The pediatrician or child health practitioner has a formidable task in establishing herself or himself as the primary care clinician for an adolescent and young adult patient. A transition interview with patients and their families at approximately 10 years of age is an effective approach for developing a new relationship with the adolescent and the family. During this interview, the clinician must inform the parents and the patient about the changing nature of the relationship with the practitioner—the need for the clinician to have time alone with the patient and query the young person directly, and for the patient to be examined alone and be encouraged to generate his or her own questions for the clinician. These changes are best done through a discussion of normal adolescence and the need for adolescents to begin to make some decisions in a more independent manner with guidance and support from their families. During this transition interview, the clinician may want to provide the adolescent and family with some general information regarding the normal physiological and psychosocial changes of adolescence. Depending on the age and psychosocial functioning of the adolescent, the clinician may want to encourage the young person to come to the next visit alone. As the patient completes the second decade of life, the young adult needs to have developed the skills to assume primary responsibility for his or her own health care. At 18 years of age, young people have the legal right to assume full responsibility for their care even though they will often continue to receive significant emotional and financial support from their family. Given these changes, the clinician will need to have a discussion with the patient and family focusing on clarifying how the young adult wants health information shared with the family.
Confidentiality issues are fundamental to the delivery of health care to adolescents and young adults; they need to be able to seek the necessary care in a timely manner and give a candid and complete heath history when they do so. Some clinicians may feel uncomfortable with these principles and may want to clarify their position with the young person. From the first visit, the clinician must assure the young person of the confidentiality of all information within the confines of the legal system based upon the state or country in which the health care is being delivered. The clinician may need to restate this position on confidentiality during the gathering of information in sensitive areas (eg, gender identity, sexual behavior, substance use). In the areas of life-threatening disease or behavior (eg, suicidal behavior, homicidal intentions, or the management of chronic disease), the clinician always has the right to intervene on behalf of the patient’s well-being, which generally involves identifying a parent, guardian, or supportive adult who can assist the young person with the problem.