The letter from Dr Copperman raises interesting issues regarding the nature of the interactions between physicians and their adolescent patients. He stresses the importance of an ongoing relationship; an annual psychosocial evaluation; and, in particular, the annual "laying on of hands. "We shall comment on the latter 2 deficiencies, as he sees them, in GAPS recommendations.
The HEADSS psychosocial evaluation referred to is a time-honored aid in assessing the most significant areas of an adolescent's life (we point out that the traditional acronym refers to Home, Education, Activities, Drugs, Sex, and Suicide).1We also use HEADSS in our adolescent preventive health encounters; several of our providers consider this to be the most important component of the visit. In our setting, this work is actually performed by family physicians and (skillfully) by family nurses.
The GAPS recommendations do provide for this sort of annual assessment in recommendation 1, which calls
Knishkowy B, Palti H. GAPS (AMA Guidelines for Adolescent Preventive Services)-Reply. Arch Pediatr Adolesc Med. 1997;151(9):958. doi:10.1001/archpedi.1997.02170460095020