Teens With Health Insurance Absent in the Doctors' Offices


"By engaging the parent as well as the teen, it increases the chance you may be able to have them return to continue a more in-depth look at issues you may uncover through the initial screening process," said Dr. Ann Budzak, a pediatrician at Gundersen Lutheran Medical Center in La Crosse, Wisc. "Having office hours in the evening and on weekends also increases the chances a teen will come for a routine visit along with a parent."

Dr. Lee Green, a professor in the department of Family Medicine at the University of Michigan, agrees that parents play an important role in the process.

"My experience is that if teens come in for any preventive services, it's their parents' idea, or more often a requirement of the school, camp, or sports team they join," said Green.

"They make the appointments!" said Dr. Caryl Heaton, associate professor and vice chair in the department of Family Medicine at New Jersey Medical School. "You would never hear a teenager say, 'Oh, I better get a checkup.' That's just not the way their brains work."

'No-Missed-Opportunities' Paradigm

On top of parental involvement, study authors suggested the idea of a "no-missed-opportunities" paradigm to solve the dwindling teen presence in preventive medicine. The idea is that every adolescent visit to the doctor, whether for strep throat, a broken bone, or bronchitis, is seen as an opportunity to provide preventive care services, even in busy practices with short encounters with the clinician.

Eaton said the idea of no-missed-opportunities paradigm has already been incorporated into her routine with teenagers.

"[I] discuss weight, diet, activity levels, flu vaccines, etc.," said Eaton. "Generally, mentioning weight issues doesn't take a long time, and [it's] often helpful."

And Schwenk said that many practices and family physicians already ask preventive care questions at each visit. The University of Michigan has already put a plan into place that will answer preventive care issues for any type of doctor appointment with a teen.

"At U.M., we have a sophisticated system that provides all of these prompts and reminders for any services we choose to emphasize, and they show up for all visits," Schwenk said. "We do not differentiate preventive service from chronic disease from acute care visits any more, everything happens at every visit."

A Time Crunch

But Dr. Michael Good said time would continue to be the enemy when it comes to the no-missed-opportunity paradigm.

"I cannot see how one would have time to sneak in a half-hour of preventive counseling in a seven minute double-booked sick visit," said Good, a family practice physician in Middletown, Ct. "In today's world, a primary care practice would run hours behind, patients would storm out of the waiting room, income would be lost and everyone would be unhappy if we tried to hold up all our patients because a delinquent teenager happened to come in with a sore throat."

Would it Make a Difference?

And even with preliminary systems in place, some doctors wonder if the regular visits would really do much good. Green wasn't convinced that the low level of teen preventive care should be a cause of concern.

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