Adventures in Primary Care

I enjoy seeing my teenage patients. Someone said that when you see an adolescent there are three people in the room – the patient, you, and you-when-you-were-a-teenager. I think that’s a pretty insightful description. My goal with them is to have them share their highs and lows, concerns and confidences with me, and to reflect back to them how they are fitting into the common tasks and concerns of adolescence. I want to be a comfort to them. A lot of times I can reflect back to my own life and my own family, and how I succeeded and failed, worried and finally survived. Or I can reflect on the usual frustrations, sexual longing and inexperience, the experiences of other teens I know. It usually works and we both feel enriched.

So on Monday I was seeing brothers of 9 years and 13 11/12 years of age. The elder boy, G., is a gangly, good-looking kid who has matured a bit early physically. His father told me that he had worked hard to get him into a good junior high of his choice, which sounded like a good move to me, very devoted of him to do. As usual, after I finished with the younger brother I asked him and his father to step outside so I could talk to G. alone.

As always happens with these kids, as the parent left the teenager came into his own and we had an honest conversation. How were things at home, good? Well, not always, he said. His father is pretty dominating and won’t admit when he’s wrong. Sure, I said, I can see that that must be frustrating. But in these years of striving for independence, it gets unclear who is responsible for what, etc. This is what usually comes up, and I think I can be helpful.

So then I turned to sex, drugs, and rock ‘n’ roll. Not much drugs, it turns out. We had a little conversation about what is dangerous. Then I said, OK, G., when you get older and get a girlfriend and if you guys are going to have sex, how often are you going to use a condom? The right answer is “always,” but his answer was a little different: “Both times!”

“Both times?” I said.

“Yes, I used a condom both times.”

“So, you’ve had sex twice?”

“Yes, with two girls.”

“Really? How’d that happen?”

“Well, you know our school is right there with a high school attached. So they came to me and asked if I wanted to have sex with them. So I thought about it, and then I did.”

I held it together and didn’t probe for details, but he was pretty earnest, so he just went on. As far as I could see, they went somewhere, I don’t know where, and he did one and then the other. At 13 11/12 years old.

“But I’m not going to do it sophomore year,” he continued. “Maybe junior year. I’m pretty picky. I’m not going just to do it with anyone.”

“Yeah, OK,” I said. “So, have others asked you?”

“Oh, yeah.” he said. “But I’m going to be picky.”

So, as I say, I like to reflect back on the struggles of adolescence and relate it to my memory of my own life. I like to say, yeah, I remember how it was. In this case I didn’t think I could honestly say that.

Things might have changed since my day. I mean, he’s not that good-looking.

Budd Shenkin