Young women describe the ideal physician

Adolescence, Winter, 2002 by Marsha Clowers

Effective physician-patient communication is consubstantial to high-quality health care and to patient well-being. Patient compliance, morbidity, mortality, and risk behaviors all have been linked with the medical encounter, highlighting the importance of effective provider-patient communication (see David & Rhee, 1998; Kollias-Greber, 1998; Terry & Healey, 2000). This is no more true than with adolescent patients--the age group with the least usage of health services (MacKenzie, 2000) and perhaps the most propensity to engage in high-risk behaviors (Ehrman & Matson, 1998). In fact, lack of effective health communication compromises the quality of care young people need in order to grow into healthy adults (Coupey, 1997).

Some studies indicate that physicians are poorly prepared to treat their young patients. For example, a recent study of 57 medical practitioners found that 52 of them had little or no training in adolescent health (Veit, Sanci, Young, & Bowes, 1995), even though prevention of risky behaviors related to violence, sexual activity, and drug and alcohol use is somewhat dependent upon the nature of the interaction between physician and patient (Ehrman & Matson, 1998). Furthermore, physicians may fail to spend enough time with young patients. Jacobson, Wilkinson, and Owen (1994) found physicians' consultations with teenagers were 23% shorter than were those with older patients. Consultations with teenagers were shorter for all six of the physicians in the study.

By engaging adolescents in discussions of the typical risk-taking behaviors of this age group, physicians can try to prevent such behaviors, with success depending in part on effective physician-patient communication (Smith & Inskip-Paulk, 2000) and clear assurances of confidentiality about those discussions (see Lieberman & Feierman, 1999; Veit, Sanci, Young, & Bowes, 1995). Physician communication may ultimately determine the degree of patient satisfaction with the encounter (Terry & Healey, 2000), yet another variable that has long been linked with compliant behavior (Kyngas, Hentinen, & Barlow, 1998; Roter, Hall, & Katz, 1988). The significance of patient-provider interaction thus cannot be overemphasized, especially when the patients are adolescents.

Being younger does not mean being easier to treat--teens have an array of special needs. For example, adolescents' lack of communication skills, or reluctance to communicate, means that they need the provision of information from their physicians regarding contraceptive use more than other age groups (Davis & Wysocki, 1999). In addition, they desire those conversations to be direct, nonjudgmental, and open (Blythe & Rosenthal, 2000; Rosenthal, Lewis, Succop, Burklow, Nelson, Shedd, Heyman, & Biro, 1999). Although it is clear that health care providers need to focus on communicating with adolescents about sexual behavior (see, for example, Hassan & Creatsas, 2000; Lindberg, Ku, & Sonenstein, 2000), it is equally clear that conversations about such issues require the utmost in provider communication skills. In fact, one of the most significant barriers to adolescent prenatal care might involve physician-patient communication (Teagle & Brindis, 1998), perhaps due to the fact that teenagers and physicians have re markably different perceptions about the nature of medical care (see St. Claire, Watkins, & Billinghurst, 1996). Physician behavior has even been found to influence the effectiveness of adolescent-based clinic programs (Jaccard, 1996). Indeed, effective communication is necessary in the treatment of sexually active teens (Harbin, 1995; Samet, Winter, Grant, & Hingson, 1997). Finally, appropriate care of pregnant adolescents necessitates a cognitive and psychosocial evaluation (Drake, 1996), something that can only be accomplished through patient-provider interaction.

In short, of all age groups, adolescents are the least likely to receive medical care, typically engage in high-risk behaviors, and are clearly influenced by interactions with physicians. Thus, it is imperative that health communication scholars focus their efforts on adolescent patient-physician communication. Previous research has shown that adolescent females prefer to interact with physicians who are comforting, tell jokes, understand the patient's needs, and explain medical procedures, variables which have been previously linked to the concept of communication competence (Clowers, 1995, 2000). As an outgrowth of that earlier research, the purpose of this study was to investigate whether adolescent females have a preferred physician "type"--in other words, an ideal. Certainly the importance of clinical skill cannot be ignored, but if teens have preferences relative to physician behavior and communication, ephebiatricians could attempt to incorporate the most effective communication strategies into their i nteractions with teens, thus helping to insure achievement of the overarching goal-- that a young person has received the highest possible quality of care.