Medico-legal: Top tips on treating teenage patients

The medico-legal pitfalls of treating teenage patients and how to avoid them. By Dr Marika Davies of the MPS.

Young patients may find it difficult to talk to healthcare professionals
Young patients may find it difficult to talk to healthcare professionals

Teenage patients pose a unique set of challenges to the GP. They may be reluctant to seek advice from an adult and do not go to the doctor as frequently as adults or as often as an adult would take a child. This means there may be limited opportunities to build relationships, make diagnoses and manage chronic conditions.

Key points
  • Young people are not 'mini-adults.' Consider specific training on treating and communicating with this age group.
  • If a young patient is reluctant to talk or to be examined, arrange a further appointment, either with or without an adult or friend to accompany them, depending on what makes the patient feel more comfortable about the appointment.
  • Avoid giving the impression (whether directly, through reception staff or in any other way) that young people cannot access healthcare services without a parent.
  • Continuity of care is important - seeing the same GP wherever possible is helpful to build relationships and recognise patterns.
  • Good record-keeping, including the reasons behind your clinical decisions, will assist with continuity of care and be invaluable if a complaint or claim arises.

1. Communication

Research by the Teenage Cancer Trust revealed that 33% of 13- to 24-year-olds found it difficult to speak to doctors about their health worries. The reasons given were embarrassment (68%), difficulty expressing themselves or describing what was wrong (42%) and fear the doctor would think they were stupid (31%).1

Anxiety, nervousness or self- consciousness may all delay these patients' presentation to a healthcare professional.

It is important to have a style of consulting that allows young people to feel comfortable when describing their symptoms and concerns.

The GMC says that effective communication between doctors and young people is essential to the provision of good care: 'You should take children's and young people's views seriously and not dismiss or appear to dismiss their concerns or contributions.'2 Make it clear that you are available to see young people on their own if they wish.

2. Considering cancer

Although cancer is the leading non-accidental cause of death in the 13 to 24 age group, it is extremely rare, so healthcare professionals may have a low level of suspicion for it.3

It is also difficult to diagnose. Early symptoms are likely to be attributed to common illnesses, such as infection, injury or psychological factors, which in most cases will prove to be the correct diagnosis.

Delays not only have an adverse impact on prognosis and pose a risk of litigation, but can also harm the doctor/patient relationship.

Keep good medical records, review earlier consultations and follow up previous presentations, even if the patient presents with another problem. Use safety-netting and consider investigation or referral for symptoms of common illness if they are persistent or do not improve after the expected period of time.

3. Compliance

Compliance can be another challenge when treating teenage patients, and chronic conditions such as diabetes and asthma can be particularly difficult to manage.

A good doctor/patient relationship is key. The GMC says: 'You should listen to and respect (the young person's) views about their health, and respond to their concerns and preferences.'2

If patients refuse to comply with monitoring, decisions about continued prescribing should be made after careful analysis and discussion with the patient about risks and benefits.

Be aware of support groups and liaise with the patient and their specialist to agree a mutually acceptable treatment plan.

4. Confidentiality

The GMC says 'without the trust that confidentiality brings, young people might not seek medical care and advice, or they might not tell you all the facts needed to provide good care.'2

A young person who is considered to have mental capacity is entitled to the same duty of confidentiality as an adult. If a parent seeks access to the medical records of a competent teenager, patient consent should be sought first.

In exceptional circumstances, for example if abuse if suspected, information may need to be shared without consent if there is a risk to the young person or to others.

5. Consent and contraception

At 16, a young person can be presumed to have the capacity to consent to treatment. A young person under 16 may have the capacity to consent, depending on their maturity and ability to understand what is involved, and the complexity of the decision to be made.

Contraception, abortion and STI advice and treatment can be provided without parental knowledge and consent to young people under 16, provided they understand the advice, cannot be persuaded to tell their parents, are likely to have sex with or without such treatment, and it is in their best interests.

  • Dr Davies is medico-legal adviser at the Medical Protection Society

References

1. Teenage Cancer Trust. Embarrassing bodies prevents teens seeking help (www.teenagecancertrust.org/)

2. GMC. 0-18 years: guidance for all doctors (October 2007). www.gmc-uk.org/

3. Teenage Cancer Trust. Improving Diagnosis. Report on improving the diagnostic experience of young people with cancer. www.teenagecancer trust.org/workspace/documents/ Teenage-Cancer-Trusts-Improving-Diagnosis-report.pdf

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