Saying goodbye to the pediatrician

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Maybe it’s the lollipops and the stickers, but people tend to love their pediatricians. Nowadays many kids keep seeing their pediatricians right through college and even beyond, as Ross did in a classic scene from “Friends.”

But once you’re in your 20s, it’s time to look around for a primary care doctor who knows how to take care of adults. Because most young adults are essentially healthy, they may not feel any sense of urgency, but part of growing up is taking control of your health and your health care. Getting sudden problems like sore throats and sprained ankles seen to in an emergency room or a walk-in clinic is convenient, but you should have an ongoing relationship with a health care provider who can think about all the different aspects of your health. You need a medical home, and you want to establish it before you have a major problem.

“Easy isn’t always the best care,” said Dr. Mary R. Ciccarelli, who is trained in both medicine and pediatrics, and is the associate dean for pediatric education at Indiana University School of Medicine; she directs a statewide program called the Center for Youth and Adults With Conditions of Childhood which works to help young people with chronic illnesses navigate this transition. When you get your medical care problem by problem, no one works up the underlying medical issues, and no one looks at the whole picture of your health. “I have to spend time explaining why getting this problem fixed in the E.R. isn’t equivalent to having a relationship and working through it in steps.”

(Related: The 8 health habits experts say you need in your 20s)

So look for a primary care doctor with whom you feel comfortable, and let that doctor get to know you in the course of taking care of minor issues that crop up. If you’re in or near the place you grew up, your pediatrician might be a good place to start looking for recommendations.

There are any number of online sites that provide ratings of doctors, and my own adult son immediately pointed me to one site, ZocDoc, which lets you search for doctors who take your insurance, read reviews and schedule your appointment online.

Speak up for yourself when you meet the doctor. If you’re seeing an internist or a family physician, go ahead and ask whether she’ll do your gynecological and contraceptive care. Or if you’re seeing a gynecologist and you’d like to have her be your primary doctor, ask whether you can come in for your flu shot, or for minor illnesses.

“It can take a couple of visits to establish a trusting medical home,” said Dr. Ciccarelli. “Everybody needs a medical home, everybody needs a flu shot, everybody needs to minimize health risks, to be counseled on risky behavior, weight management, use of substances, mental health.”

So your primary care doctor should ask about your health habits, your health risks, and your mental health, and you need someone with whom you will be comfortable discussing these subjects.

This transition is especially critical for children who are already living with complex medical problems, who may be cared for by a coordinated group of pediatric experts — and may now be expected to assemble a whole new team. The Center for Health Care Transition Improvement can provide information for patients and families.

But even for the 82 percent of young adults who do not have a chronic health problem, it’s worth remembering that many such problems do begin in your 20s and 30s, and that the habits you form when you’re young have an impact on your life later on. “Finding your hypertension when it’s new is better than you showing up 10 years later,” Dr. Ciccarelli said.

So when you take control and establish that primary care relationship, you are also thinking of your future well-being, looking for someone you trust who can help you minimize your risks and keep yourself healthy, and take care of you when you do get sick.

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