New directions, new doctors: Changing from pediatric to adult doctors

If you have a son or daughter who?s leaving the nest this fall?whether off to college, a new job or some other adventure?you?re probably facing a big change in your child?s medical care. For those who are still a couple of years away, it?s a good idea to start thinking about how you and your child will make the transition from pediatric to adult health care?particularly if your child has a chronic disease like asthma or diabetes.

?Pediatric and adult health care are very different,? says Dr. Francine R. Kaufman, a pediatrician and NIH-supported researcher affiliated with the University of Southern California. ?In pediatric care there?s really an interaction and a focus on the parents as well as the child. In adult care, it?s very common that the parents are excluded from the encounter altogether.?

That means you might not be there to hear things that could be critical to the health of your child. Your child will also have to learn to make appointments, get prescriptions, keep health records together, make insurance co-payments and manage many other details. ?You have to prepare for this transition,? Kaufman says.

When to make the change depends on many things. Some insurers and health care systems require patients to move to adult care by a certain age. Kaufman says families should definitely start to get ready to make the transition by the time a child is 18 years old. At that point, patients are protected by privacy laws. That means a health care provider can?t share information with family or friends unless the patient gives explicit permission, which usually means signing a consent form.

Kaufman recommends discussing the timing with your pediatric care provider well in advance. Ask your doctor how long your child should remain in pediatric care before moving to adult care.

?It really should be collaborative,? Kaufman says. ?The patient and family have to be proactive. They shouldn?t just wait for their doctor to bring it up.?

Plan with your pediatrician about how to make a transition that your child feels comfortable with. Kaufman says there should be at least a couple of years where the child takes on more responsibility but still has the family?s support.

Once you have a plan to prepare your child for the transition, you?ll need to find a new doctor. Kaufman advises choosing a primary care doctor well in advance who can help coordinate your child?s care. It?s important not to wait until there?s a problem.

Think in advance about what kinds of doctors your child will need. What will insurance allow? Will your child be able to get appointments?and get to the doctor?s office?when there?s a problem?

The more complex your child?s health care needs, the more providers you usually have to plan for. ?That?s where a good medical home really comes in,? Kaufman notes. ?You need to find a primary care physician who?s helping coordinate care.? Try to meet with the doctors you?re considering, if possible, to make sure your child is comfortable with them.

Some medical centers set up transition appointments for their teenage patients with chronic diseases. The family, pediatrician and adult care workers all get together to discuss the best way to make the transition.

If your medical center doesn?t arrange transition appointments, you can try to set one up yourself.