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How Young People Can Own Their Health Care (Even if They Still See a Pediatrician) - The New York Times

Owning your health care is a key life skill for young people, like doing laundry, voting and making ramen — and it’s one you can start learning, even (or especially) while living under your parents’ roof.

Adolescent medicine specialists want you to embrace your own medical care, and now might be the perfect time. Dr. Hina J. Talib, the adolescent medicine medical director of Children’s Hospital at Montefiore, identifies the pandemic as a “golden opportunity” for teenagers to practice self-care and self-advocacy skills.

The National Alliance to Advance Adolescent Health offers advice and resources on a website, gottransition.org, including setting up a “Medical ID” app on your phone.

Following are some of the foundational elements of transitioning to self-care.

Adolescent medicine specialists recommend starting at around age 13 or 14 — or even younger as needed. This alone time gives you a chance to share private mental-health concerns, high-risk behaviors, or personal issues related to sex, sexuality, gender and substances. Dr. Cora Breuner, a professor of pediatrics and adolescent medicine at Seattle Children’s Hospital and the University of Washington, uses this time not only for more revelatory and trusting conversations, but also so that young people can practice talking — and listening — to doctors, without their parents butting in.

Do understand that, before you turn 18, the issue of confidentiality is tricky and varies by state. It tends to cover conversations about reproductive, sexual and mental health — but if the doctor determines anything to be life-threatening or dangerous (a big gray area), they can talk to your parents about it.

If you have questions about what is and isn’t confidential, and what a minor can and can’t consent to in terms of birth control, vaccinations for sexually transmitted infections and other aspects of sexual or reproductive care, don’t hesitate to ask for clarification. Dr. Breuner also recommends a visit to the Guttmacher Institute website, which breaks down reproductive health consent issues by state. Even if a procedure or lab test is confidential, a charge for it may show up on a bill your parents receive, so ask about that too.

And if you want to loop your parents in, but aren’t sure how, Dr. Ellen Rome, head of the Center for Adolescent Medicine at Cleveland Clinic Children’s Hospital, recommends asking your provider: “How do I have a healthy conversation about this with my parents?”

And a Covid-era issue: If you’re doing a telehealth appointment from home, ask everyone in the house to respect your privacy before it starts (or, a tip from Dr. Talib, conduct it from the bathroom).

Once you turn 18, your health information is yours alone. If you’ve ever seen the acronym HIPAA (Health Insurance Portability and Accountability Act) on any forms you’ve filled out, that’s one of the things it refers to. If a parent wants to be part of the conversation, they must ask you; this is true even if they pay for your health insurance or health care. If you want to, you can sign a waiver allowing your doctor or health center to talk to them about your health.

If your doctor’s office has a health care portal such as MyChart, you may be able to schedule an appointment online; otherwise, you’ll need to actually call (I know!) and have a calendar handy. (While you’re at it, put your doctor’s name and number in your phone.) If you’re having an urgent health crisis — mental or physical — say so and ask for advice; if it’s after hours, you’ll talk to an answering service who will have the doctor call you back to discuss next steps — going to the emergency room, for example.

And a plea from Dr. Talib: “If my teen patients would actually cancel appointments, I would love that so much — they just don’t show up.” Plus, you can be charged for a missed appointment that you don’t cancel.

Daunted? Don’t be! Call as if you’re making an appointment, then say, “Hi, this is [you]. I was supposed to see Dr. Healthperson on [date], but I need to cancel that appointment.” They’ll likely ask if you’d like to reschedule, and you can take it from there.

If you have a cognitive, physical or developmental difference or disability, then your individualized education program — I.E.P. — or 504 plan may be a useful starting point for figuring out the accommodations you might need to become medically independent.

With some conditions, this can be a lot of work (one friend of ours took a gap year before college to learn to manage his diabetes independently), so transition gradually. Ask a parent to walk you through everything that’s been happening behind the scenes, such as the appointments or labs they routinely schedule, and any prescriptions they’ve been managing. Know what you take and why, how often you need to pick it up, if you have to call the pharmacy first, and if your doctor will need to call in a refill.

Have a parent, doctor, or pharmacist teach you how to read the label on your medication: the number of refills left, the dosage, the possible side effects. And make sure to build in plenty of lead time; you don’t want to end up in the E.R. simply because you, say, forgot to pick up your inhaler.

Any questions? Ask the pharmacist. Dr. Talib describes them as a “wonderful and underutilized resource for taking care of people.”

Ask a parent to explain how co-payments (the amount you pay out of pocket) work for office visits, emergency care and prescription medications; get in the habit of saving receipts for any payments you make; learn how to get a referral to a specialist; look at a bill with your parents and start to learn what gets covered and why — and when and how to contest an erroneous charge.

If you’re going to college, decide with your family whether to enroll in your college’s health plan or waive the coverage. And plan, far in advance, for the age of 26, when you’ll get bumped from your parents’ plan.

If you’re going away to school this fall, have a family conversation about what would happen if you got sick, familiarize yourself with the location and hours of your health center, and memorize your parents’ telephone numbers in case you are ever separated from your phone.

Bring along some supplies for self-care. Beyond masks and hand sanitizer, Dr. Rome recommends packing up a thermometer, Advil and Tylenol, and Benadryl (in case of an allergic reaction). And Dr. Breuner recommends regularly checking the website of the Centers for Disease Control and Prevention for updates on the virus because, as she says — and as you already know — “knowledge is power.”

Remember that independence doesn’t mean you have to do everything on your own. As Dr. Talib puts it, “We’re not saying you need to have a parentectomy at age 18.” Always ask for help, company or advice when you need it. That’s what smart adults do.

  • 911 if you or a friend are having a life-threatening emergency of any type, including a drug overdose.

  • The National Suicide Prevention Lifeline: 1-800-784-2433 if you or someone you know is thinking about self-harm or suicide.

  • The Safe Place hotline: 1-888-290-7233 or visit the website if you need help with bullying, suicidal thoughts, homelessness, abuse or neglect.

  • The Trevor Project hotline: 1-866-488-7386 or visit the website if you need LGBTQ+ support or suicide prevention assistance related to gender identity, transgender issues or sexuality.

  • The National Runaway Switchboard: 1-800-621-4000 for referrals to hospitals, soup kitchens, drug abuse centers, S.T.I./H.I.V. information and testing facilities, and free bus tickets home.

  • Planned Parenthood: 1-800-230-7526 (business hours only) for information about birth control, the morning-after pill, reproductive health, relationship safety, sexually transmitted infections, pregnancy and abortions.

Catherine Newman is the author of the teen skill-building book “How to Be a Person.”

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How Young People Can Own Their Health Care (Even if They Still See a Pediatrician) - The New York Times
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