Lm Otero  /  AP
Dr. Laura Scalfano, left, takes a throat culture from Kellen Frank, 15, at Children's Medical Center in Dallas. Scalfano specializes in treating patients ages 11 to 21.
updated 7/8/2005 12:25:56 PM ET 2005-07-08T16:25:56

When 16-year-old Marissa Skembo sees her doctor, she jokes that their conversation can go beyond typical ailments to include anything a teen might encounter — “drugs, sex, rock ’n’ roll.”

For about two years, Skembo has been seeing a doctor who specializes in treating patients ages 11 to 21.

“I think that there’s a special art to caring for a teenager — from earning their trust to being able to understand their behaviors,” said Skembo’s doctor, Laura Scalfano, assistant professor of pediatrics and the director of adolescent medicine at the University of Texas Southwestern. Her practice is at Children’s Medical Center Dallas.

While some teens are sent to doctors who specialize in adolescents for specific problems, others use them as their primary care doctors — a bridge between their pediatrician and finding a doctor as an adult.

“I think that people are realizing more and more that teenagers aren’t just big kids,” said Dr. James Fitzgibbon, director of adolescent medicine at Akron Children’s Hospital in Ohio.

Doctors who specialize in teens will often make a point of spending an extended amount of time talking to their patients.

“Sometimes it takes a long time to get the information out of the young adult. Sometimes you have to hear a lot of information before you really get down to the root cause,” said Dr. Deborah Poteet-Johnson, who has a private adolescent medicine practice with another doctor in Chattanooga, Tenn.

She said that while some patients are direct about their concerns, some are more evasive.

“Others will come in and say ’I’ve got this bad cold. Oh, by the way, can we talk about birth control?”’ said Poteet-Johnson, whose practice has been steadily growing, mainly word-of-mouth, since it opened in January 2003.

Juggling act
While the specialization began in the 1950s, an actual subspecialty certificate in adolescent medicine has only been offered since 1994 to those who have passed the board in pediatrics and internal medicine and since 2001 to those in family medicine.

It’s something that few officially pursue, however, with only about 550 people currently holding the designation. Others have focused on teens for their entire careers, not bothering with the subcertification. It requires extra training and doesn’t guarantee more money, said Dr. Charles Irwin, editor of the Journal of Adolescent Health and a past president of the Society for Adolescent Medicine.

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Basically, doctors say, physicians of adolescents are more focused on issues that might be on the minds of teens. And they are careful to balance their young patient’s need to maintain some autonomy with the parent’s need for information.

Many times the doctor will talk separately to each and then both parent and teen together, said Dr. Bret J. Rudy, associate chief of the adolescent medicine division at the Children’s Hospital of Philadelphia.

“It’s a little bit more of a juggling act,” he said.

And at times, a doctor needs to help a teen talk to her parents, said Dr. Rana Pascoe, who has a family and adolescent practice at the Baylor Family Health Center at Mesquite, a Dallas suburb.

“Sometimes you are a mediator between them,” she said.

Of course, finding a teen specialist can be a challenge, especially in rural areas, and many teens are happy with their pediatricians.

But Marissa Skembo’s mother, Consie, said she really appreciates the time that Scalfano devotes to her daughter.

“We really like her style, she treats the whole person, not just the physical — the emotional and social person too,” Consie Skembo said.

“She talks about anything and everything.”

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