Posted by: notdeaddinosaur | May 28, 2010

Mail Call: Transitioning Away from the Pediatrician

I get mail:

I have a question if you don’t mind answering it. I’m 20 years old, and I’m still seeing my pediatrician. She said she would see me until I was 22 but should I go ahead and find another doctor? I really don’t want to; she’s been my doctor all my life. But I worry that I’m taking up appointments that other little kids might need. And I also worry that maybe she thinks I’m weird for not wanting to change doctors just yet, although shes never given any indication that she does. Thanks in advance!

Yes, you should find yourself another doctor. Yes, you’re taking up appointments that little (sick) kids might need, but no, you’re not weird.

Forgive me if I point out that had your parents chosen a family physician instead of a pediatrician, you would not now be facing this issue. Pediatrics is an interesting field in that you continuously lose your patients even when you do everything right — a statement that is also true of geriatrics and hospice care, when you stop to think about it. As the pediatricians frequently remind us, children are not just little adults. Everything from anatomy to physiology to drug metabolism varies by age, so special training is appropriate when dealing with very sick children. Health maintenance for well children, on the other hand, is an integral part of primary care medicine, in which family physicians are very well trained. Although lots of family docs stop seeing kids as soon as they leave residency, practicing the full scope of “cradle to grave” primary care is extremely rewarding.

Why should you transition to someone other than a pediatrician, though? Because adults are not just large children (DS watching hockey notwithstanding). As you move into adulthood, your medical needs change. When you become sexually active, you need gynecological care. You need to be screened for hypertension, diabetes, and other assorted ailments to which your family history may predispose you. As you move into middle age, you’ll need age-appropriate cancer screenings. And although things like dietary counseling, exhortations to exercise and not to smoke start early, general adult medicine is simply not part of pediatrics’ scope of practice.

You do not need a whole series of new doctors. You don’t need a dermatologist for your acne, an orthopedist for your sprained ankle, a neurologist for your headaches, or a gynecologist for your birth control pills. A good family doc can do all that for you and more. One of the things I find frustrating is the degree to which so many patients not only accept, but seem to prefer the outrageously fragmented “care” provided by the myriad of partialists that dominate American medicine.

Finally, though, I’d like to point out that unless you die young, it will not be humanly possible for you to have one physician care for you over your entire life. Doctors are human. We too are born, grow up, grow old, and die just like everyone else. If not now, then someday you will have to find a new doctor when your current one either dies or retires. There’s no way around it.

A good relationship with a doctor you like and trust is not hard to find, yet is very much to be treasured when it is achieved. You’re actually quite lucky to have already had one, and, contrary to your fears, this makes it easier for you to form another. Just think in terms of looking for another doctor who makes you feel like this one does. This crotchety old guy in his 80s whom I’ve known for years puts it like this (referring to new spouses as well as new doctors):

You don’t look for a replacement, you look for a successor.

Hope that answers your question.

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Responses

  1. Thank you that did answer my question and calmed my fears also.

  2. Many if not most people don’t realize that family physicians are also trained to treat children. Your specialty association needs to do a better job of communicating that–that you are the ONLY doctors who can treat just about everyone.

  3. AAFP does go to great lengths to let people know that. Alas, the peds apparently have better publcity. And there is a real pro-specialist bias in a lot of the popular press–check most women’s magazines: it’s always ‘your pediatrician/gyno/dermatologist etc.” I once saw an article in Womans’ Day magazine that stated you’d need to see an allergist to get a nasal steroid spray for allergies, of all things. I’d written three prescriptions for nasal steroids the day I read that article, and am now a former subscriber to that publication. It’s not allowed in our waiting room either.

  4. “You do not need a whole series of new doctors. You don’t need a dermatologist for your acne, an orthopedist for your sprained ankle, a neurologist for your headaches, or a gynecologist for your birth control pills. A good family doc can do all that for you and more.”

    I love this statement — You just summed up good Family Medicine in a nutshell! I am so lucky to be taking care of lots of kids, adults, and everything in between. This is the beauty of family medicine!

  5. Is there a protocol for leaving a practice? I recently left the internal med practice I’ve been seen at for 6 years and the kids their pediatrician that they’ve seen for 11 years and moved to a family practice. I was frustrated with the office staff of one and the oldest kid wanted a same gender doc.

  6. Shouldn’t the pediatrician have initiated the transition?

  7. What’s the next step? How does someone go about finding a family physician?

  8. Anon–If you’re transitioning from a pediatrician, the easiest thing would probably be asking the pediatrician for a recommendation, making sure the family physician is in-network if you have insurance. Some family physicians aren’t taking new patients, but if the pediatrician makes a call on your behalf, they may make an exception, especially if you’re young and don’t have many medical problems.

    You can also ask friends for recommendations. Some sites like ratemds.com have reviews of physicians. You should take those reviews with a grain of salt, but if they’re overwhelmingly positive or negative, that’s a sign.

  9. Hi – I moved my family to Dr. Dino after the aged pediatrician for my 2 year old daughter blamed ME for her scarlet fever (The rash was because I ‘bathed her too much’!). Also my own internist’s office staff were difficult and nasty (though I loved the doctor, they just got too much in the way). since then I have been extremely satisfied with the total care my ‘family practioner’ has provided my children and me. She has referred me when necessary, but kept on top of things. I am very relieved that SOMEONE has the total picture. I’m too afraid of things falling through the cracks otherwise!

  10. I’ve always used a Family Doc — maybe they are more common in some areas? I live in Kansas and they seem to be the norm for well care here. Many of them also provide obstetrical care, so my first two kids were delivered by my family doctor (my third and fourth were delivered by midwives). I like having one practice care for all of us.

  11. […] I’m not sure about how this will work in a less contained (i.e., “partialist”, as Dr. Dinosaur would say) […]

  12. If I ever have a child… He/She will be taken to a family doctor. I never had a pediatrician and had a horrible internist in my teens which still makes me clinch my teeth when ever I think about his many misses. So in my head, primary care = family doctor.

    I wish my medical needs could all be taken care of by one doc but, unfortunately, I have complex problems that require me to goto super-sub-specialists. Which makes primary care docs scared to treat me for ‘specialist’ problems, while the specialist is too sub-specialized to treat ‘general specialist’ problems. Leaving me in a position having to goto multiple specialists with the same board certifications… Oh, and the generalist specialist will also get scared to treat… Aghk.

  13. I also stayed with my pediatrician til I was 20 – she was wonderful, and her thing was adolescent medicine so she could do the gyn stuff and so on. She would have kept seeing me to 22, but then I moved. It is a transition that’s hard, especially since my next option in the plan was an internist, which is not great for a 22 year old whose problems are more likely to be orthopedic, gynecologic, dermatological or even psychosocial than internal med.


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