CONSULTATION DYNAMICS Ideally, there should be two moments during the consultation: the adolescent alone and the adolescent with family members/companions. Interviewing the adolescent alone offers the opportunity to encourage him/her to express his/her perception of what is happening to him/her, and gradually become responsible for his/her own health and the conduct of his/her life. In addition, this space allows the adolescent/young person to address some confidential aspects that are worrying him/her. The interview with the family is essential for understanding the dynamics and structure of the family and for clarifying important details. The health professional should not be limited to obtaining information about the main reason that led the adolescent to the health service, but rather get to know the client as a whole. This includes assessing how the adolescent is feeling in relation to the physical and emotional changes he/she is going through, his/her relationship with his/her family and peers, how he/she uses his/her leisure time, his/her previous experiences in the health service, expectations regarding the current care and his/her plans for the future. It is important to note that communication barriers may arise during the anamnesis. In addition to recognizing and trying to overcome them, the professional should seek to explore the reasons that determine this behavior. Another situation that should be observed is the possibility of the health professional feeling seduced by the patient and vice versa. The professional must be clear about his or her role and avoid other types of relationships that are not strictly technical. One alternative to overcome these difficulties is to present the situation to the team and discuss solutions or referrals. At this time, other options may arise in the management of the case, including the possibility of referring to another professional. PHYSICAL EXAMINATION The physical examination is the procedure that presents the highest degree of difficulty for the poorly qualified health professional. This is due to the fact that, in the training of doctors or nurses, there are no disciplines that develop this skill taking into account the discomfort caused to the professional by the need to manipulate the body of an individual in full physical and sexual development and vitality. Given these difficulties, many professionals choose not to perform a complete physical examination, resulting in missed opportunities in the diagnosis of health problems(5). An alternative for professionals in training, or for those who do not feel comfortable performing a physical examination, is for another professional from the team to participate as an observer during this part of the consultation. If the adolescent appears embarrassed about the physical examination, or if there is any indication of seduction on either side, it is also recommended that a member of the team be present during the procedure. Explaining in advance what the physical examination is and how it will be performed is important to reassure the adolescent and reduce their fears. In addition to anxiety about handling their body, adolescents are often anxious about the prospect of abnormal findings. Therefore, it is desirable for the professional to respond to this expectation, revealing what is normal during the evaluation. The physical examination should be an opportunity for the professional to address educational topics with the client regarding their body, such as by instructing them on self-examination of their breasts and testicles. Guidance on hygiene habits is also an important aspect to be addressed at this time. Whenever possible, a complete physical examination should be performed at the first appointment, including visual screening , dental caries screening, careful observation of the skin and mucous membranes, examination of the spine and genital tract, among others. During the clinical appointment, some instruments are essential for recording the data obtained during the consultation. Given the peculiarities of a maturing body, the measurement of anthropometric measurements and their arrangement in graphs (National Center for Health Statistics – NCHS), in addition to pubertal staging (Tanner criteria), are essential. Data related to the anamnesis and physical examination should be recorded on appropriate forms adopted by the services. ADOLESCENT COMPUTER SYSTEM The Adolescent Computer System[1] (SIA) was created to systematize adolescent care with the support of the Pan American Health Organization (PAHO) and the Latin American Center for Perinatology and Human Development (CLAP). The main objective of this system is to improve the quality of comprehensive care for adolescents in health services. In addition, it aims to promote epidemiological knowledge among the user population. The SIA consists of forms for recording data on history, physical examination and clinical evolution. This system has a computer program that facilitates local processing of information. In cases of care for pregnant adolescents, the perinatal clinical history should be used. A complementary reproductive health form was recently included. Data can be recorded by different team members, according to information obtained during the client’s visit to the service. To achieve this, there needs to be good integration between professionals and confidentiality in the handling of medical records. THE HEALTH TEAM Comprehensive health care for adolescents and young people requires the participation of professionals from different disciplines, who must interact through an interdisciplinary approach. Team care focuses on the problem, avoiding fragmented views from only each specialty and/or discipline. The main characteristic of interdisciplinary work is the provision of services to the same population through interconsultation or referral. This work, even with good interaction between team members, is carried out independently, sometimes in different locations. In multidisciplinary team work, professionals from different disciplines interact to provide care to the client. This integration is achieved through joint discussions, in which decisions are shared and made from different perspectives, resulting in a more effective therapeutic proposal. LEVELS OF CARE According to the degree of complexity, health services are classified into three levels: primary, secondary and tertiary. This hierarchy is important for the functioning of a service network that uses a referral and counter-referral system. For greater effectiveness, the client must move between the levels of care without losing the continuity of their care, which is guaranteed through integration between the three levels. The health service network must be organized into levels of increasing complexity, with adequate coordination between them. RETHINKING A NEW PARADIGM The team can take advantage of the moment of consultation with adolescents and young people to exchange information and understand the new trends of the target population. It should be borne in mind that, as this is a contingent in constant change, it is necessary to be aware of what is in transition and the new customs. Another issue that services often avoid adopting is the client’s participation in the care provided. With this age group, distancing may mean little understanding of the rules and conduct, decreasing adherence to the service and low cooperation in planned activities.
- be available to assist the patient and their family without being authoritarian;
- be attentive to the teenager and be able to ask questions that help the conversation, seeking to understand their perspective;
- not be prejudiced, avoiding making judgments, especially when it comes to approaching certain topics such as sexuality and drug use;
- continually seek technical updates in the specific area of professional activity.
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