The kids are pretty much past the cute stage when they see Dr. Leslie Walker. Not for her are chubby babies cooing during checkups, toddlers playing with her stethoscope, 6-year-olds proudly showing off how many letters they can read on the eye chart. Nope, she gets the sometimes surly or silent crowd, the ones with piercings or tattoos, the ones who need to talk about sex—but don’t. You know, the ones who must be asked to take out their earbuds so others can talk to them.
That is to say, teenagers. Walker is a specialist in the largely unknown world of adolescent medicine, a specialty a fair number of doctors would likely pay good money not to practice. It’s a specialty that doesn’t remunerate especially well for the medical world, and one that doesn’t come with automatic prestige, the way that being a heart surgeon or a neurologist does. It’s a specialty that requires three years of extra training, patience by the boatload, superb listening skills and the ability to tap into one’s inner 16-year-old. Extra points for a keen interest in mental health, dermatology and the prevention of motor vehicle accidents. Seattle Children’s, where Walker practices, is one of the country’s leading centers for adolescent medicine.
For Walker, it is nirvana. During medical school, she was torn about which specialty to pursue: Psychiatry? Gynecology? Pediatrics? Men’s health? Women’s health? She enjoyed them all and didn’t want to choose just one. Then, during medical training, she met someone who practiced adolescent medicine. Although it has been an area of medical focus for about the last 50 years, it has only been a board certified specialty since 1991, and it is a comprehensive specialty that includes all the areas of medicine Walker wanted to pursue.
Adolescent medicine specialists “focus on patients from roughly the ’tween years, starting at 10 or so, until about age 24,” says Walker. It is becoming increasingly important as a specialty because of factors impacting teens, such as mounting social and academic performance stress, the rise in bullying, issues relating to sex occurring at earlier ages and escalating competition in sports. The teen years are a critical time—the teenaged brain is not fully developed until about the age of 24, and teens are most susceptible to chemical dependencies during this developmental phase, Walker says.
It’s a specialty that requires three years of extra training, patience by the boatload, superb listening skills and the ability to tap into one’s inner 16-year-old.
Dr. Wallace Hodges, a physician specializing in adolescent care at Minor & James Medical and affiliated with Swedish Medical Center, says the field has changed considerably since he began in the late 1970s. Back then, there was little collective understanding of the unique nature of adolescence and its challenges, he says. That meant many medical issues impacting the group were effectively orphaned because doctors were so uncomfortable with the issues—and with the teenagers who suffered. Hodges decided to focus on eating disorders. “I’m sort of a sucker for problems that are hard to solve,” he says.
Adolescent medicine specialists are uniquely qualified to deal with complex medical issues that teens face because the specialty is “whole person-based, not just organ-based,” says Walker. For example, a teenager with complex symptoms may have a medical issue, a psychological issue causing medical-like symptoms or another problem altogether. It’s the job of the adolescent medicine specialist to solve the puzzle.
In one of Walker’s most compelling and troublesome cases, a 16-year-old female patient experienced chronic severe abdominal pain and extreme fatigue. She was routinely too tired to go to school. Even more alarming to her family, she couldn’t even summon the energy to go to the mall with her friends—and what teen doesn’t want to do that? Something was definitely very wrong. When Walker first saw her, the teen’s medical file was the size of a telephone book. Numerous tests had not revealed any apparent medical cause for the pain, so doctors thought mental health issues were likely a factor. Walker began the painstaking work of figuring it out. In the end, Walker discovered the teen had a heart condition requiring immediate surgery. Had it not been discovered and treated, her condition would have become life threatening.
Most teens don’t face such severe health issues, but Walker worries that for many patients, the teen years are a time when they simply disappear from organized health care, except for perhaps the occasional sports physical. “[Adolescence is] its own developmental stage,” Walker insists. Even so, “a lot of kids tend to fall out of the [medical] system then. Internists—they’re not ready for that. The kids always say [about pediatricians], ‘I hate going there and having to sit in those little chairs.’ It’s a developmental stage that isn’t well served by either traditional pediatrics or internal medicine, and we lose them. It’s like a no-man’s land.”
And it is such a complicated age: doctors serving this population must be comfortable with discussing everything from sexuality—from practicing safe sex to exploring one’s sexual identity—to drug use, drunk driving, suicide, depression, eating disorders, dating violence and steroid use.
It can be a hard transition for parents as well, who themselves may be bonded with a pediatrician who talked them through their child’s colic, teething and ear infections. And then there’s another awkward stage: parents learning to let their child go into that exam room alone, with nearly all resulting conversations staying confidential.
But those who make the leap say the rewards are clear. Woodinville parent Lucinda Brezak first met adolescent medicine specialist Cora Collette Breuner after one of her daughters suffered a hip injury from playing soccer and lacrosse. “She had a pretty devastating sports injury that wouldn’t heal,” Brezak says. “Cora helped us through that process.” Her daughter found Breuner to be enormously helpful in transitioning to more grown-up health care. “Pediatricians don’t always understand the adolescent part of it,” Brezak says.
Breuner, who practices at Seattle Children’s and works with Walker, says teens take more time than younger children when they visit the doctor, often because their health issues require both trust and talk. The leading causes of death for this age group are motor vehicle accidents, suicide and homicide, she says. “It’s all preventable. With motor vehicle accidents, half of all of them occur when kids are under the influence.” Parents have to help teens reduce at-risk behavior, Breuner says.
How will you know when you need an adolescent medicine specialist? Your child’s primary care doctor or specialists can help you make this decision. When things get complicated and you feel you and your teen need more than standard medical care to get through the turbulent years, it’s time to explore options. But you have to be prepared: It’s an age where young people need to learn how to take responsibility for their health and, independent of their parents, learn how to navigate the medical system. Adolescents need to start taking on this increased responsibility sometime in their mid-teens, including filling out forms, talking to medical providers and following any instructions they are given, according to adolescent health specialists. That can be impeded if parents continue to helicopter over their offspring in medical offices. “Unlike medical visits with small children in which providers rely mostly on parents for information, providers should spend some time alone with teens so they can discuss in private concerns they may have about their health,” says Breuner, who encourages this practice at age 10 or 11 to help patients develop awareness of their own bodies.
Many adolescent medicine physicians, like Breuner, have subspecialties; half of her patients have sports injuries. That includes 12-year-old Andrew Burdgraff of Seattle. The seventh grader started seeing Breuner after she noticed him walking with a limp at a football game she was attending. His mother Kim Burdgraff said Breuner knew immediately that Andrew had suffered more than the simple muscle pull they initially thought had happened, and tests indeed showed he had a pelvic fracture.
Burdgraff says she’s grateful for that chance meeting with Breuner. Not only did the physician understand the medical aspect of his injury, Breuner totally understood the psycho-social aspects as well, including how he suffered because of other kids teasing him about his limp, she says. “[Andrew] had a really hard time. It was just phenomenal how she was able to relate to him. She used the words right out: ‘Hey, has this ever happened to you—kids making fun of you because of your injury?’ and telling him that’s not okay.” Breuner likewise helped Andrew understand the seriousness of the injury, encouraged him through treatment and kept him optimistic about returning to his beloved sports, Burdgraff says.
Working with teens is rewarding for the physicians who choose this path. Hodges says he’s learned plenty from the age group. Breuner says it’s intensely gratifying work. “You become a medical expert in social aspects of adolescence as well as the medical issues. It takes a specific breed [of doctor], that’s for sure,” says Breuner, but she loves the challenges—and the rewards. ✚
Adolescent health resources for kids and parents
Seattle Children’s naturally has a deep bench on this, with a number of specialists covering this age range, and is considered one of the nation’s leaders in adolescent medicine.
Harborview Medical Center experts likewise offer an Adolescent Medicine Clinic, with a broad range of care provided
Group Health Cooperative has an Adolescent Center for teens aged 11 to 18. Others, like The Polyclinic (polyclinic.com), Minor & James Medical (minorandjames.com) and Swedish Medical Center (swedish.org) also have adolescent medicine specialists.
Blogs and WebSites
Teenology101: A handy blog for teens and their parents (since teens don’t come with a user’s manual) published by Seattle Children’s Hospital. Topics range from losing weight and healthy eating to tips on talking about sex and contraception. teenology101.seattlechildrens.org
TeenHealthFX: Lots of answers—and links—on health, nutrition and sexuality are on this nationally recognized website created by Atlantic Health System in New Jersey. teenhealthfx.com/index.php
Society for Adolescent Health and Medicine: This is the professional association for adolescent medicine specialists. The site provides links to teen and family resources, research, publications and a searchable database of local adolescent health providers.
National Institutes of Health: Lots here, on everything from prevention and medical treatment to alternative therapies, nutrition
and mental health.
The Teen Health Book: A Parents’ Guide to Adolescent Health and Well-Being, by Ralph I. López, M.D., a nationally respected pioneer in the field of adolescent medicine from Cornell University. This book is a comprehensive guide to teen health, considered by many to be the bible for parents of teens, just as Dr. Benjamin Spock’s books were for the parents of babies. Dr. López addresses physical and emotional concerns for this life stage. ($24.95 on amazon.com)
Healthy Teens, Body and Soul: A Parent’s Complete Guide, by Andrea Marks, M.D., and Betty Rothbart, M.S.W. An adolescent medicine specialist and a social worker who specializes in parent-child relationships, both based in New York, penned this critically acclaimed book which aims to help parents partner with their children for healthy, happy teen years ($23.99 on amazon.com)