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Consultation Skills

Talking with Teenagers



Talking with teenagers is different

You may well have learnt a lot of consultation skills for the general adult patient.   And of course, a lot of this will help with talking with teenagers.  But teenagers are a particularly difficult group to get to open up – even if they are without their parents!   Of course, some are very talkative but many are not!   And many will not want to share their thoughts for fear of coming across as stupid, or you judging them in a paternalistic way!   So, this section highlights ADDITIONAL consultation microskills that can help.  (Oh, and you may get a teenager in the CSA!)

What is Teenage Health all about?

Teenage Health (age 14-18) is not just about spots, periods, dugs, drinking or smoking.  There’s a lot going on health-wise during the teen years – like too much growth in places they don’t expect – and it helps to have a medical person who understands.  Topics like reproductive health, drugs, eating disorders, irregular periods, mood changes, questions about sexual identity, and problems at home or school.  And don’t forget about the challenges of having dual cultural identities that teenagers from different ethnic backgrounds face.

Therefore, it is important that today’s generation of GP is able to talk to teenagers positively and sensitively.  It is important to know how best to communicate with cross cultural teens, equip them to handle stress, build self-esteem and resilience.

Did you know about half of teenagers have never talked to a doctor alone!

We would urge teenagers to start seeing a GP alone about 14 onwards because there are a lot of sensitive issues at this age that they would not openly discuss in front of their parents.   And a lot of what we need to focus on in terms of Teenage Health is prevention, not just treatment.  But a research study from America shows most only start coming to see a doctor alone at age 18 onwards.   Whilst the legal definition of an adult is 18 and anyone under is a minor, physiologically, a person does NOT mature just because the clock says they have turned 18!    A 15 year old can be more mature in attitude and behaviour than an 18 year old!  18 is an arbitrary age. An 18-year-old is not suddenly more mature.

And so it is crucial to see them at age 14 onwards.   Some even say it should be age 11 onwards because it is at this critical age that maturity starts to develop and we can influence this and prevent teenagers from getting into things like smoking, alcohol and drugs.    A GP may want to begin discussing topics such as mental health, sexual and reproductive health and exposure to drugs, alcohol or tobacco as early as 11 or 12 years old.  It really is about prevention.  Eighteen is not a magic number in terms of physical or cognitive development.  14 or 15 is more often when a teenager exhibits the ability to think about things differently and to understand long-term consequences to actions. The ability to then make good decisions continues to evolve even through the 20s.  It’s an opportunity to make them more aware of common problems kept hidden by teens like anxiety, depression and suicidal feelings.  These are age-appropriate conversations.  In so doing, we start changing the teenage culture and get them to open up and be comfortable with talking to the doctor.    Doctors need to talk to teenagers EARLIER, not just later when they’re already in trouble and firefighting!  There is a lot at stake in us getting it right. Teenagers deserve to be heard, they deserve to have a voice and they deserve to be able to talk to their GP alone

PS Have a look at your GP surgery.  Is there a poster indicating that teenagers will start having one-on-one time with doctors, to make parents aware of what’s coming?    If not, why not suggest it at the next Practice Meeting?

The Ripple Effect

When you throw a rock in a pond, the ripples start small and continue to spread farther than the eye can see. Harmful choices in the teen years can potentially create life-long health issues if those ripples continue to spread. Likewise, positive ripples and healthy choices set up a teen’s for future good health and success.  As GPs, if we are able to uncover the start of a negative ripple effect, we can work to stop the spread of those ripples and counteract them with a positive ripple effect.

Issues Teenagers face

  • Skin – acne
  • Females – starting periods
  • Mental Health – Anxiety, Depression & Suicide
  • Addictions – Drugs, alcohol, smoking
  • Sexual & Reproductive Health – Sexually Transmitted Infections, Sexual Identity, Sexual Protection, Consent, Grooming, Sexting, Pregnancy
  • Rest – Sleep Hygiene, Screen Time
  • Schooling – Progress, Dyslexia & Intellectual Difficulty, Bullying, Cyberbullying
  • There’s lots more – that’s what I can think of from the top of my head.

How to say to a parent you want to see their teenager alone...

When you phrase it in these ways, most parents are less oppositional about you seeing their child on their own because you’ve identified an opportunity for their child to grow.
  • “Thanks for coming with him today mum.  Tom is now 14 isn’t he?   I was just wondering… when do you think your son will be ready to take responsibility for his own health and start coming on his own?”   
  • “I wonder if I may have a few moments with Tom?    I’d like to ask a few sensitive questions and I’m sure you can remember when you were in your teens where you would have rather talked on your own.  What do you think?”
  • “I wonder if I may have a few moments with Tom?   He’s 14 now and I’d like him to become comfortable talking to doctors on his own.  Would that be okay?”

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Bradford VTS was created by Dr. Ramesh Mehay, a Programme Director for Bradford GP Training Scheme back in 2001. Over the years, it has seen many permutations.  At the time, there were very few resources for GP trainees and their trainers so Bradford decided to create one FOR EVERYONE. 

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