Gain the trust of teenage patients

Working with teenagers offers both challenges and rewards to the registrar, suggests Dr Tillmann Jacobi

A sense of trust and confidentiality is vital for young people who may be dealing with issues such as sexuality, relationships, drug use and self-esteem
A sense of trust and confidentiality is vital for young people who may be dealing with issues such as sexuality, relationships, drug use and self-esteem

Teenagers are usually a healthy group in a practice population. In general, they tend to see the GP only about two to three times a year. In many cases these consultations are for minor medical issues, for example skin problems, hay fever or sports injuries.

Recent evidence suggests that consultations with children and teenagers tend to be 20 per cent shorter than those with adults.

The role of the GP registrar

As a registrar you may have more time per appointment with a teenager and they may make use of the fact that you are only with the practice temporarily.

You do not know the entire family, so you are less likely to have conflicts of interest and any consultation with you will have less impact on the long-term professional relationship with the teenage patient. However, if you do establish a good relationship, it could also be frustrating when you have to leave.

Relationships and sexuality

Some of the more complex issues that teenagers will consult about are relationships and sexuality (including contraception, STIs, abortions, risks of emotional or physical abuse and consent issues regarding sex), self-discovery, self-esteem and interacting with their peers, exposure to drugs, and acts of self-harm.

In most cases of teenage pregnancy, the patient will have seen a GP at least once in the preceding 12 months, and a certain proportion will have indicated the need for information or help regarding contraception. 

Mental health issues

There are a variety of mental health issues to look out for in young people. The self-reported rate of psychiatric morbidity is about seven times higher than what healthcare professionals detect and record. Many mental health issues in younger children are not recognised by GPs unless the parents express additional concern.

Young people experience depression, obsessive-compulsive disorder, anxiety and schizophrenia. Some signs of mental illness can be expressing a drug problem or an abusive relationship. There is evidence that the small number of teenagers who attend the surgery frequently have far more psychiatric, psychosomatic and psycho-social concerns, which are negative predictors for future outcomes if not detected and addressed.

Three-way consultations

Be aware of the likelihood and the implications of three-way consultations when teenagers come to  your surgery either with their parents or when they bring a friend.

Confidentiality and trust

It is vital for teenage patients to have a sense of trust and confidentiality. They also do not want to be judged or patronised. Trust them, take their problems seriously and do not rush them. Include a few questions about peers and school because problems in either area indicate more complex and possibly serious problems. Always try to offer a genuine ‘anything else?’ at the end of a consultation.

However, if you notice that a problem will need the involvement of parents or other healthcare professionals or services, make sure that you communicate this calmly and clearly before going ahead.

Difficult consultation

Always encourage teenagers to share concerns and conditions with parents or other family members they can trust. If there are genuine and severe conflicts you could, depending on the local facilities, mention that from the age of 16 teenagers could register with a different surgery than their parents, although this may be impractical in emergencies.

If you think that the teenager is consulting because of a difficult situation then you could schedule a consultation with the teenager and the parents. Consider a double appointment if you think you’ll need more time.

As a registrar you can help create a friendly and welcoming atmosphere for teenagers in the surgery. In a survey by the Brook Advisory Centre, 78 per cent of respondents said that it would be good to have a specialist GP for teenagers.

Dr Jacobi is a salaried GP in York. He qualified as a GP in February 2005

Learning points

Points to keep in mind when teenagers come to the surgery

Common problems for teenagers include sexual health and relationships.

Other issues include with emotional or physical abuse, self-discovery, self-esteem, interacting with their peers, and exposure to drugs or acts of self-harm.

Of those teenagers who become pregnant, most will have seen a GP at least once in the preceding year.

Concerns and problems related to finances can become a real issue.

Mental health problems include depression, OCD, anxiety and schizophrenia.

Beware of three-way consultations where a teenager brings a parent or friend to the surgery.

References

Jacobson L D, et al. Is the potential of teenage consultations being missed? A study of consultation times in primary care. Fam Pract 1994; 11: 296–9

Sayal K, Taylor E. Detection of child mental health disorders by general practitioners. Br J Gen Pract 2004; 54: 348–52.

Kramer T, et al. Which adolescents attend the GP? Br J Gen Pract 1997; 47: 327

Brook Advisory Centre at www.brook.org.uk/content/M1_aboutbrook.asp

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