From Wikipedia, the
free encyclopedia
Adolescent medicine is a
medical subspecialty that focuses on care of patients
who are in the
adolescent period of development. Patients have
generally entered
puberty, which typically begins between the ages of
9 to 11 for girls, and 11 to 13 for boys. A
primary care subspecialty, adolescent medicine
incorporates aspects of
psychiatry,
endocrinology,
sports medicine,
nutrition and
gynecology.
Issues with a high prevalence during
adolescence are frequently addressed by providers. These
include:
In addition, issues of
medical ethics, particularly related to
confidentiality and the right to
consent for medical care, are pertinent to the
practice of adolescent medicine.
Training
Adolescent medicine providers are
generally drawn from the specialties of
pediatrics,
internal medicine or
family medicine. The certifying boards for
these different specialties have varying requirements
for certification, though all require successful
completion of a
fellowship (a comprehensive list of which is
available through the Society for Adolescent Medicine
) and a passing score on a certifying exam.
The American Board of Pediatrics requires evidence
of scholarly achievement by candidates for subspecialty
certification, usually in the form of an original
research study.
Scope of
care
Providers of care for adolescents
generally take a holistic approach to the patient, and
attempt to obtain information pertinent to the patient's
well-being in a variety of different domains. This
approach, similar to the
biopsychosocial model, is encapsulated in the HEADS
assessment (for information on the development of this
tool, see Wikipedia article on HEADSS), which is a
screening acronym for adolescent patients. It includes:
-
Home -- how is the
adolescent's home life? How are his/her
relationships with family members? Where and with
whom does the patient live? Is his/her living
situation stable?
-
Education (or
Employment) -- how is the adolescent's school
performance? Is he/she well-behaved, or are there
discipline problems at school? If he/she is working,
is he/she making a living wage? Are they financially
secure?
-
Eating (incorporates body
image) -- does the patient have a balanced diet? Is
there adequate calcium intake? Is the adolescent
trying to lose weight, and (if so), is it in a
healthy manner? How does he/she feel about his/her
body? Has there been significant weight gain/loss
recently?
-
Activities -- how does the
patient spend his/her time? Are they engaging in
dangerous or risky behavior? Are they supervised
during their free time? With whom do they spend most
of their time? Do they have a supportive peer group?
-
Drugs (including alcohol
and tobacco) -- does the patient drink caffeinated
beverages (including energy drinks)? Does the
patient smoke? Does the patient drink? Has the
patient used illegal drugs? If there is any
substance use, to what degree, and for how long?
-
Sex -- is the patient
sexually active? If so, what form of contraception
(if any) is used? How many partners has the patient
had? Has the patient ever been pregnant/fathered a
child? Does the patient get routine reproductive
health checks? Are there any symptoms of a sexually
transmitted infection? Does the patient identify as
heterosexual, homosexual, or unsure? Does the
patient feel safe discussing sexuality issues with
parents or other caregivers?
-
Suicidality (including
general mood assessment) -- what is the patient's
mood from day to day? Has he/she thought
about/attempted suicide?
-
Some providers favor the addition
of Strengths to the list, in an effort to
avoid focusing on issues of risk or concern, and
reframe the patient interaction in a manner that
highlights resilience.
In addition to a detailed history,
adolescents should have a comprehensive physical exam on
a yearly basis. Developmental progression, including
assessment of
Tanner stage, should be noted, and appropriate
endocrinological work-up undertaken for patients that
fail to develop in an anticipated manner. Screening lab
tests, including a
complete blood count to screen for anemia, and
either a spot
cholesterol check or (ideally) a fasting lipid
profile to screen for
hyperlipidemia, should be obtained at least once
during adolescence. For patients who are sexually
active, particularly in areas of high prevalence or with
patients participating in higher-risk behaviors,
screening tests for sexually transmitted diseases
should be performed, including an RPR or VDRL
for
syphilis, screening for
gonorrhea and
chlamydia, and
HIV. Sexually active females should have a pelvic
exam (including a
Pap smear to screen for early signs of
cervical cancer), though the timing of the initial
exam following first intercourse and how aggressively
abnormal Pap smears must be followed up are subjects of
controversy within the field.
Health
centers
Many subspecialists practice as part
of general specialty clinics or practices. In addition,
many major metropolitan areas have clinics that offer
adolescent-specific care. A partial list includes:
New York
City
Los
Angeles
San
Francisco area
Boston
Philadelphia
Further adolescent medicine clinics
may be found by looking for a local resource from a
list of children's hospitals.
Professional Organizations
In addition to membership in the
organizations for their various specialties, adolescent
medicine providers often belong to
The Society for Adolescent Medicine and/or
the North American Society for Pediatric and Adolescent
Gynecology.
The Journal of Adolescent Health and The Journal
of Pediatric and Adolescent Gynecology are the
publications of the two organizations, respectively.
