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Skills for Youth

All Skills for Youth

Advocating for Your Health Care

Introduction

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:

  1. Youth will hopefully have better experiences with their health care providers, and

  2. 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:

  1. 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.
  1. 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.
  1. 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.
  1. 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.
  1. 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?
  1. 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?
  1. 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:

  1. 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.
  1. 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."
  1. 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.
  1. 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:

  1. Stop the exam and ask for someone else.

  2. Call or write the clinic after your appointment and describe your treatment.

  3. Do not go back to that clinician. Tell your friends not to see that clinician.

  4. Report the clinician to his/her medical board.

  5. 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

  1. Divide the class into small groups of 4-5 students.

  2. Give each small group the scenarios listed below.

  3. Ask two students in each small group to practice making a reproductive health appointment by acting out a role play based on Scenario #1.

  4. Ask the other students to observe the role play for the various parts that are present or missing from their peers’ performance.

  5. 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.

  6. Ask role play actors and observers to switch places and proceed with Scenarios #2 and #3.

  7. Repeat steps 3-5.

  8. 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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References


1 Columbia University College. (2000). The Adolescent Years: Health care of the adolescent.
http://cpmcnet.columbia.edu/texts/guide/hmg08_0004.html#8.27
2 National Cancer Institute. (2001). Testicular cancer. http://cis.nci.nih.gov/fact/6_34.htm
3 Tabers Cyclopedic Medical Dictionary. (1985). F. A. Davis Company. Philadelphia, PA.
4 Webster’s II New Riverside University Dictionary. (1984). Houghton Mifflin Company. Boston, MA.
5 AviaHealth. (2000). Adolesent Medicine. http://gotomydoctor.com/Articles/898.html