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“Adolescence” is a stage, not an age; however, the World Health Organization defines adolescence as age 10 to 19 years. Our physical, social, and emotional growth during adolescence defines who we will be as adults and our long-term health outcomes. Just as babies achieve important developmental milestones as they grow, so do adolescents (Figure 21-1). Failure to progress normally through these adolescent milestones may result in significant functional impairments in adulthood.
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Key developmental milestones that adolescents must navigate include the following:
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Separating from their parents and learning to exist independently in a world of their peers
Coming to terms with physical changes associated with puberty and achieving acceptance of their adult bodies
Developing a sexual identity
Developing their moral codes, values, and ideals
Experiencing stronger emotions while improving their executive functioning (eg, sound judgement, reasoning, and understanding the consequences of their actions)
Identifying their sense of purpose and desired vocation
Increasing their capacity for abstract thought
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Clinical assessment of adolescent patients uses many of the same history and physical examination techniques described in the chapters about adults, but also requires the provider to give special consideration to the adolescent’s stage of development.
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SPECIAL CONSIDERATIONS IN ADOLESCENT HISTORY TAKING
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Confidentiality in a healthcare setting means that the practitioner is required to keep the patient’s information private. Pediatric patients who can talk to practitioners by themselves have the right to confidential healthcare, even if they are not old enough to consent to their own medical care. There are, however, limits on the right to confidential healthcare. If a practitioner is concerned that the patient (or another minor) is at risk of being seriously harmed or that the patient is at risk of harming someone else, then the practitioner is obligated to break the patient’s confidentiality and share whatever information will ensure the safety of the parties involved. The limits of confidentiality should ideally be explained to a patient before any sensitive topics are discussed privately. This discussion achieves 2 purposes:
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Assures the patient that they can freely discuss sensitive health topics privately with their practitioner without fear of their caregivers knowing
Allows the patient to understand the conditions under which the practitioner might need to disclose their health information so they can choose what not to share and are prepared for the consequences if they do share information that must be disclosed to others
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If a practitioner must break an adolescent’s confidentiality, it is preferable to let the adolescent know before making a disclosure and to assure them that the disclosure will be limited to whatever portion of information is relevant for safety. It is ...