Am Fam Physician. 1999 Aug 1;60(2):660-662.
This document has been endorsed by the American Academy of Family Physicians and was developed in cooperation with the Society for Adolescent Medicine, the Association of Departments of Family Medicine, the Association of Family Practice Residency Directors and the Society of Teachers of Family Medicine.
The ultimate concern of all physicians must be the welfare of the patient. The family physician, as a specialist with a breadth of knowledge in the health care profession, must develop skills appropriate to manage the social, psychologic and physical problems of all groups of patients, regardless of age or sex.
The care of the adolescent is as specific as the care of children or the elderly; therefore, the adolescent patient requires special attention in family practice. Nearly two thirds of all physician office visits made by adolescents are to family physicians. Thus, the family physician has an opportunity to intervene at an early age to correct any health behavior patterns the young person is forming and to counsel appropriately regarding the specifics related to adolescent growth and development.
The following outline specifies certain knowledge and skills basic to the diagnosis and management of adolescent patients. However, the family practice resident should understand that there are yet other areas of knowledge and skills that might be essential to the appropriate care of a given patient. Therefore, these guidelines are not intended in any way to limit the family practice resident's effort to acquire other important knowledge and skills relating to adolescent health.
The resident should develop attitudes that encompass an understanding of:
The preoccupation of adolescents with their bodies
The effects of peer pressure and peer support
Adolescents' inquisitive and confrontational attitudes toward society, parents and others
Adolescent sexuality, including physical, psychosocial, moral, heterosexual, homosexual, bisexual and gender identity issues
The adolescent sense of invulnerability and the tendency toward high-risk behavior
The issues of confidentiality in the physician-adolescent patient interaction
The promotion of health, wellness and prevention habits
The resident should develop knowledge of:
Normal anatomy and physiology associated with puberty and the adolescent years
Growth and development
Tasks and stages of adolescence
Early adolescence (10 to 13 years of age)
Midadolescence (14 to 17 years of age)
Psychologic growth and development in each stage
Preoccupation with body image
Sexuality and physical changes
Peer pressure and support
Feelings of invulnerability
Family/parental relationship attitudes
Concrete versus abstract thinking
Adolescent health care
Screening tests and interpretation
Patient education information that is specifically intended for adolescents
The adolescent athlete
Acute musculoskeletal trauma and other trauma
Health problems of athletes
School screening examinations
Prevention of risk-taking behavior
Preventive health care
Safe sexual practices
Avoidance of recreational drug use
Variations in physical growth and development
Short and tall stature
Major threats to life and health in adolescence
Specific problems of adolescents
Urinary tract infections
Sexually transmitted diseases
Human immunodeficiency virus infection
Body image issues
Sexuality and adolescent pregnancy
Sexual concerns (identity, orientation, body image, masturbation, contraception, sexually transmitted disease, human immunodeficiency virus infection)
Pregnancy (prevention, health risks, psychologic and educational issues, family and parenting issues)
Cultural, class, ethnic and gender differences that affect adolescent health care
Interpersonal violence as a health issue
Particular health risks of homeless/runaway adolescents
Effects of family, social and cultural environment on growth and development
Medicolegal issues of adolescents
The resident should develop skills in:
Taking a history and sexual history and performing a physical examination with emphasis on interviewing techniques specific to adolescents
Confidentiality and legal rights
Determining patient's parental relationship during interview and physical examination
Performance of specific procedures and interpretation of results
Formulating a plan of management, investigation and further consultation, if appropriate
Providing patient education for preventive measures appropriate for adolescent health care needs
Interpersonal relationships with an open-minded attitude toward adolescent patients
Counseling specific for adolescents
Dealing with adolescents in the context of their family and community (i.e., awareness of their interactions with parents, siblings, peers, teachers, etc.)
Resourcesshow all references
Emans SJ, Laufer MR, Goldstein DP, eds. Pediatric and adolescent gynecology. Philadelphia: Lippincott, 1998....
Friedman SB. Comprehensive adolescent health care. 2d ed. St Louis: Mosby, 1998.
Hofmann AD, Greydanus DE. Adolescent medicine. 3d ed., Stamford, Conn.: Appleton & Lange, 1997.
McAnarney ER, et al., eds. Textbook of adolescent medicine. Philadelphia: Saunders, 1992.
Guidelines for adolescent preventive services (GAPS): recommendations monograph. 3d ed. Chicago: American Medical Association, 1996.
Neinstein L. Adolescent health care: a practical guide. 3d ed. Baltimore: Williams & Wilkins, 1996.
Copyright © 1999 by the American Academy of Family Physicians.
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