Straight Health Talk with Teens

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In the January 2009 issue of the Journal of Adolescent Health it was reported that young people had a better perception of their provider when they were able to discuss sensitive subjects. What remains to be studied is whether those discussions will result in better health outcomes, I believe they will.

National treatment guidelines recommend that all teens and young adults have annual, confidential visits with primary care providers (PCPs). The purpose of these visits is to screen and counsel them about multiple risk behaviors.

Critical to this type of screening is creating a sense of trust, having the ability, and allowing enough time to discuss sensitive subjects. The following is what 358 young people had to say when asked about their experience with the primary care providers they saw.

What the teens were asked.

  • Overall, do you feel that during today’s visit your doctor/nurse practitioner understood the problem you wanted to discuss at this visit?
  • Overall, do you feel that during todays visit your doctor/nurse practitioner helped ease your mind in terms of your worries?
  • If there were choices to make about any treatments that may have been discussed today, how often do you think this doctor/nurse practitioner would ask you to help make the decisions?
  • How often does this doctor/nurse practitioner give you some control over your treatment?
  • How often does this doctor/nurse practitioner ask you to take some of the responsibility for your treatment?

Directly after the visit the teens were asked to answer “yes or no” to whether they were alone during the visit, whether they would have liked more time with the provider and if the visit included a discussion of the following:

7 sensitive subjects

  1. Getting into trouble for behavior
  2. Mood
  3. Getting along with other people
  4. Parent mood or feelings
  5. Family stresses or problems
  6. Sexuality or birth control
  7. Drugs, tobacco, or alcohol.

What the teens answered.

  • 76.2% agreed or strongly agreed that the PCP understood his or her problems.
  • 64.5% agreed or strongly agreed that the PCP eased his or her mind
  • 60.3% reported that the PCP often or very often allowed him or her to make treatment decisions
  • 56.9% reported that the PCP often or very often gave him or her control over treatment
  • 61.4% reported that the PCP often or very often asked him or her to take responsibility for treatment
  • Female PCPs got higher satisfaction scores than male PCPs

On their answers to sensitive subject questions:

  • Subjects had higher odds of agreeing or strongly agreeing that the PCP understood his or her problems or eased his or her mind when the visit included the discussion of one or more sensitive topics.
  • When the visit included the discussion of one or more sensitive topics, the subjects also had higher odds of reporting that the PCP “often” or “very often” asked them to make treatment decisions, gave them control over treatment, and asked them to take responsibility for treatment.
  • Subjects who visited a male PCP had lower odds of reporting that the PCP understood his or her problems or asked them to make their own treatment decisions.

So how well did PCPs do discussing sensitive subjects with the 358 subjects in this study?

  • 77% of visits included the discussion of one or more sensitive subject.
  • 21% of visits included the discussion of only one subject.
  • 19.3% of visits included one sensitive topic and one additional subject.
  • 17.3% of visits included two additional subjects.
  • 12.2% of visits included three additional subjects.
  • 12.6% of visits included four additional subjects.
  • 7.1% of visits included five additional subjects.
  • 10.2% of visits included six additional subjects (or all seven).

My thoughts as a nurse practitioner and PCP.

We can do better.

When I was a teen and young adult I knew nothing – and I mean nothing – about health, medicine, sex, my body or much else. It was distressing and a source of a lot of anxiety for me.

I still remember that, so now that I’m a health professional, I encourage all the teens and young adults I see to ask me questions about anything – and I mean anything.

I tell them, “I’m not your parent, your teacher, or your boss. There are very few things I haven’t seen or at least heard about so ask me anything.” It doesn’t matter what the subject is – sex, STDs, anxiety, depression, relationships, school or job problems, their aspirations – whatever. I tell them that I am impossible to embarrass and there is nothing that is too embarrassing to ask about.

I think everyone deserves a private place to ask private questions. As a Nurse Practitioner and PCP I feel it is my obligation and responsibility to provide such a place for all my patients, not just teens.

My message to teens and young adults.

If you are a teen or young adult reading this, here’s my advice:

  • You are on the threshold of becoming an adult. You should expect and receive respectful and confidential care in which your dignity is always protected.
  • If you do not receive this you are with the wrong provider and should seek care elsewhere without apology.
  • Negotiating an adult world is fraught with contradictions and confusion and will remain so throughout your life.
  • Always trust yourself and your own instincts. You will know when you are with a provider who will be a partner and ally to help you stay healthy and safe.

Anyone – young or old – have any thoughts about how we can do a better job taking care of our young people?

This information is offered for educational purposes only and is not intended to diagnose, prescribe or treat. For that please seek direct care from a health professional.

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