From the Harbor-UCLA Family Medicine Residency Program, Torrance, Calif

This column aims to help residents recall “pearls of wisdom” before they go on a certain rotation. Use them to capitalize on the experience of others to avoid common pitfalls.

1 Privacy is key. Stress confidentiality, but remember to let the teenager know that admission of abuse as well as suicidal or homicidal ideation is not confidential and will be reported to the appropriate services.

2 Make an effort to spend at least a portion of the physical examination alone with the teen­ager; state this at the beginning of the visit.

3 Above all, do not forget your HEEADSSS (home, education, eating behaviors, activities, drugs, suicide, safety, and sex) assessment. Every visit should focus on injury prevention and safe-sex education.

4 The obese adolescent should have a random or fasting blood sugar test and a cholesterol panel, as well as tests for alanine aminotransferase and thyroid-stimulating hormone levels. Stress exercise, especially participation in team sports, at each visit. Nutrition education should emphasize the need for 5 fruits and vegetables each day and adequate calcium intake, especially for female patients.

5 The American College of Obstetrics and Gynecology guidelines state that the pelvic examination should be performed in sexually active adolescent females 3 years after initiation of sexual activity or at age 21 in those who have never been sexually active. Family planning should not be delayed in the absence of a complete physical or pelvic examination. For adolescent males, perform a testicular examination, and stress self-examination in age-appropriate teens.

6 Use this time to approach sexually transmitted infection (STI) prevention, birth control/ condom use, and emergency contraception. Screen all sexually active teens for STIs every 6 months or when reporting a new partner.

7 In all teens, check for deafness secondary to noise pollution, and screen for myopia and hyperopia.

8 Incorporate simple addition and subtraction problems as well as 2- to 3-line sentences in your HEEADSSS assessment to grossly screen for literacy and learning difficulties.

9 Screen for sickle cell anemia and thalas­semia in adolescents of African American, Southeast Asian, and Mediterranean descent. Order a complete blood cell count for all menstruating girls who are symptomatic.

10 A thorough musculoskeletal examination is key in the symptomatic teen. For example, check for Osgood-Schlatter, slipped capital femoral epiphysis, leg length discrepancy, and in-toeing. Screen for scoliosis by using the simple forward-bending test during the physical examination. If scoliosis is suspected, evaluation with plain films and/or a scoliometer is warranted. Adolescents with curvatures of more than 15° to 20° should be referred for evaluation, close follow-up, and possible bracing and an exercise program.

To submit clinical pearls to this column, please contact the editor, D. Buffery, at dbuffery@ascendmedia.com, or call 732/656-1140, ext. 168.