Adolescence is an overlooked area for health promotion and disease prevention. Adolescents are considered healthy, but at least 20 percent have serious health issues. Many adolescent disorders and deaths are due to substance abuse, depression, accidental pregnancies, and sexually transmitted infections (STIs). One must note that open communication between the physician and the adolescent can find the root cause of these problems. Several guidelines emphasize the importance of psychological screening of adolescents. Studies suggest a shift from a family-focused care system to a different adult care system where the family physician (FP) is the primary health care provider for adolescents nearing age 20. Hence, the FP must understand the adolescent physical and mental development, environmental influences, and risk factors affecting their health and wellness.
What Are the Challenges Faced by Adolescents Regarding Family Physicians?
As compared to other age groups, adolescents underuse the health care system. The adolescent patient-FP relationship is mediated by various factors.
1. Less adolescent males visit FPs compared to their female counterparts. They also use emergency departments, walk-in clinics, community pediatricians, and the Internet as the primary care source. As a result, there is a lack of continuity that prevents a visit to the FP’s office.
2. The FP’s visits with teens are short, with limited effort on counseling or education. Research suggests that physicians give counseling on only 50 percent of the visits. Further, adolescents are more concerned about their physicians' characteristics than their system characteristics.
3. Another consideration regarding adolescent patients and FP is the relationship concerning healthcare management and decision-making, such as arranging appointments or seeing the physician alone.
4. As adolescent patients transition from family-centered care to adult care, the role of the FP in care coordination and management changes. Hence, both must behave as one unit during the transition phase.
5. Further challenges include the complexity of the illness, management of the patient at a tertiary hospital, accessibility to FPs, and the perceived role and importance of the FP.
6. One must note that teens prefer honest, knowledgeable, and experienced healthcare professionals. They want physicians to treat all patients equally, with confidentiality, and relate well to teens.
What Are the Five Premises to Be Used While Caring for Adolescents?
The five ‘F’s of adolescent care are:
Facts: Adolescents must have a clear recognition and understanding of their illness. The FP plays a crucial role in explaining the facts to them.
Fears: Adolescents may have certain fears about their illness or the effects on their life. Further, they may be worried about their body image, identity, companions, and other interpersonal relationships.
Fables: Adolescents may have wrong information about their illness. FPs should address them and clear the misinformation.
Family: The FP must explore the family-adolescent relationship. Further, communication issues and home conflicts must be settled.
Future: The FP must ask how the adolescent views the future. For the same, the FP must be accessible.
What Should Be the Approach of a Family Physician for Better Adolescent Health?
1. Trust: If adolescents do not trust physicians, it is difficult to discuss sensitive health concerns. In order to earn trust, the physician must be seen as the adolescent’s advocate. It should begin with an introductory meeting with the adolescent and the parents. It is crucial to establish the parents' concerns and obtain a family and medical history. Next, the parents must wait in the waiting room for a private conversation with the adolescent. The physician must perform a physical examination with an accompanying person and invite the parents back to discuss the findings.
2. Relationship: The adolescents must establish a rapport with the physician. If the parents express resistance, the physician must stress the importance of an adolescent-physician relationship. It is because the teen can confide and discuss future issues. Consent is implied by the nature of the disorder or the adolescent’s status in the absence of parents. However, consent laws vary, and practitioners should be familiar with them.
3. Motivational Interviewing: During a discussion with the adolescent, the conversation must begin with a non-threatening topic discussion. Further, it is beneficial if the topic is interesting for the adolescent. The goal is to identify potentially risky behavior endangering their health and assess their motivation to change it. Hence, a motivational interviewing technique gives feedback on risks and promotes responsibility for health and wellness.
What Is the Role of the Family Physician in Adolescent Health and Wellness?
A family physician can discuss many issues related to the health and wellness of an adolescent. Diet, physical appearance, and exercise topics have a universal appeal. It can help physicians discuss the changes that adolescents undergo in the future. However, the frequent conditions that require counseling in adolescents are:
1. Alcohol and Drug Abuse: Alcohol and drug abuse can lead to various emotional issues in adolescents. Also, adolescents are more prone to alcohol influence compared to adults. Most adolescents provide accurate information on substance abuse in a confidential and non-judgemental environment. Physicians must also deliver preventive messages at every visit.
2. Tobacco Use: About 25 percent of male adolescents use smokeless tobacco. Tobacco smoking also occurs in the background of other risky actions. Tobacco cessation programs have been effective in reducing smoking for several years. Hence, teen enrolment in a smoking cessation program is elementary. Furthermore, when adolescent patients do not use tobacco, the physician must provide positive reinforcement.
3.Sexual Activity: Teen pregnancy poses significant physical and mental problems. In adolescent females who delay prenatal care, high-risk pregnancies occur. Condoms and oral contraceptives are effective and well tolerated by teenage women. Furthermore, hormonal contraception is safe and effective. However, a family physician must begin pregnancy discussion before their sexual curiosity.
4. Physical Inactivity: Studies suggest that many adolescents are physically inactive, and exercise declines during adolescence. Adolescents should be counseled regarding physical activity. Physical activity and fitness reduce the risk of coronary artery disease (CAD), hypertension, obesity, diabetes mellitus, depression, and anxiety. A physician must emphasize increased daily physical activity and lifetime sports. Further, signs of excessive exercise, steroid use, or eating disorders are also pertinent to evaluate. Lastly, the physician must provide positive reinforcement to active adolescents and work to encourage health education programs.
Caring for adolescent patients can be frustrating and challenging. However, with proper guidelines, physicians and teens can work together. The family physician must take responsibility for improving adolescent patient health literacy. Also, to ensure continuity of care, pediatricians can encourage adolescents to see their family physician for primary health issues between specialist visits. Hence, family physicians can create a more sustainable world for adolescents.