Adolescent Medicine

Adolescence is a time of tremendous growth and change – social, psychological and physical. That journey to adulthood isn’t all on a well-lit, smoothly paved, four-lane highway, either. While potholes, side roads, and wrong turns may be an inevitable part of the trip, a good map and an expert pit crew can help ensure a successful arrival. A trusted physician, specifically one who specializes in adolescent medicine, can be a great ally along the way.

Board-certified in General Pediatrics and Adolescent Medicine, Paul Benson, M.D., MPH, is the George Kaiser Family Foundation Chair in Pediatrics and an Associate Professor of Pediatrics at The University of Oklahoma-Tulsa School of Community Medicine. Although OU’s medical clinics are open to all patients, with its focus on community medicine, one of the goals for the clinics is to provide health care to underserved communities.

In his practice, Dr. Benson sees patients between the ages of 12 and 21 several days a week at OU’s Schusterman Center and Wayman Tisdale clinics. He also works a half-day at the OU clinic at Youth Services of Tulsa (YST), caring for patients in YST’s emergency shelter and street outreach programs. As part of his practice in working with underserved populations, Dr. Benson is particularly interested in providing care to LGBTQ adolescents. In addition to seeing patients, Dr. Benson regularly trains medical students and residents at all of his clinic sites.

 What is Adolescent Medicine?

“Adolescent Medicine is a field. It’s its own subspecialty under the American Board of Pediatrics,” Dr. Benson explained.

Board-certified physicians who practice Adolescent Medicine have done an additional three-year fellowship after completing a residency in pediatrics, family medicine or internal medicine. That training gives them expertise in health issues that affect adolescents, such as eating disorders, mental health and behavior concerns, contraceptive management and other non-surgical gyencologic health issues, sexually transmitted infections and substance abuse.

“[These are] areas where the overlay of psycho-social issues in adolescents impacts their physical and mental health,” Dr. Benson said.

Dr. Benson completed his Adolescent Medicine fellowship at Baylor College of Medicine in Houston, one of only seven sites in the U.S. to offer a specialized training program called Leadership Education in Adolescent Health (LEAH). The program uses an interdisciplinary team approach. While at Baylor, Dr. Benson worked with faculty and fellows in adolescent medicine, nursing, nutrition, psychology, public health and social work, giving him a broad base of knowledge to apply in his practice.

“We learned from each other,” Dr. Benson said. “Now, when I see a patient who has an eating disorder or other weight management issues, for example, I take what I learned…and pass it along to my patients. I feel like I gained more depth from my LEAH-supported fellowship.”

Treating Adolescents

Like a regular pediatric practice, Dr. Benson does primary care for an adolescent patient population. He also consults on issues relating specifically to his subspecialty of Adolescent Medicine. For example, patients from OU’s general pediatric clinic or from other practices in the community may be referred to him to help manage eating disorders or treat sexually transmitted infections.

While Dr. Benson also refers his patients to other specialists when necessary, with his training, he can take care of a wide range of physical and mental health issues, everything from depression and anxiety to substance abuse and menstrual disorders.

“Not every patient who has bleeding irregularities or menstrual problems has to go to a gynecologist, and not everyone who has depression or anxiety has to see a psychiatrist,” he explained. “In fact, it takes a lot of the burden off our psychiatry colleagues for our primary care and adolescent medicine physicians to take care of these issues, so they can devote their time and energies to more complex issues. I take care of patients and manage issues that I feel comfortable managing. Certainly, if someone has bipolar disorders or schizophrenia or other more complex mental health issues, I’m going to refer him or her to psychiatry. I want the patient to have the best care with the right specialist.”

 Confidentiality

A large part of practicing adolescent medicine is establishing a trusting relationship between the child and the physician from the very first appointment. Adolescent health issues are often a complex combination of psychosocial and physical factors that a patient may be hesitant to reveal.

Dr. Benson’s focus is on the patient. After meeting with the patient together with his or her parent or caregiver, Dr. Benson spends at least a portion of the visit with the patient one on one. According to Dr. Benson, there’s a need to balance the caregiver’s concerns with respect for the patient’s autonomy.

“You have some teens who are very open and explicit about their behaviors with their parents, and that’s great, but it’s not always the case that a teen may be so forthcoming. I really want to encourage and foster open communication between the adolescent and his or her parent, but ultimately, a patient’s health may well depend upon mutual respect and confidentiality with his or her physician,” he said.

Dr. Benson begins the visit by introducing himself to the patient, and then asking the patient to introduce the caregiver. He then explains how the visit will proceed. He says,

‘We’ll spend some time with you and your mom together in the room. We’re going to hear any concerns she might have. We’re going to spend some time one on one, as well, when we have your mom step out to the waiting room. What we’ll talk about during that part of the visit stays confidential between you and me with the exception of three major safety concerns: thoughts about hurting yourself, thoughts about hurting someone else, or somebody hurting or abusing you. I would need to let your mom know about those things.’

Most parents, Dr. Benson finds, are fine with the arrangement.

“Autonomy is one of the developmental milestones they should be learning,” he explained. “If all along you’ve had mom do everything for you – make your appointments, make sure you take your medicine on time – then you suddenly hit that magic age of 18, boom. Teens need to build on that autonomy, especially teens with chronic illnesses where there’s complexity and compliance issues with medication, and where they’ll be managing those issues into adulthood. They need to be taking those steps.”

 Patient History

When seeing a new patient, Dr. Benson, like any other pediatrician, takes a patient history, posing a variety of medical, social and other questions. However, with adolescent medicine, this part of the visit tends to be longer and more detailed.

“You don’t just assume things about people; you ask,” Dr. Benson said. “The social history is probably one of the longest parts of a brand-new patient’s visit, and then their annual well visits, too.”

Dr. Benson asks questions about home life, education/employment, activities, drugs/depression/diet and body image, sex and sexuality, and safety issues. Or HEADDSS, as it’s referred to in Adolescent Medicine.

“Generally speaking, we ask a broad range of questions. Some are very nonpersonal. If I ask you whom you live with, you probably wouldn’t mind sharing that with me in front of other people, but if I ask about your sexual behavior or drug use, more personal things, that’s much more sensitive,” he explained. “That social history is structured such that you ask the ‘easy’ questions first and build that rapport and trust, then you ask the more sensitive questions. These are the sorts of issues and behaviors that affect their health.”

Dr. Benson emphasizes the importance of not making assumptions about his patients.

“Teens don’t generally come in and say, ‘I’m having issues with marijuana abuse,’ or ‘I want STD testing.’ You unearth those things by taking a history,” he noted. “Part of what we do in adolescent health is to take a broad social history with an open mind.”

While Dr. Benson stressed that general pediatric practices are well equipped to take care of adolescents, for some patients and their families, a practice that specializes in Adolescent Medicine can be a helpful alternative.

“I would say one thing to parents is don’t assume things,” Dr. Benson advised. “I don’t like to assume things about my patients. I’d rather ask. It’s okay for parents to ask things, and not assume things. I have a very diverse group of patients, all walks of life and all different beliefs. I think it’s important to respect diversity, even within your own home.”

For more information on OU Physicians, visit www.ou.edu/tulsa/ou_physicians.html.

Julie Wenger Watson is a freelance writer who’s worked in all aspects of music promotion. She’s also Co-Director of “Live From Cain’s,” a public radio show pilot.