Adolescents/teenagers in clinic

[InternistDO]

For those practicing outpatient IM, what the is the usual age limit at which you will not see a patient? I've seen internists see patients as young as 12-14 and others who draw a hard line at 18. I was wondering if there is a general consensus on this. It doesn't appear that the ACP or ABIM have any firm guidelines on this, or at least not that I could find. I also wasn't sure if there was a malpractice coverage issue.

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[gutonc]

Since the average American 16 year old is an obese, hypertensive diabetic, it's probably right up the average internist's alley.

 

[DrMetal]

For those practicing outpatient IM, what the is the usual age limit at which you will not see a patient? I've seen internists see patients as young as 12-14 and others who draw a hard line at 18. I was wondering if there is a general consensus on this. It doesn't appear that the ACP or ABIM have any firm guidelines on this, or at least not that I could find. I also wasn't sure if there was a malpractice coverage issue.

Even if you don't impose strict guidelines on yourself, you institution might. I worked for an urgent care type place that drew a firm line at 12-yo. I never saw any that young, but did see plenty of of 16- 17-yo. I got consent from their parents to treat 'em like an adult. Had an ear infection? You're getting the 500 mg Amoxicillin horse pill, not the weight based liquid stuff. They were ok with it. [And if they don't give such consent or you don't feel comfortable, tell them to find a pediatrician or an FP. You're perfectly in the right for doing that.]

 

[InvestingDoc]

Youngest I see is a 14 year old who is part of an entire 5 person family and the youngest of the family. I called my malpractice and surprisingly they don't have an age limit since I'm IM and not FM. I can see any age I want. I don't really feel comfortable any younger than 14 though. I think is most likely going to remain my limit.

 

[tantacles]

A lot of this will depend on your catchment area. In my big city with a childrens' hospital, while our adolescent medicine physician loves to hold on to her 18-22 year olds, the same does not hold true for the internists. I have not heard of an internist in my city taking patients under 18, though I assume it occasionally happens when someone wants to transition care from their pediatrician.

 

[jdh71]

Just like geriatrics is different from adults there is nuance in medicine and reflexes you won’t have on the younger simply assuming they are just younger or smaller adults. This is a reason why there is an entire specialty for children, yeah? Arguably a lot of this likely begins to phase out by the late teens if puberty has generally set in. Lung disease tends to take YEARS to show up and I think often behaves differently in teens. As I have a few. And at least for asthma often goes away for decades before coming back again after age 40-50. The things I tend to worry about are missing drugs that might have an impact of sex hormone axis and or fertility that I basically never think about in adults. And these are probably few and far between but they exist and I don’t have the quick reflexes on them. Medicolegal liability is often on the table much longer for anything done while still pediatric age, though I don’t think that is a reason to be paranoid it should factor in. I’m a 15+ on a case by case basis kind of guy. Put the referral on my desk first and let me decide. I don’t think I’ve ever said “no”. But it doesn’t really come up often. Most of the teenagers sent to me have have been reasonable.

 

[Raryn]

I'll see the occasional 16 or 17 year old for a thyroid condition, but it's pretty rare. There's peds endo in the area.

I refuse to see them for type 1 diabetes. Adolescent and young adult type 1 diabetics drive me batty with noncompliance - I leave it to the peds endos.

 

[tantacles]

I'll see the occasional 16 or 17 year old for a thyroid condition, but it's pretty rare. There's peds endo in the area.

I refuse to see them for type 1 diabetes. Adolescent and young adult type 1 diabetics drive me batty with noncompliance - I leave it to the peds endos.

that's good because the peds endos love it. Engaging the parents and ignoring the patient in front of them is their specialty. "Hi Tanya! Hi, mom. How have Tanya's blood sugar's been?"

 

[Raryn]

that's good because the peds endos love it. Engaging the parents and ignoring the patient in front of them is their specialty. "Hi Tanya! Hi, mom. How have Tanya's blood sugar's been?"

I let the patient drive, even when the parents are with them. But the proportion of adolescent type 1s that are actually motivated/engaged is... Small. I'd settle for honest, but even that's hard to ask sometimes.

It's frustrating for all parties and doesn't get magically easier when they turn 18, but I have to set a limit somewhere.

 

[tantacles]

I let the patient drive, even when the parents are with them. But the proportion of adolescent type 1s that are actually motivated/engaged is... Small. I'd settle for honest, but even that's hard to ask sometimes.

It's frustrating for all parties and doesn't get magically easier when they turn 18, but I have to set a limit somewhere.

As a med-peds physician, I relate to this intensely.

 

[HemeOncHopeful19]

I don’t pretend to know the answer to this question but I have occasionally seen departmental squabbles with Peds when there are pregnant patients <15 years old who have some sort of medical problem OB wants a consult on and it is always a huge pain in the rear end!