When young adults outgrow their pediatricians, tough life lessons may follow

frenzpediatrician-300x203Moms and dads, please don’t gawk at the college-aged and older men and women parked in the pastel-colored, animal-themed pediatrician’s waiting room. Sure, they stick out among the runny-nosed, bawling babies and wiggly little children. But these older patients are part of a reported trend that says a lot about contemporary health care and the current difficulties of growing up.

As Caren Chesler reported in the Washington Post, a popular and important aspect of the Affordable Care Act allows parents to keep their sons and daughters on their health insurance plans up to age 26. That has proved a boon for those in the Millennial and Generation Z age groups, providing parent-supported health coverage to more than 2 million young adults between 2010 and 2014 alone.

But along with health insurance from the ‘rents, many young adults also have kept their medical care givers, chiefly their beloved pediatricians. These specialists in some cases have treated them almost from birth. They know well their patients and their medical conditions. This can be important, Chesler reported:

“Medical advancements over the past decade are extending the life expectancy of those with chronic childhood illnesses, such as congenital heart issues, cystic fibrosis, hemophilia and diabetes, and the pediatricians who cared for children with these conditions sometimes remain with them as they get old, says Michelle Hofmann, medical director in pediatric services at NeuroRestorative in Riverton, Utah.”

At the same time, Joann Alfonzo, a pediatrician in Freehold, N.J., offered Chesler a medical counterpoint to kid specialists retaining the care of increasingly older patients:

“‘We’re now treating [young] people for adult diseases, things we weren’t trained to treat,’ she says, such as adult hypertension, Type 2 diabetes, high cholesterol, pregnancy, even depression and anxiety. If she encounters something she can’t handle, Alfonzo says she will refer the patient to a specialist.”

Pediatric care for young adults has other aspects that need considering, experts say. A crucial concern: What the American Academy of Pediatrics politely calls “transitions,” but which young folks dub “adulting.” This also is known as growing up.

It’s a challenge these days. Young people struggle with staggering educational loans, soaring costs for housing and living, and skimpy pay that for too many that makes it hard to get along, much less to get ahead. Experts report that more millennials are living at home than at any other point this century, and the number of adults aged 23 to 37 staying or returning home to their parents has risen since 2000. It’s a lot to ask of the young, grappling with as many challenges as they must already, to jump into fraught decision-making about their own medical care.

In my practice, I see not only the harms that patients suffer while seeking medical services, but also their ordeals in accessing and affording safe, efficient, and excellent medical care. This has become a daunting task due to the skyrocketing cost, complexity, and uncertainty of medical therapies and prescription medications, too many of which prove to be dangerous drugs.

Patients of all ages need trustworthy help to navigate and get the best possible outcomes when dealing with what can be a scary health care system filled with risks and needless medical errors, too many of which kill patients. Finding and choosing a good doctor isn’t always easy.

To get safe and excellent medical care, patients may wish to start by researching and finding a generalist doctor they can rely on to provide them sound diagnosis and direct care. Your doctor may refer you to specialists, and you want to have confidence in her judgment. The also internet has moved key resources online to patients’ potential benefit. Uncle Sam provides resources (click here) that include links to state medical licensing and state medical board complaints. Consumer Reports, in a valuable article, points out that patients need to know doctors’ qualifications by digging to learn where and how they were trained and their hospital affiliations.

A familiar specialist — like a pediatrician — may be a source for young adults to get advice and referrals. And moving on from a doctor need not occur in arbitrary fashion, decided, for example, because a patient has gone off to college, graduated from same, or even if they have passed the age when they can get parental coverage. As pediatricians argued in a 2017 policy statement, quoted by the Washington Post:

“The decision [for a new doctor and not the pediatrician] ‘should be made solely by the patient (and family, when appropriate) and the physician and must take into account the physical and psychosocial needs of the patient and the abilities of the pediatric provider to meet those needs,’ the policy statement said. In addition, it said that ‘the establishment of arbitrary age limits on pediatric care by health care providers should be discouraged. Health care insurers and other payers should not place limits that affect the patient’s choice of care provider based solely on age. ‘ ”

Young people may find, with research, that they can benefit from getting off their parents health insurance. They should avoid “going naked” and foregoing coverage. And they should be wary of “skinny” plans proliferating in markets now, promising lower monthly premiums but failing to deliver important protections (such as for preexisting conditions and against life-time benefit limits) or even any help when patients need it most if they get sick or injured.

By the way, grown-ups may not have space to criticize younger folks for finding specialists and expecting them to provide an array of medical services not exactly central to their practices. This has become an issue, for example, with those with extensive (and less-so) medical training taking up cosmetic procedures in addition to their usual services.

Experts call this a medical drift, and it has history. In times past, a general practitioner in a small town might do everything from delivering babies to stitching up gashes to taking out tonsils and appendixes. Over time, though, doctors have specialized — to deal with the deep knowledge, training, and experience required in the increasingly complex practice of medicine.

But some doctors drift: For many patients, their cardiologists serve not just as their heart specialist but also as their internist or family doctor, handling their overall care. Many doctors themselves try to be careful about not exceeding appropriate bounds. Their colleagues, medical licensing boards, and hospitals are supposed to provide due restraint.

Pediatricians and their patients, of course, may both run out of options and be leading the way in limiting one kind of specialized care. As doctors told Chesler, it has become a big-time awkward and recognized moment for young adults — in coats and ties or dresses for business life — when they get the message from the eye-rolls and sighs of moms, dads, and grandparents bringing tots and toddlers to see the pediatrician: Shouldn’t you be in another kind of doctor’s office? Maybe so, in due time and in the right ways.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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