How to save a life in 15 minutes or less

It is important to recognize that as pediatricians we have the unique opportunity to see to the lives of a very vulnerable group of people known as teenagers.

We can all relate to the discomfort of the stone-faced teenager with one-word answers and one foot out the door. There is usually a parent present who is answering all of the questions, and if you are lucky, the patient may put the cell phone down long enough to get an eye exam in, but, we must realize that the 15 minutes of captive audience could be the most important 15 minutes of the teen’s life.

Before we start our exam, we should have a plan in place for what topics we should be addressing. Every thorough physical should include a screen on drugs and alcohol, depression, sexual activity, and violence. In a busy practice, it seems impossible to address these issues in a time-conservative manner, but if we plan ahead, we can be thorough, casual, and informative.

First, you must analyze your own style. If having these discussions is uncomfortable for you, then attempting them without a plan will be disastrous. Many pediatricians just choose to avoid the entire discussion and hope that the parent is parenting and will address the major issues. But fewer than half of all parents talk to their children about the issues that they are faced with daily, and a great majority are ill-informed, or driven by their own beliefs.

First, pediatricians must make a list of hot topics to be discussed. Review the most current data and how they are affecting the teens in your area. Next, whether your talking style is comfortable or not, having a questionnaire that introduces each topic is always helpful (Am. J. Psychiatry 1995;152:1601-7

Lastly, have teenagers come in by themselves. Parents cannot help themselves and will always speak for their children, and most teens will not ask questions that they don’t think their parent will approve of or that relate to private family issues. So, you must set the stage for a comfortable talking environment. By having the questionnaire available, you can use it as a guide to see what issues are affecting the patient.

Knowing current information is also imperative to a good wellness exam. Know what the latest drugs are being used by the teens in the area, and know the street names of drugs (drugabuse.gov/drugs-abuse). Where do the local teens hang out? Major issues happening at the local high schools can help guide your conversations and build trust as patients begin to see you as an active and involved leader in the community.

Depression affects 8% of teens every year. Therefore, there is a guarantee that at least a handful will present in your office every year. Asking the right questions is key to getting helpful answers. Be direct, ask, "Have you ever, or are you now having suicidal ideation?" Over 90% of children and adolescents who commit suicide have a mental disorder (J. Clin. Psychiatry 1999;60 (Suppl. 2):70-4). There is a Web site supported by the American Academy of Pediatrics that has questionnaires to assist in identifying symptoms of depression (brightfutures.aap.org). Knowing the family history of psychiatric disorders can be very helpful in guiding the physician of what questions to ask. Many teens are fearful that they may be having symptoms of a psychiatric disorder, but are too afraid to ask, given the stigma that goes along with it.

Address issues of self-image. If patients are overweight, give tips on healthy eating and exercise. Develop a nutritional plan and track a patient’s progress by having her follow up. Allow her to discuss what make her feel sad or uncomfortable. How is she interacting with her peers, does she fit in or is she often alone?

A wellness exam is not complete without addressing sex and sexuality. No matter how you slice it, talking about sex with a complete stranger will never be easy. Using the questionnaire to bring up the topic helps. Start with generalizations about the risks of unprotected sex and general statistics of sexually transmitted infections in teenagers. Next, a general statement about abstinence is important so that teens realize it is an option. Review the common birth control methods and their risks. Encourage him to have at least one adult that he can trust to discuss delicate issues with and to return to your office if other issues arise.

Teenagers also are under the belief that they are invincible and that bad things only happen to other people. Discuss the leading cause of death in teenagers so they understand the reality of risk taking. Talk about date rape and physical abuse amongst teen couples. In a study done in California, 35% of teens questioned had experienced some form of violence with-in their relationships (Social Work 1986;31:465-8)

Knowing the laws that govern what advice can be given and what information can remain confidential is imperative. A great resource in understanding the basic laws that protect the physician and the patient’s rights is guttmacher.org/statecenter/spibs/spib_OMCL.pdf. Most states provide an online version of their laws governing teens and medical practice.

Establishing a rapport with your teenage patients can be very rewarding. Many teenagers are in search of a listening ear and need guidance in this new and critical era of their life. With a little planning and practice, you will provide with ease the information to help them make good decisions. It is important that we are equipped and ready because you may just save a life!

Dr. Pearce is a pediatrician in Frankfort, Ill. E-mail her at [email protected]. Go to pediatricnews.com to view similar columns.

It is important to recognize that as pediatricians we have the unique opportunity to see to the lives of a very vulnerable group of people known as teenagers.

We can all relate to the discomfort of the stone-faced teenager with one-word answers and one foot out the door. There is usually a parent present who is answering all of the questions, and if you are lucky, the patient may put the cell phone down long enough to get an eye exam in, but, we must realize that the 15 minutes of captive audience could be the most important 15 minutes of the teen’s life.

Before we start our exam, we should have a plan in place for what topics we should be addressing. Every thorough physical should include a screen on drugs and alcohol, depression, sexual activity, and violence. In a busy practice, it seems impossible to address these issues in a time-conservative manner, but if we plan ahead, we can be thorough, casual, and informative.

First, you must analyze your own style. If having these discussions is uncomfortable for you, then attempting them without a plan will be disastrous. Many pediatricians just choose to avoid the entire discussion and hope that the parent is parenting and will address the major issues. But fewer than half of all parents talk to their children about the issues that they are faced with daily, and a great majority are ill-informed, or driven by their own beliefs.

First, pediatricians must make a list of hot topics to be discussed. Review the most current data and how they are affecting the teens in your area. Next, whether your talking style is comfortable or not, having a questionnaire that introduces each topic is always helpful (Am. J. Psychiatry 1995;152:1601-7

Lastly, have teenagers come in by themselves. Parents cannot help themselves and will always speak for their children, and most teens will not ask questions that they don’t think their parent will approve of or that relate to private family issues. So, you must set the stage for a comfortable talking environment. By having the questionnaire available, you can use it as a guide to see what issues are affecting the patient.

Knowing current information is also imperative to a good wellness exam. Know what the latest drugs are being used by the teens in the area, and know the street names of drugs (drugabuse.gov/drugs-abuse). Where do the local teens hang out? Major issues happening at the local high schools can help guide your conversations and build trust as patients begin to see you as an active and involved leader in the community.

Depression affects 8% of teens every year. Therefore, there is a guarantee that at least a handful will present in your office every year. Asking the right questions is key to getting helpful answers. Be direct, ask, "Have you ever, or are you now having suicidal ideation?" Over 90% of children and adolescents who commit suicide have a mental disorder (J. Clin. Psychiatry 1999;60 (Suppl. 2):70-4). There is a Web site supported by the American Academy of Pediatrics that has questionnaires to assist in identifying symptoms of depression (brightfutures.aap.org). Knowing the family history of psychiatric disorders can be very helpful in guiding the physician of what questions to ask. Many teens are fearful that they may be having symptoms of a psychiatric disorder, but are too afraid to ask, given the stigma that goes along with it.

Address issues of self-image. If patients are overweight, give tips on healthy eating and exercise. Develop a nutritional plan and track a patient’s progress by having her follow up. Allow her to discuss what make her feel sad or uncomfortable. How is she interacting with her peers, does she fit in or is she often alone?

A wellness exam is not complete without addressing sex and sexuality. No matter how you slice it, talking about sex with a complete stranger will never be easy. Using the questionnaire to bring up the topic helps. Start with generalizations about the risks of unprotected sex and general statistics of sexually transmitted infections in teenagers. Next, a general statement about abstinence is important so that teens realize it is an option. Review the common birth control methods and their risks. Encourage him to have at least one adult that he can trust to discuss delicate issues with and to return to your office if other issues arise.

Teenagers also are under the belief that they are invincible and that bad things only happen to other people. Discuss the leading cause of death in teenagers so they understand the reality of risk taking. Talk about date rape and physical abuse amongst teen couples. In a study done in California, 35% of teens questioned had experienced some form of violence with-in their relationships (Social Work 1986;31:465-8)

Knowing the laws that govern what advice can be given and what information can remain confidential is imperative. A great resource in understanding the basic laws that protect the physician and the patient’s rights is guttmacher.org/statecenter/spibs/spib_OMCL.pdf. Most states provide an online version of their laws governing teens and medical practice.

Establishing a rapport with your teenage patients can be very rewarding. Many teenagers are in search of a listening ear and need guidance in this new and critical era of their life. With a little planning and practice, you will provide with ease the information to help them make good decisions. It is important that we are equipped and ready because you may just save a life!

Dr. Pearce is a pediatrician in Frankfort, Ill. E-mail her at [email protected]. Go to pediatricnews.com to view similar columns.

It is important to recognize that as pediatricians we have the unique opportunity to see to the lives of a very vulnerable group of people known as teenagers.

We can all relate to the discomfort of the stone-faced teenager with one-word answers and one foot out the door. There is usually a parent present who is answering all of the questions, and if you are lucky, the patient may put the cell phone down long enough to get an eye exam in, but, we must realize that the 15 minutes of captive audience could be the most important 15 minutes of the teen’s life.

Before we start our exam, we should have a plan in place for what topics we should be addressing. Every thorough physical should include a screen on drugs and alcohol, depression, sexual activity, and violence. In a busy practice, it seems impossible to address these issues in a time-conservative manner, but if we plan ahead, we can be thorough, casual, and informative.

First, you must analyze your own style. If having these discussions is uncomfortable for you, then attempting them without a plan will be disastrous. Many pediatricians just choose to avoid the entire discussion and hope that the parent is parenting and will address the major issues. But fewer than half of all parents talk to their children about the issues that they are faced with daily, and a great majority are ill-informed, or driven by their own beliefs.

First, pediatricians must make a list of hot topics to be discussed. Review the most current data and how they are affecting the teens in your area. Next, whether your talking style is comfortable or not, having a questionnaire that introduces each topic is always helpful (Am. J. Psychiatry 1995;152:1601-7

Lastly, have teenagers come in by themselves. Parents cannot help themselves and will always speak for their children, and most teens will not ask questions that they don’t think their parent will approve of or that relate to private family issues. So, you must set the stage for a comfortable talking environment. By having the questionnaire available, you can use it as a guide to see what issues are affecting the patient.

Knowing current information is also imperative to a good wellness exam. Know what the latest drugs are being used by the teens in the area, and know the street names of drugs (drugabuse.gov/drugs-abuse). Where do the local teens hang out? Major issues happening at the local high schools can help guide your conversations and build trust as patients begin to see you as an active and involved leader in the community.

Depression affects 8% of teens every year. Therefore, there is a guarantee that at least a handful will present in your office every year. Asking the right questions is key to getting helpful answers. Be direct, ask, "Have you ever, or are you now having suicidal ideation?" Over 90% of children and adolescents who commit suicide have a mental disorder (J. Clin. Psychiatry 1999;60 (Suppl. 2):70-4). There is a Web site supported by the American Academy of Pediatrics that has questionnaires to assist in identifying symptoms of depression (brightfutures.aap.org). Knowing the family history of psychiatric disorders can be very helpful in guiding the physician of what questions to ask. Many teens are fearful that they may be having symptoms of a psychiatric disorder, but are too afraid to ask, given the stigma that goes along with it.

Address issues of self-image. If patients are overweight, give tips on healthy eating and exercise. Develop a nutritional plan and track a patient’s progress by having her follow up. Allow her to discuss what make her feel sad or uncomfortable. How is she interacting with her peers, does she fit in or is she often alone?

A wellness exam is not complete without addressing sex and sexuality. No matter how you slice it, talking about sex with a complete stranger will never be easy. Using the questionnaire to bring up the topic helps. Start with generalizations about the risks of unprotected sex and general statistics of sexually transmitted infections in teenagers. Next, a general statement about abstinence is important so that teens realize it is an option. Review the common birth control methods and their risks. Encourage him to have at least one adult that he can trust to discuss delicate issues with and to return to your office if other issues arise.

Teenagers also are under the belief that they are invincible and that bad things only happen to other people. Discuss the leading cause of death in teenagers so they understand the reality of risk taking. Talk about date rape and physical abuse amongst teen couples. In a study done in California, 35% of teens questioned had experienced some form of violence with-in their relationships (Social Work 1986;31:465-8)

Knowing the laws that govern what advice can be given and what information can remain confidential is imperative. A great resource in understanding the basic laws that protect the physician and the patient’s rights is guttmacher.org/statecenter/spibs/spib_OMCL.pdf. Most states provide an online version of their laws governing teens and medical practice.

Establishing a rapport with your teenage patients can be very rewarding. Many teenagers are in search of a listening ear and need guidance in this new and critical era of their life. With a little planning and practice, you will provide with ease the information to help them make good decisions. It is important that we are equipped and ready because you may just save a life!

Dr. Pearce is a pediatrician in Frankfort, Ill. E-mail her at [email protected]. Go to pediatricnews.com to view similar columns.