Treating the Adolescent Endocrine Patient a Delicate Process

Teenagers can be tricky patients to treat. Parents know that, patients who progress through the adolescent years and reflect on their teen years know that, and increasingly, organized medicine is acknowledging it with structured specialties in adolescent medicine. Endocrinologists who treat adolescents need unique communication skills and plenty of patience.

The January 2016 issue of Endocrine Development includes a review paper describing current approaches to adolescents who need endocrine care.

As part of their report the authors discussed adolescents' psychosocial changes as they search for autonomy and build their unique identities. Any medical problem that develops in puberty profoundly interferes with these processes, so endocrinologists who treat these patients need keen emotional and psychological skills.

The authors emphasized approaches that move from parent-inclusive education in early adolescence to shared information and decision making as the patient approaches adulthood, placing the teen at the center of the therapeutic process.

They discuss 6 core principles of care:

· Respecting the adolescent affective and cognitive development;

· Providing privacy and confidentiality;

· Molding the therapeutic process to the patient’s expectations with careful consideration of his or her self-image and self-esteem;

· Appreciating the teenager’s lifestyle, sexuality and sexual behavior, and

· Involving adolescents in all therapeutic choices, regardless of the parents’ expectations or choices.

In their findings the authors reminded endocrinologists that every patient develops and matures at markedly different rates. Patients who appear biologically mature at age 13 may be emotionally immature, while some who seem more child-like may be either precocious or mature for their ages.

The authors also remind physicians that almost all physicians will have trouble reaching some adolescents. For this reason, they recommend a team approach that includes a clinical nurse, and possibly a psychologist or social worker. These professionals can help with behavioral issues, and also assess the patient's ability to make autonomous decisions.