Right now, teenagers make up 13 percent of the U.S. population. This generation is more diverse than the ones before it, and more urban. As always, youth are pushing for social change. It seems, by most markers, the kids are alright. But with the right doctor, could they be even better?
Angela Diaz has worked as a physician at the Mount Sinai Adolescent Health Center in New York City for more than 25 years, and she says treating teens isn’t just a matter of taking care of overgrown tots. Unlike children, they’re struggling with the physical and emotional effects of puberty. They sleep differently and later. Some may be experimenting with drugs and alcohol, or first wading into the world of sex. And many mental health issues begin to manifest in adolescence.
But, Diaz says, reading the latest journals on teen technology use and keeping up to date on trends in sexually transmitted infections (both of which she does) are not the most important part of her job. The most crucial thing she does is listen. “Often, people do just not treat [teens] with respect and appreciation,” she says. As a result, adolescents often “feel people are not being authentic with them or do not like them.” And if they don’t feel they’re being respected, they don’t tell you the truth—or follow your directions. “If you don’t make the teenager feel comfortable, a teenager will come to you and say, ‘Yes, I have a headache,’ when in reality, they are really, really anxious about their sexual identity,” Diaz says. But if you do build trust, Diaz says teenage patients are the most “honest, authentic, and compliant” patients in the world.
Adolescence—and, with it, adolescent health medicine—is a fairly recent concept. While many cultures have recognized the transition between child into adult with pomp and circumstance, until recently, young people were just considered tiny adults. This started to change at the turn of the 20th century. In the 1890s, psychologist G. Stanley Hall (who had many, many problematic ideas about the world) popularized the still-applicable phrase “storm and stress” to describe this unique period of physical, cognitive, and social development. In the 1910s, activists began to organize to bring about the end of child labor, requiring both the recognition of the concept of “childhood,” as well as the belief that it was a special time that, ideally, would be free of many of the burdens of adult life.
While adolescence was catching on culturally, the idea that young people in this stage of life should be treated differently by doctors took a bit more time. Popular Science coined the word “teen-ager” in 1941, but it wasn’t until 1968 that the Society of Adolescent Health and Medicine, the preeminent professional organization for adolescent healthcare providers, was founded to improve “the physical and psychosocial health and well-being of all adolescents through advocacy, clinical care, health promotion, health service delivery, professional development, and research.”
Even today, Diaz says, most teenagers still see a pediatrician. “I think if a pediatrician has a great relationship with a teenager, that’s great,” she says. “You have 42 million teenagers and not that many adolescent medicine experts.” But surveys of doctors suggest some pediatricians feel uncomfortable dealing with older patients. (The reverse is also true, with many teenagers sensing they’ve outgrown their childhood physicians.)
While doctors of all specialities can build relationships with adolescents, Diaz worries that some kids aren’t being asked the tough questions—because their pediatricians don’t want to know the answer. “Sometimes [doctors] say they do not feel they have the skills in things like substance abuse, or mental health, or family planning. In that sense, if you don’t have the skill, you are not likely to be asking about those things, because you would not know what to do,” Diaz says. “The training of an adolescent medicine doctor makes it more likely they are comfortable in those areas.”
At the Mount Sinai clinic where Diaz works, she and her peers aren’t just experts in these teenage-specific conversations. They’ve also built the entire facility with teenagers in mind. “Developmentally, when teenagers want help, they want it ASAP,” Diaz says, so Mount Sinai works on a drop-in model, where the 11,000 individual teenaged patients they treat each year can come in whenever they need care. The services are free, and Diaz says an even bigger premium is placed on privacy than in a typical doctor’s office.
“People who work with teenagers often say, oh, they are hard to reach, they’re non-compliant,” she says. “But the thing that’s hard to reach are the way those services are designed. The U.S. healthcare system is designed by adults, for adults. Here, we ask them, what are typical barriers that will keep you away? Often, it’s an issue of privacy.” Mount Sinai “loves parents,” Diaz says, and she thinks treatment is most successful when they’re involved in the process. The doctors work to ensure they don’t make adults feel like the enemy, while also striving to make teens comfortable. But the clinic is free, private, and accessible to patients who don’t believe that’s an option.
Sometimes, Diaz and her colleagues can even help change that family dynamic. If a teen says their parents will hate or hurt them if they come out as gay, for example, Diaz will encourage them to bring their family in to talk about it. She’ll work to help parents understand what’s going on and what her patient needs, she says, and she makes sure the kids know beforehand that she won’t send them home if the situation seems dangerous.
“What you want is to make a place where they can come before things get out of control,” she says. And Mount Sinai finds the best way to do that is to pay for medications, cover transportation costs, and let teens come to them directly. Diaz firmly believes that with the right care, adolescents are the best patients a doctor could ask for. “[They have an] openness and ability to try,” she says. “They don’t have those layers and layers and layers and layers of association that adults have. They are more raw.”
If you’re looking for an adolescent specialist for yourself or a teen in your life, U.S. News & World Report has a state-by-state database you can check. High school nurses can also be a good resource, as these health professionals are well-seasoned in talking to adolescents.
Ultimately, many kids will make it through their teen years without the help of a doctor specializing in adolescent care. But for those who need the support, doctors like Diaz are there. “We were all adolescents before. We all grow up. Well, most of us grow up,” she says with a laugh. “We just need to navigate that.”