August 19, 2019

If you like your doctor, you can keep your doctor.

"He’s 26 years old but still sees a pediatrician: Why some young adults don’t move on" (WaPo).

What the hell is wrong with sticking with your regular family doctor? You have a relationship with this person. He or she is a real doctor. It's not like you're going to a veterinarian. You like what you have. Why is The Washington Post age-shaming the young?

Well, age-shaming the young is an old game. Grow up, they say and have been saying for eons. If it's not that you're acting too babyish and unserious, it's that you're old before your time. I say a young person can be young in the way that feels right to them. I say you are the master of your own time. You are how you feel, and you don't have to match up your chronological age with a stereotype of how people that age are supposed to be. I mean, take care of yourself, don't hurt others, and work on making your life what you want it to be. And use your actual chronological age when interfacing with a system that uses chronological age — getting a driver's license, running for President, etc. But other than that, you're your own person. Don't let people push you around with act-your-age shaming.

Anyway... from the article (which I'm finally skimming):
The American Academy of Pediatrics (AAP) attempted to address the issue of transition from pediatric care into adult care in a policy statement in 2017 and concluded “the age of transition” should be based not on a number but on the patient’s individual needs. The decision “should be made solely by the patient (and family, when appropriate) and the physician and must take into account the physical and psychosocial needs of the patient and the abilities of the pediatric provider to meet those needs,” the policy statement said. In addition, it said that ‘the establishment of arbitrary age limits on pediatric care by health care providers should be discouraged. Health care insurers and other payers should not place limits that affect the patient’s choice of care provider based solely on age.”...

Living at home and remaining on parents’ insurance policies aren’t the only reasons ­20-somethings stay with pediatricians. Medical advancements over the past decade are extending the life expectancy of those with chronic childhood illnesses, such as congenital heart issues, cystic fibrosis, hemophilia and diabetes, and the pediatricians who cared for children with these conditions sometimes remain with them as they get old....
And I want to criticize the Washington Post's illustration for its "26 years old but still sees a pediatrician" article (skillfully, charmingly rendered by Ery Burns):



The idea is, clearly, that the millennial is a snowflake. Now, what I think is interesting is that of course the generic snowflake millennial is a white male. Secondly, his snowflakitude is signaled by the playthings (presumably the stuff one encounters in a pediatrician's waiting room) but also by the colors he wears, notably pink pants. I've got a problem with the use of pink to say weak and childish. Pink is associated with females. It's a purplish pink and the jacket is purple. I think the message is: effeminacy. I reject the use of femininity to mean weakness and childishness.

79 comments:

Michael K said...

"Adolescent Medicine" was a big thing a few years ago. Sort of like Pediatrics plus Psychiatry.

Shouting Thomas said...

I reject the use femininity to mean weakness and childishness.

Then condemn the junior high school girls' clique method of denouncing men thru media gossip and insist that they either prove their case in court or shut up, or failing that that women pay a steep price for their gossip campaigns.

You want it both ways. You want to resort to the schoolgirl tactics when it suits your purposes.

rhhardin said...

My Doberman stays with the same vet from puppy shots on.

Martha said...

When my son turned 18, I asked my son’s pediatrician for a referral to a primary care doctor.
The pediatrician declined to recommend anyone because he felt the care would not be up to his standards.

traditionalguy said...

Those psychosocial needs must be served. The Medical Profession is naming whatever they choose to name with a name that fosters their Monopolies on Medical treatment and on Pharmacy.

stevew said...

I'm old enough that when I was a kid we went to Dr. Crowley who was a local GP. He saw all people of all ages for as long as they wanted to go see him. I only stopped going when at age 21 I moved about 70 miles to the other side of Boston. Wasn't practical to go see Dr. Crowley any longer.

What's the downside to the payer or insurance company of a late teen or early adult seeing a pediatrician?

Fernandistein said...

It's not like you're going to a veterinarian.

Still obsessing about Whole Foods, I read that as "vegetarian".

FWIW, 26 is now considered the cut-off age for dependent children in some cases.

henry said...

gee, they don't have to buy their own insurance through age 26. Maybe they should be treated as children until then.

Nonapod said...

Yeah, that illustration is a bit insulting. And I'm usually one of those guys who is constantly griping about mollycoddled millenial snowflakes.

Honestly though, when you're in your mid twenties generally your healthcare isn't something you think much about unless you have some kind of preexisting condition or you're in an accident. I expect the real reason why so many young people stay with the same doctor is just that they don't care and/or aren't even aware.

rhhardin said...

I reject the use of femininity to mean weakness and childishness.

Stamping of tiny foot.

Fernandistein said...

Young Adult Coverage

Under current law, if your plan covers children, you can now add or keep your children on your health insurance policy until they turn 26 years old.

Children can join or remain on a parent's plan even if they are:
Married
Not living with their parents
Attending school
Not financially dependent on their parents
Eligible to enroll in their employer’s plan

rhhardin said...

Wm. Empson reports that the Egyptians had a word meaning woman or child, and wondered what its performance was.

He thought something like "no good for fighting" perhaps.

SDaly said...

Pediatricians specialize in the care of children and young adults. The APA is one of the most politically correct medical associations out there, and while their statement sounds nice, it is wrong. Pediatricians are primary care doctors, but are not the same thing as the old-fashioned "family doctor."

It is not a matter of age-shaming. Adults have diseases and medical conditions that children don't have, and vice-versa. Every adult that sees a pediatrician is seeing a doctor that may not be up to date on adult medical conditions or recognizing what is a serious versus non-serious adult medical complaint. Also, every adult that sees a pediatrician is taking a specialist's time away from the population that pediatrician has been trained to serve.

Sebastian said...

"I say you are the master of your own time."

Sure. On your parents' dime.

Usually.

MadisonMan said...

My kids' pediatrician was brilliant. But I don't know how up-to-date he is on things that affect adults (pretty well, I'm guessing, given that he is an adult, and he has boys whose ages bracket my kids'). My kids can find their own doctors though. I wonder: if kids are still seeing pediatricians, are parents still setting up the appointments? That's a major parenting fail. Both of my kids are off my healthcare, and their pediatrician is out of network, I'm guessing.

richlb said...

I don't have a problem per se with seeing a pediatrician into your late teens as you transition to adulthood. But the biggest problem with continuing to see a pediatrician after your adolescence is that it takes time and resources away from legit child patience who need the specialized care these young people are taking.

Meade said...

“And use your actual chronological age when interfacing with a system that uses chronological age — getting a driver's license, running for President, etc.”

Yes. And can we agree to a chronological age cut-off for throwing tantrums? How about 30?

Ann Althouse said...

There's nothing about being on your parents' insurance that requires you to stay with the same doctor you had as a child. It's just a way to have health insurance and the decision relates to the price, not the desire to think of yourself as a child!

Michael K said...

Most pediatricians I know are into child development and well baby care. They are useless with really sick kids. Those kids all end up at Childrens Hospitals where the pediatricians who are good at treating sick kids congregate.

Pretty much the same with GPs.

mockturtle said...

"I say a young person can be young in the way that feels right to them."

Yes, of course. Age is, after all, like gender, merely a social construct.* Let's say a 26-year-old man wants to stay in diapers and have mommy change them several times a day. This is his personal comfort zone. How cruel for someone to tell him to at least graduate to pull-ups!

*Is a /s really necessary here?

richlb said...

I spelled "patients" wrong.... or did I?....

Michael K said...

It's just a way to have health insurance and the decision relates to the price

Since Obamacare destroyed the catastrophic care insurance plans that are appropriate for young adults.

BleachBit-and-Hammers said...

WaPo-(D) - this is your deal, man. Turning Americans into dependent cradle to grave infants is what you and your party(D) want. Mission accomplished.

Ann Althouse said...

"Yes. And can we agree to a chronological age cut-off for throwing tantrums? How about 30?"

That's within the concept that you're defining yourself for yourself. There's no institution of government that's putting specific age numbers on things and requiring you to be honest about chronological age.

You're just being you. If the you that you really are is a you with tantrums, that's for you. And it's for your parents and others to figure out how they want to be in your vicinity. But that was also true when you were chronologically two years old.

Fernandistein said...

"I started out as a child." -- Bill Cosby

Ken B said...

Question. Are pediatricians just doctors who usually see kids, ie really just GPs, or are they quasi specialized, with specialized equipment? If they are specialists then it’s wasteful to not let them specialize their patients. Put another way, imagine your neighbor is an oncologist. Should you visit him just like a GP? You shouldn’t.

henry said...

"It's just a way to have health insurance and the decision relates to the price"

It's another way to transfer the price / liability to business. Why must all virtue signalling be paid by me?

Galt is looking to be a better option by the day.

Nonapod said...

"Yes. And can we agree to a chronological age cut-off for throwing tantrums? How about 30?"

In public, sure. In private I'd like to reserve the right to behave like an overgrown toddler when I can't find my smart phone because is slid off the night stand into the laundry basket.

Ken B said...

Why do I get the feeling that if the cartoon had drawn him in shorts that this whole post would have been about that?

Needs the purple tag.

Char Char Binks said...

"I reject the use of femininity to mean weakness and childishness."

Yet many, certainly not all, but many, of the physical characteristics that distinguish men from women are neotenous: less robust facial features; lesser muscularity; higher voices, usually almost unchanged in pitch from childhood; less body hair.

Could there be corresponding mental characteristics that go along with these physical differences? Of course not!

reader said...

Our family GP signed my son out of the hospital when he was born. She was my doctor for 30 years and my son’s doctor for 21. She has retired and my son uses the campus health center now.

Your family vet is important too and I’ve been with her for 30 years.

To keep things in perspective I’ve only known my husband for 28 years.

Fernandistein said...

There's no institution of government that's putting specific age numbers on things and requiring you to be honest about chronological age.

I can think of two institutions of government which require one to be honest about their chronological age: the "U.S. Department of Health & Human Services", and

A kid walks into a bar and orders a double scotch and the bartender says "You look kinda young to be in here, let's see your ID" and the kid says, "I'm a master of my own time!" and the bartender says, "Oh, right, you are how you feel, and you don't have to match up your chronological age with a stereotype of how people that age are supposed to be. Will a Glenlivet 12 hit the spot for you?" And the kid replies, "I want 10,000 double scotches."

Oh, and the gummnit cares about chronological age in one other instance instance, um, well lets see, register for draft or join the military, drive a car, collect social security.

Geoff Matthews said...

What happens if pediatricians are unable to accept new clients (actual children) because too many adults want to continue seeing a doctor where they feel comfortable?
Change can be uncomfortable. Successful adults deal with it.

Ficta said...

Mayyybe you could defend the pink as being a "childhood" signifier since it's a "mothering" color, but I think you're mostly right about that. However: I know what purple and green mean.

Freeman Hunt said...

A friend's husband has to see pediatricians and have surgeries at the children's hospital because those are the only doctors trained about his congenital heart defect.

I think it's so many pediatricians being exclusively pediatricians that's new. Kids usually went to the same doctors as their parents when I was a kid.

Michael K said...

Are pediatricians just doctors who usually see kids, ie really just GPs, or are they quasi specialized,

Reminds me of a cartoon in a medical journal. Mother looks at pediatrician and says, "Do you think it's time to call in a specialist, doctor?"

Most of their specialty training is about infants.

dreams said...

"The idea is, clearly, that the millennial is a snowflake."

Well, they're just assisting the millennials in that effort. Snowflake journalists abound.

Mark said...

What the hell is wrong with sticking with your regular family doctor?

Absolutely nothing wrong with it.

But what the hell does that have to do with the issue at hand??

A pediatrician is not a "regular family doctor." A pediatrician is . . . a pediatrician. They are not the same thing. Adults have medical needs/issues that children do not and should be seen by a doctor who treats adults, not by one who specializes in children.

Eleanor said...

Many people are resistant to change, but there are more good reasons for an adult patient to see a doctor who specializes in adults than there for an adult to continue to see a doctor who is trained to handle the medical needs of children. My husband is currently seeing someone whose specialty is geriatrics, and it's great to have someone in charge of his care who can separate out what is just normal aging from what is illness. My pediatric cancer patient son was transitioned out of his pediatrician to a doctor who treats adults by his oncologist at 21. Adults who still have issues with childhood diseases usually also have a specialist in the mix for continuity. There's a reason why "Grow up!" has been a mantra over the generations. Some people need to hear it.

BleachBit-and-Hammers said...

Why become a doctor at all?

The creepy Kamala-State will soon control you.

dreams said...

Yeah, what's wrong with a family practice for a family?

Scott M said...

Why is The Washington Post age-shaming the young?

Because the doctor's specialty is children. The patient in question is taking up their valuable time with his ills that are outside that specialty.

Birches said...

When I was about 12, I became really self conscious every time I had to go to the doctor. There were only little babies and toddlers there. I asked my mom if I could go to a normal doctor. It's so weird that the younger generation doesn't feel that way.

My kids' first pediatrician would stop seeing boys once they hit puberty. Seemed reasonable.

dreams said...

Good luck trying to deny that we don't have a problem with the infantilization of our youth. just one example, some insurance plans may cover a dependent until the end of the year in which the dependent turns 26.

Mr. Forward said...

I’ve been listing my veterinarian as my primary care doctor for decades. He says I’m healthy as a horse.

Michael K said...

Why become a doctor at all?

I saw a new internist last week. We were talking about the electronic medical record(or "health " record under Obamacare.) and I told him that we had a faculty meeting about ten years ago and everybody agreed the EHR was a mess and it was a big part of why I quit teaching medical students. He looked at me and said "It's much worse now." I am so glad I don't have to deal with it. I was an enthusiast years ago when it looked like to would be a big help with automating routine tasks. Instead it is all about billing and punitive surveillance.

dreams said...

"A straight pediatrician is different from a family practice doctor that also does pediatric care, you get that, right?"

Yes, I get that but a family practice MD can treat most children unless they need a specialist.

policraticus said...

My pediatrician, a wonderful and as it turns out a very famous woman in Delaware's history of medicine, began suggesting that my parents start taking me to their GP when she had to stand on the stool to examine me, not the other way around.

Amy Welborn said...

I just had to get my kid's immunization record for college, so I called the pediatrician's office. The nurse said, "He might need a booster or two, but you know since he's 18 and graduated, we can't do it here. We don't see them after they graduate. Maybe go to the health department?" So...not a universal practice...

The Cracker Emcee Refulgent said...

Because finding a GP that will take new patients is frickin' ridiculous. Mine recently moved out of state and finding a new one was far more difficult than buying an assault rifle, adopting a 7 year-old dog from an upscale rescue, or changing the wifi provider without them screwing up the billing.
It may be that pediatricians like hanging on to patients with good insurance, too. There was many a day I took my kids to the local ped practice and was pretty sure I was the only one in the waiting room with private insurance. Or spoke English as a first language.

GingerBeer said...

Maybe he's just a really big fan of "Highlights."

BleachBit-and-Hammers said...

Bernie-Care will solve it all.

He's the Government Whore Millionaire who is gonna fight the Billionaire.

John said...

While I don't care what age someone transitions from one medical specialist to another I would add this little tidbit of insight gleaned from my son's medical training. When he completed medical school and began his pediatrics residency the program wanted him to complete his "step 3" testing before he completed his first year (intern year). The logic was that would be the last time he had to worry about adult problems and could focus on all the developmental issues kids have.

As he takes his board certification in pediatrics he will have to prove he understands those developmental issues to the approved level. Things an internist or family practitioner might know about the aging body won't be part of his certified skill set.

So if you like your doctor, and they know your problems and are comfortable treating your problems, then you should be able to maintain the relationship. Just know to stay with a Peditrian until you're 75 might not be the best choice.

Craig Howard said...

The pediatrician declined to recommend anyone because he felt the care would not be up to his standards.

If this is such a big deal, then the onus should be on the pediatrician to refer the patient to a new doctor. But, perhaps this really isn't such a big deal.

Laslo Spatula said...

"I think the message is: effeminacy."

The man is seeing his pediatrician to refill a prescription to keep his toxic-masculinity levels low.

I am Laslo.

gilbar said...

being effeminate isn't being weak: if you're a girl
being effeminate is only being weak: if you're a skirt boy

The Minnow Wrangler said...

My son has a genetic disorder that was undiagnosed until he was about 10 years old. We began seeing a "developmental pediatrician" who was willing to experiment with medications to help him function at home and in school. We were very happy with her and continued to see her or her assistant until we moved to another state when he was 30 years old.

We also had a family practice doctor for general health issues not related to behavioral medication.

If the doctor doesn't have a problem with it neither do I. Of course after we moved I had to go doctor shopping again to find someone who would prescribe the same medications he had been taking for years without any problems.

hombre said...

What a luxury to go to a doctor who knows you, has your records and may be interested!

Anthony said...

I don't really recall ever having "my own doctor" as a kid or an adult. I'm 57 and don't have "my own doctor". I think the longest-lasting person I saw on a semi-regular basis was about a year and a half before they moved elsewhere.

Not that there's much wrong with me anyway. Apart from being drug dispensers (for moderate sleeping disorders not having to do with sleep apnea) I don't really see the point of having "my own doctor". If something's wrong, go see someone. Why the f*** do you need some dope holding your hand all the time? Unless you have some chronic problem, I guess.

Does get a bit tedious having to recite my sleep/drug history every few months though.

Tom T. said...

I don't need a bunch of 26-year-old men sitting around my pediatrician's waiting room.

The Cracker Emcee Refulgent said...

"I don't really see the point of having "my own doctor"."

I like the personal touch when having my prostate checked.....

The Cracker Emcee Refulgent said...

I'm awarding myself the Funniest Comment I'll Read on the Internet Today award today.

Fernandistein said...

Yet many, certainly not all, but many, of the physical characteristics that distinguish men from women are neotenous:

Don't forget subcutaneous fat, the best feature of all unless it gets out of hand. So to speak.

Could there be corresponding mental characteristics that go along with these physical differences? Of course not!

Well, here in the sticks the pediatrician's department is called "Women and Family Health", and they have "Parenting" MAGAzine and "Highlights for Children" in the waiting rooms.

Whereas the real doctors have "American Rifleman, Official Journal Of The NRA" in their waiting rooms. (true story!)

That's a mental difference resulting in a quantifiable physical difference, rather than vice-versa.

dreams said...

"I'm awarding myself the Funniest Comment I'll Read on the Internet Today award today."

You crack yourself up, don't you.

Laslo Spatula said...

"I like the personal touch when having my prostate checked....."

When the prostate is touched by a doctor it is professional.

When the prostate is touched by a prostitute it is professional.

When the prostate is tickled by the fingertips of someone who does not expect money for the service -- THAT is personal.

I am Laslo.

Tomcc said...

I can understand staying with a doc that knows you after you reach the age of consent; particularly if you're a healthy male. But by the time one is in their early twenties, it's time to find your own GP. I would think the Pediatrician would make the referral.

The Cracker Emcee Refulgent said...

"You crack yourself up, don't you."

If that was a pun, I'll give it an honorable mention, junior class. If it was a criticism, guilty.

Yancey Ward said...

Wonder if Charles Blow's kids are still seeing their baby doctors.

Yancey Ward said...

"I'm awarding myself the Funniest Comment I'll Read on the Internet Today award today."

Sorry, that was funny, but Laslo topped it.

The Cracker Emcee Refulgent said...

"Whereas the real doctors have "American Rifleman, Official Journal Of The NRA" in their waiting rooms."

I once saw a psychiatrist who littered his waiting room with his personal back issues of The Nation. I knew it wasn't going to work out.

reader said...

I appreciated having a doctor that knew my son well. He has a high tolerance for pain and the doctor always took that into consideration when diagnosing him. There was only one time that he told her he didn’t feel well and she took it very seriously. Contrast this with a trip to urgent care wherein I got a lecture that colds take at least 10 days to show improvement. I knew it was more than a cold because he said he didn’t feel well. He had pneumonia.

I liked our entire family seeing one gp and I can understand a person not wanting to give up the relationship they have with a pediatrician.

Rabel said...

"Now, what I think is interesting is that of course the generic snowflake millennial is a white male."

Why do you say that?

I Have Misplaced My Pants said...
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I Have Misplaced My Pants said...
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I Have Misplaced My Pants said...
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Gabriel said...

@Ann: Ross from Friends was still seeing his pediatrician: "The One with the Pediatrician."

yoobee said...

I can't believe you blogged this article without any reference to the episode of Friends in which Ross tries to hide the fact that he still goes to his childhood pediatrician.

Phidippus said...

One problem is that he's taking up a slot in the pediatrician's schedule that a real child could use.

If he loves seeing his old pediatrician, maybe he should find a woman and make some children. Then he can say hello when he takes them there, and also ask him about that funny sore on his winkie, or whatever.

That is, if he likes women, and can find one who will have him.

So many questions.

Skeptical Voter said...

I was not quite 13 years old when my family moved to San Diego in the summer of 1956. Our family physicians (for mother, father, older sister, younger brother) were a pair of doctors who had graduated from the U. of Wisconsin medical school. They GPs--probably internists. They remained my family doctors for 18 years until I moved away to LA. If I'd continued to live in San Diego they would have been my doctors until they retired. Were they pediatricians? Well probably, although my wife found another doctor who specialized in pediatrics, and a pediatric surgeon when our 6 week old newborn needed surgery to repair a hernia.

In my mid 70's I have a primary care physician who I don't much like (and I suspect he doesn't much like me) but it's just too troublesome to switch--and the insurers want me to have a primary care physician. The world changes.