Tales from Adolescent Medicine
By Jessica Shannon Castonguay, DO, MPH
Jessica Shannon Castonguay, DO, MPH
A few weeks ago, I had a day.
I saw a frequent visitor to my office. I felt she warranted admission for worsening dehydration, acute kidney injury, and electrolyte derangement since her previous visit. This adult patient declined admission despite my recommendations otherwise. She believed none of the bad things like seizure, syncope, or death were going to happen to her.
My next patient had a recent weight loss with significant bradycardia. I recommended no athletic participation at this time as we increase caloric intake and monitor for improvement in vital signs. The adult patient and parents did not understand the importance of slow return to activity to protect the heart and prevent further weight loss. I spent over an hour discussing the risks and benefits of continued physical activity. He believed none of the bad things like arrhythmia, syncope, or death were going to happen to him.
Another patient arrived with history and exam consistent with pelvic inflammatory disease. It was her third case in six months. We again discussed condoms, partner treatment, and taking her antibiotics appropriately. She believed none of the bad things like hospitalization, tubo-ovarian abscess, chronic pelvic pain, or ectopic pregnancy were going to happen to her.
Nothing bad was going to happen to any of my patients that day. They were sure of it. Unfortunately I couldn’t be sure.
Every patient drained me that day. I felt ineffective as a physician. I had used every trick I knew. I found concrete motivators. I used motivational interviewing. I discussed risks. I spoke with care. I listened empathetically. Nothing worked. Nothing.
I drove home, worried that each of these young people would be worse off when they followed up with me. I reminded myself that higher level executive functioning continues to develop in this age group. I cried about one of the sicker ones, who is always in the back of my mind.
What I need to remember on days like this are that these young people are developing their independence. Some can receive and process information quickly while others cannot. Some still need time to think about what we as providers say and how it will impact their long term health. They may need to talk to a friend, their parent, or their therapist. They may just need time to weigh their options.
I have seen every one of those patients from that day back in the clinic. Despite their reluctance to consider my point of view in the office, all but one patient acted on the recommendations that I gave that day. All but one had improved symptoms. All but one thanked me for spending as much time with them as I did. All but one heard me that day.
September 16-19, 2016
Anaheim Convention Center