The Changing Face of Teen Health Care
The habits we form from childhood make no small difference, but rather they make all the difference. - AristotleIf we consider the trends over the last twenty years, teenagers are participating in fewer high risk behaviors. They actually drive safer, drink, smoke, and have unprotected sex less, and they do fewer drugs than teens did a couple of decades ago.
That is the good news, the bad news is that they are living with more violence, are less likely to have strong relationships with adults, have lower self-esteem, higher rates of eating disorders, are fatter, eat more processed food, and get less exercise, meaning that they are more likely to develop chronic diseases like diabetes during adulthood.
More bad news is that they are not seeing their doctors for preventive care as often as they should, only one in four young women have had the recommended HPV vaccines, and fewer than that are getting flu shots each year. In general, health care seems to be failing teens just as fast as the cost of health care is rising.
We in health care are going to have to figure out how to do what I will call "relational" health care using existing community resources whenever possible. Teens need a relationship with a medical professional - someone they can ask questions and trust the answers from. More and more health care is going to require that patients "manage" chronic conditions, and that requires information, motivation and monitoring behavior - activities that take time and ongoing support and monitoring.
How is it that we intend to educate and treat these whole people walking through a day, a disease, and a life. But what does it mean to take the "whole" person into account? Where do you start if you want to consider a person's intellectual life, relationships, home, job or career, character, parenting, spirituality, leisure activities, happiness, body, and ability to contribute to our society?
Where are the scripts, the behavioral objectives, checklists, and goals? Even if I wanted to, how can I do a "life assessment" on any teen in my life? As a parent, I find that with my own teens, I have to "pick a piece" to worry about each day. Some days I worry about the pressure they feel to "do it all." Other days I worry about their sleep, eating, and exercise patterns, peer relationships, education, spirituality, exercise, and safety habits. But as a professional, aren't I a safety net for the teens I have contact with? Aren't I somehow more responsible, and held to a higher standard?
I hear the echoes of "give me a break," "no one can do it all," "I am an expert in ____," "that is for someone else to worry about," and "I do not have time," but hey, who does?" If each of us does only our "part" in treating the whole person - a doctor makes sure a teen is immunized, the teacher educates the teenager well-enough to get into college, the parents provide the best moral and spiritual base they can, and the community monitors the safety of this imaginary teen at work, who catches them if they fall?
What if a parent is unable or incapable or worrying about these things? What if a child isn't getting regular medical care and screening? What if a child has no spiritual counseling, and is exposed to violence, or is hopeless and self-destructive? Who is responsible for identifying what is missing and "rescuing" that teen? Who makes sure that the habits they develop in childhood will lead to their happiness and health?
In my way of thinking, "not my department," just isn't in option. Every time we come in contact with a teen, whether it is for 50 minutes in a classroom or 12 minutes in exam room, I think we are morally obligated to look each teenager in the eyes and ask, "how are you?" "who are you?" "what is important to you?" and maybe "what do you think is missing in your life?" Then, we are obligated to follow-up on their answers. Sorry, but sometimes I think we need a reminder!
Photo credit: aflcio2008