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TEXTING THE TEENAGE PATIENT

Wednesday, October 10, 2012

By JAN HOFFMAN

The teenager’s cellphone buzzes. Her doctor, Natasha Burgert, is texting her: “Better morning with this medication?”

Another teenager opens his phone. “Everything is great,” reads Dr. Burgert’s discreet text. “Go ahead with the plan we discussed. Please reply so I know you received.”

And on the morning of college entrance exams, a teenager who suffers from a roiling stomach reads Dr. Burgert’s texted greeting: “Prepared. Focused. Calm. Your body is healthy and well. Good luck today.”

In this special issue of Science Times, we look at some of the many ways that technology is changing the world of medicine.

Dr. Burgert, a pediatrician in Kansas City, Mo., is making house calls. She is among a small but growing number of practitioners using social media to engage adolescents. Her patients read her blogand follow her on Twitter and Facebook. She even follows a few of the teenagers’ blogs, commenting occasionally.

During checkups, Dr. Burgert no longer gives teenagers brochures with advice on healthy living— which usually led to glazed expressions and teeming wastebaskets. Instead, a whiteboard hangs in her exam room, with hyperlinks and QR codes to sites with teenager-friendly material on sexuality, alcohol and drugs. The teenagers can photograph the board with their phones, storing the information to peruse in private.

Those topics dispensed with, Dr. Burgert has more time to listen to her patients. “This is a time for you,” she will say. “What do you want to talk about?” She often picks up subtle problems like stomachaches due to test anxiety.

She sustains those relationships through social media and, rather than leave teenagers unguided about dicey health matters, she continues sending them links to appropriate Web sites.

“I do as much as I can to get it on their phones, because that is what they live and die for,” Dr. Burgert said. She gets parents’ permission, because she doesn’t want them checking a child’s phone and chancing upon sites about, say, sexually transmitted diseases.

Medical practices are increasingly putting up Facebook pages to promote business and solder their community of patients. By adding social media, pediatricians and clinics are now capturing teenagers, some of their most elusive patients. Unlike younger children, who may see pediatricians several times a year, teenagers visit doctors infrequently. Generally healthy, they may stop by only for health forms for work permits, driver’s licenses and sports teams.

But even as they insist on their growing independence, conflating privacy with secrecy, teenagers can be vulnerable to high-stakes, impulsive behavior. Monitoring them carefully but respectfully is tricky for doctors as well as parents. So while a decade ago practitioners saw the Internet as the enemy, a tool for demanding patients who brandished printouts during visits and called at all hours with obscure questions, adolescent-medicine specialists and pediatricians are now turning technology to their advantage.

The payoff, say doctors who text, tweet and post, is a better-informed teenager who finds social media a faster and less embarrassing means to have questions asked and answered.

“I feel more attached to Dr. Natasha this way,” said Marie, 16, a high school junior from Kansas City, Kan. “It’s kind of cool. It’s direct. I don’t have to go through the office ladies. And I like having another adult who is safe to go to.”

But using social media also raises questions about doctor-patient boundaries, privacy laws and confidentiality. Should doctors “friend” young patients on Facebook? What rules should doctors establish about texting with teenagers: content, hours and expectations of speedy replies? How should doctors take into account the reality that teenagers’ cellphones are often missing in action, only to be found — and pored over — by friends and parents?

For these reasons, many doctors stop short of texting. Because texting is not encrypted and does not comply with privacy laws, “my clinic rules forbid me,” said Dr. Wendy Sue Swanson, a pediatrician who treats teenagers at the Everett Clinic, which is outside Seattle, and at Seattle Children’s Hospital.

But teenagers follow her on Twitter and her Seattle Mama Doc blog, on which she writes commentary and posts health news and videos.

During visits, she will ask a teenager the safest way to pass along private information. For those on birth control, she’ll say, “Take out your cellphone and put in a daily alarm about when to take your pill. Call it…‘strawberry.’ ”

Dr. Swanson won’t answer individual questions on her blog. “But if they ask a question in my office that I think a lot of teens would like to know about,” she added, “I can put the content on the blog without identifying the patient.”

In New York, Mount Sinai Hospital’s Adolescent Health Centeruses a program called Text in the Cityto send patients tips and reminders about medications and appointments. Patients can also text questions, understanding that answers may not arrive for 24 hours. Dr. Katie Malbon, who writes most of the responses, said she cautions: delete an answer after reading it.

New Generation Health Centerin San Francisco, a reproductive health clinic for adolescents, also incorporates social media into its services. If a teenager tests positive for a sexually transmitted disease, for example, and feels awkward about telling a partner, a clinician will point her to a Web site to anonymously inform partners through e-mail.

Recently, after financing for its schools program was cut, the clinic’s coordinator, Shawna Pattison, started a frank blog, JustAskShawna. To balance privacy with candor, Ms. Pattison allows teenagers to e-mail her questions that she posts anonymously. Her answers are reviewed by the clinic’s medical staff before she publishes them.

Using Facebook is more fraught. While Planned Parenthood has a dynamic, teenager-friendly Facebook site, with articles and exchanges, many private doctors do not friend their young patients on Facebook. Instead, they face the challenge of attracting them to their professional Facebook pages.

Dr. Todd Wolynn is a Pittsburgh pediatrician whose 19-member Kids Plus Pediatrics practice employs a communications director to manage an active Facebook pageand the group’s Web site. To encourage teenagers to follow the sites, whose readers are mostly parents, Dr. Wolynn’s practice stirs teenager-friendly topics, like texting while driving or the invention of the chocolate chip cookie, into a mix of posts about infant car seatsand sleeping tips.

“The challenge,” Dr. Wolynn said, “is will teenagers see you as cool enough to push information that will be on their Facebook news feed? Because their friends will see it and judge them.”

But many doctors cannot imagine adding social media responsibilities to an already exhausting practice. Dr. Burgert, 36, is a juggernaut: With two children, she has a busy practice, keeps a blog on her group’s Web site, posts Twitter messages, texts her teenage patients and still sticks to an 8-to-5 workday.

She carries a paper notebook to jot reminders, and spends 15 minutes a day sending texts and e-mails. It saves her hours of phone tag with patients.

The teenagers don’t overload her with exchanges, she said. “They understand it is a privilege, that not all physicians will do this. Actually, I have more problems with first-time parents.”

She brings her iPad into the exam room and, depending on what they talk about, she may even pull up a relevant video and watch it with a teenager.

She does not friend patients on Facebook, but urges parents to. “With my kids who have anxiety, eating disordersor take medication for a psychological condition, we have a heart-to-heart about what social networks they’re on,” she said.

Recently, one anorexicpatient posted a Facebook status update: “I look great with five more pounds lost!”

The thumbs-ups responses crowded onto the teenager’s Facebook page, applauding what was essentially destructive behavior. Her worried parents contacted Dr. Burgert. The family brought their laptops to her office. Dr. Burgert explained to the teenager that it was her responsibility not to leave a permanent Internet record of her health.

The girl reluctantly agreed she had to remove herself from social networks and avoid the dangerously positive feedback. “Then she and I shut down her Facebook page together,” Dr. Burgert said. “I was adamant about that.”

Dr. Burgert has been using social media in her practice for three years. “The point is to help patients make good, healthy decisions,” she said. “You can do that if you are willing to take a risk.”

http://well.blogs.nytimes.com/2012/10/08/texting-the-teenage-patient/?smid=fb-share

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