Author interview: Maria Veronica Svetaz

This is the second of two interviews with the editors of the new WONCA book Working with Adolescents and Young Adults in General Practice: A Guide for Family Physicians. Here, co-editor Dr Maria Veronica Svetaz reflects on why young adults are so often left behind, how a strength-based approach changes the consultation, and what 25 years of intergenerational care have taught her. Edited with Pierre-Paul Tellier and Muna Chowdhury, the book grows out of the WONCA Special Interest Group on Adolescent and Young Adult Care, which the three editors have led between them. You can read our first interview, with co-editor Dr Muna Chowdhury, here.

The three of you have led the WONCA Special Interest Group on Adolescent and Young Adult Care between you, and the book grows out of that community. How did the SIG shape what this book set out to do, and what does it offer a family doctor who has never thought of adolescents as a distinct group?

The WONCA Special Interest Group united clinicians, educators, and researchers from diverse backgrounds, yet we faced similar questions: How do we meaningfully engage young people? How do we balance autonomy with family involvement? How do we address emerging health concerns while supporting development? The book grew directly from these discussions. A key goal of the SIG was to highlight that adolescents are not simply older children or younger adults—they navigate a unique developmental period marked by identity formation, increasing autonomy, evolving relationships, and significant opportunities for growth. That requires different parenting style and different medical care styles. Family physicians are well-positioned to guide young people through this process because we often care for both them and their families. This book is not just about adolescent diseases; it seeks to help clinicians support young people as they move toward adulthood, focusing on relationships and skills for this transition.

The health challenges facing young people today seem to be shifting fast, from mental health and disordered eating to substance use and the pressures of identity formation. What worries you most about what you are seeing in practice?

While concerns such as anxiety, depression, disordered eating, substance use, and self-harm are increasingly visible, what worries me most is not any single diagnosis but the cumulative impact of adversity on young people's ability to imagine a hopeful future. Across many settings, I see increasing isolation, polarization, attacks on identity, and a loss of meaningful connection and belonging. Adolescents are navigating developmental tasks while simultaneously facing unprecedented social, political, and digital pressures. Many of the conditions we diagnose are manifestations of deeper challenges related to chronic stress, uncertainty, and disconnection. At the same time, I remain hopeful because adolescence is also a period of tremendous resilience, creativity, and possibility. One of the most important protective factors we can help foster is hope, the belief that one's life has purpose, that one's identity is valued, and that a positive future remains possible.

And our medical systems are not equipped to devote the time this care requires, nor to recognize how much impact on adulthood you can have by supporting teens in processing context, crisis, and traumatic events, and by coaching them on the next steps in their development. YOU are the healer! The time spent in the teenage years shapes adult and the next generation's health, yet we miss the impact we can have in real time. The Lancet Commission on Adolescent Health really hammered this home, and we hope its work continues to remind global organizations of our care gap.

What is the most common mistake family doctors make when treating young adults?

Young adults are usually the weakest link, the portion of healthcare left behind. We often forget that young adults have the same developmental needs as adolescents. I recently learned that in Africa, several countries consider Youth Adulthood to go as far as 30 years old, as their economic independence comes later in life, not because of them, but the hardships that their countries have to face in this unequal global economic model. Young Adults have the same needs within the context of identity formation, growing autonomy, peer relationships, and family dynamics. And this transition comes with what I call a taxing developmental anxiety, most of which is created by our own societal expectation of considering them “Adults”. With the upcoming arrival of AI, which will be much faster and more forcefully integrated into our lives than we all anticipated, I suspect their need for our coaching and support will grow. Most of our job will be to reassure them, but we need to be aware that they need all our space and strength-based support for that to take place.

You brought together contributors from very different regions and health systems. What surprised you most during the process, and did anything you assumed was universal turn out not to be?

One of the most rewarding aspects of our SIG and editing this book was discovering how much family physicians around the world share, despite practicing in vastly different health systems and cultural contexts. We expected differences in resources, legal frameworks, access to care, and social norms—and those differences certainly emerged. What surprised me most was how universal young people's developmental needs proved to be. Whether contributors were writing about adolescents in urban centers, rural communities, conflict zones, or migrant populations, the same themes surfaced repeatedly: the need for belonging, identity, safety, connection, opportunity, and hope. What varied was the context in which those needs were expressed and the barriers young people faced in meeting them. The process reinforced for me that while healthcare systems differ, adolescence itself remains a remarkably universal experience. The challenge for family physicians is to meet these developmental needs within their unique communities, turning shared understanding into meaningful action.

Another perk is the number of SIG members and authors from the Global South. Today, Youth Health centers on the Global South, where most of the world's youth live. Seeing so many leaders create spaces for youth was phenomenal.

Confidentiality with young patients can put doctors in a difficult position with parents who want to know what is going on. How do you handle that tension?

I often begin by reframing the issue. Confidentiality is not about choosing between adolescents and their parents; it is about building trust with both. One of the strengths of family medicine is that we frequently care for young people within the context of their families and communities. Adolescents need opportunities to develop autonomy, practice decision-making, and discuss sensitive issues openly, while parents remain essential sources of guidance, support, and protection.

Rather than creating an adversarial dynamic, I try to establish a triadic collaboration among the adolescent, the family, and the clinician. I proactively explain confidentiality, normalize private time with all adolescent patients, and emphasize that my goal is to strengthen communication and trust rather than create distance. I make it clear that I am there to support BOTH of them, one at a time, while protecting their confidentiality. In my experience, parents are often more comfortable when they understand that confidentiality is a developmental tool rather than a barrier. It creates a safe space where young people can ask difficult questions, seek help early, and develop the skills they will need to manage their health as adults. When handled transparently and respectfully, confidentiality often strengthens families by fostering trust, accountability, and healthier communication for everyone involved. If you want to learn more about this, please go to Chapter 3, where I lay it all out with great resources to support you in doing this.

I have been using this model for 25 years in our clinic, Aqui Para Ti/Her for you, for our Latine youth and families in MN, and I can attest that my favorite outcome (of the many showing how an integrative, culturally responsive, and inter-generational approach not only protects but promotes health) is the fact that half of our referrals have come from our parents! How about that! And at the same time, our scores about contraception and LARC (long-acting reversible contraception) rates are far higher than those of other physicians in our Safety Net using the regular model of care (Not Parallel Care). Intergenerational care, with clear confidentiality guidelines, does not compromise youth care. It impacts them exponentially but supporting the main “influencer” in a teen's life: their parents.

The book devotes real attention to highly vulnerable young people, including child soldiers and asylum-seeking or trafficked youth. What do family doctors most often miss when these patients are in front of them?

One of the most common mistakes we make is seeing vulnerability before we see humanity. When young people are introduced through experiences such as trafficking, forced migration, violence, exploitation, or displacement, it is easy to focus exclusively on trauma, risk, and pathology. Those experiences are important and must be addressed, but they do not define the whole person.

What family physicians most often miss are the strengths, relationships, identities, cultural assets, and survival skills that have allowed these young people to reach our clinics in the first place. Some of the most vulnerable youth I have cared for have also demonstrated extraordinary resilience, courage, creativity, and determination. A strength-based approach does not ignore suffering; rather, it recognizes that healing is more likely when young people feel seen as whole people rather than as collections of problems.

For these youth, trust and safety are essential, particularly after experiencing betrayal by individuals, institutions, or systems. Our role is not simply to diagnose the consequences of adversity, but to create conditions where healing, belonging, and hope can emerge. The most important question is often not, “What happened to you?” but also, “Who are you, what strengths have helped you survive, and who are you becoming?” That shift can transform clinical encounters and open pathways toward recovery, growth, and thriving.

This ability is what it is called in medicine as Structural Competency: you are aware that the symptoms that the patient in front of you presents comes from their challenging context and lived experiences, not a flaw in their personalities, and broadens your role as family physician: not only to support and affirm our youth, but also to your role as witness to advocate for changes around those Structural issues affecting our youth and families health.

Meet the editor at the WONCA Europe Conference in Paris

Working with Adolescents and Young Adults in General Practice: A Guide for Family Physicians
Edited by Pierre-Paul Tellier, Muna Chowdhury and Maria Veronica Svetaz

Join us at the WONCA booth to meet co-editor Dr Pierre-Paul Tellier and learn more about the book.

Book launch: Wednesday 1 July, 10:15 – 10:45 (morning coffee break)
Location: WONCA booth, Exhibition zone

The book will be available for purchase at the conference, and can also be ordered here: Order the book

Explore other titles in the WONCA Family Medicine Book Series: See the full series