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A Primary Care Approach to Curbing Dangerous Teen Trends

0978d61b-7390-4aee-8b62-8190eb89b5a0Teenagers, no matter how smart, sometimes do senseless things. There are countless viral challenges and trends online, ranging from silly to downright dangerous, that physicians and parents should be aware of.

Need a few examples?

Two Tennessee teens died in mid-January after drinking “dewshine,” a toxic mixture of racing fuel and Mountain Dew.

That same week, a 14-year-old boy in Washington shattered his eye socket and cheek bone and landed in the hospital with a brain aneurysm after suffering a fall during a “duct tape challenge.”

And car surfing resulted in the deaths of several young people in the past year.

Risky behavior during adolescence is not new. Historically, physicians have associated risky behavior in youth with drugs, sexual activity and alcohol. These days, the modern influence of technology has added additional concerns such as texting while driving, meeting strangers online, participating in social media trends and a host of other issues that have parents unnerved.

Predictors of risky teen behavior are often complicated but include parental monitoring, peer influence and the teen’s mental health. Violence at home, academic difficulties, poverty and lack of extracurricular activities are also associated with risky behavior.

For physicians, helping to curb risky teen behavior is a complex proposition. Screening tools such as the Rapid Assessment for Adolescent Preventive Services (RAAPS) are validated but underutilized because of limited evidence on outcomes. Primary care teams of physicians, behavioral health specialists and social workers should be comfortable with any followup preventive interventions based on the screening results.

The HEADSS assessment (home/habits, education/employment/exercise, accidents/ambition/activities/abuse, drugs/diet/depression, sexual activity/suicidal ideation) is a standard part of the adolescent exam, but physicians should make sure they are careful, not cursory, in their history-taking. Awareness of current trends can narrow the societal gap between patients and their physicians.

Communication is also key to adolescent care. Physicians should approach teens in a way that is nonjudgmental with open-ended questions. Although most of the exam should be done without a parent in the room, including a parent in the discussion at the end of a visit offers a unique opportunity to start a conversation. Physicians can often play a powerful role in creating a safe space to facilitate discussions between teens and their caregivers.

Parents can minimize risky behavior though open communication and social media monitoring. They should be aware of and connected to their child’s peer network, teachers, etc.

Society can address some dangers through legislative efforts, such as banning texting while driving, but these efforts cannot guarantee teenagers will be safe from their own poor decision-making. Nonetheless, as times change, our approaches to adolescent care should evolve as well.

Natasha Bhuyan, M.D., is a board-certified family physician in Phoenix. You can follow her on Twitter @NatashaBhuyan.

Medicine, Media and the Need for a Physician’s Perspective

“I don’t like taking medicine unless I really have to.”

That is the most common complaint I hear from my patient Sandra whenever I talk with her about why she should be taking a statin or why it’s important to get an annual flu vaccination. Unfortunately, she bristles at discussions about quality of life and mortality.

But a conversation I had with her at this time last year was different. Sandra was eager to learn more about an immunization and medication she thought she really needed. This patient, who had rejected recommended preventive care that could protect her from far more prevalent diseases, was worried about Ebola.

My visit with Sandra was during the peak of the Ebola scare. After the first case was reported in the United States last fall,parents pulled their children from schools, politicians called for a ban on travelersfrom West African nations, and health experts had to put down fears that Ebola would become airborne.

Although more than 28,000 cases resulting in more than 11,000 deaths have been reported in Guinea, Liberia and Sierra Leone, Ebola has not made much of an impact on public health in the United States. According to the CDCthere were four cases and one death in this country last year.

In stark comparison, heart disease is the No. 1 cause of death in the United States, claiming more than 600,000 lives each year. But, no, Sandra won’t take a statin. And although more than one-third of Americans are obese, many patients don’t want to talk about diet and exercise. Diabetes, by the way, kills more than 75,000 Americans per year.

Influenza and pneumonia (nearly 57,000 annual deaths) pose much bigger, immediate threats to U.S. public health than Ebola, yet some Americans were panicked by the incessant news coverage generated by a handful of Ebola cases being treated in the United States. Sandra had heard about an experimental Ebola vaccine on the news, but she didn’t understand its indications or the fact that it was still in trials.

The intersection of medicine and the media is a peculiar place. What the media considers newsworthy — interesting, impactful, timely or novel — often has little or nothing to do with scientific validity and reliability.

Mainstream news outlets frequently tout new treatment modalities and new drugs long before we know their true potential. News outlets also love stories (and ratings) related to “looming” health threats, even if the threat isn’t particularly great. The urgency of Ebola was easier to convey than the long-term, more significant threat of heart disease. And news about a pill being developed to prevent Alzheimer’s (someday) or a cutting-edge therapy for cancer will always beat out common-sense recommendations about exercising to prevent obesity.

In reality, newer medical treatments and technologies do not necessarily translate to better medical care or health outcomes. In fact, they are often ineffective or come with higher costs. What is new should not trump what is true. Yet the health information disseminated to the public isn’t always helpful.

Medical statistics and information can easily be misunderstood by the average person. Ideally, health care news should be dominated by systematic reviews of multiple high-quality randomized controlled trials; however, this is limited by a number of factors, including a paucity of resources to execute these trials. Consequently, media outlets often cover the results of observational studies or presentations from academic meetings, although many of these abstracts will never be published in a peer-reviewed medical journal. It’s no surprise such cursory information can be misinterpreted.

The good news is more media outlets are starting to rely on physicians to convey health news. Physicians are consistently rated favorably by the public in surveys regarding honesty and ethical standards. As members of a profession that has earned the public trust, physicians can work with the media to deliver important health messages. Family physicians, in particular, are in a unique position: We have both the most intimate and the most global perspectives when it comes to the health of our patients. We are able to interpret research without distorting its impact and articulate this information to the general public. Finally, given the broad scope of our capabilities, we can comment on topics ranging from antibiotic overuse to sleep hygiene.

Social media is another venue that allows physicians to potentially reach an audience that extends far beyond the exam room. Physicians can recommend evidence-based guidelines, provide commentary on journal articles and dispel misinformation.

Of course, the best way to combat medical misinformation is to have a trusting relationship with your patients. I explained to Sandra what I knew about Ebola and eased her fears about transmission. I also engaged her in a goal-oriented discussion about statins and the influenza vaccine. Although she didn’t change her mind that time, I took comfort in the fact that she always comes back to see me. And she’s no longer worried about Ebola.

Natasha Bhuyan, M.D., is a family physician in Phoenix. You can follow her on Twitter @NatashaBhuyan.

AAFP Congress of Delegates in Denver a Huge Success

Although the AAFP President-Elect Election did not go the way we had hoped it would, it was a successful trip for the AzAFP.  The AzAFP enjoyed learning more about and promoting our wonderful member Carlos Gonzales and his family!  He has made an enormous contribution to family medicine in Arizona.  We were so proud to have him as our candidate and to represent the State of Arizona.  For more information on the COD and the election, please visit www.aafp.org.

AAFP COD Election Results

The AzAFP would like to congratulate the following people for their newly elected positions:

Vice Speaker:
Alan Schwartzstein, MD- Wisconsin

Board of Director Members:
John Bender, MD, Colorado; Gary Leroy, MD, Ohio & Carl Olden, MD, Washington

President Elect:
Former Speaker, John Meigs, MD, Alabama

Commission chairs:
COCPD – Richard Lord, MD, North Carolina
Education – Deborah Edburg, MD – Illinois
Commission on Finance & Insurance – Russell Cole, MD, Kansas
CGA – Sarah Sams, MD, Ohio
CHPS – Patricia Czapp, MD, Maryland
CMMS – James Elzie, MD, Uniformed Services
CQP – Lee Mills, MD, Kansas

Check out what you missed at the AAFP COD & FMX:

The AzAFP also hosted it’s first ever FMX AzAFP Member Appreciation Reception. Thank you to all who attended! Please visit the AzAFP’s Facebook page in order to view photo’s from the Denver trip.