Pediatrician Veenod Chulani, MD, chose to specialize in adolescent medicine because “I have always rooted for the underdog.” He explains, “Although we have made tremendous gains in the areas of child and adult health, there remain these gap years during which many adult health behaviors are formed. Adolescence profoundly influences health outcomes yet gets very little attention.”
For the last nine years, Dr. Chulani—known as Vinny—has served as director of the division of adolescent medicine at Arnold Palmer Hospital for Women and Children in Orlando, Florida, where he has had to make room for teens—literally.
“The adolescent outpatient clinic is tucked in between the acute and well-child care sections of the pediatric outpatient center. When I took the job, pediatric services had completely taken over unused clinical space dedicated to adolescents. Parents with infants and children occupied the adolescent waiting area and were frequently roomed beside adolescents. It was a challenge reclaiming and marking the territory for adolescents.”
In addition to reclaiming physical space, Dr. Chulani has changed the atmosphere of the teen clinic to better reflect the needs and preferences of teens. “I have created a home—a medical home for teens.” he says. He knows his patients and members of their families by name. Dr. Chulani is motivated by his belief “that if you provide youth with positive healthcare experiences, you help shape healthcare-seeking behaviors and probably make them more likely to approach than avoid the system as adults.” His patients tell him how much they appreciate his efforts and concern.
To Dr. Chulani, adolescent medicine demands mastery of the principles of working with teens as much as it requires specific knowledge of diagnostics and therapeutics—especially in sexual and reproductive health. “How you diagnose and treat chlamydia is searchable and readily accessible in the public domain. You can google it. What I find is that healthcare providers generally want help with their approach to treating teens,” says Dr. Chulani. He notes that teens may not open up during medical encounters unless the provider’s manner makes them comfortable enough to do so. For instance, if a physician does not communicate with a teen the right way, the patient might not reveal that she or he had unprotected sex and might not get testing or treatment.
Typically, providers who are not comfortable discussing sex with adolescent patients will not communicate effectively with them. Dr. Chulani says that medical professionals often fail to recognize the normalcy of adolescent sexuality and regard youth as sexual risk-takers incapable of making responsible decisions. Some of these providers fear that discussions of sexuality and reproductive health only encourage teens to have sex.
To help his colleagues treat teens better, Dr. Chulani joined Physicians for Reproductive Health’s Adolescent Reproductive and Sexual Health Education Program (ARSHEP) in 2005. As one of the 46 ARSHEP faculty members, Dr. Chulani delivers presentations to physicians, medical students, and other health professionals about how to approach adolescent patients and meet their needs for sexual and reproductive healthcare. He draws from his hospital experience as well as his ongoing community work as the medical director of Orlando’s Teen Xpress, a mobile health clinic serving uninsured and medically underserved youth at four high schools and a homeless shelter.
Dr. Chulani and the other ARSHEP physicians develop and update the PowerPoint curriculum—which is available online and as a CD-ROM—in a highly collaborative process. He was particularly involved in the latest revision, promoting a shift from healthcare’s current, risk-based approach to adolescent sexuality to a philosophy that treats teens’ sexual development and relationships as normal and positive. Citing sociologist Amy Schalet’s landmark 2004 article “Must We Fear Adolescent Sexuality?” Dr. Chulani says, “Our discussions with teens about sex are fear-based. We confine ourselves to assessing adolescents’ risk for unintended pregnancy, sexually transmitted infections, and sexual coercion and identifying the medical services they require. We do not have the language to frame sex positively for youth, to present it as something other than inherently risky.”
Dr. Chulani was first exposed to adolescent medicine during his residency at Maimonides Medical Center in Brooklyn, where he trained under Physicians for Reproductive Health member Dr. Warren Seigel (now the chairman of the pediatrics department at Coney Island Hospital). “I had some initial reluctance to committing to three years of training in adolescent medicine and subspecializing in an age group rather than an organ system. During my residency, however, Warren pointed out how much my teen patients and I laughed during visits and how caring for adolescents came naturally to me. I am glad he did.”