Doctors must be trained to deal with adolescents

BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7160.751b (Published 12 September 1998) Cite this as: BMJ 1998;317:751
  1. Russell Viner, Director of adolescent medicine
  1. Great Ormond Street and University College London Hospitals, Paediatric Services Directorate, Middlesex Hospital, London W1N 8AA

    EDITOR—Siersted et al report an association between high levels of undiagnosed asthma in adolescents and family problems, as well as the health risk factors of high body mass index, passive smoking, and low physical activity.1 The high rate of underdiagnosed asthma in young people is, however, explained only through the misinterpretation or neglect of symptoms of asthma by patients, parents, or medical professionals.

    Siersted et al found that less than a third of those with undiagnosed asthma had reported their symptoms to a doctor. The relationship between adolescents and their doctors is likely to play a part in this. General practitioners believe that they are badly trained in dealing with adolescent patients.2 Less than a third of paediatricians and doctors actually enjoy working with young people,3 and general practitioners often allow less time for consultations with adolescents than for those with other age groups.4 Young people themselves know little about gaining access to health care and frequently find doctors to be unsympathetic.5

    Neglect or misinterpretation of symptoms are unlikely to be the cause of a missed diagnosis of asthma in young people. Each of the factors that the authors found to be associated with undiagnosed asthma—high body mass index, passive smoking, low physical activity, and family problems—are frequently associated with other social problems and high risk behaviours in adolescents. Adolescents do not fit easily within a medical model that recognises only disease, diagnosis, and treatment. Instead we must recognise that social and developmental factors are important in mediating the relationship between the person, the disease, the doctor, and medical treatment in this group.

    An awareness campaign that targets a single disease is not an effective enough measure. Solving the problem of underdiagnosis of asthma in this age group must include improving young people's access to health care and increased training for doctors in dealing with adolescents.


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