medicIn 1991, Michael J. Fox starred in the charming movie Doc Hollywood. The story tells of Benjamin Stone, M.D. (played by Fox), a young hotshot surgeon who’s driving across the country in his 1956 Porsche 356 Speedster. He plans on travelling from Washington, D.C. to Beverly Hills, where he’ll complete a fellowship with a high-end plastic surgeon.

Along the way, Dr. Stone crashes his car in the mythical rural village of Grady, South Carolina, “squash capital of the South.” The crash damages the fence of the town judge, who sentences Dr. Stone to provide medical services at the neighbourhood hospital, while the local mechanic awaits the parts to repair Stone’s vintage Porsche.

The hospital work in Grady is relaxed, compared to the busy emergency room in Washington, D.C., and Dr. Stone begrudgingly addresses the simple cases he encounters, like clearing the spots before an elderly patient’s eyes by cleaning her glasses. But, one day, he mistakenly diagnoses a bellyache as an urgent case of mitral valve regurgitation in a child who dipped into his father’s chewing tobacco and was given too much Bismuth subnitrate (homegrown antacid) to settle his stomach.

He calls a helicopter to take the child and his parents to the closest trauma hospital for emergency open-heart surgery before the aging Doc Hogue briefly steps out of retirement, cures the child with a 65-cent can of Coca-Cola, and puts the cocky Ben Stone in his place. Doc Hogue admonishes Ben Stone as a “snot nose puppy doctor,” who “probably wouldn’t know crap from Crisco.”

Experienced practitioners know what matters

If you’re like most people, then you want the most experienced doctor—or mechanic, for that matter—when you have a problem. You want the specialist who’ll leave no stone unturned, no question unanswered and every possibility considered. But in contrast to what you might imagine, most experts, like Doc Hogue, cut to the chase. They don’t spend a lot of time pondering over irrelevant details, and based upon their experience and repeated practice, they usually know which details matter.

While Ben Stone is listening to the child’s heart, palpating his abdomen, examining his eyes, placing an oxygen mask over his mouth and nose, getting him on a stretcher, shouting at the nurse, advising the family and calling a helicopter to fly the boy to Atlanta for emergency surgery, Doc Hogue is popping open a can of Coke and heading back to bed.

So what does this have to do with kids?

The story of Doc Hollywood has great relevance to adolescents and their risk-taking behaviour. Contrary to popular wisdom, adolescents (similar to the novice doctor, Ben Stone) generally overthink when faced with what seem like insurmountable problems and questions that they haven’t faced many times before:

  • Should I drive, now that I’ve had three beers?
  • Should I have sex with this person, even though I don’t have a condom?
  • Should I swim across the river like my friends, even though I’m not a strong swimmer?

Adolescents generally overthink when faced with what seem like insurmountable problems and questions that they haven’t faced many times before.

But adults, like Doc Hogue, get right to the point. Adults recognize the patterns and situations they’ve seen before, and don’t debate these risky decisions for long. They act.

Unfortunately, most of our adolescent risk reduction programs fail to appreciate this fact. Instead, even our most popular programs such as D.A.R.E., Scared Straight and school-based zero tolerance policies, focus on teaching our kids more and more detail about the risks they face: “Don’t you see that unprotected intercourse can cause pregnancy? That trying cigarettes can lead to addiction? That driving under the influence of alcohol and drugs can lead to a car accident?”

We hammer our kids with these facts and admonishments, but our finger-wagging only contributes to our kids’ natural tendency to overthink in risky situations. Instead of having hard and fast rules at their fingertips, like Doc Hogue, our kids tend to mull over lots of irrelevant details like Ben Stone. They think about everything under the sun when making a decision involving risk.

Benjamin Stone gets caught in a relatively common situation among those who’ve studied hard-to-learn complex skills and are just starting out in their careers. He has the hubris of the young, the zeal of the recently minted physician. At this point in his career, he’ll likely do better on a multiple-choice medical board exam than at any other time in his life.

He’s just like all the psychiatry residents I teach. He knows the facts and can rattle off countless possible diagnoses for any set of symptoms, and he does just that. However, he lacks maturity and experience, so in his efforts to be comprehensive, he misses what’s right in front of him. The competent but amateur physician, Dr. Stone, mistakenly sees too many possible explanations for the child’s symptoms, while the seasoned Doc Hogue accurately sees few.

Alternative ways to teach kids about risks

The good news is that we actually can teach our kids to appreciate the gist of the risks they face, which will help them stay safe in dangerous situations. We can do this in a number of ways:

  • By using analogies (“Would you play Russian Roulette for one million dollars?”)
  • By role-playing and letting them practice how to respond in risky situations
  • By helping them plan decisions in advance
  • By providing our kids with specific emotional cues to help them understand the possible outcomes of taking risks, with frequent reminders
  • By cuing them in to “red alert” situations, where risk is immanent (for instance, being home alone with your girlfriend)
  • By role modelling and explaining our logic when we’re faced with risky situations ourselves

With patience and lots of  practice, we can enhance our kids’ ability to act safely, even before they gain Doc Hogue’s level of experience. And anyway, don’t worry too much about poor Ben Stone! In the end, he gets the girl.

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born to be wild book coverNationally recognized child and adolescent psychiatrist Jess P. Shatkin, M.D., M.P.H., is one of the country’s foremost voices in child and adolescent mental health. He serves as Vice Chair for Education at the Child Study Centre and Professor of Child and Adolescent Psychiatry and Paediatrics at New York University School of Medicine. He’s been featured in top print, radio, TV and Internet outlets; and for the past eight years, has been the host of About Our Kids, a two-hour call-in radio show broadcast live on SiriusXM’s Doctor Radio. He lives in New York City with his wife and two teenage children. His book, BORN TO BE WILD: Why Teens Take Risks, and How We Can Help Keep Them Safe, was recently published by TarcherPerigee.
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