Residency 1.5: Teen Clinic

I finished up my month of Adolescent Medicine. Rather than try to think back and summarize the whole month in one post, I thought I would share some of what we learned at a training seminar that the department got to do while I was there, because I think it's an intriguing idea for anyone who tries to motivate change in others.

They brought in a consultant to talk about risky behavior in teenagers and how to talk to them about it. One activity had us come up with scenarios of risky behavior we would like to change in our patients (drug use, unprotected sex, unhealthy eating, etc), but then to think about what we were asking the teenager to risk by giving it up. For example, one patient that we used as an example was a heavy marijuana user, who also happened to have suffered a fair amount of loss in her life. We typically say, "Smoking pot is a risky behavior; you could end up doing a lot of stupid and dangerous things when you're high, plus it's a gateway drug, so just stop." But asking her to stop is risky too. If she stops smoking pot, she risks not only the loss of her current social support, but also part of her identity, and maybe most importantly, her mechanism for coping with grief. When you look at it from her standpoint, it's not so easy to say "Just stop smoking pot; it's dangerous" because for her, it may feel more dangerous to quit. It doesn't justify risky behavior, but if we look at what we're asking our patients to risk by following our advice, we may be able to help them find alternatives that are acceptable.

If only we had the time to go through this with all of our patients. That's one thing that I continue to find frustrating about being in the clinic, whether it's Teen Clinic or my regular continuity clinic: the lack of time to cover everything I want to with my patients and their families. How do you find the time to talk about diet, exercise, school, safety, discipline, sleep, drugs, depression; not to mention things like stomach pain, headaches, back pain, and other vague chronic symptoms that could be anything. There's not enough time in the day, let alone in one appointment slot. I always leave feeling like I've let my patients down. It's super frustrating, and the alternative is to just not care and stop mentioning all those things. If anyone has the magic answer, let me know.

So now I'm off to Owl Team (aka Night Shift). It will be hard on my psyche and my social life to be working nights, but it's supposed to be a fun month. I'll let you know how it goes.