Too Old for the Pediatrician?
When is it time to transition to an adult doctor?
Has your teen ever scheduled his own doctor’s appointment or called the pharmacy to refill a prescription? Does he know the family health insurance plan and carry subscriber information in his wallet or on his phone? Can he describe his medical needs clearly to others?
When a teen turns 18, her health records become confidential and she must give written permission for providers to share this information with parents. Even at younger ages, minors’ health records for specific services are subject to confidentiality . . . a signal that the time may have come to consider a move away from the pediatrician toward an adult doctor.
“Transition is a process,” explains Kathleen Ward, CPNP, MSN, nurse practitioner at CHOP Primary Care, Chestnut Hill, PA. Because families tend to build a strong relationship with their pediatric office over the years, transferring from a comfortable, secure setting can generate anxiety or a sense of loss.
Therefore, by the time a child is 14, “We introduce the idea of transition to [parents] so they’re not caught off-guard or feel pushed out,” says Ward’s colleague, social worker Jodi Houlon, LSW, MPH.
Whether you’re contemplating your child’s graduation from a pediatric office to an adult healthcare provider, or whether he is already part of a general or family medicine practice (as are about 15 percent), the goal is to help prepare him (and you) for greater healthcare independence.
The transition from pediatrician to adult doctor begins
The importance of finding an “adult medical home” is recognized by the American Academy of Pediatrics and the National Alliance to Advance Adolescent Health, both of which support structured transition efforts through grants, programs and protocols. Children’s Hospital of Philadelphia offers brochures and guidelines about the process. And pediatric offices increasingly expect to assist families in finding adult practitioners, through referrals or a narrative “transition summary” that transfers with formal medical records.
After a youngster is about 14, a portion of a pediatric exam may be conducted without the parent in the room. Such opportunities allow a teen to ask questions and advocate for himself. In cases where he is engaged in risky sexual or social behaviors, Ward notes, pediatricians may encourage him to discuss issues with his parents and/or recommend tests, treatments or resources. Parents may also stay involved longer if a child has a chronic medical condition or special needs.
Puberty isn’t necessarily a trigger to switch a female patient to a gynecologist or a male patient to a male doctor. Such decisions are very individual. Many pediatricians are highly qualified to treat routine menstrual issues, discuss sexual behavior and know when referrals to specialists are appropriate.
When Laura Kelly and her family moved a few years ago from Colorado to an inner-ring suburb, she chose to send her three maturing children to a physician in a general practice convenient to their home rather than to a pediatrician. Son Conner is happy with this doctor, who exemplifies what the 14-year-old says he likes in a physician: “humor, just a little,” and someone who “doesn’t delay but gets straight to the point.”
Much of navigating one’s healthcare is communication. “Office visits are often pressed for time. A teen might feel intimidated,” says Houlon. She advises teens to know their medical history, insurance, pharmacy and to write down questions in advance: “Teach your teen, ‘Be an advocate for yourself.’ ”
Donald Liss, MD, vice president of medical management at Independence Blue Cross, Philadelphia, suggests that teens learn how their doctor’s office prefers to communicate — email, call-in hours, text messages — and how to follow up on test results, prescription renewals and return-appointment scheduling.
Under the Affordable Care Act, employers must allow dependents up to age 26 to remain on their parent’s health plan, says Dr. Liss. However, families should consider how that compares to buying a plan on the marketplace exchange. They should also inquire carefully what services are covered at college or wherever the young adult is spending those years. A visit to the infirmary might be covered, but not the throat culture sent out to an independent lab, he notes. Young adults should be prepared with insurance cards and co-pays. Dr. Liss recommends the customer service department of your plan to help you with the fine print.
Finally, Houlon says that young adults should feel comfortable with the way a healthcare provider speaks with them. Does a doctor explain things in ways they can understand? Does it feel OK to ask an awkward question? She stresses that it’s fine to ask a doctor about his medical philosophy — for instance, when he would take a wait-and-see approach or quickly run tests.
Remember that there’s no need to rush the transition. Ward says she’s seen insurance companies pay for an initial visit or two for teens to interview and try new adult providers, only for patients to return to the pediatric office until they’re ready to transfer their records somewhere else.
Ann Rappoport is a contributing writer to MetroKids.