Everyone's heard the old saying that teenagers "think they're immortal." That's one explanation for why they're less likely to go to the doctors than any other part of the U.S. population.
But is it true? As any teen can tell you, being a teenager is hardly carefree. Experts agree. While they statistically don't have a great number of medical problems, teenagers are exposed to a lot of risks, says Charles Irwin, MD, president of the Society for Adolescent Medicine and director of the Division of Adolescent Medicine at UCSF. Being a teen often means facing a lot of stress and hard choices about issues like using alcohol and drugs or having sex.
Despite the significant risks that teens face, Mary-Ann Shafer, MD, argues that teenagers are not always well-served by the traditional healthcare system and they can get stuck in limbo. "Teens reach a certain age where they're not kids, but they're not adults either, so neither the internists nor the classic pediatricians want to take care of them."
Shafer, who is associate director of adolescent medicine at UCSF, says that some teens are seeking out experts who specialize in treating teens, especially at centers like hers. And that's making not only teens happy, but their parents, too.
More Than Medicine
So what's wrong with continuing to see the family pediatrician as a teenager?
Often nothing. But according to Shafer and Irwin,, for a teen, hitting puberty can sometimes make the relationship with his or her pediatrician awkward. It may feel strange to ask your doctor about sex or drugs when, just a few years before, this same doctor was giving you lollipops after you got your shots. A teenager may find it hard to take herself seriously if she has to sit in a pediatrician's waiting room, surrounded by wailing toddlers, picture books, and stuffed animals. For many teens, it may just seem easier and less embarrassing to stay away from the doctor altogether.
But to negotiate the risks that teenagers face, they could really use the help. The teenage years are a short period of time with a profound impact on the rest of a person's life, according to Shafer. A lot of the behaviors and habits -- both good and bad -- that people have as adults develop when they are teens.
The emphasis in adolescent medicine isn't strictly medical. "The advantage for a teenager seeing an expert in adolescent health is that they have a physician who knows about not only the physiological issues of adolescence, but also the behavioral." Says Irwin.
Shafer agrees. "When I do a well-care visit with a teenager," Shafer says, "most of the time, I'm doing more than a physical." She's often talking with them about the issues they're worried about, including alcohol, drugs, and the risks of sex.
Teens Taking Charge
An advantage of teenagers seeing an adolescent health specialist is that they are encouraged to take the initiative and become responsible for their own health, instead of passively letting others take care of it.
Both Irwin and Shafer suggest that around the time a child reaches puberty, he or she should meet with his or her doctor and parents in what Irwin calls it a "transition interview." The doctor should explain how treatment will change, and parents will be encouraged to allow their children the medical privacy and confidentiality that they have with their own doctor. Gradually, teens are pushed to take more control of their health, learning to take medicine without being reminded and maybe scheduling their own appointments.
The added privacy and responsibility can breed a mature and trusting relationship between a patient and doctor, says Irwin. That's important, Shafer says, since comfort with a physician is crucial for a teenager.
Katie S., who is 13, agrees. She has recently changed doctors and now sees a physician who specializes in adolescent health. She likes their open and respectful relationship.
"Doctors that are used to treating younger patients may treat me as if I'm younger than I am, and as if I can't handle mature topics," she says. "Doctors who specialize in teen health ask me questions that apply entirely to me, and to no one else."
Still, teenagers are still minors, and Irwin and Shafer stress that their patient-doctor confidentiality has its limits. "If a young person is at risk or a danger to him or herself," says Shafer, "the parents will be brought in, too."
Will It Work for Me?
Going to an adolescent health specialist may not be for everyone. Some parents may simply feel uncomfortable with the loss of control over their children's health, and they may not like their kids talking about subjects like sex and drugs without their supervision. Irwin says that certain cultural and religious values are at odds with the notion of a teenager meeting with a doctor in private.
But while one might imagine that a lot of parents would be resistant to the idea of their children taking charge of their health, both Irwin and Shafer report few complaints from the parents of teenage patients.
"Most of the time, when you tell the parents that you're going to see their kid alone, the parents are really relieved" says Shafer. "They wanted it too, but didn't know how to ask."
Finding a Specialist
Unfortunately, the small number of specialty facilities like the one at UCSF will benefit only a minority of teens, and according to Irwin, there are only about 1,200 members of the Society for Adolescent Medicine in the country. The odds of finding one in your town are not very high.
However, the influence of adolescent medicine has been widely felt throughout the field of pediatrics.
"There's been a big movement within pediatrics to make sure that pediatricians are trained to treat young people up to 21," says Shafer. So even if you can't find a certified adolescent medicine specialist, you should be able to find a doctor with some expertise in treating teens.
Shafer says the easiest way to find a doctor who knows about adolescent medicine is to start in the pediatric group you're currently in, since there may be someone there who specializes in treating teens. If there isn't, Shafer suggests calling a local medical center or health organization or the American Academy of Pediatrics.
Teenagers should also be aware that they have the right to visit low-cost or free clinics, some of which are run by organizations like Planned Parenthood. It can be a good way to find out information privately, although Shafer cautions that they may not be well-funded and that teenagers may get very little continuity in their treatment.
Ultimately, Shafer and Irwin urge teens to use their initiative and exercise their right to good medical care.
"Teens should know that if they're not getting the help they need from their doctor, they have the right to go somewhere else," says Shafer. "There are plenty of doctors out there who really want to work with them."