By Rod Moser, PA, PhD
From the last two years of high school to the first few years of college, parents are usually still actively involved in their teenager’s health and well-being. Although many teens profess total independence once they go away to college, the first time that they become ill, they will still call Mom to find out what to do.
We have cared for many of the teenagers in our practice since they were infants, but making the transition from pediatric care to adult medicine can be very difficult. I have allowed a few new adults to remain in my practice until they choose to leave. I have a needle-phobic high school football coach who still comes in to see me because I told him when he was five years old that I use “special needles” for him – the same ones that we use for infants – when I give him an injection. I don’t have the heart to tell him that this was a little white lie. All of the needles are the same. Another of my former teens is now a firefighter and another is a mother of two now. We care for her kids as well.
Many of our longtime patients went away to college this past September. Before they left, I made sure all of their immunizations were up to date and that they had sufficient medications for any chronic diseases, like asthma, allergies, or acne. The young women who have not started contraception will often request it before leaving for college, resulting in endless counseling about safe sex practices, and yes, even the safest practice of all — abstinence.
Most colleges have Student Health Services and for some crazy reason, they tend to have dubious reputations. One of my best friends is a PA in Student Health in Michigan. He absolutely loves his job and I am sure he provides the highest quality of care. I couldn’t imagine someone complaining about him. College health services provide much of the routine and primary care that parents once provided.
A typical Student Health waiting room has young students with strep throat, common colds, influenza, sexually transmitted diseases, potential pregnancies, headaches, and a smattering of various psychological conditions, such as depression, anxiety, insomnia, and panic disorders. College has a way of stirring up the psyche.
One very wonderful thing about the holiday season is that many of our older patients are home from college. While they are home, their parents often send them in for a tune-up. The week before Christmas, just like the swallows returning to Capistrano, their recognizable names started to appear on my schedule. I am often amazed how much older and mature they have become in just a few months. These visits tend to be lengthy since I debrief them about college like I was an auxiliary parent. I ask about their grades and how well they have adjusted to dorm life (and the cafeteria). I inquire about alcohol use or any dabbling in drugs. I ask about new relationships to make sure that I don’t have to give them “the talk” again. Most of the time, I just do anyway.
Many of my college patients are on athletic scholarships, so I live vicariously through their first college sports season. I have former patients playing college football, basketball, volleyball, swimming, gymnastics, golf, and lacrosse. The scary-smart academics are attending prestigious colleges, taking advanced mathematics, physics, and chemistry. Many are aspiring physicians, nurses, physician assistants, pharmacists, engineers, and scientists. I treat them well because they may be taking care of me someday.
Our job as parents and clinicians is to properly prepare novice adults for the complex world of medicine. For many, this will be the first time that they are making independent health and lifestyle decisions. Yes, some will still call or e-mail their parents for advice, but as the years progress, they will do more and more on their own – as it should be. I get e-mails from our college-age patients as well. I respond to them like the young adults that they are, and encourage them to take more adult roles in their health care.
“My roommate and I have terrible sore throats. Can you call an antibiotic prescription in for both of us?”
“You both will need to go to Student Health so that you can be properly examined and treated, that’s not something that I can do over the Internet. Unfortunately, I cannot treat your roommate since she is not one of my patients. Make sure they test you for Strep or even mononucleosis. Let me know what happens.”
Later that day, I will get another e-mail proclaiming that their Strep tests were negative and that neither one left with an antibiotic prescription. I use this opportunity to tell them how important it is to be properly examined and appropriately treated. To take an antibiotic would not have been the right thing to do. End of lesson.
When teenagers go off to college, the roles of parents and clinicians become more health consultants, confidantes, and life-navigators.
These are nice roles to have.