After late childhood and into adulthood, adolescents should be afforded a “Welcome to Adolescence” letter as a new rite of passage, say two Adolescent Medicine Specialists, in their commentary, published in the July edition of The Journal of Adolescent Health. The proposed letter would offer a structured way to answer adolescent and parent questions on the way healthcare changes during adolescence, and allay concerns.
There are ceremonies and community recognitions that mark the onset of adolescence, with the recognized “evolving capacities” of maturation being around age 12-14 years of age. And, The American Academy of Pediatrics endorses the growing patient having private time the doctor.
For Dr. Lonna P. Gordon, M.D., Pharm.D., of Nemours Children’s Health System, and John S. Santelli, M.D., M.P.H., of Columbia University, a letter from the health care provider to the adolescent reaching age 12, and his or her parents could begin to formalize and guide future health care.
“The Welcome Letter marks a change in how health care is provided to adolescents, and recognizes a developing cognitive capacity for reasoned judgment, the adolescent’s desire for autonomy and privacy, and changing social roles that young people face,” said Dr. Gordon, the lead author. Additionally, in a practical way, the letter would explain confidentiality and its limits, the importance of private time between the provider and the adolescent patient, the ongoing role and rights of the parent, and expected communications among providers, parents and adolescents, she added. Parents are still involved in their child’s care until adulthood, but this letter could help the growing patient understand the role he/she plays in staying healthy, said Gordon.
Normally, a growing patient’s private time with a doctor happens when adolescents are older and have a 2- to 10-year relationship with their doctor, the authors found. This alone time is important to the patient experience, said Gordon, as it can involve discussion of critical health issues, from sexuality, substance use, and mental health. “Private time is essential to mitigating the health risks of adolescence,” she said.
The idea of a letter presented to a patient at age 12 to formally mark this time would invite the patient and their caregiver to begin a “significant, multiyear journey” together.
