Growing up in the Healthcare System: Making the Move From Pediatric to Adult Medicine

You guys know that when I go to my office to see patients I go to a place called PM Pediatrics, right? As in pediatrics meaning kids. You’re with me on this, I think.

Well you can imagine my surprise recently when the office received a phone call asking if we would see a patient in their 30s. I mean, ok many of us are kids at heart but I’m not sure this includes going to an urgent care for children. In this situation all’s well that ends well and we were able to redirect this ADULT to an appropriate place for care, but it got me thinking about all the elements of transitioning care for someone from pediatric medicine to adult medicine. It can be intimidating and confusing for many, and not a bad idea to identify some key components that are part of the process.

Decide when to make the transition

First you need to figure out when the transition needs to happen. For some people, that’s the minute they turn 18, and for others it’s in their mid-twenties. The optimal age depends somewhat on the pediatric practice: some practices will only see up to age 18, whereas others will see patients through college age. It’s nice when the decision is made based on more criteria than just the age terms of the individual practice. For example, there are some medical conditions that are best suited for care by healthcare professionals (HCPs) trained in internal medicine, and others are best suited by pediatricians. Those with a clinical condition for whom pediatricians have traditionally had more experience (such as cystic fibrosis) will sometimes stay in the care of their pediatrician for longer than others.

Picking a practice

So how do you pick an “adult HCP” anyway? A little reflection is really beneficial here. Asking a few questions about your child’s vision of the ideal HCP can help guide the selection. Male or female? Younger or older? Big practice or small? Much of this comes down to personal preference and recommendation. It is helpful to ask friends and family about their experiences to narrow down the right professional. As far as online reviews go, I encourage everyone to take these with a grain of salt as many times they are not at all representative of the majority of opinions of that particular HCPs actual patients.

Go in prepared

Once the HCP is selected, then there’s some administrative work to be done. All of the records need to be transferred to the new medical home; preferably well before the first appointment. The whole process takes several weeks, so this is important to know. Additionally, I recommend that all patients get their daily medicines refilled to have plenty prior to the transition, so there’s no running out of the supply in the interim.

Encourage self-advocacy

Sometimes kids arrive to the first visit having never been to a clinician alone, so some preparation about health self-advocacy is important. Encourage your child to write down their own questions before the appointment. This gives them one less thing to think about in the moment.

Take time to review your family history with your young adult child. Many kids have no idea whether or not they have a close relative who was diagnosed at an early age with heart disease, or even the exact kind of surgery they might have had as a baby. These are questions they will definitely be asked.

Understand your health insurance benefits

A little primer on health insurance, co-pays and prescription coverage is helpful as well. I don’t know about you but I didn’t know anything about this stuff until I well into my mid-twenties. Now that many people have high deductible plans with a specific amount that is paid out of pocket before any insurance benefits kick in, understanding the details of your individual plan is now more important than ever.

Does your child know what an EOB is (explanation of benefits)? I sure didn’t when I started my journey into adult medicine. This form is a document that comes from your insurance company describing the services rendered from a medical visit and details the amount covered by insurance as well as the amount covered by the insured. Good stuff to know about, right? Arm your young adult with this info before their first visit alone.

Although the details of a visit to a healthcare professional are private and protected by HIPAA laws, the EOB will be addressed to the primary insurance holder (oftentimes a parent until the young adult opts for their own). They should know that basic information about visits to a healthcare professional using this insurance will be included in the EOB.

Know your resources

My final thought is for kids who head off to college or move away to a new place and may not be familiar with the healthcare resources around them. Most colleges and universities have a student health clinic/service that can be utilized. Beyond that, it’s smart to get the lay of the local healthcare land. Know which urgent care offices, hospitals, and emergency services are nearby. Many primary care providers also have an after hours phone number for emergencies, so they should know this information and what types of calls are appropriate for that after hours phone line. This is another part of good emergency preparedness.

Perhaps part of the reason I haven’t written about this before is that I can’t stand to think of the day when my own two kids will transition out of needing a pediatrician. Why do they all have to grow up so fast? The days are long but the years are short, right?