Rapp C E
Ann Intern Med. 1983 Jul;99(1):52-60. doi: 10.7326/0003-4819-99-1-52.
The physician must establish a confidential and trusting relationship with the adolescent patient. All states allow treatment of adolescents over 18 without parental consent and some allow treatment for special problems such as venereal disease or drug abuse before 18. The depressed adolescent often presents with behavioral problems, school failure, or medical symptoms. The medical history should include a description of the pregnancy and delivery, immunizations and childhood diseases, family history of coronary disease, sexual activity, school performance, and drug use. The physical examination should include an evaluation of growth and sexual development, blood pressure determination, a breast examination in older teenagers, and a pelvic examination if the patient is sexually active or if a gynecologic problem is suspected. All adolescent patients need a urine analysis and hematocrit test. Sexually active patients need a serologic test for syphilis, gonorrhea culture, and Papanicolaou smear. Determination of cholesterol and triglyceride are needed when there is a history of a myocardial infarction in a first-degree relative younger than age 50 years.
医生必须与青少年患者建立起保密且相互信任的关系。所有州都允许对18岁以上的青少年进行无需父母同意的治疗，有些州还允许在18岁之前对诸如性病或药物滥用等特殊问题进行治疗。抑郁的青少年常常表现出行为问题、学业失败或身体症状。病史应包括对妊娠和分娩情况、免疫接种及儿童期疾病、冠心病家族史、性活动、学业表现和药物使用情况的描述。体格检查应包括对生长发育和性发育的评估、血压测定、年龄较大青少年的乳房检查，以及如果患者有性活动或怀疑有妇科问题时的盆腔检查。所有青少年患者都需要进行尿液分析和血细胞比容检测。有性活动的患者需要进行梅毒血清学检测、淋病培养和巴氏涂片检查。当一级亲属中有年龄小于50岁的心肌梗死病史时，需要测定胆固醇和甘油三酯。
