Half of America’s teenagers have never had a private conversation with a doctor, according to a new study.
Since 1992, federal guidelines have recommended that kids start seeing a doctor on their own from the age of 13.
But a nationally-representative survey suggests that the rate of teens seeing physicians independently has barely changed in three decades.
Doctors warn that could be a key stumbling block to driving down teen tobacco use, sexually-transmitted diseases, and drug use.
Guidelines published in 1992 said teens should see doctors on their own from 13 but for half the population, that’s not happening (file image)
By most accounts, the current batch of American teens is more sensible than previous generations.
Despite eating more junk food and getting hooked on e-cigarettes, they generally drink less alcohol, start having sex later, do more yoga, and more diligently research their own health issues and healthcare providers.
But with sexually-transmitted diseases, anxiety and suicides on the rise, and drug overdoses at an all-time high, pediatricians aren’t exactly relaxed about the current state of things.
Even without alarming epidemics circulating, having private conversations is important for your health, period, says lead author of the Dr Jon Klein, executive vice head of pediatrics at the University of Illinois at Chicago Medical Center.
A doctor’s office is meant to be a place where you can disclose your activities, habits and concerns comfortably so your doctor has a good idea of what advice you need.
‘There should be one on one time for screening and counseling,’ Dr Klein told DailyMail.com.
‘It’s important that some advice be given that reflects the adolescent’s individual needs.
‘Unless there’s a confidential discussion, teens aren’t likely to disclose their own needs.’
One clear example is sexual health.
‘If a young person has chosen to have sex, knowing about sexually-transmitted diseases, contraception, testing needs, HIV is important,’ he says.
Of course, everyone should be having ‘The Talk’ with their parents, ‘because we know that when parents talk with adolescents about their expectations for healthy behaviors, adolescents are more likely to [act accordingly].’
But those conversations can be limited, thin, and cut off quickly. And parents may not be sure when’s the right time (‘adolescents generally don’t ask their parents whether to have sex or not’).
Doctors, meanwhile, are trained to discuss sexual health, tobacco use, drinking, drug use, and all the things that parents are typically most concerned about.
Why aren’t these conversations being had? It’s not clear. (Dr Klein’s study, published in the Journal of Adolescent Health, is part of a broader investigation with national healthcare organizations to try to answer that question.)
Most parents in the survey – which encompassed parents from a range of races, backgrounds, and ages – said they would welcome doctors speaking privately with their kids about health issues.
Dr Klein’s conclusion is that doctors simply aren’t instigating the conversation (though he says it would help if more parents pushed for it, too).
That is certainly a well-documented factor.
A study in 2013 by Duke University found that doctors and teens alike feel uncomfortable talking privately about sex and sexuality, and spend an average of 36 seconds discussing it, based on recordings of more than 200 teen doctor visits.
‘Sexual health is a very difficult conversation for a number of pediatricians,’ lead author of that study, Dr Stewart Chang Alexander, now head of consumer science at Purdue University, told DailyMail.com.
‘I don’t think that it’s intentional but adolescents are very awkward about it. When they will only give you “yes” or “no” answers it’s hard to dig deeper.’
He suggests pediatricians should take baby steps: tell the teen, ‘it may be uncomfortable at first but maybe in a couple of years you’re going to have questions about it.’
That is, if the doctor can get mom and dad out of the room.
Dr Chang Alexander’s research, and previous studies, suggest that parents are open to teens getting advice on any kind of subject – but not out of their earshot.
‘I think that one of the big challenges has been with parents,’ he explained.
‘A lot of surveys show parents are really supportive of adolescents having conversations with their doctors but often they want to stay in the room.’
With that resistance, it can be awkward ordering parents out of the room. And, regardless, many doctors prefer parents being there.
‘Doctors [often] feel more comfortable with a parent in the room so the parent hears everything and it doesn’t feel like there are any secrets or it’s uncomfortable.
‘The intention there is to be helpful and transparent.’
Having conversations about sex with teenagers can be yet more pressing for all parties in states that teach abstinence-only education – like North Carolina, where Alexander conducted his study, and where there is a strong taboo against discussing or acknowledging sex among teens in general.
Both Drs Klein and Chang Alexander insisted that state-by-state education and attitudes should not impact how doctors carry out healthcare.
As Dr Klein sees it, there are clear ways to discuss sexual health in any context.
‘While there are states that recommend abstinence only education the clinical recommendations are very clear,’ Dr Klein said, suggesting doctors can talk about ‘abstinence plus’ – aiming for abstinence, but understanding safe sex practices if they choose to do otherwise. ‘Abstinence is a safe choice but if someone chooses other behaviors, there are things you can do to protect yourself,’ he added.
Dr Chang Alexander concedes that cultural taboos can make the situation more awkward. But he doesn’t believe it is the biggest factor preventing teens and doctors having confidential conversations.
At the end of the day, it might all boil down to something more simple.
Clinics are crowded, doctors are pressed for time, and there is a lot to get through.
‘Doctors are doing so much in such a short period of time, they often fall behind and sometimes you don’t have time for that pause,’ he said.
‘Clinics are quite busy. People are not always closing doors all the time. Sometimes the clinics are set up in a way that parents bring multiple children in the room, which makes confidentiality… very difficult.
‘If [the adolescent] has multiple issues it can crowd out the idea of confidentiality.
‘It’s just not at the top of their mind.’