For teens at risk, talk isn't cheap New list of AMA guidelines helps doctors get to the heart of youths' health problems

January 05, 1993|By Maryalice Yakutchik | Maryalice Yakutchik,Contributing Writer

State-of-the-art scans won't alert Dr. Marianne Felice if a 14-year-old patient is having unprotected sex. No gleaming machine will clue her into a 16-year-old's eating disorder.

In fact, technology often falls flat when it comes to uncovering the high-risk behaviors that are contributing to a worsening adolescent health problem.

Suicide rates are escalating, especially among white males; homicide rates among black males are alarming; greater numbers of middle-class females are being diagnosed with anorexia and bulimia; and all classes and races are affected by sexually transmitted diseases, substance abuse, accidents, unplanned pregnancies, obesity, poor self-image and sedentary lifestyles.

Dr. Felice, director of adolescent medicine at the University of Maryland, has stashed her stethoscope and listens instead to her young patients at risk.

"Certainly the things killing teen-agers are preventable," says Dr. Felice.

She has believed for years that talking with teen patients is as vital to their health as any examination. Now, that is also the official opinion of the American Medical Association, which recently released GAPS: Guidelines for Adolescent Preventative Services.

GAPS is a collection of 24 recommendations for physicians suggesting that practitioners as well as parents shift their fundamental focus from physical ailments to behavioral issues and from treatment to prevention.

According to Dr. Arthur Elster, director of the Department of Adolescent Medicine of the AMA, "Physicians and other health officials have a role in countering some health issues which continue to escalate. Until now, there's not been a delineated strategy about what health professionals can do in their own offices. The doctor's office is a vastly untapped resource" for adolescent health and the more it's used the less chance they will slip through the cracks.

At its most basic, GAPS recommends that adolescents from ages 11 to 21 have annual "preventative services visits."

"Teens are the orphans of the medical care system," Dr. Felice explains. Parents and doctors think they don't need health care if their throats aren't sore and arms aren't broken; for years people have presumed that adolescents are healthy.

But given the adolescent health crisis that has existed -- and has been worsening -- since 1985, she says, that is not the case.

The list of high-risk behaviors among adolescents in recent years is staggering. According to the AMA and the Centers for Disease Control:

* More than 50 percent of adolescent deaths are attributable to injuries from motor vehicle accidents, homicide and suicide.

* One in four adolescents in grades nine through 12 have thought seriously about attempting suicide; one in 12 actually attempt it.

* Suicide rates among 10- to 14-year-olds almost tripled in the past 20 years, and almost doubled among 15- to 19-year-olds.

* The homicide rate among 10- to 14-year-olds almost doubled in the past 20 years, and increased 20 percent among 15- to 19-year-olds.

* Currently, one in every three adolescents has used an illegal substance before the 10th grade.

* 54 percent of high school students have had sexual intercourse, 19 percent with four or more partners; only 48 percent of those sexually active report using a condom.

* 1 million teens become pregnant each year.

* Every day, more than 3,000 adolescents become regular smokers.

* More than half of adolescents lead inactive, sedentary lives.

* 440 adolescents were diagnosed with acquired immune deficiency syndrome in the 1980s. Because it can take several years for someone infected with HIV to develop AIDS, adolescents diagnosed today will probably be in their 20s before they develop AIDS.

As it stands now, a teen's asthma might be assessed at annual visits, and his immunizations brought up to date, but the exams need to go beyond that, says Dr. John Santelli, a reviewer of GAPS who will begin working with the city health department on JTC

behavioral prevention programs for adolescents. (Dr. Santelli is also a part-time faculty member in Maternal and Child Health at the Johns Hopkins School of Hygiene and Public Health.)

"We need to develop a whole profile of how the kid is doing in terms of physical, emotional and social health," he says.

A physician or parent will do absolutely no harm by broaching sensitive issues such as unprotected sex and suicide, says Dr. Oscar Taube, chairman of the Committee on Adolescents of the Maryland Chapter, American Academy of Pediatrics. (Dr. Taube is also medical director of the Pediatric Outpatient Department at Sinai Hospital.)

It's a myth that by questioning teens, you will plant the thought in their heads, he says. "If you ask and nothing is going on, you've done no harm, except perhaps to cause someone to blush a little."

"It's great to have guidelines to show how to go about it," says Dr. Santelli: "How to set up one's office to be adolescent-friendly and how to focus on the important things . . .

"If you really make an attempt to find out how they're doing, you rapidly find all kinds of issues."

The very nature of GAPS requires physicians to allot a precious -- and expensive -- chunk of time to each patient. "The [GAPS] guidelines are saying that the three-minute visit is not going to cut it with adolescents," says Dr. Felice. "You cannot shortchange the teen."

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