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Welcome to Skills For Youth! The
skill described this month is:
Advocating
for Your Health Care
Advocating
for health care is an important skill to have. By choosing to advocate
for yourself, you are caring and respecting your body and your health.
Teaching youth to advocate for their own health care can lead to two major
outcomes:
- Youth will hopefully have better experiences with their health care
providers, and
- Because they are beginning to care for and respect their bodies, they
may be motivated to take fewer risks.
This month’s
column describes how youth should advocate for themselves during a reproductive
health exam. The following topics are covered:
| A Description
of the Skill |
The
Importance of Making a Reproductive Health Appointment
- Sexually active young men should be screened yearly for gonorrhea,
chlamydia, syphilis, and testicular cancer.1
Testicular cancer is most commonly found in men 15-35.2
- Sexually active young women should also be screened yearly for gonorrhea,
chlamydia, syphilis, and receive a Pap smear.1
- The American Academy of Pediatrics (AAP) (1991) suggests that adolescents
have general health screenings at least every two years, at 14, 16,
18, and 20. But, more recently, AAP has been leaning towards yearly
exams for adolescents.1
- Youth who are not sexually active should still be examined regularly
by a clinician. Young men should be screened for normal development,
receive testicular exams, and be taught to examine their own testicles.
Young women, who are not sexually active, should be screened for normal
development and the regularity of their menstrual cycle, receive breast
exams, and be taught to examine their breasts.
Young women may also want to use the birth control pill for the treatment
of severe PMS, endometriosis, acne or to prevent ovarian cancer. Youth
may be seen by a variety of different types of clinicians in different
fields. Some of these clinicians and specialities are listed below.
Types of Clinicians
- Nurse Clinicians
Registered nurses who have taken extra classes to specialize
in a certain area of health care. Nurse clinicians are identified
by the initials RNC after their names.3
An example would be Jane Doe, RNC.
- Nurse Practitioners
Registered nurses with advanced preparation in the care of particular
types of patients. Nurse practitioners may be able to prescribe
medications. Nurse practitioners can be identified by the initials
NP after their names.3 An example
would be John Doe, NP.
- Nurse Midwives
Registered nurses who manage the care of mothers and babies
throughout pregnancy and postpartum periods. These skills must be
obtained through a school accredited by the American College of
Nurse Midwives. Nurse midwives can be identified by the initials
CNM after their names.3 An example
would be Mary Doe, CNM.
- Physician’s Assistants
Specially trained and licensed to perform tasks usually done
by physicians. Physician’s assistants can usually prescribe
medications. Physician’s assistants can be identified by the
initials PA after their names.3
An example would be Doug Doe, PA.
- Physicians (Doctors)
People who have completed medical school and the other requirements
of medical licensure. Physicians can prescribe medications. Physicians
can be identified by the initials MD after their names.3
An example would be Kathy Doe, MD.
Types of Specialities
- Obstetrics
Branch of medicine that cares for women during pregnancy, childbirth,
and the post childbirth period.3
- Gynecology
Branch of medicine that deals with diagnosing, treating or preventing
diseases of the female reproductive organs, including the breasts.3,
4
- Internal Medicine
Branch of medicine that deals with diagnosing, treating or preventing
diseases of the internal organs by other than surgical means. Many
internists will not see anyone under the age of 16.3,
4
- Family Practice
Branch of medicine that deals with comprehensive medical care.
Family Practitioners have particular emphasis on the family unit,
in which the physician’s continuing responsibility for health
care is not limited by the patient’s age or sex, a particular
organ system, or disease entity.3
- Urology
Branch of medicine concerned with the urinary tract in both
sexes and the genital tract in the male.3
- Pediatrics
Branch of medicine that deals with diagnosing, treating or preventing
diseases in infants and children. Pediatric specialists may see
youth up to the age of 24.3, 4
- Adolescent Medicine
Branch of medicine that specifically deals with adolescent health
promotion, wellness and medical care of adolescents, aged 10-19
years.5
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Making
and Preparing for a Reproductive Health Appointment
Several
important steps should be taken before scheduling a reproductive health
visit. These steps are described below:
- Talk to your parents.
- If you feel comfortable talking to your parents about visiting
a reproductive health clinician, you might want to ask your parent
to help you make your appointment, and/or recommend a good clinician.
- If you do not feel comfortable talking to your parents about your
visit, talk with a trusted adult.
- Find out about health insurance coverage.
- If your parent(s) are helping you make your appointment, ask him/her
to explain how the family’s health insurance works.
- If your family has health insurance, make a call to the insurance
company and ask how your visit would be billed. Ask both your insurance
provider and your medical provider if your parents could find out
about your medical exam.
- If your family does not have insurance or you cannot use your
family's insurance, you may be eligible for state or federal insurance,
free services from Planned Parenthood or a local city or county
clinic. Call the clinic and explain your situation. The clinic can
help enroll you in insurance or tell you when free services are
available.
- Find a clinic or medical practice.
- Do you already have a health care provider (i.e. doctor, nurse
practitioner)? Do you know his/her phone number? If not, check your
medical card or the yellow pages to find the number.
- Find out if your school has a clinic and if you can be seen there.
Your school may also be able to refer you to a clinic.
- Call your local Planned Parenthood. The toll free number is 1-800-230-PLAN
(7526). The toll free number will direct you to the nearest Planned
Parenthood clinic near you. You can also find Planned Parenthood’s
number in the yellow pages.
- Look in the green pages of your phone book under county or city
government to find the number for the local public health clinic.
- Choose a clinician.
- Choosing a clinician who will meet your needs may allow for an
easier experience at your reproductive health appointment. Make
a list of the traits that are important to you. Below are some questions
to ask yourself about what you want in a clinician:
- Would you prefer to have a male or female clinician?
- Would you like to see someone who is experienced in working
with youth?
- Would you like someone who is non-judgmental about being sexually
active, sexual orientation, drug use, smoking or drinking?
- Would you prefer to see your family doctor, pediatrician,
adolescent medicine specialist, a clinician specializing in
obstetrics and gynecology, an internal medicine specialist,
a family practitioner or an urologist?
- Once you have developed your list, communicate your preferences
to the person scheduling your appointment.
- Describe your symptom(s) or reason(s) for scheduling your appointment.
- Below are some questions to ask yourself about why you are scheduling
your appointment. The answers to these questions should help you
describe your symptom(s) or reason(s) for scheduling your appointment.
This information will help the clinic to know the type and length
of appointment to schedule for you.
- Are you sexually active?
- Do you want birth control?
- Do you think you are pregnant? When was your last period?
- Are you having problems with your genitals or urinary tract?
When did the problems start?
- Would you like to use the birth control pill to treat your
acne or Premenstrual Syndrome?
- Schedule your reproductive health appointment.
- To better prepare for your exam, there are several questions you
should ask the person scheduling your appointment. These questions
include:
- What should you bring to the appointment (an insurance card,
picture ID, your social security number, and/or a copy of your
birth certificate)?
- If you drive, where will you find parking? If you do not drive,
is the clinic on a public transportation route?
- Do you need to do anything to prepare for the exam? Should
you refrain from using tampons, douche or having intercourse
before the exam? Do you need to fast before the exam?
- Will it be okay if the clinic gives you a reminder call at
home? If not, make sure you tell the person booking your appointment.
- How much will the exam cost?
- Prepare for your reproductive health exam.
- Decide how you are going to get to the clinic and how long it
will take you.
- Decide if you want to go alone or take someone with you for support.
- Follow instructions given to you by the clinic when you made your
appointment.
- Write a list of questions to ask the doctor.
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Communicating
with Your Reproductive Health Clinician
During your
appointment, there are several things you can do to make your appointment
more pleasant. These include:
- Relax.
- The more relaxed you are the easier it will be to ask questions,
and the easier it will be for both you and the doctor during the
exam.
- Communicate your needs to the clinician.
- Ask the clinician to describe the whole exam before starting.
You may want to have this discussion while you are still dressed
instead of in an exam gown.
- Ask the clinician to tell you what he/she is going to do before
he/she does it. Example: "I am now going to examine your external
genitalia."
- Ask the clinician to tell you what he/she is doing while he/she
does it. Example: "I am now inserting the speculum in your
vagina."
- Ask the clinician to tell you what he/she is seeing. Example:
"Your labia look healthy." Or, "You don’t have
any sores on the outside of your penis, or scrotum."
- Be truthful in answering the clinician's questions.
- The clinician will ask about your sexual activity, diet, exercise,
vitamins and herbs you take, prescription drug use, over-the-counter
drug use, contraceptive use, smoking, drinking and illegal drug
use.
- The clinician is asking about your behaviors not to judge you
but primarily to find out what impact these behaviors may have on
your health and possible interactions that might take place with
a drug he/she is prescribing for you.
-
Follow up on a problem your clinician may find.
- If your clinician identifies a condition that needs to be treated,
it is important for you to ask him/her several questions concerning
your diagnoses. These questions include:
- What is the name of the condition that the clinician is diagnosing?
What effect does this condition have on your body?
- How is this condition treated?
- Will you need follow-up treatment?
- Can you give this condition to someone else?
- How can you prevent yourself from getting this condition again?
- What type of treatment or medication is the clinician prescribing?
How often should the treatment be administered or the medication
taken?
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What
to do if Treated Poorly by a Reproductive Health Professional
Do not accept
being treated poorly by a reproductive health professional. Youth are
just as entitled to good treatment as adults. Poor youth are just as entitled
to good treatment as rich youth. Sexually active youth are just as entitled
to good treatment as abstinent youth. Large youth are just as entitled
to good treatment as thin youth. Drug using youth are just as entitled
to good treatment as non-drug using youth. Youth of all colors are entitled
to equally good treatment.
You are
entitled to good treatment even if you are receiving free treatment. If
you receive free services, keep in mind that someone donated money to
that clinic to ensure that you would receive good health care.
Listed
below are some steps to take if you are treated inappropriately by a reproductive
health professional:
- Stop the exam and ask for someone else.
- Call or write the clinic after your appointment and describe your
treatment.
- Do not go back to that clinician. Tell your friends not to see that
clinician.
- Report the clinician to his/her medical board.
- Write a letter to the clinician telling him/her what he/she did wrong.
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| Teaching Suggestions
for the Educator |
After presenting
the "making a reproductive health appointment" skill, ask two
students to volunteer to model a scripted role play
of a youth calling to make a reproductive health appointment. Explain
to the students that this will be a positive example of a youth making
a reproductive health appointment. As the two volunteer youth act out
the role-play, ask students to take notes on how the youth in the role-play
advocated for herself while scheduling her appointment.
Scripted
Role Play for Making a Reproductive Health Appointment
Ring,
Ring, Ring
Clinic:
Hello, Public Health Department.
Youth:
Hi, um I would like to make an appointment.
Clinic:
What kind of appointment?
Youth:
Well, um I missed my period…and uh, I think I might be pregnant,
so maybe I need to see someone in obstetrics and gynecology.
Clinic:
How late are you?
Youth:
Three weeks?
Clinic:
Okay, Dr. James Brown is available on Thursday, at 11:30 am. Can I have
your name?
Youth:
Um, I have seen Dr. Brown before, and I would prefer to see Ms. Perez,
the nurse practitioner. Also I need an appointment after school gets
out at 2:30 pm.
Clinic:
Okay, that might be difficult, but I will see what I can do. Hmm, oh
it looks like we do have a cancellation tomorrow at 3:30 with Ms. Perez.
Youth:
Yeah, that would work better. The last time I was at the clinic, I was
signed up for the county insurance. Is this still good?
Clinic:
Not if you turned 18. But, if you are 18 or older, you might qualify
for the state’s family planning program, which would also entitle
you to a free visit.
Youth:
Oh, yeah, I think my mom told me about that program. I just turned 18
last week, so she thought it was important I was covered. She said I
would need to bring a picture ID. Do I need anything else?
Clinic:
No, just a picture ID. What was your name again?
Youth:
Judy Smith. Does the 54 bus still stop in front of the clinic?
Clinic:
Yes. Well, let’s see. I have you down for tomorrow at 3:30 with
Ms. Perez. She will be doing a pelvic exam and a pregnancy test. Remember
not to put anything in your vagina, like tampons. Do not douche, and
do not have intercourse between now and the exam.
Skill
Discussion of the Role Play
Ask youth
to identify which parts of the "making a reproductive health appointment"
skill were present in the role play. As the youth to give specific examples.
For example: The youth in the role play chose her own clinician instead
of just letting the clinic assign one to her. She stated that she did
not want to see the male physician, Dr. Brown, but she did want to see
the female nurse practitioner, Ms. Perez.
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| Suggestions
for Behavioral Practice |
- Divide the class into small groups of 4-5 students.
- Give each small group the scenarios listed
below.
- Ask two students in each small group to practice making a reproductive
health appointment by acting out a role play based on Scenario #1.
- Ask the other students to observe the role play for the various parts
that are present or missing from their peers’ performance.
- Upon the completion of the role play, ask the group to discuss if
all the components of advocating for health care through making a reproductive
exam were present in the acted out version of Scenario #1.
- Ask role play actors and observers to switch places and proceed with
Scenarios #2 and #3.
- Repeat steps 3-5.
- Ask the class to join together as a full group. Facilitate a brief
discussion with the following questions:
- Were there times in the role plays when you felt uncomfortable?
- Were there times in the role plays when you felt empowered?
- Do you think you could follow the skill process for making a reproductive
health appointment in real life? Why or why not?
Scenario #1
La Tanya
is 16. She and her boyfriend Anthony have been dating for a year. Anthony
and LaTanya have decided to wait until they are at least out of high
school to have sex.
LaTanya’s
aunt died of ovarian cancer three months ago, and her mother is in remission
from ovarian cancer. LaTanya’s mother suggested that LaTanya make
an appointment with a reproductive health professional to start the
birth control pill to lesson her chances of developing ovarian cancer.
LaTanya’s
family does not have health insurance because her mother’s employer
could no longer afford to cover his employees after LaTanya’s mother’s
bout with cancer.
Scenario #2
Chen is
a 15-year-old boy. He has been having unprotected sex with both men
and women. He noticed last Friday that his urethra burned when he urinated,
and yesterday a green puss started coming out of his penis.
Chen’s
family has been seeing the same doctor in Chinatown his whole life,
but he is afraid to go to the family doctor for fear of his family finding
out about his sexual activity.
Scenario #3
Cassidy
is 15, and her boyfriend Juan is 16. They have just started having sex.
So far, they have always used condoms. On Saturday night when Juan and
Cassidy were having sex, the condom broke.
Juan and
Cassidy both feel they are too young to have children. Cassidy wants
to join the army like her sister, and Juan has plans of going to college.
They have decided they need to start using another form of birth control
in addition to the condoms.
Juan asked
Cassidy to go to Planned Parenthood to get another form of contraception.
Cassidy feels if she needs to go have a reproductive health exam, so
should Juan.
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