What are the age parameters for your practice? I suspect that at one end of the spectrum, you feel that a child is never too young to come to your practice. In fact you may even go out of your way to encourage expectant mothers to make a get-acquainted visit before they deliver because you know that a face-to-face encounter is very likely to make your job easier for the next decade or two.
On the other hand, I suspect that you have set an upper age limit above which you suggest that your patients transition to a physician whose practice is focused on adult care. Is this limit stated as a number – 18? 19? 21? Or are you so uncomfortable with the challenges of adolescent medicine that you urge the teenagers in your practice to find another medical home?
You may not have an official upper age limit, but the architecture and decor of your office scream out, “We love little kids! Maybe it’s time for you preteens to move on.” Is your waiting room shared by all ages? Are there zebras on the walls and giraffes on the exam room doors? Is “The Hungry Caterpillar” the most mature reading material in the basket of books and magazines in your waiting room? Do you and your staff dress in scrub suits and jackets plastered with cartoon characters? Is there a monkey hanging from the yoke of your stethoscope?
In my practice, I had a very simple and seldom-enforced upper age limit. A patient who was still a student, not even a full-time student, was welcome to keep coming to see me. This made us very popular with college students who knew that we would be there for them when they came home between semesters with a sore throat or needed a refill for their anxiety medicine. No long waits to see a customer-unfriendly internist. Of course, this meant that it was not unusual for me to see patients who were working on their master’s degree or just a few months short of their doctoral dissertation.
One of our exam rooms had large plywood cutouts of the number 1-10 on the walls, but otherwise I avoided large murals of jungle figures or cartoon characters. A checked shirt and a muted wine-red knit tie were about as wild and crazy as my professional wardrobe ever got. I never really bought into the notion that I could put a nervous young child at ease by dressing like a clown. In my experience, it was the personality and warmth radiating from the caregiver that set the tone of the visit, not what he or she was wearing.
We didn’t have the space or the time to allow adolescents and young adults to have their own waiting room. I am sure that a few moved on to other practices because they felt they were too old to be sharing the waiting room with crying infants and shrieking toddlers. More often, I heard from older patients that they enjoyed the patient mix, and on occasion some of them told me they enjoyed playing with the younger patients.
Recently, the American Academy of Pediatrics published a recommendation discouraging pediatricians from setting upper age limits for their patients ( Pediatrics. 2017;140[3]:e20172151 ). As someone who practiced most of his career with a very lenient age limit policy, I think this is an excellent and long overdue recommendation.
Patients in their older teens and early twenties seldom present with problems that are beyond our professional competency. Furthermore, one cannot underestimate the value that comes from the years of continuity we can fall back on, particularly for those patients with chronic and multiorgan system disease. But most of all, the chance to spend a few quiet minutes having an adult conversation and catching up with someone you have known since infancy can be a pleasant oasis in an otherwise hectic day spent seeing unappreciative, inarticulate infants and whining toddlers.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.”
