Talking With Teens: A Doctor’s Guide to Adolescent Health
By Dr. Rebecca Weinshilboum
I am a pediatrician, which means that while I treat children’s medical needs I spend a majority of my time talking with their parents -- that is until my patients become teenagers.
As my patients mature, their role in the discussions about their care increases. When they’re infants, I can play peek-a-boo with them. My school-age patients compare notes with me on the latest toys and “in” activities. But with these age groups, the most detailed discussions happen between me and mom or dad. With my teenage patients, the dynamic often takes a dramatic shift. I still talk at length with their parents, but at this age the most important conversations take place between me and my patients.
I like keeping parents in the room as we tackle the tough topics of adolescence. I feel this facilitates discussions at home. But often, by the time patients turn 13, it’s time to encourage their parents to leave the room so that I can examine and talk with my patients in private. I let my teenage patients decide whether or not they want that privacy. Whatever they decide, I want them to understand that there is a level of trust and responsibility that comes with their age, which is reflected in our patient-physician relationship.
Medical issues change rapidly with adolescence. Adolescents can often get rundown because they don’t get enough sleep. Their skin breaks out. They suddenly need deodorant. And menstruation and poor eating habits put some adolescent girls at risk for anemia.
The toughest issues for pediatricians, parents and teenagers still boil down to sex, drugs and alcohol. Some parents resist these conversations, but if I don’t talk with my patients they’ll learn about sex and drugs from someone else. I can take better care of them when they get accurate information from me. And I encourage parents to have those conversations too. A trusting parent child relationship will always be a primary goal for me with all my patients.
On the other hand, I never expect honesty from my teenage patients. Teenagers lie for a number of reasons: to save face, out of fear or in defiance. That is normal. When I talk to teenagers, I say: “I’m not here to judge you. I’m here to educate you and give you information. I am a realist. I know at the end of the day you are going to be out there making your own decisions. I’m hoping you’ll make the best decision for yourself and if you make a mistake, you will trust me enough to come in and let me help and take care of you.”
I try to keep it real, using humor and plain language to build trust with my adolescent patients. I might ask a 12-year-old girl, “So, do you have questions about getting boobs, having a period, wearing bras, boys and girls, or growing hair and deodorant?” A few years later the questions get tougher. I’ll ask her in front of her parent, “Are you sexually active?” If I think she’s being less than honest, I’ll walk with her to the bathroom. “Straight up,” I say. “Tell the truth. I need to know or I can’t take good care of you.” I believe in empowering my adolescent patients because ultimately I believe they’ll make better decisions.
Adolescence is a time to start talking about mental health issues. Teenagers all think the world revolves around them, their needs, wants, and problems. Again, this is normal. Adolescents often seem as though they’re about to come unhinged at minor issues. So, how do we separate the normal teenage volatility from a mental illness? I tell the parents of my patients to pay attention to unusual behavior. Has your outgoing child turned into a loner? Has your son stopped sleeping? Or does your daughter suddenly sleep all day? Pay attention to dramatic weight loss or weight gain. These changes in behavior can be a sign of any number of serious psychiatric disorders that first appear in adolescence, including depression, schizophrenia and anorexia.
Adolescence is also a time for a new round of immunizations. Teenagers often need boosters for vaccines against tetanus, diphtheria, whooping cough and meningitis. There’s also a vaccine recommended for girls --and now boys -- that protects against Human Papillomavirus, a sexually transmitted disease that causes cervical cancer. There is some controversy about this vaccine. But I recommend that all my adolescent patients get the HPV vaccine prior to becoming sexually active. For my female patients, the vaccine will protect them in adulthood against a deadly disease. For my male patients, the vaccine protects them against some forms of genital warts and also prevents them from spreading the disease.
I understand that even healthy teenagers are more stressed than they used to be. College-bound students feel the pressure to succeed. Others juggle responsibilities at home with school and maybe even a job. Social pressures weigh heavily on teenagers. Almost all my patients have a winter when they’re sick all the time. They get rundown from lack of sleep and catch every bug around. “Remember, that at the end of the day, you are responsible for you,” I tell them. “Take care of yourself. And if you have a problem, I hope you trust me enough to tell me so that I can take care of you.”