‘Unicorn doctors’
Teens find allies who help them gain control over their health
There are some things that 16-year-old Jean-Paul “JP” Durand can’t talk about with his mom. And that’s OK because he has a doctor who is trained to deal with every part of his health care — from bumps on the head to depression and anxiety.
Legacy Community Health has ramped up TeenWell, a program specifically designed to help teenagers and young adults manage their health through one-on-one doctors’ appointments, online resources and answers to tough, and sometimes awkward, questions.
Going to the doctor without his parents makes JP, who runs crosscountry and loves anime films and TV shows, feel empowered and independent.
“It’s just me vocalizing my problems or my questions, and I feel like it’s a really judgment-free zone. I can really speak about everything that I’m concerned about.”
Examining data between 2019 and 2020, Legacy found a major decline in preventive care during their clients’ adolescent years — between 10 and 19 years old. Only 4,100 checkups were conducted on teenagers in that time period out of more than 45,000 wellness appointments for children.
While nearly all 12-yearold children complete their annual well-child visits, only 41 percent of 13-year-olds finish their visits. By 18, only 2 percent of teenagers attend all of their appointments.
From the time a child is born until they’re in kindergarten, parents don’t miss appointments, said Dr. Tamisha Jones, senior medical director of clinical affairs,
“They’re excited, they take pictures, and they bring Grandma — it’s an event,” Jones said. “But as the kids get older, they require less shots for school. Right around their 11th or 12th year, they’re pretty much done with the doctor. No more photos or Grandma.”
The drop-off in adolescent health care is why Legacy started TeenWell, Jones said. And while a large portion of each appointment is about body health, the physicians — which Legacy often refers to as “unicorn doctors” — want to help teenagers become adults mentally and emotionally.
Dr. Jenn Feldmann, service lead for adolescent medicine and gender health and wellness at Legacy, is a unicorn doctor who specializes in this patient age group. Peak conflict for adolescents are typically 16 to 17 years old, or when they are juniors in public high school.
Adolescent medicine outside of an academic or research setting is rare, Feldmann said, which is why teenagers are typically seen by pediatricians, even though they’ve aged out of their care.
Legacy has three adolescent health providers who have finished their residency programs, one who is fellowship-trained and another who is a physicians’ assistant. Having five “unicorns” for one health system is great for a city as large as Houston, she added.
“Everyone has a need for an emancipation process, which is adolescence,” Feldmann said. “You’re going from being dependent on your family to becoming independent in managing your life. There’s a change of relationship between parent and teen, but it doesn’t require less parenting — it’s requires a different kind of parenting.”
During a typical TeenWell visit, questions range from “What do I do about this acne?” to “What do I do when my friend doesn’t want to talk to me anymore?” to “I think I might be depressed.”
Patients are also given a personal questionnaire that is not shown to their parents unless there is something that could put the child in danger. The questionnaire delves into identity, as well as any romantic or sexual relationships.
“We have conversations about how to be safe with somebody, but we always encourage the teen to talk to a parent or guardian,” Feldmann said. “The goal is to keep you safe and encourage you to keep talking.”
JP is a TeenWell teen ambassador who helps guide his peers to the service through social media and Legacy’s cellphone app. He said he enjoys spending time at the clinic with his doctor on a regular basis because he feels like he can open up and not be judged for what he says or asks.
“They’ll try to answer all your questions or help you fix it if it’s an issue or concern,” JP said. “The doctors really help you discover who you are as a person, find your physical and mental strength and better your overall wellbeing.”
As a cross-country runner, JP needs to keep his body in shape for his sport. But he’s just as focused, if not more so, on becoming independent before he goes to college or decides what his next step in life will be.
His mother, Jess Ferdinand, is learning to be OK with not knowing every detail of her son and younger daughter’s lives. But she admits it has been a tough adjustment.
“I don’t know everything they talk about when they’re alone with the doctor unless it’s something potentially dangerous,” Ferdinand said. “The first time, I felt like I was listening from outside the door.”
Teen years are typically healthy ones, Jones said. But according to a National Survey of Children’s Health, almost 31 percent of American adolescents have one moderate-tosevere chronic illness, such as asthma or a mental health condition.
Legacy providers want to be that other trusted adult in a teenager’s life, Jones said, so no problem or question goes unanswered or is neglected until it’s too late. Especially with mental health.
The health center has therapists on-site that are available for brief interventions for adolescents and their doctors as needed. And for the most part, all the information is confidential between doctor and patient.
“A huge part of growing up is figuring it out. But you can’t always safely share this information with your family,” Jones said. “By keeping it private, we serve as an outlet for the adolescent to talk it through.”
Parents have a tendency to hold a teenager too close, Feldmann said, because they constantly worry about their safety and whether they’ve learned to make healthy choices.
But teenage brains are wired to take more risks, she said, and nothing magical happens when a person turns 18 — they still need help figuring the world out.
Until age 25, frontal lobes are still developing, which leads to a unique brain and a more carefree kind of mindfulness, she said. But once complete, the brain does lose a sense of fearlessness. The adolescent brain is a one-time experience that should be appreciated and developed with purpose, Feldmann said.
“The thing I love about teens so much is they don’t have a fully formed frontal lobe, so they don’t always make good choices,” she said. “They don’t mentally have the capacity to understand long-term consequences. Without that, they think they can drive well while talking on the phone. But they also believe they can change the world because no one has told them they can’t.”