When is it a good idea to seek out a specialist in adolescent medicine?
Most adolescents are cared for by pediatricians or general practitioners. At Pelisyonkis Langone’s Hassenfeld Children’s Hospital, subspecialists like me care for patients who need an extra level of evaluation. When the medical or psychological issues are not so clear or obvious, it might be worth getting evaluated by an adolescent medicine specialist. For example, I saw a 15-year-old girl who had unintentionally lost 20 pounds in the last year. Instead of assuming that it was an eating disorder, I spent a lot of time delving into her social and psychological situation. It turned out that her weight loss was the reaction to trauma. About 90% of my time is spent teasing things out.
How do you connect with patients?
Recently I asked a young man to stop looking at his phone and talk to me for five minutes. He refused. So I started looking at my phone. He said, “You can’t do that!” We ended up laughing. It was a breakthrough. I do a lot of observing and note taking so that on follow-up visits I can say, “What happened to your green hair?” Adolescents really appreciate the attention. I pay attention to teenagers wherever I am. I’m like an anthropologist of adolescence.
What drew you to this specialty?
Every adolescent needs at least one person to identify with, one person who is there for them. Someone they can trust, rely on, cry on. For some patients, I may be that person.
What was your own adolescence like?
I have an identical twin. As teens, we both had braces, freckles, and wore glasses. When the popular girls wouldn’t let me sit at their lunch table, at least I had Danielle to eat with. My sister is now the principal of the middle school we attended. She will walk through the cafeteria and sit down with a kid who is eating alone. So we both ended up taking care of teenagers.
Does your approach to caring for teenage boys versus girls differ?
Boys tend to use healthcare less frequently, so when one comes in, I want to engage, engage, engage. When boys leave the office, it’s usually “OK, bye.” The girls are different, and sometimes they give me a hug.
Do parents need to give consent for you to talk to their teens?
No. I always explain confidentiality policies and ask for “alone time” with the patient. It’s about empowering the adolescent, not keeping secrets from parents. I partner with parents. Our strategies may be different, but we both have the same goal: a happy, healthy teenager.
Adolescence is a time of great transition. Do you ever feel like you’re treating a moving target?
Yes, patients can be very different even from visit to visit. Rapid, uneven development is typical in adolescence. They can be very smart—the parts of the brain that process information and control movements mature first—but the ability to control impulses, assess risk, and plan ahead are among the last to mature. Hormonal changes also have a powerful influence, not only on reproductive development but on social behavior.
When a patient moves on to a doctor who cares for adults, do you feel a sense of loss?
Adolescent specialists do have a hard time letting go. It used to be that 18 was the cutoff for seeing a pediatrician, but now we know that brain development continues through the 20s. Neuroscience is showing that some people in their early 30s still have an adolescent brain.
If you could give adolescents and their parents one piece of advice, what would it be?
This too shall pass.