Pediatric Annals

EDITORIAL 

A Pediatrician's View: "Beleive Me, It Hurts"

Robert A Hoekelman, MD

Abstract

Adolescent Medicine is a tough field of practice. Most adolescents don't want to visit a doctor, and when they do, they are more often than not reluctant to talk about their illness or to reveal their concerns about what might be wrong with them. Today's pediatricians are much more skilled at interviewing adolescents than were their predecessors. They are also much more knowledgeable about the ills of adolescents and how to diagnose and treat them.

Adolescents are much maligned as harborers of psychosoc ially-caused complaints and as patients who are less likely to have organic illnesses than are other pediatrie patients. This is simply not true. Our Guest Editor for this issue of Pédiatrie Armais, Paul G. Dyment, MD, along with five other adolescent medicine experts, presents six of the most common medical conditions that affect adolescents. All of these conditions - low back pain, chronic abdominal pain, anterior knee pain, recurrent chest pain, headaches, and infectious mononucleosis - are organic diseases that cause significant disability. Yet each diagnosis carries with it a psychogenic overlay that often takes precedence in the minds of parents, teachers, friends, and doctors - all of whom interact with adolescents who suffer these maladies. That is not surprising, because each disease has emotional effects - the same effects that accompany any illness that causes discomfort and is slow to heal.

The pediatrician's role when dealing with any of these problems in adolescents includes:

* Taking a thorough history from the patient and parents, and sometimes from the school teacher and school nurse, to determine the severity of the symptoms and the extent to which they interfere with normal activities at home and in school.

* Conducting a complete physical examination to pinpoint positive physical findings, to gauge the extent of loss of function, and to rule out other causes for the symptoms.

* Obtaining appropriate diagnostic tests to confirm the suspected diagnosis and to eliminate others from consideration.

* Consulting, when necessary, with subspecialists to substantiate the suspected diagnosis or to entertain others.

* Making a definitive diagnosis, whether it be organic, dysfunctional, or psychogenic, based on fulfillment of all diagnostic criteria for the disease in question. In some instances, this may take some time to do.

* Telling the patient and parents the exact nature of the illness and outlining a definitive treatment plan.

* Providing ongoing support to the patient, with assurance that advice and counseling will supplement specific therapeutic interventions and that sensitivity to and understanding of the patient's difficulties will be sustained.

* Maintaining an attitude of accepting new treatment modalities that may become available.

Perhaps most important in managing these patients is letting them know that you believe their pain is genuine and that they really do hurt.…

Adolescent Medicine is a tough field of practice. Most adolescents don't want to visit a doctor, and when they do, they are more often than not reluctant to talk about their illness or to reveal their concerns about what might be wrong with them. Today's pediatricians are much more skilled at interviewing adolescents than were their predecessors. They are also much more knowledgeable about the ills of adolescents and how to diagnose and treat them.

Adolescents are much maligned as harborers of psychosoc ially-caused complaints and as patients who are less likely to have organic illnesses than are other pediatrie patients. This is simply not true. Our Guest Editor for this issue of Pédiatrie Armais, Paul G. Dyment, MD, along with five other adolescent medicine experts, presents six of the most common medical conditions that affect adolescents. All of these conditions - low back pain, chronic abdominal pain, anterior knee pain, recurrent chest pain, headaches, and infectious mononucleosis - are organic diseases that cause significant disability. Yet each diagnosis carries with it a psychogenic overlay that often takes precedence in the minds of parents, teachers, friends, and doctors - all of whom interact with adolescents who suffer these maladies. That is not surprising, because each disease has emotional effects - the same effects that accompany any illness that causes discomfort and is slow to heal.

The pediatrician's role when dealing with any of these problems in adolescents includes:

* Taking a thorough history from the patient and parents, and sometimes from the school teacher and school nurse, to determine the severity of the symptoms and the extent to which they interfere with normal activities at home and in school.

* Conducting a complete physical examination to pinpoint positive physical findings, to gauge the extent of loss of function, and to rule out other causes for the symptoms.

* Obtaining appropriate diagnostic tests to confirm the suspected diagnosis and to eliminate others from consideration.

* Consulting, when necessary, with subspecialists to substantiate the suspected diagnosis or to entertain others.

* Making a definitive diagnosis, whether it be organic, dysfunctional, or psychogenic, based on fulfillment of all diagnostic criteria for the disease in question. In some instances, this may take some time to do.

* Telling the patient and parents the exact nature of the illness and outlining a definitive treatment plan.

* Providing ongoing support to the patient, with assurance that advice and counseling will supplement specific therapeutic interventions and that sensitivity to and understanding of the patient's difficulties will be sustained.

* Maintaining an attitude of accepting new treatment modalities that may become available.

Perhaps most important in managing these patients is letting them know that you believe their pain is genuine and that they really do hurt.

10.3928/0090-4481-19910401-04

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