In this post on transition to adult medical care, we’ll discuss tips and strategies from parents, providers, and family advocates for those who are starting to navigate the complex process of transitioning out of pediatric care and into adult health care. Thank you to Dr Raina Voss and Joy Gehner for their help in organizing the series.
As an adolescent medicine specialist, I feel comfortable talking with teens about many different topics. Our conversations range from gender identity to managing homework. Almost nothing takes me by surprise at this point in my career, but there’s one topic that I always find challenging to approach: transitioning my patients to a provider who manages adult concerns. Pediatricians develop long-term relationships with the families they care for. We watch children grow into young adults, support parents in raising their families, and get to know the intimate details of our patient’s lives. As teens emerge into adulthood, we often find it challenging to transition their health care out of our hands.
Transition sounds like a straightforward concept. As we enter adulthood, we stop seeing the health care provider who knew us as a child and move onto to someone who cares for adults.
However, for children with chronic health care needs, this can be wrought with challenges. Some of these include:
1. Timing the process can be hard. Ideally transition is a process. We gradually work with patients and families to increase the teen’s autonomy, introduce them to a new team of health care providers, and equip the patient and their family with appropriate summaries of their care. In reality, I notice a patient’s 21st birthday is in 1 month and scramble to find resources for them.
2. We may talk about transition, but no action is taken. I don’t want patients to feel like I’m ‘kicking them out’ or to push them to take charge of their health if they’re not ready. So I may mention the need to consider adult health care providers early, but we don’t have time to carve out a plan for what this process will look like.
3. Letting go of a longstanding relationship doesn’t feel good. Often I’ve known the patient and their family for years and years. I understand little details that don’t make it into a patient chart, like having a specific toy at the bedside with a blood draw will allow it to go smoothly. How do I ensure that those tiny, but important details will not only be communicated, but carried out by the next team of providers?
There’s no quick and easy solution to transition, but I’m continuously learning that there are some important steps I can take to make the process go smoother. These include:
1. Having conversations early and setting goals during the visit. When we not only talk about finding another provider, but I provide some names and the patient sets a goal to call their office, we have a better outcome.
2. Use tools that are available online. I don’t need to create a plan from scratch. The Gottransition.org website has a number of resources for providers and patients including checklists, timelines, and tips on what to consider when starting the transition process.
3. Include parents, but empower teens (when applicable). Am I asking parents to schedule follow up? Instead, I start to shift my directions to the emerging adult. If the patient isn’t able to make their own medical decisions, I can work with parents on resources around seeking legal guardianship.
4. I can recognize that transition to adult care is an amazing accomplishment! I am a pediatrician, my training did not include learning how to manage adult health care concerns; this is best left to those in family and internal medicine. I’ve had the privilege of caring for the patient as a child, now it’s time to allow the same privilege to a new team.