Think about your pediatrician's office. Chances are that "Winnie-the-Pooh" or "Sesame Street" murals decorate the walls and restless toddlers pass the time before their appointments by playing on the floor with brightly colored toys. Now imagine you're a 16-year-old girl waiting for your checkup in this same room. How comfortable would you feel? How likely would you be to tell the doctor who has treated you since you were in diapers that you're thinking about sleeping with your boyfriend and you need birth control?Help for such girls, and boys, may be on the way, thanks to a growing recognition in the medical community that teenagers have health-care needs that aren't always met by pediatricians (who officially treat patients from birth to 21) or doctors specializing in adult care. "Pediatricians spend most of their time with little babies and young children," says Robert T. Brown, president-elect of the Society for Adolescent Medicine (SAM) and chief of adolescent health at Children's Hospital in Columbus, Ohio. "Family practitioners spend most of their time with older people." Neither is generally trained to help teens, who are "the healthiest age cohort there is as far as organic disease," Brown says. "But it's sort of a paradox that at the same time, they have relatively high mortality and morbidity rates, and those come from behavior. That's what makes them different."
Since 1994, nearly 1,000 doctors have been certified in the subspecialty of adolescent medicine. Though most of them work in academic medical centers and are not available to help every teen in need, SAM hopes that, by highlighting the need and providing training and role models, the specialists will pass on their methods to many more doctors.
The most vital skill is how to talk to teens about sensitive issues: drinking, drugs, sex and violence. Dr. John Kulig, the current president of SAM and the director of adolescent medicine at Tufts-New England Medical Center, says pediatricians often just blurt out: "You're not having sex, are you? You're not drinking or smoking, are you?" And he adds, "They don't want to hear a yes—because they lack the time and skills to intervene." If Kulig were seeing a patient for the first time, he would take a different approach. "What's it like in your community, in your school?" he'd ask. "Do a lot of kids drink?" Then he would narrow the field: "Do your friends smoke or drink?" Finally he would get personal. "What's your experience? How do you deal with someone who offers you a beer or passes you a joint?" The idea is to avoid being judgmental or threatening, Kulig says.
Finding the right approach is vital because this generation of adolescents faces unique pressures. They're more likely than their parents to be from divorced or unstable families, which contributes to emotional problems and a lack of support at home. Substance abuse and eating disorders appear to strike at younger ages. Emerging sexuality is more intertwined with the threat of disease than it was a generation ago, when avoiding pregnancy was the primary concern. This generation is also more likely to go far from home for college, which can be overwhelming for many young people.
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