Your teen is too old to go to the pediatrician but too young for a doctor who treats adults. This is a dilemma faced by most parents. The answer may be an adolescent medical specialist.

“I’m not going to the doctor,” thirteen-year-old Sam told his mother. “I don’t care if my stomach falls out.” But when Sam threw up for the third time that week, his mother insisted. “What is it that’s bugging you about getting help?” she demanded. “I am NOT sitting in that waiting room with a bunch of toddlers reading Spongebob Square Pants,” he fumed. “That’s final.”

If your teenager complains that she or he no longer likes going to the “kid doctor,” but you don’t feel that a primary care physician would have either the bedside manner or the experience to deal with a teenager, an adolescent medicine provider may be just what the doctor ordered.

Adolescent medicine specialists—pediatricians, internists, or family medicine practitioners who have undertaken an additional three-year fellowship in adolescent healthcare—are filling the niche between pediatrician and primary care practitioner. Most insurance plans consider these doctors the same as primary care physicians – since most of them are also either PCPs or internists. Depending on your plan, this would mean that you might not need a referral to see an adolescent medicine provider. However, you should keep in mind that many insurance plans do not cover some of the services these physicians provide, such as counseling, substance abuse, or unusual treatments like growth hormone injections.

These specialists can:

• Offer routine age-appropriate screenings and exams
• Provide basic gynecological care and advice for a girl reaching puberty
• Help teen boys with the transition through puberty and growth spurts
• Deal with psychosocial and emotional issues
• Act as facilitator for confidential talks with both sexes on STDs, smoking, birth control, and risk-taking behaviors such as prescription or street drug abuse

Mom’s gynecologist is not a substitute for the pediatrician because he or she cannot meet all the medical needs of a girl. Nor can a general practitioner always meet the needs of a teen boy. The healthcare provider a teen requires now is part medical expert, part counselor, and always, trusted ally.

“Adolescent medicine is technically defined as healthcare starting at the onset of puberty,” says Andrea Marks, M.D., an adolescent medicine specialist in private practice in New York City, and a member of the Society for Adolescent Medicine. The majority of her patients are individuals in high school and college—those who want to take that next step in separating their healthcare decisions and discussions from mom and dad.

Right to Privacy
Experts stress that this separation is critical. While many pediatricians can adequately care for and counsel teens confidentially, adolescents often crave their own “grown-up” doctor without a parent present in the exam room. They need to discuss issues privately without making their parents feel that they are trying to hide something.

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“We make it a strict point to uphold their confidentiality,” says Dr. Marks, who stresses that this trust between doctor and patient makes it easier to discuss touchy, yet crucial, subjects and get truthful answers to tough questions. “It is a scary time, when your child is maturing, starts experiencing the outside world and, at the same time, becomes more private. At the first visit (often, at follow up visits), I tell my patients that what they share with me is completely confidential, except if the matter is very serious, in which case we will talk together about how to inform their parents. I assure patients that I will never call their parents behind their backs. At the end of the first visit, I have parents join the conversation, and repeat this policy and assure parents that they may call me, but should always tell their child first. My threshold for involving parents depends on the patient’s age, maturity, stability, and other factors. It usually works out fine.

“This way, the teen knows that the doctor and their parents may speak to each other, but only with the child’s knowledge. Likewise, parents know that they will be informed if something serious is going on.

Many times, these doctors can simply take the stigma out of awkward health issues for teens by explaining that they are a normal part of growing up, opening the door to future communication between the parent and child.

Embarrassment over certain health issues can lead to avoidance, and lack of care. A study conducted by the University of Rochester of more than 6,700 teenagers found that one third did not get the medical care they needed, often because they were afraid to tell their parents about health-related problems, such as depression, sexuality, or puberty-related concerns.

Getting the Care They Need
There are many situations where a teen wants care but won’t go because she’s embarrassed, she thinks her parents will be angry, or family issues are very complex and she fears the consequences. For example, a girl who has irregular menstrual periods may fear she is pregnant, but may be unwilling to ask for a doctor’s appointment because she fears her parents’ disapproval.

But it is crucial that young girls get regular medical care. Data from the Alan doctor Guttmacher Institute, a nonprofit organization focused on sexual and reproductive health research, shows that nearly 61 percent of all teenage girls have had sex by the time they turn eighteen, and that over one-fifth of all cases of STDs in the US are contracted by adolescents and young adults. Many STDs have no symptoms and, without proper medical diagnosis, can increase the risk of cervical cancer and fertility problems in the future.

Sex isn’t all that the experts worry about. A 2004 National Survey on Drug Use and Health showed that more young women than men started using marijuana, alcohol, and cigarettes in the previous two years. According to the National Center on Alcohol and Substance Abuse at Columbia University, male and female ninth graders are just as likely to drink (40 percent vs. 41 percent) and to binge drink (22 percent vs. 20 percent). More girls than boys start smoking cigarettes as teens, often believing it will help to control their weight. It is well known that the vast majority of those with debilitating eating disorders are adolescent girls.

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Boys may not see a doctor quite as often as do girls, but like girls, they need a doctor they can talk to and trust. They may be mortified by their own hormonal changes (mothers may tease a son who is suddenly washing the sheets without being asked) or may not want to discuss sharing birth control responsibilities with a girlfriend. Boys of this age also want a doctor attuned to their medical and developmental needs in a setting that is age-appropriate. In addition to issues related to puberty and changing genitalia, boys often have acne, weight concerns, depression, substance-abuse related issues, and a host of other medical concerns.

Good Teen Healthcare = Good Life Choices
If a doctor asks the right questions, assures confidentiality, is nonjudgmental and seems to understand the teen’s environment (peers, school issues, etc.), the teen is much more likely to engage in a sincere conversation about risky behavior, be it cigarette smoking, sex, alcohol, or drug use. A trusted doctor is in a great position to act as an influencer to get teens to consider making positive changes. The best way to do this is for the doctor to follow the patient. She might suggest, “See how you do with quitting smoking and let’s meet in a few weeks. Then we can talk about any problems you are having.”

Dr. Marks adds, “Experience shows that the right care will make them less likely to engage in risky behaviors and more likely to develop good lifelong habits. It’s all about the relationship!”

The Right Care, From the Right Doctor
What types of treatments do adolescent health specialists provide?

Adolescent health specialists provide adolescents and young adults with comprehensive care and treatment for a variety of problems and conditions, including:

• Physical exams required for driver’s permits, college entrance, and sports participation
• Sports medicine and orthopedic problems, such as scoliosis
• Growth and development issues
• Acute or chronic illness, from strep throat to asthma, diabetes, or cerebral palsy
• Headaches, chest pain, and other aches
• Gynecologic and reproductive health/sexuality issues
• School, learning, and attention problems
• Nutrition, obesity, and eating disorders
• Drug, alcohol, and tobacco use prevention and counseling
• Psychosocial problems including depression, stress, anxiety, self-esteem, and sleep problems
• Acne and other skin conditions

According to individual state law pertaining to adolescents and confidentiality, certain health care issues related to reproductive and mental health can be assessed and treated confidentially. To learn more, read the whole brochure from the American Academy of Pediatrics.

By Alyson O’Mahoney