Independence and Transition to Adult Care

Community Pediatrics of Andover and I ask that adolescents/young adults transfer to an Internist or Family Practitioner that is comfortable taking care of young adults at age 19. We ask this because these providers have an expertise in the young adult care. This is a natural transition consistent with being legally responsible for one’s self and moving onto the next phase of life after high school. This is a slow transition that we work on with the patient and their parents. We start with the child having increasing responsibility for their health as they grow.

By age 3, I ask children questions during the visit before asking parents. For example, during a sick visit, I will start by asking the child why he or she is here. I will continue to ask questions pending the response. Then, the parent helps fill in the details.

At age 4 at their physical, I ask children questions about their health including what they are eating, their self-care habits, sleep, preschool skills including colors etc. Again, parents fill in the missing information. Also, parents are asked questions about family dynamics, concerns etc. The goal is for the children to have a responsibility for their health. Further, this helps the child develop independence and confidence in talking about their health.

At age 11, we discuss with the child and parent that at their 12 years old physical we will change the format of the visit. Instead of parent and child having the visit together, I will talk with the parent first about the child/adolescent and then take a history from the child/adolescent. During that 11-year-old physical, the parent and child are told that we will start talking about adolescent issues at the 12-year-old physical. These issues will include alcohol, drugs, and dating. This is because they will be young adolescents and will be challenged by some of these issues in the near future, if they have not been already. This is where adolescent confidentiality starts. I tell both the parent and the child/adolescent that I will not share the information with the parent unless the patient tells me something that is placing them or someone else in imminent danger. Rather, the patient and I will solve this issue and move forward. The parent and child will be also told that following the separate histories at the 12 year physical, an exam will then be preformed. For a girl, she will be asked whether she would like her mother or my nurse to be in the room during the exam. Whoever she chooses will stay in the room during the exam. For a boy, they have the option of having someone else in the room if they wish, otherwise it is just the patient and myself.

At age 12, when the adolescent comes for the exam, everyone knows what to expect though the process is reiterated prior to the visit starting.

At age 16, we work to make sure that the adolescent understands and knows what meds and doses, medical issues, allergies, and any learning issue they have. Also, we start to discuss future life plans after high school graduation including goals of attending college, trade school, going into the military etc., and how to pursue these plans.

At age 17, the history includes all the previous discussions and the fact that at 18, they become responsible for their own health care. At 18, they are now considered an adult under the law. As such, I cannot provide any information to parents unless the patient agrees. Further, the choice of a physician is their choice. They are responsible for making all appointments and can come to an appointment on their own, if they so choose.

At age 18, the formal process of transition occurs. We reiterate the above and tell the patient that I am happy to continue to be their doctor until age 19, if they so choose. But at age 19, they will receive a letter from the office asking them to transition to an Internist or Family Practitioner. We will provide names of Internists that I like and know as suggestions and a transfer form. If a patient has significant medical issue(s), I will talk to the physician that the patient is transferring to, as well as transfering the medical records. I do this to make sure the transition is a smooth one.

While transitioning can be a difficult process for everyone, this is a necessary and important activity. We feel that the above process helps the patient, their family, and our staff. This makes the process a positive experience for everyone and builds confidence and independence in our patient and their families.

Sincerely,

Joseph Desiato MD