A teenager who is sad and maybe even considering suicide may be reluctant to tell a doctor about life-threatening troubles. But the same teenager is far more likely to tell a computer a secret that he or she would be hesitant to share with even a close friend, much less a clinician who may be a friend of the family.
Researchers in Ohio are using that intimate relationship between teens and computers to enhance communications with doctors, revealing behavioral patterns that could lead to adolescent morbidity or mortality. It's all done in confidence, using a touch-screen device and software called "Health eTouch."
Even mom, sitting next to the teen, can't see the answers to behavioral questions without the teen's consent. The single exception would be if the teen reveals that someone is in immediate danger, according to Kelly Kelleher, a researcher in the Center for Innovation in Pediatric Practices at Nationwide Children's Hospital in Columbus, Ohio.
Kelleher, who is also a pediatrician and a faculty member at Ohio State University, has been working for years to figure out a better way for young people to communicate with their doctors.
Physicians are supposed to ask a series of questions recommended by the American Academy of Pediatrics and other national organizations, but in most cases it simply doesn't happen, Kelleher said. The 15 minutes allowed for a typical face-to-face meeting between the doctor and patient isn't enough time.
Some physicians have used pencil-and-paper questionnaires to collect data, but that often fails.
"We completed one of the largest studies ever in previous research, handing out 25,000 questionnaires in 400 doctors' offices," Kelleher said, but after two or three weeks the paper load was just too great.
"It's just too overwhelming for a busy practice," he added.
So instead, he and his colleagues turned to what is often a teenager's best friend, an electronic device with access to the Web. This is, after all, the Facebook and YouTube generation, with Web sites where millions pour out their secrets.
More than 50 studies have shown that young people are more likely to reveal socially sensitive behavior to a computer than they are to a clinician, Kelleher said.
The researchers put 878 patients, ages 11 to 20 years, through a computerized behavioral screening system between June 1, 2005 and Feb. 20, 2006. Each teen answered a series of questions in absolute confidence, although with the knowledge that the results would be shared with the physician. Only the teen, sitting with his or her back to a wall, can see the directionally sensitive screen. The results were transmitted immediately to some of the physicians and three working days later to the other physicians.
The reason for the delay was to see if the information was really all that useful to the clinician. Some 59 percent of the teens revealed at least one behavioral concern, such as injury risk behavior, significant depressive symptoms, or substance use.
Pediatricians who received the results immediately identified the problem in 68 percent of the cases. Those who received the results later had identified the problem in only 52 percent of the youths.
Interestingly, about one-third of the time the teenager was more concerned than the doctor about behavior that might be condemned by others, such as the teenager's parents.