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Adolescent medicine is a medical subspecialty that focuses on care of patients who are in the adolescent period of development. Patients have generally entered puberty, which typically begins between the ages of 9 to 11 for girls, and 11 to 13 for boys. A primary care subspecialty, adolescent medicine incorporates aspects of psychiatry, endocrinology, sports medicine, nutrition and gynecology. Issues with a high prevalence during adolescence are frequently addressed by providers. These include: In addition, issues of medical ethics, particularly related to confidentiality and the right to consent for medical care, are pertinent to the practice of adolescent medicine.
Training Adolescent medicine providers are generally drawn from the specialties of pediatrics, internal medicine or family medicine. The certifying boards for these different specialties have varying requirements for certification, though all require successful completion of a fellowship (a comprehensive list of which is available via the Society for Adolescent Medicine website below) and a passing score on a certifying exam. The American Board of Pediatrics requires evidence of scholarly achievement by candidates for subspecialty certification, usually in the form of an original research study. Scope of care Providers of care for adolescents generally take a holistic approach to the patient, and attempt to obtain information pertinent to the patient's well-being in a variety of different domains. This approach, similar to the biopsychosocial model, is encapsulated in the HEADS assessment, which is a screening acronym for adolescent patients. It includes: In addition to a detailed history, adolescents should have a comprehensive physical exam on a yearly basis. Developmental progression, including assessment of Tanner stage, should be noted, and appropriate endocrinological work-up undertaken for patients that fail to develop in an anticipated manner. Screening lab tests, including a complete blood count to screen for anemia, and either a spot cholesterol check or (ideally) a fasting lipid profile to screen for , should be obtained at least once during adolescence. For patients who are sexually active, particularly in areas of high prevalence or with patients participating in higher-risk behaviors, screening tests for sexually transmitted diseases should be performed, including an RPR or VDRL for syphilis, screening for gonorrhea and chlamydia, and HIV. Sexually active females should have a pelvic exam (including a Pap smear to screen for early signs of cervical cancer), though the timing of the initial exam following first intercourse and how aggressively abnormal Pap smears must be followed up are subjects of controversy within the field. Health centers Many subspecialists practice as part of general specialty clinics or practices. In addition, many major metropolitan areas have clinics that offer adolescent-specific care. A partial list includes: New York City Los Angeles San Francisco area Boston Philadelphia Further adolescent medicine clinics may be found by looking for a local resource from a list of children's hospitals. Professional Organizations In addition to membership in the organizations for their various specialties, adolescent medicine providers often belong to The Society for Adolescent Medicine and/or the North American Society for Pediatric and Adolescent Gynecology. The Journal of Adolescent Health and The Journal of Pediatric and Adolescent Gynecology are the publications of the two organizations, respectively. | ||||||||
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