Consultations with health professionals can be perceived as opportunities to practice communication, problem-solving, and negotiation skills, all of which are important in the rest of life. The clinic is a safe place to start such skills training, and this can be an effective "sales technique" to encourage parents to allow their son/daughter to be seen alone. "This is a safe place for your son/daughter to practice talking to professionals on their own, which will prepare them for the world of work etc."
To foster such skills, the use of the strategies detailed in Table 6 can be useful.
Table 6 Skills Training in Adolescent Rheumatology
Managing consultations independently Making own appointments Self-medication
Requires education, including rationale, risk-benefit, side effects, monitoring requirements, contingency planning for missed medication doses, etc. Pain self-management techniques
Preparation for spending time away from parental home, e.g., sleepovers, school trips, camps, foreign travel Problem solving (including contingency planning): "What would do if your arthritis flared and you were away from home?" "What might you do if your friends are drinking alcohol at a party and you are still taking methotrexate ?" "What would you do if you didn't get accepted to a university?" "How would you disclose your condition to a potential employer?" Accessing advice from
Primary care professionals The rheumatology team Requires knowledge of whom, how, and when to contact Requires discernment of elective versus urgent inquiries Other health resources, such as local sexual health services Collecting repeat prescriptions
Requires knowledge of who, how, and when, in addition to any likely change in payment criteria, particularly in late adolescence Goal setting
Requires negotiation, priority setting. Working knowledge of rights with respect to health, education, employment, disability, etc.
Working knowledge of available resources for young people
Treat me like a person Try to understand Don't treat me differently Give me some encouragement Don't force me Give me options Have a sense of humor Know what you are doing
Source: Adapted from Ref. 57.
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