Adolescent Medicine
Foreword K n o w You r A u d i e n c e
Joel J. Heidelbaugh, MD, FAAFP, FACG Consulting Editor
Clinicians in primary care practices encounter adolescent patients on a daily to weekly basis for a variety of reasons, ranging from acute to chronic conditions, well examinations, and reasons for which their parents or guardians have brought or sent them in. As the years pass by and my expertise theoretically grows, I find it increasingly challenging to adequately address all of the appropriate acute and screening provisions necessary for adolescents in a single office visit. Even if an adolescent presents for an acute issue, due diligence tells me that I should ask him or her about 20-odd questions to assess their safety and promote the best health status for them that I can offer. Then, I have to hope that the adolescent can believe, understand, remember, and integrate the information. So, I often reflect upon some great advice that my medical school advisor once gave me relative to patient encounters: know your audience! Do you remember going to the doctor when you were an adolescent? Odds were, that you didn’t want to be there, conversed and interacted with the clinician very little, and freaked out over the prospect of any form of a “sensitive” examination. This is likely the typical response from most teenagers. Was the visit for a sports physical? To catch up on immunizations? For birth control or sexually transmitted disease testing that you didn’t want your parents to find out about? Clinicians are left with asking: “How many adolescents actually seek out health care clinicians on their own, without any pressure or guidance from an adult, to simply ask their doctor for help?” Of those, how many actually feel comfortable discussing their fears, embarrassments, and nightmares with their clinician? Every day, the lay press is riddled with accounts of children being bullied for being obese or gay, teenagers engaging in homicidal and suicidal behavior, and overdosing on illicit drugs. Rates of drug use among adolescents are skyrocketing due to increased availability of both prescription and narcotic substances. It seems as if attempts to “win the war on drugs” have not only failed, but have also left the doors wide open to our country’s middle schools, high schools, and neighborhoods.
Prim Care Clin Office Pract 41 (2014) xiii–xiv http://dx.doi.org/10.1016/j.pop.2014.06.003 primarycare.theclinics.com 0095-4543/14/$ – see front matter Ó 2014 Elsevier Inc. All rights reserved.
xiv
Foreword
This issue of Primary Care: Clinics in Office Practice provides an outstanding compendium of articles dedicated to adolescent medicine for primary care clinicians. This edition commences with the blueprints for health maintenance in adolescents, predicated upon normal growth and developmental parameters including psychosocial development, and highlights strategies to care for adolescents with developmental delay. The article entitled, “Parents and Family Matter: Strategies for Developing Family-Centered Adolescent Care Within Primary Care Practices,” provides key strategies on how to talk with adolescents and, more importantly, how to listen to them. Expert clinician authors provide current data-rich articles on how to approach the adolescent with suspected or documented eating disorders and body dysmorphism, caring for incarcerated adolescents, how to conduct a preparticipation sports physical, and how to evaluate and treat adolescents with substance dependence and mental illness. A provocative article takes an in-depth look at the role of technology in the daily life of the adolescent, surveying both potential pitfalls and opportunities for proactive health engagement. Articles highlighting teen violence, bullying prevention, and sexuality provide informative constructs for clinicians to engage adolescents and offer appropriate support, resources, and acceptance. The common thread in all of these articles allows for enhancement of communication between clinicians and their adolescent patients, perhaps the most important tenet in promoting health care in this group. I would like to compliment and thank Drs Shore, Leanza, and Chaisson for their extensive efforts in creating this unique and densely informative volume of articles dedicated to improving the health care of adolescents. This is truly an invaluable reference that has the potential to substantially improve outcomes in adolescent health care. I hope that the readers of Primary Care: Clinics in Office Practice will find this volume to be as engaging and didactic as I have. Joel J. Heidelbaugh, MD, FAAFP, FACG Departments of Family Medicine and Urology University of Michigan Medical School Ann Arbor, MI, USA Ypsilanti Health Center 200 Arnet Suite 200 Ypsilanti, MI 48198, USA E-mail address: [email protected]
Foreword K n o w You r A u d i e n c e
Joel J. Heidelbaugh, MD, FAAFP, FACG Consulting Editor
Clinicians in primary care practices encounter adolescent patients on a daily to weekly basis for a variety of reasons, ranging from acute to chronic conditions, well examinations, and reasons for which their parents or guardians have brought or sent them in. As the years pass by and my expertise theoretically grows, I find it increasingly challenging to adequately address all of the appropriate acute and screening provisions necessary for adolescents in a single office visit. Even if an adolescent presents for an acute issue, due diligence tells me that I should ask him or her about 20-odd questions to assess their safety and promote the best health status for them that I can offer. Then, I have to hope that the adolescent can believe, understand, remember, and integrate the information. So, I often reflect upon some great advice that my medical school advisor once gave me relative to patient encounters: know your audience! Do you remember going to the doctor when you were an adolescent? Odds were, that you didn’t want to be there, conversed and interacted with the clinician very little, and freaked out over the prospect of any form of a “sensitive” examination. This is likely the typical response from most teenagers. Was the visit for a sports physical? To catch up on immunizations? For birth control or sexually transmitted disease testing that you didn’t want your parents to find out about? Clinicians are left with asking: “How many adolescents actually seek out health care clinicians on their own, without any pressure or guidance from an adult, to simply ask their doctor for help?” Of those, how many actually feel comfortable discussing their fears, embarrassments, and nightmares with their clinician? Every day, the lay press is riddled with accounts of children being bullied for being obese or gay, teenagers engaging in homicidal and suicidal behavior, and overdosing on illicit drugs. Rates of drug use among adolescents are skyrocketing due to increased availability of both prescription and narcotic substances. It seems as if attempts to “win the war on drugs” have not only failed, but have also left the doors wide open to our country’s middle schools, high schools, and neighborhoods.
Prim Care Clin Office Pract 41 (2014) xiii–xiv http://dx.doi.org/10.1016/j.pop.2014.06.003 primarycare.theclinics.com 0095-4543/14/$ – see front matter Ó 2014 Elsevier Inc. All rights reserved.
xiv
Foreword
This issue of Primary Care: Clinics in Office Practice provides an outstanding compendium of articles dedicated to adolescent medicine for primary care clinicians. This edition commences with the blueprints for health maintenance in adolescents, predicated upon normal growth and developmental parameters including psychosocial development, and highlights strategies to care for adolescents with developmental delay. The article entitled, “Parents and Family Matter: Strategies for Developing Family-Centered Adolescent Care Within Primary Care Practices,” provides key strategies on how to talk with adolescents and, more importantly, how to listen to them. Expert clinician authors provide current data-rich articles on how to approach the adolescent with suspected or documented eating disorders and body dysmorphism, caring for incarcerated adolescents, how to conduct a preparticipation sports physical, and how to evaluate and treat adolescents with substance dependence and mental illness. A provocative article takes an in-depth look at the role of technology in the daily life of the adolescent, surveying both potential pitfalls and opportunities for proactive health engagement. Articles highlighting teen violence, bullying prevention, and sexuality provide informative constructs for clinicians to engage adolescents and offer appropriate support, resources, and acceptance. The common thread in all of these articles allows for enhancement of communication between clinicians and their adolescent patients, perhaps the most important tenet in promoting health care in this group. I would like to compliment and thank Drs Shore, Leanza, and Chaisson for their extensive efforts in creating this unique and densely informative volume of articles dedicated to improving the health care of adolescents. This is truly an invaluable reference that has the potential to substantially improve outcomes in adolescent health care. I hope that the readers of Primary Care: Clinics in Office Practice will find this volume to be as engaging and didactic as I have. Joel J. Heidelbaugh, MD, FAAFP, FACG Departments of Family Medicine and Urology University of Michigan Medical School Ann Arbor, MI, USA Ypsilanti Health Center 200 Arnet Suite 200 Ypsilanti, MI 48198, USA E-mail address: [email protected]
