teen pregnancy rate in her neighborhood as a problem at the time, it did raise questions for her.  

“It was almost a normative thing, and I wondered, what was it that made these kids more susceptible to these reproductive health outcomes?” she said. “Was it a desire to have children, or was it an access issue for the ability to protect themselves? Was that just the status quo for where we were?”  

By then, Crewe was already forging her path toward medicine. Nobody in her family had worked in health care, and she’d never met a physician who looked like her, but Crewe's tight-knit community rallied around her as she pursued the dream.  

“Stephanie always knew what she wanted to do. She wanted to help people,” said Katina Worsham, Crewe’s older sister who lives just outside of Richmond in Glen Allen. “It was just her demeanor. She was always caring, always asking how she could help — that’s just the way she is.”   

After completing medical school, residency and fellowship training out of state, Crewe came back to Richmond to join the VCU School of Medicine faculty as an adolescent specialist in 2010. Returning home, she realized it had all come full circle — some of her teenage patients were the children of her old high school classmates.  

“For me, it was about coming back and helping the population that raised me, that got me to this level of recognizing that there are disparities,” Crewe said. “I am now able to give back, understand what people in that population are going through, and work on chipping away at some of the barriers that exist. I can be a voice for my community.”

All in the family 

Crewe noted that adults tell teenagers what to do and what not to do “all day every day,” which can be frustrating for kids who are developing their own identity. Because adolescents aren’t always comfortable sharing private details in front of a parent or guardian, Crewe uses what she calls the “sandwich approach” during appointments: The parent begins and ends the appointment in the room and is asked to leave in the middle to allow Crewe and the adolescent patient to speak one-on-one. 

Crewe said some parents struggle with this approach at first, concerned that they’ll miss crucial information. She assures them they’ll be the first to know if the child shares anything that would put themselves or anyone else in danger. 

The purpose of that middle, one-on-one session is to help the adolescent patient start to build a foundation for their autonomy. By speaking to them at their level, encouraging them to ask questions and listening to their concerns without judgment, Crewe gives them the tools they need to take control of their physical and mental health.

“We know that when kids don’t have confidential settings in which to discuss, explore or begin to advocate for themselves, they have worse outcomes,” Crewe said. “So, what I try to do is use that visit as the ultimate way that they can start to advocate for themselves.”    

While that one-on-one time with her patients is invaluable, Crewe said understanding the family unit is also critical to her care for a patient. She encourages parents and guardians to be active participants in their teens’ lives — whether the teens like it or not. 

“It’s important for every mother, father, guardian, person raising this kid, to know that their relationship with this kid matters,” Crewe said. “I think that the absence of the family in its entirety contributes to some of the waywardness of a kid. So, I try to make it part of my plan to build the family around this developing teen.”

Worsham, a mom of three, can attest to the value of that joint approach. Her kids are 13, 17 and 21 — right in Crewe’s wheelhouse. She said her sister “has more patience” than she does, and not only does she often turn to Crewe for advice (medical and otherwise), but she encourages her kids to do the same.

“I feel comfortable with them talking to her about things that I don’t have to know,” Worsham said, adding that all three of her kids, especially her 17-year-old daughter, have a special connection with their Aunt Stephanie. “Her approach is different. She has that laid-back demeanor and she’s a good listener, so they know they can call her.”

Servant leadership 

Robin Foster, M.D., a colleague of Crewe’s in the Department of Pediatrics, described Crewe as “a servant leader who comes in every day, keeps her head down and does the right thing.” As director of the Child Protection Team, which treats children who have been abused or neglected, Foster often works closely with Crewe on cases involving adolescents. Foster noted that in addition to her outpatient practice and inpatient consultations, Crewe also quietly supports youth in the community through the United Methodist Family Services’ foster program, the Richmond Juvenile Detention Center and St. Paul’s Baptist Church. 

“She serves these populations with humility, and stays off the radar at a grassroots level,” said Foster, who nominated Crewe for the Medical Society of Virginia Foundation’s 2024 Service to the Uninsured and Underserved Award. “She has such grace, such class, no ego and no pretense.” 

Foster recalled the first time she witnessed Crewe’s gift with adolescents firsthand: It was at a leadership development event for local teenage girls, where Crewe had been invited to speak to the group about taking care of their health. One young lady at Foster’s table, who had struggled to pay attention and stay engaged, tapped Foster on the shoulder, pointed at Crewe and asked where she was from. 

“She’s from here,” Foster told her. “She grew up in Richmond, went to George Wythe.” The girl was stunned. “I go to George Wythe,” she whispered back. For the rest of the day, Foster said, this teen was enraptured, taking in everything Crewe shared, asking questions and even trying some new foods from the buffet she’d previously refused to touch. 

“To me, that was a classic example of how Stephanie’s story gives her so much credibility with this patient population,” Foster said. “Gaining their trust and allowing them to see that she fulfilled their dreams gives them the onus and opportunity to fulfill their own dreams. I just think she’s such a phenomenally good example.” 

This story was originally published on the VCU School of Medicine website.