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The Silent Treatment

Too old for the pediatrician and too young for the OB-GYN, teenage girls -- none too communicative to begin with -- are often shut off from smart medical care just when they're confronting major issues like sex, smoking, and diet that will affect them for the rest of their lives.


When Kerry Washington was in high school at Spence, she was known as the Condom Lady. An aspiring actress with a heart-shaped face, she was one of a troupe of teens, trained at Mount Sinai hospital, who traveled around New York doing safe-sex skits in schools. For years, she played a virgin on stages across the city. Meanwhile, at Spence, she was passing out condoms to anyone who asked. "They knew this was my after-school job," she says of her classmates. "They were coming to me as a friend who had more information and had read a few more books than they had. I know they weren't going to their parents."

She knows this, says Kerry, who is now 21, because as cool as she was on the subject, she still didn't welcome heart-to-heart talks with her own parents about her sex life. "My mom knew I was sexually active in high school, but I had a lot of issues about wanting to be a perfect daughter. I wanted to protect my mom from all this scary stuff. Once, I had a scare that I had an STI a sexually transmitted infection. I didn't talk to her about it. I had a scare that I was pregnant. I didn't talk to her about it."

An Upper East Side mother of three teenage girls, one of whom developed a weight problem in high school, says she knows just enough to be aware that she doesn't know much at all. "This is a heartrending transition," says the woman. "You're just baffled that this lovely child you adore is pushing so far from you and is so unreachable, and you can't figure out what the hell is going on with her." This much the mother was told by her daughter: She didn't want to talk about her diet with her pediatrician. She felt it was not a childish problem.

Parents who micromanaged their children through toilet training and sleep upsets, who saw the pediatrician more often in strep season than they saw their spouses, who sought the best medical care offered the modern American child, find the information blackout of adolescence deeply unnerving. Teenage girls are developmentally wired to evade their parents' anxious attention to detail. Too bad this happens just at the time of highest risk from smoking, eating disorders, and sexually transmitted diseases. And at the very time they're entering the Bermuda Triangle of health care.

The teenage girl is almost no doctor's primary business. She's getting too old for the pediatrician, but she's hardly the bread and butter of the internist or family practitioner. Those few experts who do specialize in adolescent medicine (there are fewer than 1,000 physician members, across the country, of the national Society for Adolescent Medicine) contend that the average physician's checklist approach -- do you smoke? Do you drink? Do you exercise? Check, check, check -- does not shed much light on the byzantine mesh of emotional and developmental changes that drive an adolescent's life. And it doesn't get at the truth; pro forma questions, or none at all, are like a license to lie, say girls interviewed.

Many generalists were never trained to ask adolescent-specific questions, and they're not comfortable asking, say adolescent specialists. Moreover, "in an age of managed care and financial restraints, people feel that taking care of adolescents is a financial liability," says Dr. Andrea Marks, who treats teenagers at her office on East 90th Street. "To sit and talk to an adolescent will take me half an hour."

And there's one more problem: "Adolescents don't have a great reputation with doctors," says Marks, whose office is an aerie of soft couches in green leafy prints. "They're difficult, and doctors like to feel confident that they can help somebody.''

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