The MassGeneral Hospital for Children Adolescent Medicine Handbook PDF
Preview The MassGeneral Hospital for Children Adolescent Medicine Handbook
The MassGeneral Hospital for Children Adolescent Medicine Handbook wwwwww Mark A. Goldstein Editor The MassGeneral Hospital for Children Adolescent Medicine Handbook Editor Mark A. Goldstein Massachusetts General Hospital Division of Adolescent and Young Adult Medicine Boston, MA USA [email protected] ISBN 978-1-4419-6844-9 e-ISBN 978-1-4419-6845-6 DOI 10.1007/978-1-4419-6845-6 Springer New York Dordrecht Heidelberg London Library of Congress Control Number: 2010937420 © Springer Science+Business Media, LLC 2011 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) First Edition © 2010 by Mark A. Goldstein M.D. Chief, Division of Adolescent and Young Adult Medicine MassGeneral Hospital for Children Department of Pediatrics Massachusetts General Hospital Harvard Medical School 175 Cambridge Street Boston, MA 02114 All rights reserved. This publication is protected by copyright. No part of this publication may be reproduced in any form or by any means, including photocopying, or utilizing by an information storage and retrieval system without written permission from the copyright owner. Disclaimer The authors, editor, and publisher have made every effort to ascertain the accuracy of the information presented and to describe generally accepted practices at the time of publication. However, the authors, editor, and publisher are not responsible for any errors, or omissions or consequences from the application of information in this publication. We further do not make a warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of this publication. The practitioner retains the professional responsibility when information in this publication is applied in a particular situation. The authors, editor, and publisher have made every effort to ensure that drug selection and dosage set forth in this publication are in accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. wwwwww Preface Having been started in Boston by Dr. J. Roswell Gallagher in 1951, adolescent medicine is a relatively young specialty. Board certification was first offered in 1994. Many practitioners consider adolescent medicine to include ages 12–21 years, although exceptions are made at both ends of the age spectrum. Unique to this specialty is the emergence and completion of puberty, and all of the developmental tasks and events that may give rise to problems. In adolescent medicine, there are strong links and interrelation- ships between developing physical bodies, emerging intellect, and social adaptations. As a result, the biopsychosocial aspects of each teen should be considered. For example, delayed puberty may affect academic achievement, and together these problems may lead to behavioral issues. During adolescence, the first manifestations of mental illness may occur, sexual awakening may lead to risk taking behaviors, and the growing need for independence arises affecting the adolescent’s relationships with family, peers, schools, and other social institutions. Issues in any of these domains may result in inter- actions with the healthcare system. It is important to have resources to address these problems. We have not intended that this handbook be a complete survey of adolescent medicine. Rather, we designed a text that we hope is vii viii Preface practical and user-friendly. In addition, this is not a work consisting only of facts, diagrams, tables, charts, and pathways. Instead, it was our hope to develop a resource that addresses best practices in adolescent medicine where practice not only means the most appropriate approaches, diagnostic evaluations, and best treatments, but also the best ways to connect, communicate, and continue care with teenagers. After all, if the physician cannot develop a good relationship with an adolescent, then treatment and follow through will surely be compromised. This handbook has three sections: general adolescent medicine, sexuality, and mental health. There is also an appendix with additional materials. References and additional readings are listed at the end of each chapter. Knowing that mental health and substance abuse competencies are goals recommended by the American Academy of Pediatrics for primary care pediatricians, we have included an extensive section on these areas of learning. In addition, adolescents surface in the medical home asking for sexuality services, so we have included broad content for these important adolescent issues. We have made every effort to include practical materials useful for the primary care physician realizing that these core areas of learning may not be addressed extensively in pediatric or internal medicine training programs. Except for neonatologists and geriatricians, adolescents may be seen by any other medical or surgical specialist. While this handbook is aimed at clinicians who see a number of adolescents in their practices, it should be relevant to most clinicians. Each of our outstanding physician authors represent expertise in pediatric or adult specialties and has taught or trained at Massachusetts General Hospital. Using their collective knowledge and wisdom, we have crafted a multispecialty approach to adolescent healthcare hoping to present a balance of the science and the art of adolescent medicine. Adolescence is time limited, and eventually adolescents will need to seek a new medical home. The last chapter addresses the issues inherent to care transition and offers a model for transfer of care to adult medicine. September 2010 Mark A. Goldstein Acknowledgments I wish to thank Dr. Ronald E. Kleinman, Physician-in-Chief, MassGeneral Hospital for Children, Chair, Department of Pediatrics, Massachusetts General Hospital and Charles Wilder Professor of Pediatrics, Harvard Medical School for his enthusiastic support of this project. Without his commitment, this handbook would not have been possible. Dr. Karen Sadler, faculty member of the Division of Adolescent and Young Adult Medicine, read the entire manuscript and offered many constructive criticisms. Dr. Eugene Beresin, Chief of the Child Psychiatry Residency Program, Massachusetts General Hospital and Professor of Psychiatry, Harvard Medical School reviewed the mental health chapter. I am grateful to both for their input. Dr. Young Ho Yoon, a graduate of the MassGeneral Hospital for Children pediatric residency program, kindly offered his vast library of references to augment our reading list. I very much appreciate the scope and depth of his library, and am grateful that he allowed us to utilize these materials that add so much to the richness of the appendix. Pamela Zhang drew the sketches in Chapter 3 and the section dividers. This young artist, a student at the Rhode Island School of Design, was able through her art to effectively portray the spirit and meaning of adolescence. ix
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