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The Practice of Medicine in Adolescence
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Charles G. D. Brook; ed. 283 pages. London: Edward Arnold; 1993. $95.00.
How should we provide medical care to adolescent patients? Thorough knowledge of the health problems that affect adolescents and an appropriate clinical approach to adolescent patients are essential to providing excellent medical care to this group. Adolescents are rarely ill with traditional ailments. Instead, the major causes of death and disability among adolescents are the consequences of their health behaviors, such as tobacco, alcohol, and drug use; sexual experimentation; diet; exercise; and use of injury-protection devices. These behaviors also lead to morbidity and early mortality during adulthood. Because most of these health behaviors and their resulting illnesses or injuries are preventable, the clinical approach to adolescence should include effective preventive strategies such as immunization, screening, and counseling.
This multiauthor book is written primarily by our colleagues from the United Kingdom. The first four chapters comprise an interesting description of the physical and psychological development of adolescents. The following 19 chapters are an uneven discussion of select medical problems, which appear in no apparent sequence. As does much of medical education, the text includes lengthy discussions of less common problems but only briefly addresses more common problems affecting adolescents (for example, cystic fibrosis is covered in 18 pages, cancer in 12 pages, smoking tobacco in 2 pages, and musculoskeletal sports injuries in 3 pages). The limited discussion of chronic illnesses does not include sickle cell disease, epilepsy, or closed-head injuries. The few pages addressing health behaviors and prevention are disproportionate to the corresponding disease burden. Topics such as acne vulgaris and other dermatologic disorders and obesity are notably missing or inadequately addressed. Injuries, the major cause of death and disability among adolescents, are neglected (with the exceptions of sexual abuse and overuse sport injuries).
My clinical practice differs from that recommended by the authors for the treatment of pelvic inflammatory disease. The authors recommend treating adolescents with this disease for Neisseria gonorrhoeae only if the Gram stain or culture is positive, despite high rates of infection among adolescents, imperfect diagnostic tests, and high rates of coexisting infection with Chlamydia trachomatis. Because there is no reliable way to distinguish gonococcal from nongonococcal pelvic inflammatory disease and because the therapy for N. gonorrhoea is effective, inexpensive, and low risk, many would agree that appropriate treatment for adolescents presenting with the disease should include gonococcal coverage. In this clinical decision, physicians should also consider the prevalence of disease caused by N. gonorrhoea in their adolescent patients.
This book adds little to the information found in recently published textbooks of adolescent medicine. I do not recommend it for physicians caring for adolescents, particularly in North American settings.
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