✓ From pediatrician to family doctor: 4 tips for a peaceful transition

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The transition to the general practitioner

The pediatrician isn't forever: at some point - typically around 14 years but it can be earlier or, in some special cases, even at 16 - the transition to doctor of general medicine. A passage not very codified - there are no guidelines to make it happen in the best way - which can involve some critical aspects. Let's see how to best deal with it.

Up to what age at the pediatrician?

For each newborn child, the parents choose a trusted pediatrician, affiliated with the National Health Service, which

will be your child's doctor surely up to six years.
Between six and 14 years you may already decide to go to the general practitioner.
The transfer takes place automatically a 14 years.

Read also: Pediatrician, how to choose the right one

"In practice, the ASL automatically eliminates 14-year-olds from the pediatric care lists, sending parents a communication inviting them to choose a new doctor, this time a general practitioner". He explains it Adima Lamborghini, pediatrician of free choice in Silvi (Teramo), member of the Study Center of the Federation of Paesena pediatricians and among the authors of a guide for doctors on the transition of adolescents from pediatrician to doctor for adults.

According to the data reported in the guide "From pediatrician to adult doctor", about 79% of children between 7 and 14 years are assisted by the family pediatrician, while one out of two adolescents (from 11 to 14 years) is assisted.

To push children to family doctors even before the age of 14 can be various factors, for example the fact that the family is particularly comfortable with their "grown-up" doctor and for convenience prefers to bring the little ones too or, vice versa, the fact that she finds herself particularly badly with the pediatrician. "It can happen," admits Lamborghini. "Moreover, especially in some areas, pediatricians are few and competition is scarce: a situation that does not favor the quality of work".

The ASL can also automatically anticipate the transfer, again as a matter of scarcity of resources: where pediatricians are few, "pushing away" those who are already 10-12 years old may be necessary to make room for newborns.

However, it must be said that there are also situations in which it is possible to stay with the pediatrician a little longer, that is up to 16 years.

Pediatrician, when extension is possible

Formally, the family can request that their son or daughter stay with the pediatrician up to 16 years of age in the presence of

chronic diseases (such as diabetes, asthma, cystic fibrosis)
o handicap.

"But beware: also psychological discomfort lighter ol 'psychophysical immaturity of the child can be considered valid reasons for extending the stay with the pediatrician "explains Maria Luisa Zoccolo, family pediatrician in the province of Treviso and head of the adolescence group of the cultural association of pediatricians. - this extension.

Families are increasingly asking (and obtaining) to be able to keep the pediatrician's assistance for their child even after the age of 14

How to deal with the transition

One might expect that in the face of such a major change - the pediatrician has seen and followed the baby from birth to adolescence and the general practitioner will do so for decades to come - a handover specific. In reality, however, this is not the case.

Sure: the pediatrician has filled in one over the years computerized medical record, but there is no direct transfer of information from doctor to doctor. The family will act as an intermediary on the occasion of the first visit, which generally will take place the first time a problem arises.

Moreover, it all happens at a very particular moment in the life of the "patient", who is no longer a child but is not yet an adult. He's a teenager, with all that this entails from the point of view of physical development (it is the moment of puberty), psychological, social. Maybe it needs less special medical interventions, but it would need specific interventions on the front of the prevention and dell 'health education and neither for the pediatrician nor for the general practitioner is it easy to implement them.

Also read: The letter your teenager cannot write to you

In short, even if it is an automatic transition, precisely from an organizational point of view it is not prepared in the best way, and even for individual adolescents there may be uncomfortable situations related to the peculiar characteristics of their age. Between these, two in particular:

feeling disoriented both by his "old" doctor and by the new one. Sometimes it is just a question of "environment" and just think about waiting rooms outpatient clinics to realize this: those of pediatricians are child-friendly, in games but also in posters and information brochures, generally dedicated to childhood issues (vaccines, SIDS, diarrhea or infant constipation ...) , those of family doctors are instead suitable for the elderly.
the shame and worry in showing up, in the midst of pubertal development, to a doctor of a different sex: so girls often refuse to be examined by a male family doctor and boys by a female doctor.

Tips for a peaceful transfer

The difficulties are therefore not lacking, but some simple tricks can help. Here are the main tips for families:

Prepare the transfer in good time. "We shouldn't be taken aback by the ASL announcement that pediatric care is over" says Lamborghini, who recommends starting to think about it as early as the child's 10-12 years of age.
The role of the pediatrician in this preparation is fundamental: "Together with the family, we must make the child understand that he is becoming older and, therefore, more autonomous, and that in a short time things will change" explains the pediatrician. For example, you can help him become aware of any medications who takes: "Medicines for any chronic diseases, but also medicines to be taken sporadically, such as antibiotics or painkillers" says the pediatrician. "The little patient should begin to know the drugs he uses, to understand how and when he should take them, how he should store them and so on."
Or, again, it can be explained to him that, little by little, he will have to learn how to be more active towards the doctor, reporting what is wrong or asking him questions if in doubt.
Help the child understand that the care model is about to change: "You go to the pediatrician not only when you are sick, but also when you are healthy, to make the so-called health checks" explains Lamborghini. Recalling how important the budgets at 10/12 and 12/14 years are for the possibility of discussing aspects of sexual education, accident prevention and risky behaviors.

On the other hand, one usually goes to the general practitioner when there is some problem. "But be careful - underlines Claudio Cricelli, president of the Del Paesena Society of general medicine - this does not mean that between one illness and another the adolescent is left to himself. Let us remember that in the vast majority of cases his doctor is also the doctor of the whole family and he is therefore constantly informed by his parents about his conditions, his attitudes, his strengths or weaknesses ".
With regard to the choice of the adult doctor, in the vast majority of cases it is a non-problem: "In general, one automatically chooses one's own family doctor, and this is also the advice I would like to give, precisely because in this way the child finds himself inserted in a context who manages to keep in touch with him even indirectly, through his parents ", says Zuccolo.
What if there is some resistance related to the doctor's gender? According to Zuccolo, there is no need to worry too much if you consider him a good doctor and trust him. "However, there are strategies that the sensitive doctor is able to implement during the visit with the adolescent, to minimize this type of difficulty" explains the pediatrician. If things just don't work out, you can always try to change at a later time.
A particular indication concerns the families of adolescents with chronic diseases. "In this age it often happens that the disease is experienced as a challenge" explains Lamborghini. "The greatest and most frequent risk is that sick children stop taking their therapies. For this, they must be kept well under control on the part of the parents ". If it is true that chronic diseases are often managed by specialist clinics in the area, a good alliance with your family doctor it is one more tool to reduce the risk of problems.