|
Chapter 3 Index
A. General:
--Approach to the Adolescent Patient |
|
Managing Problem Health Behaviors in Adolescents
Robert Pendergrast, MD
Introduction: In order to manage health problems in
teenagers, information about sensitive topics must be elicited. Methods of
doing this should include using transitions from one topic to the next,
validating information, and using open-ended questions. After gathering
data, it must be managed properly, emotions recognized and handled, and only
then can the patient be educated and a treatment plan negotiated:
1. Eliciting Honest Information About Sensitive Topics: Use
an unhurried, non-judgmental method e.g. HEADS = home, education,
activities, drugs, sex:
| |
Good Approach |
Bad Approach |
|
Home: |
Where do you live/who lives
with you? |
Tell me about Mom and Dad |
|
Education: |
What are you good at/ not good
at?
|
How are you doing in school?
How are grades this year compared to last? |
|
Activities: |
What do you do for fun/ with
friends? |
Do you have any activities
after school? |
|
*Drugs:
|
Many kids your age have tried
drugs; have you and your friends tried them? |
Do you use drugs? What? |
|
Sex: |
Tell me about sexual
experiences you may have had. What do you do to protect yourself from
AIDS? |
Are you sexually active? Tell
me about your boyfriend/girlfriend? |
| *If get positive
answers in this area, go directly to CAGE: cut back, annoyed, guilty,
eye-opener: Two positive responses are indicative of a major problem.
(See previous page for CAGE details) |
2. Medical Interview Techniques: A Three-Function Model:
A. Gathering data: --use transitions such as “now I would like to move on
to....”
- validate information: explain why you need the information
- use open-ended questions and probe if need more information
B. Information management and handling of emotions:
- recognize patient’s emotions and reactions especially when hostile or
defensive. e.g. “You seem annoyed/angry that your parents brought you
here”
- xhibit genuine concern for the patient by providing support and
empathy.
- anticipate patient’s anxiety about sharing information. “I know this
may be difficult to talk about, but I would rather you give me accurate
responses”
C. Educating the patient and negotiating a treatment plan:
- give feedback of relevant data “I heard you say that....”
- arrive at closure by summarizing information, and give a follow-up
plan.
3. Intervention Talks Related to Stages of Behavioral Change:
based on Prochaska/DiClemente
- Precontemplation: create doubt, increase patient’s awareness of
risks/problems with behavior
- Contemplation: help weigh relative risks/benefits of behavior change;
evoke reasons to change
- Determination: help patient determine best course of action to change
behavior
- Action: help patient establish a clear plan of action to change
behavior
- Maintenance: help patient identify and use strategies to prevent
relapse
- Relapse: help patient renew process of change starting at
contemplation
Next Page |