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Monday Jan 11, 2016

Helicopter Parents Need to Know When to Land in Waiting Room

Scene: An exam room in a family physician's office.

Characters: A teenager, a parent and the physician.  

Setting: Teenager sits in the corner, engaged in his phone. Mother is likewise engaged. Physician enters the room, but the teen does not look up.

Physician, looking at teen: "I see that you are here because your knee has been hurting. Can you tell me about that?"

Teen does not make eye contact or answer, looking to his mother to answer the question.

Mother: "It started two days ago at basketball practice. He fell while doing a drill, and he immediately began complaining of pain."

Physician, again directing question at teen and addressing him by name: "Johnny, would you say that the pain is better, worse or the same since the injury?"

Teen shrugs shoulders and again looks to his mother to answer the question.

Mother: "He said that it was worse yesterday, but it feels a little better today."

We've all been here. Patient encounters with teenagers who A) don't get off the phone long enough to answer your questions, B) look to their parents to answer every question and/or C) try to answer but are interrupted or corrected by a parent.  

These are frustrating encounters, trying to develop a rapport and begin a patient/physician dialogue, but being stymied by the patient's parent. A recent study shows that beyond being irritating for us, this situation can be harmful for our teen patients.

A study conducted at the University of Michigan(mottnpch.org) suggests that helicopter handling of health care by teens' parents impedes young patients from learning to care for themselves. The study showed that 89 percent of parents attended their teen's visits to the doctor, and two-thirds filled out their children's health history and other forms, either because they preferred to do so or because they thought their teens would be unable to. Only 15 percent of parents reported their teenagers independently share physical and emotional health concerns with their doctors, and the top reason parents gave for teens not being involved in discussing health problems is that they are not comfortable in that role.

But if we partner with parents, we can change that.  

Parents who control visits prevent teens from learning to take control of their own health. It also keeps them from raising important health issues, questions and concerns that their parents aren't even aware of.  

As parents, we want the best care possible for our children, and the tendency to take control stems from our desire to protect. However, if teens don't learn to talk with physicians about easy topics (upper respiratory infections, muscle strains, sprains, sports physicals, etc.), how can we expect them to feel comfortable talking to us about issues such as tobacco and alcohol use or contraception?  

We need to help our teen patients become more self-sufficient when it comes to their health care, and a 2013 study(www.upi.com) found that doing so can help lower risks for anxiety and depression and improve overall life satisfaction as they age.

I encourage parents to start giving their children some autonomy in their care during their preteen years. I try to pose all questions to the patient and wait for their answers before posing questions to the parents. If a parent starts to answer for the teen, I politely ask them if I can hear the patient's answers first, and then have them help me fill in the gaps.  

At yearly well-child or sports physical visits for kids in this age group, I begin discussing with parents that I like an opportunity during these visits to speak with the patient one-on-one. Most parents are receptive to this, and they understand there are likely questions that their child may not feel comfortable asking them that they may be willing to ask me, but only if they are comfortable speaking to me. If the idea of speaking with their doctor is intimidating because they have never asked a physician a question, they are unlikely to open up to me. On the other hand, if they have been asking questions of their physician during visits since childhood, and answering questions posed by their physician, this interaction will feel familiar.  

Setting the expectation that they will have time alone to discuss their concerns with me allows them to think about questions they may have before the appointment.  

Beyond asking questions of their physician, teens need to be familiar with their own health history, as well as their family health history. One form that many parents fill out yearly is the sports physical form. There are many questions and places to write in responses. I encourage parents to sit down with their child and fill this form out together, having the child record the answers. This is a great place to start acquainting them with medical questions and wording and ensure that they understand their health history.  

I also encourage parents to have their child fill out the yearly clinic paperwork required. If parents are comfortable with it and do not have specific concerns, I encourage them to have their teens come to their sports physicals and other routine visits by themselves. It shows that their parents have trust in them to take an active role in their own care and begins the transition to adulthood.

When discussing things such as testing, it helps to make the teen an active participant in the explanation and decision-making process. Encourage the teen to ask questions about any decisions being made so that he or she feels treatment is being done for -- not to -- him or her.

Developing relationships with my teen patients as individuals has enabled me to have a more effective and rewarding relationship with them. I have maintained relationships with many patients as they headed off to college, seeing them when they are back in town on breaks and keeping in email contact with them on issues related to health, but also answering their questions about college and careers.  

As family physicians, we have a unique opportunity to help our teen patients grow into independent adults. The most important tool we can use to achieve this is simple self-awareness in our patient encounters -- addressing patients directly, encouraging them to answer questions and ask their own, and making speaking to teens alone a normal part of office visits. Although a bit more time-consuming, these changes can expand our impact on our teen patients' health and development in a way that will serve them well in the future.

Beth Oller, M.D., practices full-scope family medicine in Stockton, Kan.

Posted at 01:30PM Jan 11, 2016 by Beth Oller, M.D.

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