The Teen Health Book: A Parents' Guide to Adolescent Health and Well-Beingby Ralph I. Lopez, Kate Kelly (Editor)
A What to Expect for the teen years. With the publication of The Teen Health Book parents will finally have a single volume
“A terrific book for parents of teens (and preteens). . . . López writes with empathy and good humor and clearly has a thorough grounding inand affection forhis specialty.” Library Journal, starred review
A What to Expect for the teen years. With the publication of The Teen Health Book parents will finally have a single volume to help them navigate the confusing changes of the adolescent years. Ralph I. Lapez, a pioneer in the field of adolescent medicine, is known for his warm and accessible manner and offers health and medical information in a clear and conversational tone. Addressing both physical and emotional concerns, this essential guidebook discusses the full spectrum of adolescent issues from sexual development and eating disorders to acne, growth issues, and alcohol and drug use. In addition, a comprehensive reference section details the common and not-so-common ailments of teenagers. Dr. Spock is the bible for parents of toddlers; The Teen Health Book will be the bible for parents of teens.
- Norton, W. W. & Company, Inc.
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Read an Excerpt
The Teen Health Book
A Parents' Guide to Adolescent Health and Well-Being
By Ralph I. López
Illustrated by Ralph I. López
W. W. Norton & Company
Copyright © 2002 Ralph I. López, M.D..
All rights reserved.
A few years ago, Gary, a high school junior, came into my office and sat in one of the chairs opposite my desk. He had been the patient of one of the most respected pediatricians in the area. I asked him if this was a routine visit or if something special was concerning him. He thought for a minute and answered, "No." Then he added, "Dr. Jones has been my doctor for years. He's real good." I sensed a pride in praising his childhood doctor. "Then why did you switch?" I asked. He smiled and stood upall 6'3" of him: "Okay?"
Changing Thoughts on Teen Health Care
Today's adolescent benefits from the fact that there have been major changes in attitude toward the medical care of teenagers. The medical profession as a whole now recognizes that teens have a unique set of issues. While a few of us have chosen to specialize in adolescent health, many pediatric practices have opted to stay up-to-date on teen issues so that they, too, can provide the care the teenagers in their practices need.
In all aspects of their lives, teenagers need to feel that they are no longer "children." Despite the fact that they are not legally adults until age eighteen, they resent attempts to make them feel like youngsters. It is important for them to have a visible sign that the transition period is recognized. Is it a surprise that the Smurfs on the pediatrician's walls and the silly jokes as the ears are examined no longer amuse? The toys in the waiting room, the child-size chairs, the fellow patients who are babies all pose a threat to the teenager's sense of maturity. The logic is simple: If I don't see magazines for me, if I don't have an environment directed at my needs, I don't belong here. Let me out!
Toward a More Teen-Friendly Environment
If the teen is to be comfortable in the doctor's office, it has to be a teen-friendly one. The attitude of the office staff in recognizing the teen's transition into young adulthood can set a new stage in which teens are encouraged to assume some responsibility for their own medical care.
If you're evaluating whether or not to change doctors, the waiting room is the first place to begin to make a decision as to whether a particular practice will suit your teen's needs. A separate area for teens is ideal, though usually not possible in offices where space is at a premium. Teen reading materials, which can be as simple as having copies of People or Rolling Stone around, are a good offset to Sesame Street magazine and informational pamphlets from La Leche League.
The demeanor of the nurse or receptionist is also important. Calling out a nickname, or addressing the parent instead of the teen (as in "Would you like to bring Johnny in now?") is no longer appropriate. More adult-styled exam rooms will make the adolescent more comfortable. The Muppets posters, the infant scale, the open door all indicate "child" to the teen.
An Increasing Need for Privacy
Starting at about age thirteen or fourteen, your teen should begin to have private time with the doctor. This can be a gradual process. You might leave him for the actual physical exam, and let him call you back in later. But teens shouldn't feel like they were dropped off: The eighteen-year-old who is really sick may want you in the room. However, they should see that parents are supportive of the fact that they have a private life, which will begin to include the state of their health.
If you have an appointment with a new doctor, some physicians prefer to meet with the teenager alone before bringing in the parents. My own style is to meet with both parents and teen to take a medical history and to set guidelines for the professional relationship. This way both parent and teenager are present to hear about how I run the practice (after-hour calls, appointment length, etc.). Later on, a parent may come in at the beginning or the end of the appointment (or both, depending on the nature of the visit), but the teenager should see the doctor and be examined by the doctor without a parent there. Particularly if you are opting to remain with your "old" pediatrician, this new manner of handling the visits forces both your teen and the doctor into a new relationship. Both doctor and teen patient need to start forging a relationship that is just between the two of them.
Adolescent medicine specialists and pediatric offices addressing the needs of teenagers will offer teen girls a paper robe to wear after disrobing for a physical exam. Preventing her from feeling vulnerable and exposed is a first step toward treating her with the same respect an adult patient would receive. Some girls will want their mother present during the examination, while others prefer a female nurse to be in the room. In most cases, the physician's manner and tone will put the patient at ease.
The Importance of Confidentiality
A common complaint from the teens who switch to my practice is the sense that their "baby doctor" is somehow allied with their parents. They feel the doctor is more their parents' doctor than their own. Unfortunately, this is sometimes true. When their patients are babies and children, pediatricians tell parents about every cold, every sore, and every sprain. Parents may well expect that information disclosure to continue into their child's teens. Questions about smoking, alcohol, pot, and sex are on all parents' minds. They want to know if their son or daughter is involved in risky behaviors or is thinking about it. The latter is often true; the former is not. If parents can't elicit this information from their teens, they may turn to their teen's doctor. Most parents understand that they are crossing a boundary line by asking a doctor to break patient confidentiality, but their parental needs often overtake their judgment.
The pediatrician who unwittingly divulges that the cough is a "smoker's cough" has just about lost a patient. The parent who gets the pediatrician to do a "urine test for drugs, just to be sure" will probably have to find a new physician if the teen finds out. And what if such a test is positive? Does the parent who couldn't confront her son with her suspicions, now tell him that she knows about the teen's drug use for sure? I can imagine the response: "Dr. Jones did what!? Forget it, I'm not going back. Ever!"
One patient told me recently that he hated his old doctor because the doctor had told his mother something the boy had told him in confidence. I did not know all the details of the incident, but the message being sent by my new patient was clear. I assured him of confidentiality but cautioned that, if I felt the need to discuss something with his parents, I would discuss it with him first. He paused, looked at me, and nodded that this was an acceptable agreement. I looked at his mother and she concurred.
Considering a New Doctor
Referral from friends is the most common way of finding a new doctor, but if you're looking for doctors who specialize in treating adolescents, try contacting the Society for Adolescent Medicine (1916 NW Copper Oaks Circle, Blue Springs, Missouri 64015; 816-224-8010; www.adolescenthealth.org). The organization can send you a list of any members who practice in your area.
If there are no adolescent medicine specialists in your area, then start looking for a pediatrician who enjoys working with teenagers. Your best bet will be to search among those who are old enough to have raised teens themselves. I know that I became a better pediatrician when my daughter was born. The doctor who has lived through these stages with children has generally gained wisdom and compassion that can be found in other doctors but may be more difficult to come by.
Finding the Right Patient-Doctor Match
Let's face it, some doctors do not particularly want to see teenagers as patients. They may have chosen pediatrics because they really like young children, and the idea of serving the adolescent population is simply not to their taste. However, there is also an economic reality to taking care of teenagers.
An office visit with a teenager is longer than that of a first-grader with an earache or a baby the doctor saw just last month. The busy office of a typical pediatrician is capable of seeing as many as three to six patients in one hour. Babies can be given an overall physical and an immunization in as little as fifteen minutes. The nurse can weigh the child, the nurse can give the vaccines, and the nurse may even be the one to go over diet with the mother.
If a doctor seeing teenagers relies too heavily on staff members for the drawing of blood, taking of height and weight, and blood pressure, the teen may feel slighted. But more important, the doctor is missing the opportunity to build a relationship with the teen, which may open the door to important communication about sensitive issues. Typically I allow twenty to thirty minutes for a regular visit and, in almost all cases, time is spent covering some question that has nothing to do with the appointment. A first visit, in which I meet parents in addition to the teen, is a scheduled hour!
Another issue to consider is whether or not the current pediatrician, or the one you are considering using, is willing to stay up to date on the issues that will affect your teen. Menstrual irregularities, acne, pace of growth, and learning disabilities are just a few of the topics in which a pediatrician or adolescent medicine doctor must be well-versed.
Patients who lose weight or show other symptoms of an eating disorder are frequently referred to someone with enough experience and time to handle the issues that involve both the patient and the family. Doctors seeing adolescents must also be willing to counsel on birth control (a full discussion will follow in the chapter on birth control). They may encounter a pregnant teenager who has no one to counsel her. The physician may have to fill this role.
As of age eighteen, your teen is considered old enough to take charge of his medical care. From that age on, the doctor will have to ask your teen's permission to share any medical information with you. That's why it's so very important that you teach your teen to take charge of his own medical care.
At some point, kids will feel that they can make their own appointments. I prefer that the parent know they are doing it but, logistically, it is usually easier for the teen to determine what appointment time can be fit in around soccer practice and piano lessons. Parents should, however, stress to their children that making an appointment is making a commitment; many physicians charge for their time if patients do not show up or if they show up late. (If a teen wants an appointment without the parent's knowledge, the doctor has to be willing to potentially absorb the cost of an office visit. If the visit has to do with sexual topics or relates to drugs, then the teen can make the appointment with full rights, as this is protected confidentially. If he has strep throat, he can't!)
One way of educating teenagers about their medical care is to give them access to their lab results. In most cases, I will ask the teen if she wants to call for her lab results, or if she prefers her parents to call. Many don't realize that they can do this and welcome the idea. On the other hand, some aren't quite ready for this adult responsibility. That's fine. But the gesture on my part goes a long way in making them feel that they have a right to this information.
Billy is a somewhat heavyset fifteen-year-old who has constantly fought the "battle of the bulge." Diets, admonitions, and entreaties have gone unheeded. When I saw him, I suggested that part of the exam include blood work to check cholesterol levels and triglycerides (fats) in the blood. I asked him if he wanted to call me for results. He hesitated but then said he would call in a few days. As it turned out, his cholesterol and fats were quite high and he admitted to me that these represented not the empty stomach that I had wanted before the tests but a fairly large breakfast of eggs, pancakes with syrup, and bacon. When he heard the blood values he was shocked. "What should I do?" he asked. The obvious answer of losing weight and changing his diet were simple enough; the question was would he do it. On his own, he suggested that he be given a month to lower the numbers; if this didn't work, he would meet with a nutritionist. I told him that, because of his age, I needed to inform his parents but that I would ask them not to pressure him about his diet. At his follow up a month later, his weight had dropped by six pounds. His cholesterol and triglyceride levels were much better and he continues to lose weight weekly. He takes enormous pride in knowing that he is doing this by himself. I am convinced that, had I called his parents first, this great outcome would have been missed.
Occasionally, test results cannot be shared with a teen either because it is devastating news or because parents absolutely forbid it. Parents do have such a legal right. For example, I have had several teens with rare disorders whom I felt needed chromosome analysis. It is difficult enough to share my concern with parents, let alone the teen. In each case I consulted with the parent and simply drew an extra tube of blood at the annual visit. If the results showed a problem, the parents and I together discussed it with the teen. Legally a physician must share this information with the parent if the child is a minor. If the patient is over eighteen not only does she need to know the results, she needs to give consent to do the initial test.
The exception to informing parents about blood test results is for those in which the information is privileged. Tests done for sexually transmitted disease or pregnancy legally cannot be shared with anyone other than the patient. (This is mandated on a state-by-state basis.) However, I usually strongly suggest that the teen talk with her parents, and I offer to be present during the discussion. In some cases teens may actually request that treatment or test bills be sent to them. HIV testing is a good example. A teen may choose not to tell his parents about the test and will pay the laboratory directly. In New York even a physician needs special permission from the patient just to let another doctor know that the test was done!
The Ideal Medical Visit for the Teenager
In the best-case scenario, the following criteria will be met for a successful adolescent office visit.
1. The environment should be one that reflects the age of the teenager.
2. The office staff and especially the physician should view the teen as the primary patient. The teen should be addressed by name and spoken to directly; comments and questions should not be directed to the parent.
3. Examination rooms should have adult-size examining tables. Scales, ear speculum, and overall equipment should be consistent with the age of the patient.
4. The patient should have a chance to discuss issues alone with the physician, and a parent should not be present for the physical examination unless the teen requests. Parents may accompany the patient into the consultation room, and policies about seeing the patient alone, billing, broken appointment policies, and above all, confidentiality need to be directly presented to both parent and teen.
5. Parents should have a chance to express their concerns, but the teen should be guaranteed an equal opportunity to voice concerns. If the issue is complex, the doctor should be willing to make another appointment for further discussion.
6. Teenagers should be given privacy to get undressed and dressed without the physician in the room. Gowns are optional for boys but are almost always mandatory for girls.
7. Any procedure that is new or painful should be explained, including the drawing of blood.
8. Parents should be included in the treatment plan for illness.
9. A well-run office will have a reminder plan and will send out notices for follow-up examinations or the need for additional immunizations.
Excerpted from The Teen Health Book by Ralph I. López. Copyright © 2002 by Ralph I. López, M.D.. Excerpted by permission. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Meet the Author
Kate Kellyis an author and blogger for The Huffington Post.
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