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Chapter 3 Index
A. General: |
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The Approach to the Adolescent Patient
Robert Pendergrast, MD - Adolescent Medicine
Introduction: In order for teenagers to feel welcome,
attention needs to be paid to the following:
- Have the office user-friendly; this includes the receptionists who
greet the patient, furniture that is age-appropriate, reading materials,
etc.
- Consider having patient fill out pre-exam questionnaires before going
into exam room.
- While there are different ways to do it, in general interview the
parent outside the room, interview the patient while fully dressed, do not
act rushed, never interrupt, examine child (with or without chaperone)
without parent in the room.
- Ask open-ended questions. This is difficult in a busy practice, but
necessary to get at the real reason the child is there.
- Allow the patient to list ALL current concerns before concentrating on
chief complaint.
Consent and Confidentiality: Laws vary by state. Be aware
of “mature minor doctrine.”
Psychosocial Maturation: Process
is one of ambivalence for the teen:
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Early Adolescence |
Middle Adolescence |
Late Adolescence |
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Self-Image |
Preoccupied with
Body changes |
Reestablishes body image; fantasy |
Realistic self-appraisal |
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Family relationships |
Define dependence/ independence limits |
major conflicts; struggles |
Transfer child-parent to adult-adult |
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Peer relations |
Peers counter
Instability |
strong need for identification |
More individual rather than group friends |
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Sexuality |
Self-exploration; Limited dating |
plural relationships; may have sex activity romantic fantasy |
Stable relationships
Plans for future
Commitments made |
Interview Techniques: Use open-ended questioning
A. HEADSS - OR BIHEADSS: Following this will help prevent you to
not omit key issues:
- BI: Body Image: “How do you feel about your body and the way it
has changed recently.”
- H: Home: “Tell me about your family - what happens when people
disagree in your family.”
- E: Education: “Tell me about school - what are you good at,
having trouble in?”
- A: Activities: “What do you do for fun; tell me about your
friends; where are you after school?”
- D: Drugs: Tobacco, other drugs: “Do you have concerns about
your usage, your families, etc?”
- S: Suicide: “How do you view yourself - happy, sad; have you
thought about harming yourself?”
- S: Sex: “What are you doing to protect yourself against
HIV/AIDS?”
B. CAGE Technique: If get a positive response for alcohol, or have
concerns in that area:
- C: Cutback: “Do you think you need to cutback on your
drinking?”
- A: Annoy: “Do people annoy you when they talk about your
drinking?”
- G: Guilty: “Has anything happened that you regret while you
were drinking?”
- E: Eye-opener: “Do you sometimes drink first thing in the
morning?”
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