The adolescent patient.

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.