Where are the teens? Or their parents?
By Mark Groshek MD Kaiser Perma | Popularity: 4%I finally got email from one of my teen patients! It was from a 16year old, and concerned refilling a medication for asthma. Pretty straightforward, really, but it was exciting to have a teen email me. It got me thinking about why we have heard from so few teens.
This particular patient is actually pretty unusual in my practice–a teen who is taking (and whose parents have given) responsibility for managing her own medications. The reality of the matter is that in most families, even with older teens, it is the parents who are in charge of medication refills, getting immuniztion records, and so on. So in most cases, it might be the parents who email for a refill. I can live with that–it still makes life easier for everyone to have such a convenient way of taking care of non-urgent medical needs when your own schedule permits.
But I am not hearing much from parents of teens either. I have been mulling that over–it seemed like such an obvious win for the parents! I think the issue is that it all seems too complicated, so my colleagues and I aren’t taking the time to promote it as much as we might, and the teens and their parents are put off by the steps needed to get it all working. I am speculating, but I think this is the case. I know I sometimes consciously decide not to talk about online access for a teen and their parent when I am running behind, because confidentiality is not easy to explain, nor is the way we had to adapt our online system to conform to confidentiality rules. If it is too hard for me, what about all my colleagues?
It also takes a number of steps to get it all going in our system–the teen has to create their own account on our website (kp.org), then the parent has to fill out a paper request to gain access, then this takes time to create . . . Why bother when you know from your other web experience that folks can create an account in a matter of minutes online to many sites. Those sites generally don’t contain personal health information, but they are the standard people judge by.
So what are we going to do? I don’t know yet. I am working with some communication experts to try to distill the explanation down to a few golden points without dumbing down the idea of confidentiality. I am also thinking about how we might do more of the process right in our office while the teen and parents are there. This would simplify things, and it would also make it a lot clearer that we think it is a cool tool to have for our patients. More to come . . .
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January 8th, 2008 at 3:27 pm
Hi Mark,
I was going to ask you about this in e-mail, but this proved to be a great forum….it’s about disparities and teens.
There is a lot of effort in health care to have teens come in for care, and when they come in, to address concerns and risks that may shape their health for the rest of their lives.
With that in mind, I wanted to ask - what do you think about these tools as a method of reducing disparities -
1. By regularly advising teens to message you after they see you - like saying, “Just send me a message with your questions. If you don’t have a question, just send me a hello.” - as a way to open the door to a conversation that may not have happened in person.
2. By increasing the frequency of messaging for teens that you think may be at risk - something like, “How about sending me a message once a month or at the end of your next term telling me how school is going.”
Other ideas? Or ideas that you might tailor to patients from different home, cultural, economic backgrounds, to support great health for the diversity of our patients?
Thanks again for leading the way! These are things we can’t even try yet….
January 10th, 2008 at 6:27 pm
Dear Ted,
What great questions! Let me take them in reverse order. I think your second idea is an excellent one, and one I will try with selected patients. For us, the potential issue is that parents can also see the emails between me and the teen, so it would be useful now to help teens who are in good communication with their parents. It would be less helpful, I think, where the issues are confidential, or where the teen is unwilling to share with the parent. But there is no reason not to use something that could help some teens, just because it might not help them all!
I think the suggestion to “send me a hello” is a great one especially for teens, but also for anyone thinking about using online services. Teens especially need an invitation, I think, and “send me a hello” lets them log in, and even check out what the site offers, without having to have a medical issue to discuss.
At KP our sign up process has been arduous–you register on line, and you get a temporary password in the mail 7-10 days later. If you don’t use it within 90 days, it expires, and you have to start over. There are really valid security reasons for doing it this way, but we know that something like 40% of people who signed up never actually logged in. In the last year, we have trained people at every office to be able to register the member right in the office and give them the temporary password–much better! But they still have to go to some central site in the building. Doing online authentication so folks can register and receive a password right away sounds like a simple concept, but not when you have to be certain the person is really who they say they are to protect their personal information. Nonetheless, we are finally able to do that starting in late February.
Why am I torturing you with that detail? If you were a teen, would you go through all that? I am hoping to get my colleagues to agree to try out a streamlined solution–we invite the teen, walk them to one of our staff who can create their password, then walk them to a computer where they can log in, create their permanent password, and even send that hello message. At the same time, we could have the staff person also activate the parent’s proxy access, so they can also be part of the conversation right away.
I am not sure how long it will take to do all this, assuming I can convince my office colleagues and staff it is worth while. But I hope to get it done soon. I don’t think that with teens you can just build it and expect them to use it. We need to make it easy, and really inviting. We’ll see!