A Doctor of Their Own

Excerpted from
Healthy Teens, Body and Soul: A Parent's Complete Guide
By Andrea Marks, M.D., Betty Rothbart, M.S.W.

What is the single most important trait doctors must have in order to work well with adolescents?

They have to like adolescents.

Not everybody does, you know. Some pediatricians are unfazed by screaming babies, charmed by truculent toddlers, and amused by back-talking 8-year-olds - but oh, how they dread adolescents. That don't-wanna-talk act tries their patience. And when teens do talk--well, how exactly do you handle a kid's telling you about his sexual experimentation without spilling the beans to his parents and urging them to ground him? There's too much tiptoeing around with adolescents, playing that delicate game of protecting their confidentiality while the parents worry in the waiting room. Better to stick with the little kids.

But other doctors would rather work with adolescents than with any other age group. For them, treating adolescents is the most exciting, dynamic, and rewarding field of medicine, despite the frustrations and challenges that inevitably come with the territory.

This doctor-patient relationship is unlike any other. The patient evolves from being a child who still relies on Mom or Dad to keep track of medicine to a grown-up medical consumer who makes independent decisions. The doctor guides the patient and parents on how to make healthy choices-and on the lifelong impact those choices may have.

A Unique Set of Health Risks

Dr. Adele Dellenbaugh Hoffman, a founder of the Society for Adolescent Medicine, recognized that adolescents constitute a distinctive constituency: "What we're talking about is a decade, an age of human growth and development that has tremendously unique things happening emotionally and biologically."

Although many people believe teens are the healthiest age group, in fact they have many special needs and concerns. They benefit from seeing doctors or other health professionals who are trained to understand that social and psychological issues affect adolescents' physical health, and vice versa. This book refers to an adolescent's primary care provider as the "doctor," but some adolescents see a nurse practitioner or physician's assistant who has been specially trained in adolescent health care.

Adolescents' health problems may be

• Unique to their age group (delayed puberty, scoliosis) or common to all age groups (colds, constipation, seasonal allergies).

• Behavior-driven (sexuality, substance use, accidents, and injuries).

• Related to body image (skin problems, eating disorders, piercing, tattoos).

• Symptomatic of emotional struggles, especially depression or stress (fatigue, headaches).

• Related to difficulties within the adolescent s world at home, in school, or with peers (abuse, learning disabilities, bullying).

• Chronic or handicapping conditions (asthma, migraines, cerebral palsy).

The adolescent's doctor must be able to consider the complex interplay between biologic health and disease and emotional well-being, helping teens and parents differentiate between normal and problematic changes and behaviors.

Building Trust

Central to the success of the relationship is a doctor's ability to establish rapport. Some adolescents are open, easy to talk with, eager to ask questions. Others resist, refuse to disclose what's really going on, and must be won over. Doctors need to find ways to let patients know they are on their side. To keep communication flowing doctors avoid asking yes-or-no questions and perfect the art of asking open-ended questions:

Tell me more about what it has been like starting a new school in eleventh grade.

How does the injury affect your ability to do things you want to do?

What do you think about the fact that some kids in your grade get drunk on Saturday night?

The goal is to convey interest in the adolescent's life and to appear nonjudgmental so the adolescent will feel comfortable describing life as it is, not as he or she thinks an adult believes it should be. The patient should come to regard the doctor as more of a resource than an authority figure. Over time, as the doctor gains the adolescent's trust, they can work together as a team to steer the healthiest route to adulthood.

The doctor must also develop trust with the parents. This can be achieved in several ways: including parents in office visits as appropriate, discussing straight medical matters with them, answering their phone calls promptly, and calling family meetings when needed.

Talking About Values

"Family values" has become a heavily laden term in our society, almost synonymous with "conservative." But every family has- -and should have-values, beliefs about the best ways to live. Adolescents need to know how their parents feel about such matters as sexual activity, drug use, and ethical relationships with others. It makes sense for parents to share their beliefs with their child's doctor and ask that they be respected. Sometimes such a discussion presents an opportunity for the doctor and parents to explore an issue together and determine the best approach for the adolescent.

For example, let's say that parents tell a doctor they expect their daughter to abstain from having sexual intercourse. They ask the doctor to limit discussions of sexual behavior to abstinence. The doctor might agree that abstinence is by far the healthiest, most appropriate choice for an adolescent-but points out that if she inquires about safer sex measures, it is the doctor's responsibility to provide correct information. Indeed, what the parents might not have considered is that learning about the risks of sexual activity (contraceptive failure, pregnancy, sexually transmitted diseases, emotional upheaval) might in fact help fortify their daughter's decision to abstain.

On the other hand, if she is determined to have sex, surely the parents would not want her to be vulnerable to those risks. If she is not informed about precautions, she will be more likely to get pregnant or contract a sexually transmitted disease.

In this discussion, parents might come to see the ramifications of their original request in a new way. The doctor might take extra care to talk with the girl about abstinence. The doctor would not only honor the family's values but also be sensitive to the emotional conflict the girl might have if she pursues a sexual relationship. Is it causing her increased stress? does her ambivalence make her inconsistent in practicing safer sex-and therefore increase her risks? Is she caught between a boyfriend's desires and her parents' wishes? Is she aware that she has the right to stop having sex? Would she like the doctor to help her discuss the matter with her parents?

Throughout, the doctor must maintain the adolescent's confidentiality-unless she is behaving in ways that will cause harm to herself and others. But the doctor can incorporate the parents' views into the discussion.