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 presented case of a 15-year-old male, David, highlights the importance of adolescent patient care and building trust and rapport with them. As a medical professor, it is imperative to equip medical college students with the skills to approach and assess such cases. This assignment will require the learner to answer nine questions concerning David’s medical and psychosocial history, social and family history, important medical history, behavior changes, appropriate referrals, screening tools, and 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, it is necessary to establish a comfortable and non-judgmental environment for the adolescent patient. This can be done by using open-ended questions, active listening, and acknowledging their concerns and feelings. Additionally, it is essential to obtain information on the patient’s developmental stage, their relationships, home life, school, social environment, and mental health history.
2. When obtaining the social history, what are the important questions to ask?
Critical questions to ask while obtaining the social history of an adolescent patient include their living situation, family dynamics, relationship status, educational status, peer interactions, hobbies, and substance use. It is also essential to assess their overall adjustment to their social environment, their resilience, protective factors, and risk factors.
3. When obtaining the family history, what are the important questions to ask?
When obtaining the family history, crucial questions to ask include a detailed history of medical, psychiatric, and substance use disorders in the family. Moreover, it is essential to inquire about the adolescent patient’s relationships and interactions with immediate family members, such as parents and siblings.
4. What if anything in David’s medical history is important to know?
David’s medical history is essential to know because it may give insights into underlying medical conditions and contribute to his behavioral changes. The provider should inquire about any traumatic brain injury, neurological disorders, chronic medical conditions, sexually transmitted infections, and medication use.
5. What other information about David’s recent behavior should be obtained from his mother?
Besides David’s mother’s concerns about his irritability, outbursts, and academic decline, it is crucial to obtain details about any changes in his appetite, sleep patterns, self-harm, suicidal ideation, anxiety, and depressive symptoms. Information on substance use and exposure to violence or trauma is also essential.
6. The provider asks David’s mother to step out of the room. What questions should David be asked when alone?
When alone, the provider may use open-ended questions to establish rapport with David and assess his understanding of his concerns and feelings. Questions such as “Can you tell me more about how you are feeling?” or “What are your thoughts about your grades dropping?” may help elicit information about his mental health state and thoughts.
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 age-appropriate screening tool that may be useful in assessing David is the Patient Health Questionnaire-9 (PHQ-9). It screens for depression symptoms and has been validated for use in adolescents. The PHQ-9 is scored from 0 to 27, with scores from 10-14 indicating moderate depression symptoms, and scores above 15 indicating severe depression symptoms. The tool is self-administered, takes less than 5 minutes to complete, and has high sensitivity and specificity.
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 result is significant based on the PHQ-9, appropriate referrals would be to a mental health professional for a comprehensive evaluation and treatment. The mental health professional may provide individual therapy, family therapy, or medication management, depending on the severity of David’s depression symptoms and underlying causal factors. It is also recommended that the mother is referred to a mental health professional to provide support and guidance in her role as a caregiver.
9. As part of David’s annual physical examination, discuss health promotion and screening recommendations.
As part of David’s annual physical examination, it is essential to provide recommendations for health promotion and screening. This may involve counseling on healthy behaviors, substance use prevention, and mental health promotion. Additionally, screening recommendations may include tests for sexually transmitted infections, vision, hearing, and scoliosis. Counseling on education goals, career aspirations, and safety measures may also be provided.
