If gynecology has a gender
question (NY Times Dec 2013
) then pediatrics may very well have an age
Was thinking about the recent controversy surrounding gynecologists providing care for a subset of men, and the board of obstetrics and gynecology weighing in against it (several times) before they were okay with it. Naturally, this brought adults, teens, and pediatrics to my mind. There was a time when adolescents were nearly outside the scope of pediatrics. In 1938, the Age Limits of Pediatrics
began "at birth and extends well into adolescence
and in most cases it will terminate between the sixteenth and eighteenth year of life." Then it was updated in 1969 such that the responsibility of pediatrics may "begin during pregnancy and usually terminates by 21 years of age...when the growth and developmental processes are generally completed."
When the processes are generally completed! Ah, but can you teach an old dog new tricks? And what about those adults? Pediatricians, of course, work with adults all the time, mainly those caring for children. But are we providing healthcare
for them? There's that occasional adult parent who wants to quit smoking, those who are pregnant and seek advice, those who have congenital heart disease or cystic fibrosis or intellectual disabilities or other childhood conditions managed well into adulthood.
works on successful transitions
from pediatric to adult care
. There is a lot to it if you do it well. One could even say that much of adolescence is the act of preparing for the transition to adulthood. When is it best
to transition pediatric to adult healthcare? When it is right for the patient him/herself in the context of his/her family. We need to better understand the impact of transition on health outcomes
, particularly for children with special needs who become adults with special needs.
When I had mononucleosis back in college, I may have gone to student health services while on campus, but then over fall break I went home to my pediatrician. And then, it was time to move on. I became a young invincible of sorts, but one with a world view that recognizes the need for primary care.
(And I suspect my family practice colleagues have an even broader perspective on the matter.)