Talking with Teens

Dr. Mary Fournier in Adolescent Medicine discusses talking with teens.

How do you broach talking to teen patients about risky behaviors and other concerns?

One way we broach it is that we just normalize it. We know that these are really important topics to discuss and evaluate during the adolescent years. We do it with all of our patients consistently. 

How do you make your patients feel comfortable during these visits?

My visits are not painful. My visits are really just chatting. I tend to do a pretty thorough history and physical with more focus on the history portion. I talk to patients in a way that assumes they’ll talk back. They’ll communicate effectively. I feel like if you give teens the respect and openness to talk about their health, they often will become very engaged, be honest, and work with you to keep them healthy.

We talk about their history. We learn that sometimes teens don’t know their own past or family medical history.

We always do a biopsychosocial history. This is really focusing on what are the aspects of the teen’s life that can make him or her at higher risk for challenging health consequences. We always talk about sexual activity or substance use and things like that.

We offer confidential care, which generally means at least a portion of every visit, if not the whole visit, is done with just the provider and the patient in the room. The parent is out of the room. That allows the teen to have a private conversation about their healthcare with their provider, which is really important from the provider’s standpoint to assess some of these more sensitive topics. It gives them a little bit of privacy and trust to disclose some things they might not want to disclose if their parents were around. On the flip side, it also is important for the teen because one of my roles as an adolescent provider is to help the teen learn how to become an adult and how to become the manager of their own healthcare after the age of 18. By having these little conversations during their adolescence about their health with their providers, they can learn to take a little bit more responsibility. With teenagers, it tends to be a bit tricky.

How does pediatric care evolve between early childhood and adolescence?

That navigation between the provider, patient, and parent relationship is important throughout the pediatric lifespan.

When they’re younger, the primary relationship is between the provider and the parent with the kid being kind of the focus of the care but not really a participant. During the adolescent years, that has to start changing to allow the teen to become a little bit more engaged. Again, we do this through confidential care. At least part of the care is confidential. I try to talk with my families about always encouraging open communication. I don’t want to be a secret keeper. There are some things that because of ethical or legal reasons I can’t disclose to families. I still want them to be part of the picture, and I encourage my parents and my teens to talk to each other and at least work on open communication, which can be a little bit challenging. Parents are often a very integral part of their teen’s healthcare even up until later adolescence, so it’s very important.