American College of Physicians: Internal Medicine — Doctors for Adults ®

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Struggling to treat teens?
Try talking to them

From the May 2001 ACP-ASIM Observer, copyright © 2001 by the American College of Physicians-American Society of Internal Medicine.

By Phyllis Maguire

Atlanta—One thing hasn’t changed in thousands of years: the exasperation that teenagers inspire in their elders.

At an Annual Session presentation, “Sex, Drugs, and Rock and Roll: Has Adolescence Changed?”, Victor C. Strasburger, MD, quoted Aristotle, who said that youth is “prone to desire and ready to carry out any desire,” an observation he said still rings true.

“There is no other stage of life when you have to accomplish so much in so little time, which explains some of the shortcuts that teenagers take,” said Dr. Strasburger, an adolescent medicine physician and faculty member at Albuquerque’s University of New Mexico School of Medicine.

During his presentation, Dr. Strasburger explained that physicians who treat teenagers need to ask about those shortcuts, particularly ones that involve sexual behavior and drug use. “You have to ask teens for a sexual history and about specific drugs, starting with cigarettes and alcohol,” he said.

Current data show that roughly half of all high schoolers are sexually active, he said. More than 40% have tried cigarettes, he added, and almost 40% of male seniors admit to episodes of binge drinking.

Getting a history

Physicians can best get a history from teenage patients by using a nonjudgmental approach, Dr. Strasburger said. It helps to convince teens that any personal information will remain between the patient and the physician.

While physicians can treat both teenagers and their parents, Dr. Strasburger continued, parents must be told that physicians will not divulge their children’s confidential information unless they are likely to hurt themselves or others.

Dr. Strasburger notes that teens' vulnerability to psycho-social stress can make diagnosis and treatment decisions more difficult.

When treating adolescents, he said, physicians must be familiar with the wide range of normal adolescent growth patterns and physical characteristics. Dr. Strasburger treated one patient—a 14-year-old girl who weighed only 40 pounds—who had been seen by five different pediatricians and family physicians since she was 8 years old.

Because he knew that the teenager should be growing rapidly, he began looking for an underlying cause of her failure to thrive. He eventually realized the patient was suffering from Crohn’s disease. (None of the teen’s preceding practitioners had made the diagnosis.)

Stresses

Physicians who treat teenagers must also realize that their patients are beset by stresses, that lead to many more psychosomatic symptoms than adult patients have. For example, Dr. Strasburger treated a 15-year old boy suffering from abdominal pains, an episode the teen had experienced three years before. By the time Dr. Strasburger saw the him, the boy had already endured a colonoscopy, a sigmoidoscopy and two barium enemas, only to be told, “It’s all in your head.”

Dr. Strasburger ordered no new procedures, but began to see the boy once a week. He eventually learned that the patient’s grandmother, who had helped raise him, had died three years before. The trauma left the boy with psychosomatic symptoms from repressed grief that recurred at the anniversary of her death.

He pointed out that teens’ vulnerability to psychosocial stress often makes diagnosis and treatment decisions more difficult. To get clues about stresses affecting teenage patients, he said, physicians need to probe beyond mere physical symptoms.

Dr. Strasburger suggested asking patients about their grades, if their parents are going through a divorce, if a family member is seriously ill, if they have recently moved, or if they are having trouble with a romance, friendship or teacher.

He also warned physicians to remember that today’s teenagers are subject to new types of stress. Teens are bombarded by media images of violence and sexuality that often do not portray any consequences. These images, he said, have been proven to contribute to teen violence and early sexual activity.

In the face of growing stress and confusion, Dr. Strasburger concluded, teenagers need support from their physicians. “If you can talk to a teenager who is depressed, who is sexually active and wondering where to go for contraception, or who has a drug problem and wants to deal with it, that is real power,” he said.

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