Tips for graduating from a pediatrician to a primary care physician for adults.
For Dr. Brenna Lewis, helping her patients switch to a different doctor is a bittersweet experience. Lewis is a pediatrician at Mosaic Medical in Bend. She cares for children from birth into young adulthood, including a good number of kids with disabilities and complex medical needs. When they are ready to transition to a primary care physician (PCP) who cares for adults, she feels both proud of their progress, and a little sad to see them go.
“I get to know my patients so well over many years, so I know I’m going to miss them. But I’m also pleased that they are ready for the next step in taking care of their health,” said Lewis.
When is the right time to make the switch from pediatric care to adult primary care?
Many young adults switch doctors sometime during or after high school, but there’s no one-size-fit-all answer. For young adults with IDD, navigating this change can be challenging.
Some students might worry about whether a new doctor will understand them. They might feel intimidated about getting to know a new person in a new office. Maybe they have complex medical needs, which makes switching doctors feel overwhelming. Fortunately, there are ways to smooth this transition, and even make it a positive moment of growth.
Start the conversation early
Communication is key to finding the right adult care doctor. The process takes time, according to Dr. Lewis. She recommends starting the conversation long before the teen is ready to make a change. This helps everyone be prepared, so the teen and their parents don’t feel rushed, and the pediatrician has time to make the right recommendations.
Pediatricians care for their patients through puberty and beyond. They help with more than diagnosing illnesses—guiding teens through questions that range from gender identity to whether or not to get a tattoo. But at some point, every teen matures into an adult, with different medical needs that are best managed by adult care providers.
Most adults see family or internal medicine doctors who care for patients of all ages. Not all internists are trained to manage the specific medical needs of young adults with disabilities, however. Pediatricians usually know which adult care doctors would be a good fit for both the medical needs and the personality of the patient.
“Sometimes, caring for kids with disabilities involves multiple moving parts. That could mean support workers, different types of therapies, and adaptive devices or technologies. A strong handoff from pediatrician to adult care gives a jumpstart to both the new doctor and to the family so the transition is smooth,” said Lewis.
A strong handoff means she’s had in-depth conversations with the new doctor about the teen’s history, disabilities, and personality. They’ll share the patient’s records and discuss potential points of stress or complication. The doctors may even stay in touch during the transition.
Mosaic Medical, where Dr. Lewis practices, uses a team-based care approach, which provides each patient with an entire support team covering multiple disciplines. This makes it easy to introduce young adults with disabilities to new providers—without having to adjust to a new office setting. When separate clinics are involved, the pediatrician can still help connect to the right providers. “It’s sort of like being a quarterback, coordinating the team of care providers,” said Lewis.
One way to prepare for the switch to an adult care doctor is to practice self-advocacy during visits to the pediatrician. If possible, teens can begin scheduling appointments for themselves, and keeping track of when to refill prescriptions. Before an appointment, parents can help their teens create a list of questions or problems to discuss (and during appointments, parents can step out of the room to allow for private discussions to happen).
In case a transition student and their parents need to find an adult care doctor without the help of a pediatrician, Lewis suggests they meet for a conversation first. It’s a chance to ask important questions to decide if this is the right choice as a PCP. Examples of questions to ask the new doctor might include:
- Do you have training specific to my disability?
- What are the ways I can communicate with you (e.g.through a nurse, through emails, or will you call me directly)?
- If you are out of town, who are your team members that would cover for you? Do they have training in my disability?
- How much time are you able to take during appointments?
- Are you able to help coordinate my care with therapists and specialists that are right for me?
- Is your office in my insurance network? What should I expect for paperwork and copays?
What about dentistry?
Dr. Cate Quas practices pediatric dentistry at Bluefish Dental + Ortho in Bend. She works with many children with IDD and other disabilities. For many of her patients with disabilities, the dental care they need does not change much as they become adults. Her patients often stay at her clinic long beyond their teenage years, especially if their disabilities are significant.
“Every general dentist is able to care for both kids and adults. Sometimes, pediatric dentists have more training and capacity to care for kids who are nonverbal or have autism,” said Quas.
Young adults may choose to stay with their pediatric dentist for several reasons: the familiar routine and environment might reduce anxieties; the dental team understands what works for them and what doesn’t; and the dentist is accustomed to medically complex patients.
For young adults with disabilities who decide to move to adult care dentistry, Quas suggests a visit first to meet the new dentist and see the office. The conversation at that meeting can show whether the dental team is able to spend some extra time to understand the disability, and the patient’s individual needs.
Quas and Lewis both agree that transitioning to adult care can be an empowering moment for young adults with disabilities. Good communication and strong handoffs smooth the way when the time is right. And learning to self-advocate, bit by bit, lays the groundwork for a lifetime of good health care.
Photo courtesy of Gabriel Tovar on Unsplash