Time for An Adult Doctor?

Teen – April 2008 By Joyce Heid

Their first car, their first job, college—lots of excitement and decisions for teenagers crossing the bridge to adulthood. But choosing a doctor? Chances are, the thought will not even cross your teenager’s mind…that is, until he or she is sitting under an Elmo poster in the pediatrician’s office trying to ignore the crying 2-year old in the next chair, trying to use his or her jacket for a tissue.
If your child receives primary care from a family practitioner, he or she does not need to change unless you or your child wants to change. If, however, your teenager sees a pediatrician for his or her medical needs, somewhere between the ages of 14 and 21 years old, it is time to transition to an adult general practitioner or internist.
The right time to change is a personal decision to be made jointly between parents and child. If your teenager starts to feel uneasy visiting the pediatrician by his or her mid-teens, by all means investigate changing. If your teen is comfortable with the physician, the change can be delayed, but should be done before college.
According to Dr. Charles Shubin, director of Pediatrics for Mercy FamilyCare, a division of Family Health Centers of Baltimore, “Usually children will move the provider they call their medical ‘home’ from a pediatrician to an adult provider [primary care internist or family practitioner] when they turn 18 and are thus able to give consent for their own care totally. There are times when the special needs of the child, insurance company requirements, or other considerations can affect this change-over.”
Starting the Search
Finding the right physician should begin with the pediatrician. Explain you are thinking of initiating the transition to a general practitioner. Don’t worry about offending the pediatrician. The change to an adult doctor is routine for their type of practice and is expected. The pediatrician’s familiarity with your teenager’s medical history can provide valuable insight into who would be the right practitioner to take over your teenager’s medical care.
Talk to your teen about if he or she would be more comfortable with a male or female physician. He or she should feel comfortable with the choice, since it is important to share personal information and any health problems with him or her.
Once you have a few names, give their offices a call. Ask if they are accepting new patients. If your teenager is younger than 18, be sure to tell the staff. Next, check to see if the practice participates with your insurance company. If the practice takes your insurance and is accepting new patients, try to set up a new patient consult visit. This allows you to ask the doctor questions about the practice.
Don’t be afraid to ask lots of questions. Keep in mind that both you and your teenager are part of this process—he or she needs to be comfortable talking to the doctor, too. Make sure the physician speaks directly to your teenager when you are in the room. Speaking directly to the patient and not just to the parent demonstrates an important quality necessary in any good doctor/patient relationship—that the physician is respectful of the patient and willing to listen to what he or she has to say.
Do not be offended when the physician asks for some one-on-one time with your teen. This establishes a comfort level so that your teen will not feel apprehensive about personal health concerns. This is a big change from childhood doctor visits, but necessary. Keep in mind most teens hesitate to seek medical care for sexually transmitted infections, substance abuse, or mental health issues with their physician if Mom or Dad is in the exam room.
The legalities of confidentiality and teenagers are complex, and policies vary from state to state. When it is in the best interests of the patient, information should be divulged. The American Medical Association recommends physicians discuss their policies on confidentiality with both adolescents and their parents, ideally on the first visit.
If your teen has any unique health issues, be sure to discuss them. You want a physician to understand the specifics of your teen’s medical history. Whether your teen has attention deficit disorder or is a star athlete, make sure the physician has the right connections with professionals such as psychologists or sports medicine specialists to meet all his or her needs. BC
Joyce@BaltimoresChild.com

Extra!
Time to Explain That Not Just Saddles Have Stirrups:
When Should a Teenage Girl See a Gynecologist?
The American College of Obstetricians and Gynecologists recommends that young women have their first visit with a gynecologist or nurse practitioner between the ages of 13 and 15 years old, regardless of whether they are sexually active or menstruating. This visit will encompass growth and development, including a discussion about menstruation and a breast exam. The doctor will ask your daughter if she is sexually active and provide basic information on making good decisions, the benefits of not having sex (abstinence), and preventing pregnancy and diseases.
The doctor may or may not do a pelvic exam on the first visit. It is a good idea to explain the basics of a pelvic exam and Pap smear before the visit just in case. The first experience with the speculum can be scary if you don’t know what to expect!
The physician should describe each step of the exam. There should be a nurse or assistant in the room during the exam if the doctor is a man. Your daughter can ask you to stay if it makes her more at ease.
The Center for Young Women’s Health has a fact sheet explaining the first pelvic exam that can be accessed by logging ontowww.youngwomenshealth.org/pelvicinfo.html. The site also offers valuable information about the first breast exam and choosing a physician.
©Baltimore’s Child – April 2008

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