You sign his required college forms and give him his meningitis vaccine. As you prepare to say "good luck," you wonder what counsel you can offer to help him become a healthy and educated medical consumer and patient.
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On a warm spring day, Chris comes to your office for his "pre-college" physical examination and immunizations. Looking through his problem list, you remember rounding on him when he was hospitalized for asthma at age 5, counseling him about pubertal changes when he was 11, and treating his infectious mononucleosis when he was in high school. You are proud to see him growing into a fine young adult, but the sentiment is bittersweet when you realize that this may be one of the last times that you take care of him as your patient. Like many of your graduating high school seniors, Chris will need to go to the college health service to meet his future health needs.
You sign his required college forms and give him his meningitis vaccine. As you prepare to say "good luck," you wonder what counsel you can offer to help him become a healthy and educated medical consumer and patient.
As a graduating high school senior prepares for college, his or her thoughts are inevitably focused on the exciting prospect of a new dormitory, roommates, college food, parties, friends, and (of course) academics. Unless the student has a chronic medical condition, he will probably spend little time thinking about what he would do if or when he gets sick.
Unfortunately, most students need to enlist the aid of the university health services at some point in their college careers and this may be the first time that they see a clinician who is not their own pediatrician. Furthermore, this will probably be their first time navigating the US health care system without their parents' guidance. While most college students relish their independence, they are frequently overwhelmed by the responsibility of managing their own health care-especially in an environment with myriad insurers, all with their own complicated rules and procedures.
So when "Chris" comes in for his pre-college physical examination, what kinds of anticipatory guidance and counseling-beyond advice about good sleeping and eating habits, reproductive and mental health, and use of illicit drugs and alcohol-might benefit him most? This brief review will provide an outline of key issues that you may wish to discuss with your patient and his family.
Approximately 1600 colleges and universities have a student health service that provides a variety of health services for their students. Frequently, the institutions' needs and funding determine the breadth of services offered. Some universities may simply provide a small office for urgent care services. Other institutions may offer a broader variety of services that may include specialty services such as orthopedics, gynecology, mental health services, and alternative health modalities.
Undergraduates often have a difficult time transitioning their care from their pediatrician to a different provider. Their first visit to the college health clinic can be daunting. For some students, this may be the first time they have visited a health provider without a parent-or even the first time they have had to make and keep their own appointments. In any case, the experience is likely to be vastly different from their norm.
Key Discussion Points:
The pre-college physical examination is a great time to review past medical history and family medical history. Undergraduates are frequently oblivious; as the adolescent prepares for college, it may be important for him to understand significant and relevant details (such as a family history of alcoholism or mental illness) so as to make the best overall health decisions.
Key Discussion Points:
Students with chronic medical problems or mental health issues have probably seen their specialist for years before they start college. Before the student leaves for school, explore how he plans to manage these health issues. Make sure that some transitional care plan is in place before the student leaves home. Ideally, this plan should include some written communication between the specialist and the college health service. This may seem like stating the obvious. Nevertheless, I frequently see freshmen in crisis because of a lack of planning.
Key Discussion Points:
Seventy percent of college students have health insurance-either through a sponsoring educational institution or through their parents. Unless insurance has been a problem in the past, most pediatricians probably do not discuss the topic with the college-bound patients. However, many families must consider either enrolling in student insurance or keeping their child on their current plan. The family should review these policies with their child ahead of time: a sick visit during final exam week is not the time to learn that there are potential snafus in coverage.
Key Discussion Points:
Without wishing to state the obvious, a quick note on confidentiality in college health is appropriate. Most college freshmen are at least 18 years old when they start college; as such, they are afforded the privileged right to confidentiality that comes with adulthood. With those rights, however, comes the responsibility for their own health care.
From a medicolegal standpoint, strict confidentiality must be maintained in college health settings. Regardless of who pays the tuition and insurance bills, college health providers cannot legally discuss a clinical encounter with an outside party- unless the patient gives them express permission to do so (in writing). If your patient has a medical issue that requires you to communicate with the student health service, make sure that all confidentiality releases and permissions are granted before the patient leaves for college. Unless the student's health and life (or another person's health and life) are jeopardized, confidentiality is rarely (if ever) broken in these settings.
A patient's departure for college is a bittersweet experience for all involved. The pre-college physical is a great time to ensure that any clinical care loopholes are closed and that your patients (and their families) are adequately prepared for any unanticipated health issues. Appropriate preparation can ease a difficult transition and help ensure that your patients will remain happy and healthy as they take their first real steps to independence and adulthood.
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