Acne, sexually transmitted diseases, and pregnancy are just a few of the topics that come to mind when discussing adolescent medicine. At least these are the ones I thought about prior to my residency training. I realized there were other issues, but never thought they were prevalent. Sure, I had heard about drugs, violence, depression, and suicide, but I never thought I would have to deal with them.
However, these are the very topics that must be addressed every day in practice. If they are not addressed or perhaps if they are not covered during every visit, then the few adolescents who really have these problems may be missed. Much of adolescent medicine is prevention. Health care providers must learn this to provide adequate care for adolescents.
While in residency training, we are exposed to adolescents who already are in drug treatment programs or juvenile detention or who already have a baby. Our goal should be to prevent them from ever reaching these points. Prevention includes counseling adolescents during each office visit. However, this should start before they reach adolescence, at sick visits and during physical examinations for sports. A quick interview with the adolescent alone may elicit some habits and behaviors associated with significant morbidity and mortality for adolescents. Our expression of interest or openness to adolescents can provide a window of opportunity for them to open up at that time or at a later visit.
Although it seems ideal to discuss these topics during health care visits, not all adolescents can be reached. Many come in only when they are ill or for physical examinations for sports. This leaves out the population of adolescents who are healthy and not involved in sports. There must be programs that reach out to this population in the community (eg, schoolbased clinics). Through these programs, we can work with those who are intimately involved in the teaching and care of adolescents.
School-based clinics throughout the country have recently been associated with a dramatic decrease in pregnancy and sexually transmitted disease.1-2 These clinics allow opportunities for treatment, education, and prevention. Teachers, physicians, social workers, and counselors can be involved in school-based clinics. In addition, parents can participate. With these combined efforts, we may be able to prevent adolescent involvement in drugs, unprotected sex, and other risk-taking behaviors.
As a resident, I was given the opportunity to participate in such community-based and school-based programs. I was exposed not only to the traditional organizations, such as drug treatment centers and juvenile detention centers, but also to preventive centers. These comprehensive centers illustrated the importance of prevention and the role health care providers can take while in residency and practice. We can participate in prevention in both the office and the community and practice adolescent medicine as true primary care physicians.
1. Frost JJ, Forrest JD. Understanding the impact of effective teenage pregnancy prevention programs. Farn Plann Perspect. 1995;27:188-195.
2. Mellanby AR, Phelps FA, Crichton NJ, Tripp JH. School sex education: an experimental programme with educational and medical benefit. BMJ. 1995; 311:414417.