When evaluating adolescents for either substance abuse or suicidality, do not settle for the answer “a long time ago.” Ask specifically when was the last time they used substance x, y, or z, or ask when the last time they tried to hurt themself or thought of hurting themself.

Often adolescents will tell the examiner that it was a long time ago. The examiner may assume that this means months or years ago, but the adolescent may be thinking last week or a few weeks ago. — Pam Gurnell, NP-BC, FNP-BC, Salt Lake City, Utah


These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.