INTERVIEWING ADOLESCENTS - 11/09/11

Doi : 10.1016/S0031-3955(05)70563-0

Susan M. Coupey, MD ^{^{*
From the Division of Adolescent Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York}}

Resumen

Many clinicians believe that adolescents are more difficult to interview than patients in other age groups. There is some truth to this perception. Adolescence is an in-between age, neither childhood nor adulthood, and effective interviewing strategies require particular attention to interpersonal communication skills. The interview will fail if the adolescent patient is treated like a child with most communication addressed through the parents. Failure is equally likely if the physician assumes that the adolescent has the decision-making abilities of an adult and fails to provide appropriate support and guidance. By failure the author means that the primary purposes of the medical interview, to diagnose health problems accurately, to ensure that treatment recommendations are carried out, and to prevent future health problems are unlikely to be accomplished.

Complicating the necessity to accommodate to the evolving autonomy of the patient is the fact that many health problems of adolescents are related to behaviors often perceived by adolescent patients and their parents as secret, shameful, or embarrassing. Effective interviewing skills are an essential tool for addressing these “new morbidities” in pediatrics.^{5 Committee on Psychosocial Aspects of Child and Family Health The pediatrician and the “new morbidity.” Pediatrics 1993 ; 92 : 731-733

Haga clic aquí para ir a la sección de Referencias} Adolescents are acutely self-conscious, have a short future time perspective, and many have limited ability to understand abstract concepts, so it is doubly difficult for clinicians to find a way to approach and discuss psychosocial issues. In addition, how much or how little to involve the parents in the interview is a judgment that needs to be made for each individual adolescent patient and may require different approaches depending on the age of the patient and the health problem. Interviewing adolescents effectively is a complex skill requiring flexibility of style and in-depth knowledge of this age group.

In 1992, the American Medical Association (AMA) issued their Guidelines for Adolescent Preventive Services (GAPS) recommending annual preventive services visits for adolescents aged 11 to 21 years.^{10 Elster A.B., Kuzsets N. Guidelines for adolescent preventive services (GAPS) Baltimore: Williams & Wilkins (1993).

Haga clic aquí para ir a la sección de Referencias} In only three of these ten yearly visits do they recommend a physical examination; during the other seven visits, the interview is the recommended method of effecting prevention. Similarly, Bright Futures: Guidelines for the Health Supervision of Infants, Children, and Adolescents, a 1994 publication of the National Center for Education in Maternal and Child Health, recommends in-depth interviews for health supervision and anticipatory guidance of adolescents.^{3 Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents Arlington, VA: National Center for Education in Maternal and Child Health (1994).

Haga clic aquí para ir a la sección de Referencias} The GAPS materials include a written questionnaire to screen for problems, and many clinicians use written screening questionnaires to save time.^{23 Prazar G.E., Friedman S.B. An office-based approach to adolescent psychosocial issues Contemporary Pediatrics 1997 ; 14 : 59-76

Haga clic aquí para ir a la sección de Referencias} Use of such questionnaires is helpful, but it does not substitute for the interview. It is only through the interpersonal communication of an interview that the details of any concerns revealed on a questionnaire are clarified and that counseling and motivation for behavior change is accomplished.

Initially, this article reviews literature relating to the relationship of physicians' communication skills and patient outcome. Following that is a discussion of a functional approach to the medical interview with examples of the application of this approach to the adolescent interview. Lastly, the structure of the adolescent health visit is addressed. The emphasis here is not on what questions to ask but on how to communicate effectively with adolescent patients. Many examples of the areas that should be covered in an adolescent medical history with suggested phrasing of questions are given in the guidelines cited earlier and in other excellent articles and are not repeated here.^{2 Beach R.K. Priority health behaviors in adolescents: Health promotion in the clinical setting Adolesc Health Update 1991 ; 3 : 1-7

Haga clic aquí para ir a la sección de Referencias, 3 Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents Arlington, VA: National Center for Education in Maternal and Child Health (1994).

Haga clic aquí para ir a la sección de Referencias, 10 Elster A.B., Kuzsets N. Guidelines for adolescent preventive services (GAPS) Baltimore: Williams & Wilkins (1993).

Haga clic aquí para ir a la sección de Referencias, 16 Jenkins R.R., Saxena S.B. Keeping adolescents healthy Contemporary Pediatrics 1995 ; 12 : 76-89

Haga clic aquí para ir a la sección de Referencias}