Doctor visits

When my daughter, Annie, was 13, she developed a bit of a rash on her face and so I made an appointment with the doctor. In the waiting room, she asked to go in on her own.

A few minutes later she emerged, prescription in hand. When I asked her what the doctor had said, she responded in typical teen-speak: “Mmm, just a rash…”

“Well, did he tell you what it was, or what caused it?”

“He just said to put cream on it, but to use it sparingly.”

“What is the cream?”

“I dunno…”

I wasn’t sure if she hadn’t actually understood what the doctor had said, or simply didn’t want to share it with me. I wondered if there was another reason why she had wanted to see the doctor on her own. And what was this mystery ointment that needed to be used “sparingly”?

Managing their own health care

In fact, Annie was a bit overdue in beginning to see the doctor on her own. By the time kids are 12, they should have begun to learn how to manage their own health care, according to Canadian Paediatric Society spokesperson Jorge Pinzon, who specializes in adolescent medicine at the Alberta Children’s Hospital in Calgary. How much responsibility they’re ready to assume will depend on several factors, including their maturity level and whether they’re dealing with a chronic illness or special health care needs.

According to Pinzon, a person who is fully in charge of her own health care should be able to name and describe her condition, manage medication, understand a diagnosis, follow through on a treatment plan and take risks into account. Most 12-year-olds won’t be there yet, but families and their care providers can work together toward this goal. An annual physical might be a good time to introduce the idea of seeing the doctor on her own for part of the visit.

Chronic conditions

The issue is more complex for children with chronic conditions, such as cerebral palsy or diabetes, says Pinzon, but it is vitally important that parents support children to move toward as much independence as possible. “We have research showing that unless the young person is allowed to take responsibility for their condition, they tend to assume that the condition is the responsibility of others,” he explains.

Encourage them to take charge

To encourage tweens and teens to take charge of their health care, they should be learning to:
• make and keep appointments
• take medication according to the directions
• recount their own medical history, including hospitalizations, illnesses, injuries and medications, and have some knowledge of family medical history
• understand the potential side effects of medicines
• understand the pros and cons of certain behaviours, such as substance abuse

At the doctor’s

“Kids this age should be seeing the doctor on their own for at least a portion of the visit [if] and if that’s not happening, parents should advocate for it,” says Pinzon. Because kids can be vague or unclear about their symptoms, Pinzon often meets with the parent and child in the examining room for the first part of the appointment, then asks the parent to step out for a moment. A14-year-old with a case of moderately controlled asthma may be more likely to fess up to smoking if Mom’s not in the room, or raise an issue she’s embarrassed or fearful about.

Transition from child to adult care

During the transition from child to adult care, the doctor will also explain practices like confidentiality and informed consent. The doctor will assess patients’ capacity to consent to treatment on a case-by-case basis.

Pinzon acknowledges that parents may be concerned they’ll be left in the dark about diagnosis and treatment. “A parent saying to the doctor ‘Can I talk to you alone?’ isn’t the best approach. Any discussion of the child’s condition should be in their presence,” says Pinzon. “It’s better for a parent to say something like ‘Can we clarify what the next steps will be after you see her?’” Pinzon often asks a child if it’s OK if a parent comes back into the room at the end of the appointment to follow up.

What if kids want to switch doctors?

It’s not an uncommon request, according to Calgary paediatrician Jorge Pinzon. Having a doctor of the same gender is a common reason; kids may also want a doctor who doesn’t know their parents.

It’s important that the child’s request be taken seriously because if she’s not comfortable with her doctor, she’s less likely to seek medical care when she needs it. “Parents should ask what the reasons are, and then take it to the current doctor,” says Pinzon.

Resources

The Canadian Paediatric Society has an online guide to helping kids with chronic conditions transition to adult care. Visit caringforkids.ca and click on Teen Health.