Monday, July 18, 2011

Medical Care for Young Adult Men

A recent article in the Journal of Adolescent Health focussed on the health care access of young adults  (19-24).  Available in abstract here, it makes a number of points:
insurance matters: "young adults are twice as likely to be uninsured than any other age segment of the population"
males have greater barriers to accessing primary care than females: increasing numbers of young women seek care from their gynecologists rather than  primary care providers but clearly young men do not have such an option.
clinical guidelines need to be developed for primary care: other than in the specialties of Ob/Gyn and Adolescent Medicine, there are few guidelines for managing the health of young adults.
young adulthood remains a missed opportunity for preventive interventions: all of the health issues of middle age take root in the younger years (overweight, heart disease, diabetes, bad habits, poor stress management) and anticipatory guidelines should be laid  out early.

For young men ages 15-29, two thirds of deaths are accounted for by "unintentional accidents", homicide and suicide. In other words, behavior and mental health are more responsible for losing our young people than infections, cancer, or heart disease. And the behaviors we are talking about here are excessive and dangerous drinking; reckless driving; risky athletic pursuits; untreated anger, depression and anxiety; and unsafe, unhealthy or unethical sexual practices.

How upsetting that young men in our midst get the shortest end of the stick when it comes to health care!  In spite of the fact that young adults have higher rates of mortality, more at risk behaviors, and more chronic disease than teens, they have much less access to medical care. Just when young adults start to "think clearly again" after the fog of adolescence they are rudderless when it comes to their health care. A larger proportion of their care is delivered in emergency departments and is not covered by insurance thereby almost ensuring poor follow-up. There are numerous missed opportunities for behavioral counselling on anger management, smoking cessation, prudent alcohol use, safe driving and athletic activities.

We can hope that as more allied professionals (nurses, nurse practitioners, medical assistants) join other providers in caring for this population they will receive the hands-on approach they have been accustomed to with their pediatricians and adolescent medicine providers. In the mean tim, orthopedists, emergency room doctors, urologists, and dermatologists can all pitch in to ask the questions young men need to answer and learn from.

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