The Adolescent Patient: Building Trust and Rapport
David is a 15-year-old male who presents for his annual physical exam. When the provider asks if there are any issues or concerns, David’s mother states that he is irritable all the time, has occasional outbursts, and recently began spending more time alone in his room and less time with his friends. She also states that she has noticed that David is staying up later and is difficult to awaken for school. When asked, both David and his mother admit that his grades have gone from A’s and B’s to mainly D’s. When interviewing David, you noticed he does not maintain eye contact and gives you short answers, mostly, “yes,” or “no,” responses.
Answer the following questions in 2-3 pages, excluding title and reference page.
- How will you approach taking a more detailed medical and psychosocial history?
- When obtaining the social history, what are the important questions to ask?
- When obtaining the family history, what are the important questions to ask?
- What if anything in David’s medical history is important to know?
- What other information about David’s recent behavior should be obtained from his mother?
- The provider asks David’s mother to step out of the room. What questions should David be asked when alone?
- Discuss one evidence based screening tool (should be age appropriate) you will use to gather more information about David. In your discussion please include the validity and reliability of the tool, how it is administered and how it is scored and interpreted.
- Suppose David’s result is significant based on the screening tool, what are appropriate referrals for David and his mother? Discuss your rationale.
- As part of David’s annual physical examination, discuss health promotion and screening recommendations.
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Expert Solution Preview
Introduction:
The case of David, a 15-year-old male who presents for his annual physical exam, signifies the importance of building trust and rapport with adolescent patients. As a medical professor responsible for creating college assignments and answers for medical college students, the following questions aim to develop a comprehensive approach towards taking a detailed medical and psychosocial history and providing appropriate health promotion and screening recommendations.
1. How will you approach taking a more detailed medical and psychosocial history?
To approach taking a more detailed medical and psychosocial history, I would establish a positive and comfortable environment for David to promote truthful communication. I would start by commending David’s presence and asking him about his daily routine, academic performance, hobbies, and interests, vital signs, growth parameters, nutrition, sleep patterns, exercise, and any medical concerns or symptoms. Subsequently, I would discreetly inquire about David’s sexual history, substance use, and mental health, asking open-ended questions to encourage elaboration and establish a foundational trust level.
2. When obtaining the social history, what are the important questions to ask?
When obtaining the social history, it is essential to ask about David’s current living situation, school environment, peer relationships, extracurricular activities, and personal habits, such as smoking, drug use, and alcohol consumption. Specifically, exploring David’s social media usage, sleep, and media consumption patterns will reveal any potential risk factors and provide an insight into David’s social and psychological well-being.
3. When obtaining the family history, what are the important questions to ask?
When obtaining the family history, important questions to ask include any familial medical conditions, psychiatric conditions (e.g., depression, bipolar disorder, anxiety), drug or alcohol use, and interpersonal relationships between family members. Additionally, understanding David’s developmental milestones, genetic factors, and early childhood experiences may uncover potential contributory factors towards his current mental health and behavioral issues.
4. What, if anything, in David’s medical history is important to know?
David’s medical history is important to obtain to screen for any comorbidities that may contribute to his current medical and psychological symptoms. Specifically, a detailed history of any past or current medical conditions (e.g., asthma, diabetes), medications, allergies, surgeries, procedures, vaccines, and hospitalizations will identify any potential risk factors and inform treatment plans and preventative measures.
5. What other information about David’s recent behavior should be obtained from his mother?
David’s mother’s observation of David’s recent behavior is important to document to corroborate David’s subjective presentation. Asking his mother about David’s recent emotional and behavioral changes, such as irritability, outbursts, social isolation, changes in sleep patterns, and academic performance helps build a comprehensive clinical picture of David’s current mental and physical well-being.
6. The provider asks David’s mother to step out of the room. What questions should David be asked when alone?
When alone with David, I would ask him for further elaboration about his daily routine, school, extracurricular activities, social relationships, and personal habits. I would also inquire about David’s emotional and behavioral changes, including any symptoms of depression, anxiety, or suicidal ideation. Providing David with a safe space to talk freely and openly is critical to establish a stable physician-patient relationship and promote trust and rapport.
7. Discuss one evidence-based screening tool (should be age-appropriate) you will use to gather more information about David. In your discussion, please include the validity and reliability of the tool, how it is administered and how it is scored and interpreted.
One evidence-based screening tool that I would use to gather more information about David is the Patient Health Questionnaire-9 (PHQ-9) used to assess depression. PHQ-9 is a nine-item tool that focuses on key symptoms of depression, such as appetite and weight changes, sleep disturbances, concentration difficulties, and feelings of hopelessness. The PHQ-9 has high validity and reliability in measuring depression among adolescents and young adults. It is administered as a self-reported questionnaire and scored on a four-point Likert scale. Scores can be interpreted as minimal, mild, moderate, or severe depression, determining appropriate interventions and referrals.
8. Suppose David’s result is significant based on the screening tool, what are appropriate referrals for David and his mother? Discuss your rationale.
If David’s screening results for depression are significant, appropriate referrals would include a mental health provider, such as a clinical psychologist or a psychiatrist, who can provide behavioral and cognitive therapies, medication, or electroconvulsive therapy (ECT) if necessary. Family therapy can also help address familial dynamics or sibling interactions that may contribute to David’s stressors. Referring David to school counselors or support groups where he can seek emotional and social support from his peers may also enhance his mental and emotional health.
9. As part of David’s annual physical examination, discuss health promotion and screening recommendations.
As part of David’s annual physical examination, the following health promotion and screening recommendations are essential:
– Screen for substance use, such as tobacco, alcohol, and illicit drugs, and provide counseling and interventions to reduce substance use.
– Encourage physical activity and exercise, which are important in maintaining cardiovascular health, musculoskeletal fitness, and psychological well-being.
– Offer vaccinations, such as influenza, tetanus, diphtheria, pertussis, and human papillomavirus, to prevent potential infectious diseases.
– Screen for sexually transmitted infections and provide counseling and testing to prevent and treat STIs.
– Provide education on safe sex practices, including the use of condoms and contraception.
– Screen for vision and hearing problems to ensure proper sensory development.
– Provide education on healthy eating habits and nutrition to promote healthy weight management and prevent long-term health issues.
– Offer screening for mental health issues, such as depression, anxiety, and suicidal ideation, and provide support and treatment when necessary.
Conclusion:
The case of David highlights the importance of building trust and rapport with adolescent patients and addressing their unique physical, social, and psychological needs. A thorough approach that includes a detailed medical and psychosocial history, appropriate screening tools, and referrals, and health promotion measures is crucial in enhancing adolescent health and preventing long-term health issues.
