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TIME TO TAKE CHARGE
THE OLDER THEY GET, THE MORE TEENS NEED A DOCTOR WHO REALLY UNDERSTANDS THEM

Maria Pendolino is sick of seeing all the baby blocks in the waiting room when she goes to the doctor.

Now a sophomore at Clarence Central High School, Maria thinks it's tough for teens who are beginning to feel uncomfortable going to a pediatrician because "we're stuck right in the middle."

Too old for a "baby" doctor, too young for an adult doctor.

Maria, 15, said that as she got older, she also didn't feel comfortable seeing a male doctor. And although she found a doctor for adults whom she likes, "my mom still wants me to see a pediatrician sometimes," she said. "She doesn't really know where I'm coming from, but we're still discussing it."

Many parents want their teens to stick with their pediatrician until they are 18, or even 21. But because teens have special concerns, some doctors are starting to recognize that teen-agers need special care, says Dr. Michael Heimerl, a pediatrician and president of the Buffalo Pediatric Society.

Heimerl works at Tonawanda Pediatrics, which is trying to meet teen-agers' special medical and emotional needs.

Heimerl said the doctors at that practice can help with skin problems and can care for orthopedic problems, most of which are caused by sports injuries. They also help teens who have problems with drugs or alcohol. And give gynecological exams, when that becomes necessary.

"We try to make them comfortable in the office so they feel better talking to their physician," he said.

The medical practice recently designated a waiting room just for teens so they won't feel awkward waiting with infants and younger children. And as far as Heimerl knows, it's the first teens-only waiting room in Buffalo. He also said the doctors in that practice are considering reserving special office hours just for teens.

"We felt they would be uncomfortable waiting with babies," Heimerl said. "Certainly if we were adolescents, we'd be uncomfortable."

That's a step in the right direction, but it's also only one medical practice.

The fact is, the field of adolescent medicine is still developing, and doctors are still trying to find ways to relate to teens.

Adolescent medicine is basically the same as adult medicine, except that the doctors specialize in typical teen problems.

"It really is a matter of reference point," said Dr. Deborah J. Puckhaber, a pediatrician who treats teens. "It's someone who is in tune to teen-age problems, and can establish a rapport."

In other words, these doctors are used to dealing with issues like your changing body, smoking, drinking, sex, and sports injuries.

If you feel comfortable with your pediatrician, and if you feel he or she can answer your questions and take care of your needs, then there's no problem with health care at this point in your life.

But for teens who are thinking about switching doctors, the decision is a complicated one. And it can't be made alone.

Why?

Because most teens use their parents' health insurance to pay for medical care.

Parents are in charge of health care until their child turns 18. And without health insurance, most teens cannot afford to pay for medical care.

If you feel you've outgrown your pediatrician, "just tell your parents," says Dr. Evelyn Hurvitz, who also practices at Tonawanda Pediatrics.

Her advice is not to sweat over giving them specific explanations, but begin by talking about how you feel.

Heimerl adds that it's relatively easy to tell your parents, "I don't like that doctor," but it's a lot harder to say why you really want to switch.

Another option is to discuss the situation with your pediatrician at your next appointment. He or she can help you figure out your options, find a doctor who treats teens or line you up with a specialist, if you need to see one.

Heimerl also said pediatricians can help you tell your parents that you need to see a different doctor, and usually keep the reasons confidential.

"Parents have to understand that kids have health needs that their kids are not comfortable talking about with them," he said.

"And if a teen-age girl is uncomfortable telling a parent why she needs a gynecological exam, pediatricians can protect their confidentiality by simply telling parents that their daughter is at an age when she needs an exam."

Dr. Hurvitz's approach is to prepare teens and their parents early for "typical" teen issues.

"Once young girls start to develop, even if they're only 8, I talk to them in front of their parents about changes in their body, and what a developing teen-ager can expect," she explained.

"When a parent is in the room, I tell girls that in their mid- to late teen-age years they will probably need a gynecological exam, so parents and teens know that it's coming."

Dr. Hurvitz said doctors are in a tough position of respecting a teen-ager's confidentiality without lying to parents.

"You can't divulge the confidence of the patient, but the legal issues are hazy," she said.

"Ethically you need to give a teen-ager privacy over their own body, while encouraging family communication."

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