Am Fam Physician. 1999;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.
Attitudes
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
Knowledge
The resident should develop knowledge of:
Normal anatomy and physiology associated with puberty and the adolescent years
Growth and development
Tanner stages
Tasks and stages of adolescence
Prepuberty
Early adolescence (10 to 13 years of age)
Midadolescence (14 to 17 years of age)
Psychologic growth and development in each stage
Life aspirations
Preoccupation with body image
Sexuality and physical changes
Mood/behavior changes
Peer pressure and support
Feelings of invulnerability
Accidents
Family/parental relationship attitudes
Concrete versus abstract thinking
Adolescent health care
Health evaluation
History-taking techniques
Physical examination
Screening tests and interpretation
Patient education information that is specifically intended for adolescents
The adolescent athlete
Preparticipation evaluation
Injury prevention
Acute musculoskeletal trauma and other trauma
Health problems of athletes
School screening examinations
Prevention of risk-taking behavior
Preventive health care
Immunizations
Healthy diet
Exercise
Safe sexual practices
Smoking cessation
Avoidance of recreational drug use
Pregnancy prevention
Variations in physical growth and development
Short and tall stature
Precocious puberty
Delayed puberty
Delayed menarche
Menstrual irregularities
Oligomenorrhea/secondary amenorrhea
Excessive bleeding
Primary dysmenorrhea
Male gynecomastia
Major threats to life and health in adolescence
Violence
Accidents
Drowning
Suicide
Homicide
Malignancies
Cardiovascular diseases
Congenital anomalies
Infectious diseases
Specific problems of adolescents
Infectious diseases
Respiratory infections
Pharyngitis
Sinusitis
Otitis media
Influenza
Mononucleosis
Hepatitis
Urinary tract infections
Sexually transmitted diseases
Vaginitis
Human immunodeficiency virus infection
Psychiatric issues
Depression
Schizophrenia
Eating disorders
Learning disorders
Attention-deficit/hyperactivity disorder
Dyslexia
Body image issues
Acne
Obesity
Substance abuse
Drugs
Nicotine
Alcohol
Performance-enhancing agents
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
Gang violence
Family violence
Sexual violence
Particular health risks of homeless/runaway adolescents
Effects of family, social and cultural environment on growth and development
Media influence
Poverty
Violence/firearm safety
Family problems
School problems
Spirituality
Medicolegal issues of adolescents
Consent/confidentiality
Legislative/regulatory
Skills
The resident should develop skills in:
Evaluation
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
Management
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.)