Teenage Patients, Personal Hurdles: A Week on Adolescent Medicine

It wasn’t THAT long ago that I was a teenager… at least it doesn’t feel like it… or at least it didn’t used to.  But this week, counseling teens on the adolescent medicine service, I feel like I’m really starting to show my age.

The idea behind adolescent medicine, which as a field is very young, is to address the issues, both medical and psychosocial, that can affect a young adult’s health, all the while trying to establish a positive patient-doctor relationship such that they don’t fear coming to the doctor in the future.  It’s a novel concept, and is admirable for a number of reasons, top among them being the incredible amount of time and personalized attention each teen gets.  The average interview lasts anywhere from 30 minutes to an hour and focuses on elements of the patient’s life that are seldom addressed in other fields of medicine.  And this is with good reason, as honest discussions early on about a number of health topics such as contraception, substance abuse, eating habits, depression, etc. can have a significant impact later on.

The difficulty, however – especially for a medical student— is being the one to start these discussions, only to then walk a fine line between compassionate professional and concerned peer.  Admittedly, there are points when the conversation completely consumes me, momentarily taking me back to the mindset I had when I was their age.  But then I snap out of it, and find myself wanting to give advice, all the while constantly fearing that I will sound like I’m lecturing them.  At the risk of oversimplifying the matter, being the one wearing the white coat is intense.

After all, many of us did things in our youth that would/may have been advised against by a medical professional or other authority figure at the time, and it’s hard to embrace the hypocrisy and assume that authoritative role.  Sometimes you want to yell at them; sometimes you want to laugh and dismiss an issue that doesn’t seem all that significant, because you’ve been through something similar, and well, you turned out alright, didn’t you?; and sometimes you just want to hug them and share parts of yourself as freely as they are doing with you.

But at the same time there is that distance and professional decorum that you have to maintain.  You have to remain calm, because a lecture is seldom as effective as a discussion; you have to take every issue seriously, because different context means that what was insignificant for you may be life-altering for them; and although compassion is good and necessary, it ultimately can’t be so excessive that it impairs your objectivity in treating them.

Anyone who made it through the rigors of high school and lived to tell about it knows that the extremes of adolescence are just that: extreme.  And as if it weren’t exhausting to go through the first time, it’s just as tiring to experience through these young patients.  To make sense of why they’re behaving a certain way or understand exactly what they’re thinking I have to suspend the logical reasoning, introspection, and foresight that I’ve garnered over the past several years of adulthood and put myself in their hormonally-charged, peer-influenced, teenage shoes for a hot minute.  Unfortunately, this takes a lot more effort than I ever would have guessed, and has led me to the disconnect that I mentioned at the beginning of the post.   I may be the closest one to their age in the office, I’ve never been more keenly aware of the fact that I’m no longer a teenager.  I guess the title of student doctor is finally starting to shift more towards the “doctor” part… I mean, it was bound to happen at some point, right?

Picutre of author

About Justin Fiala, MD Candidate

Justin is currently in his third year of medical school at UIC's College of Medicine, and is hoping to pursue a career in internal medicine. He has a strong interest in addressing the health needs urban communities and is part of the College of Medicine's Urban Medicine program. Aside from academics, Justin enjoys cooking, listening to public radio, and perusing the New York Times website. He is also a trained pianist and self-professed lover of all kinds of music.

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