Adolescent Medicine: Sex, Food, ADHD – A Conversation

Doctor Pamela Murray is is the chief of adolescent medicine at West Virginia University. In the next installment of our occasional series “Windows into Health Care,” Kara Lofton talks with Murray about the role adolescent specialists play in West Virginia, and how treating the child most effectively, sometimes means getting the whole family on board.

LOFTON: When we think about medicine, we usually think about pediatrics and then we think about adult medicine. I mean, what is young adult and adolescent medicine and kind of, how does those differ from those other two ends?

MURRAY: I look at it as something that’s both integrative and kind of developmental, in that there are aspects of what we do that overlap with some other things. So, we do a lot of reproductive health. There are parts of it that overlap with endocrinology or hormone doctors. We see – we’re often the eating disorder if not experts – we do know a lot about anorexia and bulimia and binge eating disorders and often deliver care like with behavioral health specialists, therapists and psychiatrists to treat those problems. So we tend to look at the whole patients and we tend to kind of keep weaving all those things together till we kind of figure out the puzzle, hopefully.

LOFTON: Why do you like working with this population?

MURRAY: I think I like working with family systems and seeing how people can – if you can help people work together in ways that may not be obvious. I enjoy, kind of the people, the challenges, and trying to sort of listen to their stories so I can help them figure out how they can feel well and do well. You know, our appointments are set up so especially initially, but even at follow up visits, we have a lot more time and so we often get to sort of put the pieces of a puzzle together that I think in a busier primary care practice doesn’t happen.

And I remember working with somebody who [we] both used to supervise an adolescent medicine clinic because he had done that, but was working in a private practice at the same time. And I said like “what would you have done with somebody who had a really involved story?” And he said, “I would have had them come back four times before I ever could reach the same understanding of the problem.” And that I think about that a lot.

LOFTON: Is there anything that you see in West Virginia or, you know, from your Appalachian clients that is different or unique than we might see in other parts of the country?

MURRAY: I think the frequency and degree of obesity. And you know, we would call them co-morbidities – all the other parts of your body that aren’t working as well. When that’s a problem, it is really quite striking. I mean, before coming here I worked not far away. And, and those were issues, but really not to the degree that I see them here.

They don’t move their bodies much in part because things hurt more, you know. So, adults would say “my joints and my back.” I think sometimes people can complain and then we can try to help them get them moving. But I think sometimes they’ve gotten so used to just being deconditioned and not finding a way to move more that you don’t know how much of a problem it is. We know like, in the long term, your blood vessels in your heart, I treat a lot of kids for hypertension. Most all the time it’s associated with obesity. There are menstrual problems. So there’s probably not a system in the body that’s not affected by it.

But there are also a lot of the problems – I used to think – this is what adult doctors do. Right? These are the complaints you get when you’re middle age. But I think there are really real in these young adults. And I also think that – I think one of the special things about working here – kind of the more positive side – is how engaged families are. And sometimes in adolescent medicine, depending where you practice, you may just see kids alone and it’s really rare to see a parent. I think in a lot of urban areas, kids go in, they come on their bus, they go home. And it’s really rare to not have one and sometimes many family members with a kid. And I think particularly for issues around obesity, you’re more successful when the family is on board. And I think almost every teenager I’ve seen who’s been successful losing substantial amounts of weight, there is always a parent who, if you ask, says “well if it was good for him or her I thought I’d do the same thing too.” And they’ve often been similarly successful but sometimes they don’t tell you unless to ask.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Marshall Health, Charleston Area Medical Center and WVU Medicine.