Although typically the healthiest age group of all, many adolescents face complex health challenges related to acute illness and injury, chronic diseases, difficulty transitioning from pediatric to adult care and achieving independence, and various other factors. Richard Chung, MD, director of the Adolescent Medicine Program, discusses this crucial time of life and how providers can determine when a patient would benefit from the program.
How is the program structured to care specifically for adolescents?
The program is a hybrid between classic primary preventive care and specialty care, with a range of services that fall into 4 main categories: general primary care, reproductive health services, care for patients with complex medical conditions, and behavioral health care. Although we provide specialized services for a range of problems in these categories, our program is less about specific diseases or conditions and more about the stage of life of our patients. We are committed to caring for any and every issue that might arise during this important time of life; if it matters to the teen in front of us, we take it quite seriously.
What are some of the common issues that arise during this time of life?
We see many patients for reproductive health issues, eating disorders, substance use, depression, and anxiety. Another large category is patients with childhood-onset chronic conditions who are transitioning into adulthood, including teens with diabetes, congenital heart disease, sickle cell anemia, cerebral palsy, and a broad range of other neurodevelopmental disabilities. Also, we support patients facing a variety of psychosocial problems that often arise during pubertal transitions and emerging independence.
What is the role of a parent in his/her child’s care in the program?
Parents and guardians are typically involved, at least to some extent, until patients reach their late teens or early 20s, and many remain involved even longer if their child has a serious illness. But it’s important to note that even with patients as young as age 12, our providers spend time alone with them to hear their perspectives, gauge their level of maturity, and support them in actively engaging in their own health care as much as possible.
If an adolescent doesn’t have a specific medical or psychological condition, do you accept him/her into the program?
Yes, we provide primary care services for any teen who seeks our care. Some teens may choose to transition from their pediatrician to one of our adolescent medicine providers if they desire additional support in certain aspects of their health and development. Adolescents often engage less effectively in their health care when their parents stop making them see their pediatrician, which can lead to serious health problems. We hope that by providing services geared to their specific age and experiences, we can help teens stay engaged throughout this important time. In addition, teens with complex diseases can really struggle when they reach this age because they’re suddenly tasked with managing complex care needs, so we help them develop the skills to be independent and to navigate available resources. We’re eager to partner with providers in any way we can to help build a continuum of care for adolescents and keep them engaged in their care as they become young adults.
You completed your residency in medicine-pediatrics here at Duke. How did that experience help prepare you for your current position? Can you name one or two memorable moments or aspects of the program that stand out?
My residency training experience was fantastic. It is a rigorous and well-designed program that was really a perfect fit for me as I was entering the field of Adolescent Medicine. The discipline of Med-Peds is deeply committed to the value of whole-life care, without any gaps or exceptions, including the crucial interface between childhood and adulthood. Melding the keen developmental perspectives of pediatrics with the autonomy that characterizes adult-focused clinical relationships, Med-Peds really prepares clinicians to care for the patient in front of them, meeting them wherever they might be regardless of chronologic age. Whether I am seeing a 17-year-old or a 23-year-old I can really flex my approach to what their needs might be without being limited to the typical practice standards of either pediatrics or medicine.
One of my favorite aspects of having trained here at Duke is that so many of my co-residents are still here at Duke, but in widely ranging places and roles. Whether in adult medicine, pediatrics, or classical Med-Peds practice, and whether in administrative leadership, medical education, or research positions, the diversity of their interests and expertise is truly impressive and a real testament to the creativity and out-of-the-box thinking that Med-Peds cultivates.
What changes do you foresee over the next 10 years in medicine-pediatrics?
Given all of the changes afoot in our health care system related to the increasing focus on quality and value in care, I think Med-Peds is really well-positioned to lead in many respects. In thinking about how to create a network of services that offers the desired blend of depth of expertise and versatility of clinical application, Med-Peds is really well-suited. We are going to need more and more healthcare providers and leaders who can confidently traverse the whole life-course of different conditions so that we can increase value and efficiency in how we care for patients and families, so Med-Peds is really an important component of any health system strategy.
What passions or hobbies do you have outside of work?
Spending time with my family is certainly my focus outside of work. We love Durham and the wide range of activities it offers, whether it is the latest new restaurant or the Eno. We are also very involved in our church community and our faith perspective is really the foundation for how we live day-to-day and how we engage and care for our neighbors and friends. I am also a big Duke basketball fan and typically "help" my boys with whatever video game they might be working on at the moment. It's a convenient excuse to regress a bit into regular play and unwind.
A portion of this interview was originally published on the Duke Referring Physicians website.