Tess Cox, MHSC, PA-C

I am one of approximately 3,000 certified PAs in pediatrics and pediatric subspecialties who collaborate with physicians daily to treat patients from infants to adulthood.

I know that engaging adolescents in their care and during the patient visit can be especially challenging. Still, I have learned some successful strategies as a result of my PA training and experiences working with adolescents. Here are some of my tips:

1. Start a dialogue without them realizing it’s happening. 

My approach is to ask questions and start the dialogue while obtaining a thorough history and physical exam and reviewing required age-appropriate health and safety anticipatory guidance.

Begin with an attitude of genuine interest and curiosity when saying hello. Shake their hand.

 Sit back in your chair for a minute or two and let them sense that you are glad to see them. Teenagers can smell fear a mile away, and if you are uneasy or uncomfortable, your rapport will suffer.

 Set the stage for asking those “sensitive” questions about drugs, tobacco, and sexual activity by informing the parent up front that you’d like a few minutes alone with the patient to obtain further history and discuss teen health issues. Ask the parent respectfully to step outside the room. It is a rare parent who refuses.

5. Let teens know their answers are confidential and will not be shared with their parents unless they consent or unless they are life-threatening to themselves or others. 

If teens do divulge risky activities, I offer to stand with them if they discuss the issues with their parents, or make another appointment to discuss.

Why do parents trust me with their adolescent’s health? 

Because certified PAs are educated in the medical model, earn ongoing CME and pass rigorous recertification exams throughout their careers.

In addition, I am among the first to earn a new credential ­ the Certificate of Added Qualifications (CAQ) in Pediatrics from the National Commission on Certification of Physician Assistants. The CAQ requires additional pediatrics experience, CME, skills, and the passing of a national pediatrics exam.

Over the past 20 years, I have also developed three questions to explore the lifestyles of teenagers and open the door for deeper conversations about life issues:

1. What hobbies or activities do you enjoy? 

 This opens the door to further discussion. Who do you think is cool? Who is your role model?  Who are your favorite athletes, recording artists, public figures, etc.?  The answers will tell you who they aspire to emulate. You will understand the cultural influences impacting their growth and maturation and have the opportunity to give valuable reflection about the consequences of choices their role models may have made (both good and bad) all while completing their history.

2. Inquire about school and their friends/relationships.

 Ask, "Are you getting along with peers at school?” Ask if they have felt pressure to make scary or uncomfortable choices to keep their friends or avoid being hurt, or if they’ve felt disrespected, scared, or bullied at school. I’ve known several children who chose that moment to open up and talk about insults and injuries (bullying) they have experienced. Asking, “Who do you feel has the most control or ‘power’ in your life?” may help them identify peer pressure or vulnerabilities. You’ve done this all while completing a thorough physical exam.

 Finally, during the last five minutes of the appointment I review age appropriate anticipatory guidance with parent and patient and conclude with a discussion about what I’ve learned about their influences, role models, interests and goals. I ask them to look ahead to age 25 and describe the kind of person they want to be. Do they own their own car, pay their own bills, have a degree or profession, are they married with children? More importantly, are they trustworthy; do they finish what they start; are they loyal? What is their vision of the future?

I conclude with a smiling reminder that they won’t just wake up one day and “wham!” be that person with the life they’re dreaming of. The patient must create that person with every little decision and choice they make starting right then. (Ask them to look at the clock and note the time and date!).  The choices the patient makes, who the patient allows to influence and control them, and staying true to their vision of their future self helps create that person.

I assure them that it’s sometimes difficult, but if they ask themselves the three questions: “Who are my role models? Who am I giving control over my life? What kind of person do I want to be?” when they are making future decisions and choices, it will help keep them on track to reach their goals and avoid difficult consequences over time. Parents are grateful for this supportive approach, and teens will often take it to heart. You might change a life.

, is a pediatric hospitalist in Colorado Springs. She has specialized in pediatrics for 33 years and is among the first group of certified PAs to earn a CAQ in Pediatrics from NCCPA.

Articles

Engaging adolescents in their care and during the patient visit can be especially challenging. Here are some tips. 

Author | Tess Cox, MHSC, PA-C

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Engaging Adolescent Patients: Key Questions to Ask