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Students who leave for college don't always leave their pediatricians behind

Spokesman-Review - 8/24/2019

Aug. 24--While leaving for college leads to lots of changes, some things can stay the same, including who students see for medical care.

Many Spokane pediatricians offer their patients the opportunity to continue care through the college years, for a variety of reasons.

Dr. Sarah d'Hulst said managing mental health care is a major factor in the decision to continue caring for her patients through the college years. D'Hulst, a pediatrician at the Multicare Rockwood Clinic, normally sees patients dealing with ADHD, depression, anxiety and other mental health issues every three months. College breaks allow her to continue care for students who leave for school, she said.

"I think there's fear when they go to college about just time spent studying and focusing," d'Hulst said. "It's nice for them to know that that aspect of their medical care that really affects their academic performance will continue to be managed by people who have been managing it all through their academic years."

Sarah Rafton, executive director of the Washington chapter of the American Academy of Pediatrics, also said mental health treatment is important for this population.

"It's an ideal opportunity to more rapidly assess a problem and build on a trusted relationship to destigmatize a mental health need and get a young adult help faster," Rafton said.

To adapt and continue seeing patients who might otherwise move on, Multicare Rockwood and other clinics are incorporating services that might otherwise not be offered in a pediatric clinic. For example, pediatric patients at Multicare Rockwood can receive full gynecological exams and receive birth control prescriptions.

Nicole Smith, Mt. Spokane Pediatrics office manager, said the practice also provides birth control to patients. But she noted there is a limit to how long they will see patients in their pediatric setting. The cut off age at Mt. Spokane Pediatrics is 21.

"If we wanted to be a family practice, we would open a family practice, right?" Smith said. "We want to see pediatric patients."

Levi Jordan, Northwest Spokane Pediatrics administrator, also said the practice tries to stick to their specialty and mails out notices to their 18-year-old patients encouraging them to find age-appropriate health care services, though they will see patients up to 23.

"There are only a handful of people I can think of that are college students that see us on their home leave," Jordan said.

The Washington chapter of the American Academy of Pediatrics encourages patients to stay with their pediatric doctors through college, partially because young adults are poor users of preventive health care, Rafton said.

Rafton noted that the typical college years coincide with and an increase in "potential risk-taking behaviors."

" In pediatrics, we do a lot of anticipatory guidance and a lot of preventive counseling in medical visits to help assure that adolescents are well equipped to be safe as they take on more and more adult behaviors," Rafton said.

A 2017 American Academy of Pediatrics' policy statement on age limits furthered emphasized this point, stating that 21 was "an arbitrary demarcation line for adolescence because there is increasing evidence that brain development has not reliably reached adult levels of functioning until well into the third decade of life."

Dr. Matt Thompson, who has worked for The Kids Clinic in Spokane for 15 years, said working for a private practice affords him the flexibility to decide the appropriate cut off age for each patient individually. Though it isn't common, some patients approach the subject on their own.

"They might be feeling awkward in our waiting room with a bunch of newborns and toys and things," Thompson said. "I have to say that's not usually the case. Most kids seem to want to hold onto this as long as they can, for sentimental reasons, if no other reason."

Thompson said one reason patients might choose a new doctor after 18 is vaccinations. The county provides doctors with vaccines up to age 18, but Thompson is not able to vaccinate past that age. This does not come up that frequently, he said, since most receive the vaccines they require by 18.

Some parents go a different route and put their child with a family doctor from the beginning. Karolyn Wambold, an Eastern Washington University junior, said she appreciates being able to keep the same doctor throughout her life because her doctor knows her history.

"You don't have to repeat yourself to somebody else," Wambold said. "It's very helpful, in my opinion."

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