We recently moved from Michigan to southern California. Because my son is 17, we decided this would be a good time to make the change from a pediatric endocrinologist to a practice that treats adults. A local pump trainer enthusiastically recommended a doctor to us.

Based on our first appointment, we are disappointed in the doctor. We were accustomed to our old pediatric endocrinologist taking plenty of time with us, doing a thorough exam, discussing blood sugar logs with us before making basal changes, reviewing important items such as the importance of flu shots, keeping in-date glucagon kits on hand, etc. This new adult doctor spent little time with us, I’d say approximately 10 minutes for a new patient appointment. He did a very cursory exam (he checked my son’s thyroid but not his infusion sites, for example) and made changes to my son’s basal pattern with barely a glance at his blood sugar logs. He spent most of the appointment expressing dismay that we use a calculator to figure boluses and corrections instead of the on-board pump wizard.

So, is our disappointment with this new doctor really just the “culture shock” of switching from a pediatric to an adult endocrinologist? In other words, would we have a similar experience in any adult practice we visited? If not, could it be that this doctor is just not as great as the pump trainer led me to believe? How can we go about finding a doctor who provides more in-depth, personal care?

You bring up several interesting points. Clearly, there is a difference in culture between pediatric and adult medicine. On the one hand, you want your child to feel comfortable going to a physician where the other patients are not small children and they are the only older teenager. On the other hand, you don’t want them to get lost in the process either. This is an area that is interesting to me. I have a young adult diabetes clinic that is designed to bridge the care between pediatric and adult care. We have constructed our experience based on reports of other transitional care clinics for other chronic diseases. Examples include cystic fibrosis, congenial heart disease, Crohn’s disease, and others. We keep a fixed/limited number of practitioners involved in the care and are careful not to add a lot of extra providers. This allows patients to become very familiar with our personnel. In addition, there is a lot of retraining. No matter how good you were with your child, he will soon be on his own and he will have to be self-sufficient. Finally, the focus changes. The pediatrician is team-oriented and works with parents. Adult physicians are focused on the individual patient.

The concept of a young adult diabetes clinic is not new, but it is gaining more popularity. I would suggest you look around and see if there are similar young adult diabetes clinics or adolescent diabetes clinics that would be a good place to start if you remain dissatisfied with your current physician. You are more likely to find these at academic institutions or physicians who collaborate with pediatric endocrinologists.

JTL