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transitioning from pediatrician to adult doc w/o losing specialists?


Noreen Claire
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DS21 needs to find an adult doctor.

 

DS has epilepsy, food allergies, and (greatly improved) asthma. His neurologist at Children's Hospital in Boston has said that he can stay with him as long as he wants  and I'm guessing that the allergist would say the same. However, his Children's-affiliated pediatrician sent him a letter saying that he wouldn't be seen in the office again after he turns 22. Fair enough. But, they sent us a list full of their recommended doctors for him to chose, and they are all located in/around Boston; that's a 30+ minute drive from there, without traffic. (Pediatrician's office is 15 minutes away, but they only admit to Boston.) DS works an irregular schedule that changes week to week, and he's a new driver (actually, currently he can't drive for 6 months), and he's not confident driving to unfamiliar places just yet.

 

Besides asking for recommendations on facebook, how does one go about finding, meeting, and ultimately choosing a new doctor for a new adult who has prior specialists already in place? (My doc is also 30 min away and DH doesn't really have one, so we are no help.) What steps do we follow and what questions do we ask?

 

Thanks for any advice.

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Yes, we've done the same. Ask a specialist about a primary. Or if you have a good relationship with your primary, ask them about a primary with those types of specialities.

 

Our primary is a very humble individual who will clearly tell people what he feels comfortable with and what he doesn't. When our oldest was ready to leave the ped doc, he actually recommended a different doctor in the practice. DS has been very happy with him. So DH and I go to one primary in that office, and DS goes to another. DD is very fond of her ped doc, so I don't what we're going to do when that time comes. She starts college locally in the fall, but thankfully that practice covers them until they're 22 as well.

 

One of the problems I've always had with asking for local recommendations from individuals is that the majority of them go to the doctor once a year, if that. We are one of "those" families who hits our deductible in January and our out-of-pocket in May or June. So we need a primarily who can coordinate with multiple specialists along with managing our chronic issues that an internist handles. DH and I had the same primary for ten years, and then switched to another when the original practice had significant administrative problems. The second primary was horrible. We always had to review everything each time with her, and she didn't seem to "get" DH's issues that involved going to an out-of-state specialist. She was actually told to resign or be fired, and we went back to the original primary because they had fixed the problems. When we almost lost DH in June, that primary called me multiple times on his lunch hour, making sure that he understood what was going on and giving his support. I had called the office with cell number asking to have him call me when DH was in ICU. He took over some of the follow-up care after DH came home and has been completely there for us. I saw him for a blood recheck this week, and he was outstanding as usual. That's what you want.

Edited by G5052
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What do you see the ped. for regularly? If the specialists are in place to take care of the tricky stuff, how 'special' does your primary care DR need to be? DS has loads of Johns Hopkins specialists for his diagnosis, but he demands very little of his primary care ped. He sees him once or twice a year. When we moved a town over, we never changed our peds even though we added specialists.

 

I'd probably start my search near home if your needs are pretty well established and you're going in frequently. If the appointments are infrequent, the drive would be less of a consideration.

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Yes, we've done the same. Ask a specialist about a primary. Or if you have a good relationship with your primary, ask them about a primary with those types of specialities.

 

 

I'm going to call the neurology nurse on Monday and see if they have any recommendations for adult doctors near-ish us. Our pediatrician's office sent us a long list of adult doctors, but none of them are closer than 20 minutes away. I just don't want to switch to someone who then won't work with our specialists, since they are "pediatric" specialists. 

 

What do you see the ped. for regularly? If the specialists are in place to take care of the tricky stuff, how 'special' does your primary care DR need to be? DS has loads of Johns Hopkins specialists for his diagnosis, but he demands very little of his primary care ped. He sees him once or twice a year. When we moved a town over, we never changed our peds even though we added specialists.

 

I'd probably start my search near home if your needs are pretty well established and you're going in frequently. If the appointments are infrequent, the drive would be less of a consideration.

 

This is a good point. He won't be driving for the foreseeable future, so I can drive him once or twice if it is out of his comfort zone, and once he starts driving again it won't be such an unknown. He hasn't been going in more than once or twice a year for a few years, so maybe being farther (further?) away isn't as big a deal as I thought it would be.

 

Thanks!

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I would: seek a med - peds person. They are physicians who do a double residency in internal medicine (adult medicine), and pediatrics. They will be probably your best bet for a doctor that thoroughly understands pediatric illnesses and adult continuation of care. The abbreviation is IM-peds (usually).

 

Second, I would search if you have a local Facebook page for your neighborhood. We have one with 10,000 members and everyone has asked a bunch for doctor recommendations, and there's a search I can use to peruse old posts.

 

Third, I would look into the hospital where your DS has been treated and try to find an IM or IM-peds as outpatient. Some hospitals have clinics in the neighborhoods and may be an easier transition.

 

If you can find all three (a med-peds, recommended on FB, affiliated with your DS hospital), that would be the ultimate best. Imo...

 

ETA - I assume the children's hospital is affiliated with an adult hospital. If it's the same affiliation the records, results, everything will likely be accessible to the adult hospital people. If he will not likely need hospitalization again, I'd still go within the system, assuming it's a university affiliation.

Edited by displace
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I would ask the specialists for a recommendation in their system. They may know which primaries they've worked with well before.

 

If that isn't helpful, I'd ask the current ped for a recommendation. Surely they've seen that before.

 

My primary is in one system, but my MFM is in a other, one affiliated with a big teaching/children's hospital. So I asked for followups to cardiology and nephrology in the MFM's system instead of my primary's system because that way they have immediate access to my most important records. They also naturally defer to each other -- cardiology voluntarily deferred to nephrology who said he defers to MFM for a pregnant patient. Plus, he sees a lot of MFM's patients. And we know from experience that all the departments share info very happily so our continuity of care through five departments there has been excellent. So that's why I vote for asking the specialists who they recommend.

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We went with a family practice office as their docs are used to dealing with patients birth to death and make this transition often.

 

Yesterday was actually the first time EVER that my girls, now 20 and 21, had an actual MD for their primary care doctor.  Otherwise it has always been a family nurse practitioner.  We have been very very happy with the care from an NP and the only reason we switched to an MD is that the NP we were seeing in the office moved 2 hours north and this is who she suggested in the office.

We were incredibly luck to have my girls neurologist leave the Children's hospital and move to another hospital right as they were aging out.  He is dual licensed for kids and adults which made the transition extremely easy.

 

Before you need them again, I would suggest double checking with the ped. specialists to make sure they will keep him on.  Often they won't as they need the patient slots for new incoming young patients.  Better to find out the policy before you need them and run into trouble.

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