Back to school: Has your teenager had an annual primary care visit?

Aaron, his mother, and I sit together in my pediatric primary care office. He is 16 years old. We discuss his sleep schedule, nutrition, and after-school activities.  He’s trying out for the football team, and we talk a lot about concussion safety. He is doing well in school. His physical exam is completely normal.

He’s the picture of health — normal weight, blood pressure is perfect, heart sounds are steady and regular, his muscles and joints ready for football practice. I make sure he is up to date with his immunizations.

But what I don’t see in his exam —and what Aaron and I need to talk about— are the three most common causes of death in his age group: 1) accidents 2) suicide 3) homicide.

I ask Aaron’s mother if I can speak with him alone, just the two of us, as speaking privately with an adolescent is a standard part of the well-visit. She leaves to sit in the waiting room. An important, life-saving part of Aaron’s adolescent well-visit was about to begin.

For 20 minutes, Aaron and I talk about safe driving with friends, cyber bullying, gun safety, drug and alcohol use, sexual health, and mental health — including depression, anxiety, and suicide. During this time, I can identify key things threatening the life of Aaron and take the appropriate steps to help him — whether that includes anticipatory guidance, referral to services, or an emergency intervention.

Despite this crucial moment to intervene with teenagers and impact their lives, the adolescent well-visit is rare. Only about 50 percent of teenagers on Medicaid and about 45 percent of teenagers with commercial insurance have a yearly well-visit. Although policymakers have targeted the adolescent well-visit as an area of focus, the percentage hasn’t budged in years.

So, why aren’t teenagers seeing their primary care provider? It’s complicated.

Adolescents are in school all day, in sports, in after-school activities, socializing. Despite intense brain development, growth, and hormone changes, adolescents are overall a physically healthy age group, and —understandably— their health is not something at the forefront of their minds. For parents, the well-visit can be put on hold in the flurry of the everyday life of a healthy, busy teenager.

Primary care clinics are often only open during normal business hours, creating a myriad of work and transportation conflicts for caretakers. Many schools, besides requiring an adolescent be up-to-date on their vaccines (something you can do without a well-visit), do not require that an adolescent have a yearly well-visit.

So how do we increase the rate of adolescents receiving a yearly well-visit? We need to think creatively about how to solve this important health issue:

• Go where the parents are: Schools, health fairs, and parent-teacher conferences are ideal arenas for education around the importance of the adolescent well-visit.
• Go where the adolescents are:
  • Use social media for education and outreach.
  • Leverage opportunities when adolescents present to care—for sports physicals, driver’s test forms, sick visits, work forms, or reproductive health to complete a well-visit.
  • Find opportunities in school-based health centers, community recreation centers, or evening hours at the primary care office.
  • Engage adolescents to be actively involved in strategic planning around improving annual well-visit rates.

To be sure, many teenagers have support systems with whom to discuss these important safety issues, including family, school counselors, and community organizations, but the adolescent well-visit guarantees that their holistic health is examined and discussed with the teenager at least once a year.

The top three reasons for adolescent deaths are largely preventable. Together, parents, schools, clinicians, community members, policy makers, and adolescents themselves can work together to prioritize the adolescent well-visit as a key opportunity for life-saving interventions.

Dr. Katie Piwnica-Worms is part of the National Clinician Scholars Program at the Yale University School of Medicine.