Patient "age limit"

[Rollingthroughlife]

What are the legal status' of patient age of seeing a MD Pediatrician? Is there a age cut off? I see most offices have their practices cut to 18-21 years old, but is there a law against seeing older patients (esp ones they've seen since birth and have a long established history with them.. and health issues..?) What is your opinion on a ped seeing an adult until age 23-25 years old?

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[Rollingthroughlife]

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[Promethean]

The local children's hospitals kick people out at 21-22. Unless... if you have a reason to keep seeing a pediatric specialist, you can still go there. I have a cousin who gets heart surgeries at the children's hospital even though he is 45. Congenital heart anomaly = peds heart surgeon.

I don't know anyone above 13 or so who sees a general pediatrician, though. I don't know of any legal restriction, but most people who go into peds want to treat children. I've heard some peds folks say that they don't like when their patients get too old... like above 8 years.

 

[RJGOP]

The local children's hospitals kick people out at 21-22. Unless... if you have a reason to keep seeing a pediatric specialist, you can still go there. I have a cousin who gets heart surgeries at the children's hospital even though he is 45. Congenital heart anomaly = peds heart surgeon.

I don't know anyone above 13 or so who sees a general pediatrician, though. I don't know of any legal restriction, but most people who go into peds want to treat children. I've heard some peds folks say that they don't like when their patients get too old... like above 8 years.

What? Most peds I know, rather all peds I know take kids up to 17 years old.

 

[Promethean]

I don't think it is that the docs wouldn't take them. All the teens I know are just very healthy and don't want to go to a kid doctor if there are options open to them.

 

[mvenus929]

I don't know anyone above 13 or so who sees a general pediatrician, though. I don't know of any legal restriction, but most people who go into peds want to treat children. I've heard some peds folks say that they don't like when their patients get too old... like above 8 years.

Not sure which Peds people you've seen, but we take kids up til 18, or high school graduation, in our clinic. We don't see adolescents that often, because we have separate adolescent clinics that they feel more comfortable in, but we do see them.

Of course, it depends on their health problems. We had an 18 year old come into the Peds ED with a possible miscarriage. Adult problem= adult doctor (also, OB is well outside the practice of a pediatrician, even if they are younger). On the other hand, as mentioned, cardiac anomalies tend to go to the Peds heart surgeons, regardless of age.

 

[Rollingthroughlife]

I want to keep vague so I'm not breaking any privacy reasons. The patient has been seen at the clinic the past 21 years (all her life) and has an sever anxiety disorder; referred to a therapist, platelet dysfunction; referred to a hematologist, ovarian issues; referred to the obgyn, lupus; referred to a Rheumatologist, Neuro related issues from lupus; nouro, recently detected kidney issues; referred to nephrologist, she also has endocrinology issues and seen by such specialist.

A lot of her specialists/ doctors are ped's and don't want her (and have advised) her not to switch over as a lot of the illness she has are child related and they know her best. My policy has always been (general doctor) by the age of 21 for patients to have transitioned. It's a college town and the kids over 18 normally are seen for something simple as an ear ache and are treated.

Her case is very complicated and I admit there are some illnesses that as a general ped go over my head and I refer her out and give her the best resources possible. I've told her I don't think I can give her all that she needs. One of our other ped doctors saw her last in the clinic and brought up the idea of her switching to an different doctor to say the least she had a genuine panic attack.

The next visit she raised some valid concerns to me; she has a sever anxiety disorder and it took her 17 years to trust me and talk about them, she would skip most appointments and avoid for years due to anxiety and now she's comfortable talking to me, she see's specialists for all the major issues (I have dealt with anxiety medications and do so after consulting therapist, and migraine management) and with her health issues deteriorating the only thing in her life that has ever felt stable was her primary doctor never changing.

She has left very subtle hints that being made to change is so uneasy it might even make her stop treatment and that scares me.

I do not typically treat her issues with narcotics but have given or a few temporary scripts of such and in fact she requested I don't prescribe them again as sedative medications make her chronic fatigue and migraines worsen. After a hospital visit she's requested to check in with her primary and a specialist that deals wit the issues (it can take a few weeks to get into specialists). She checks in here we speak and if the ER has requested and or recommended a special script -- we'll fill it.

 

[oldbearprofessor]

Your valid medical license allows you to treat adults as well as children. Whether this is a good idea is yours and the patient's decision. Hospitals might also set rules related to who can treat what type of inpatients, but in your office, as long as you are practicing appropriate medicine, you can see who you want.

 

[mytirf]

I practice in a large tertiary care center and many of our patients are young adults and even older adults. Most of the problems that we treat patients with are life-long and because of a number of factors are not really in the skill set of most adult physicians even specialists. I think that there should be a method for transition from pediatric to adult medicine but it must be individualized for each patient and really should not be based on a strict age limit. What has worked very well is coordinated care between pediatric and adult centers for patients that have chronic conditions such that the transition of care is smooth and that pediatric physicians see the outcomes of their treatments. We were in fact discussing this topic this morning that it is important to follow patients long term, so that changes can be made if new problems emerge as patients age. In addition, given that training for internal medicine is largely focused on elderly patients, I think pediatricians are better suited to treat the young adults because at least some of their issues can often related to problems with development or congenital anomalies. I don't know how many times we get a second opinion for an older patient with chest pain and "clean coronaries" that turns out to have a coronary anomaly or unusual atrial septal defect.

Just my two c

 

[natashana]

There are some places that won't take people who have ever been pregnant (so that could be very young) and I've seen places who take up to 25 years old.

And whoever said miscarriages are not in the scope of pediatrics--that is SO not true! We may have to consult OB, but it's still an adolescent issue. My hospital admitted pregnant adolescents in the first trimester to the peds floor no matter the medical issue so it varies.

 

[mvenus929]

And whoever said miscarriages are not in the scope of pediatrics--that is SO not true! We may have to consult OB, but it's still an adolescent issue. My hospital admitted pregnant adolescents in the first trimester to the peds floor no matter the medical issue so it varies.

OB problems are OB issues. General pediatricians do not have a lot of training with OB issues, unless they take a specific interest in that area and seek further training. So what usually ends up happening is OB is consulted and the pediatrician follows their advice unless it's something that runs counter to pediatric practice (abx for UTIs, for instance). Generally, an older adolescent who is having OB issues is better served by going to the adult side and seeing the OB directly. This has been my limited experience at three hospitals.

Now, GYN issues are well within the realm of general peds.

 

[JMMH]

I saw my pediatrician until I was 20 (small town). Most places I've heard follow to 18-20 years of age.

Agree OB issues should go to adults. In fact I had a teenager this week who is in the first trimester who asked if she has pregnancy-related issues which ED to go to (adult versus peds). I told her adult since they deal with pregnancies a lot more than the peds ED.

 

[hmockingbird]

What about finding a med/peds or family med doctor for a patient with multiple complicated, possibly congenital medical problems? Seems to cover more of the bases...

Some cancer centers and children's hospitals are now hosting long-term follow up clinics for adult patients who were pediatric cancer survivors because the people who know their risk profiles best are the pediatric oncologists. The one near me offers consultations with other specialties and genetic counseling if they are interested in having kids themselves. I think this is a good idea for these patients and I hope to see more of it, or maybe at least more programs that help transition these types of patients to adult care. As someone who had multiple peds specialists, the transition to adult specialists was rough at times and it was kind-of hard after having a relationship with these doctors for years to just leave and have to start over with someone who didn't know my case, so I definitely see a need/gap there.

 

[michaelrack]

. On the other hand, as mentioned, cardiac anomalies tend to go to the Peds heart surgeons, regardless of age.

Not the best of examples. To the best of my knowledge, pediatric surgeons are surgical subspecialists who do have a lot of experience with adults (in their 5 year general surgery residency)