Direct & authentic feedback—A clinician’s avoidance of difficult topics, particularly if it is in the hopes of not alienating the young adult, will be quickly ascertained by the patient. Rather than signaling that the clinician genuinely cares, the patient is more likely to interpret such tactics as a willingness to sacrifice a measure of self-respect to appease the young adult.26
To maintain the credibility required to do an effective job, the clinician would be better received if questions or comments are delivered in a candid manner, if not done in a condescending or punitive manner. For example, the patient will likely respond positively to direct feedback on the use of medicinal marijuana in the context of the developing brain. The young adult is probably already aware of cognitive and psychomotor effects, but spent less time contemplating possible long-term risk to motivation levels (reflected in education, employment, lifetime achievement and life satisfaction) and to mood (depression and anxiety).27
The power of opinion on social media sites, often cloaked in skepticism or even disinformation, to formulate impressions on treatment should not be discounted.
Conclusion
Transition clinics exist so that developmentally appropriate healthcare can be delivered to young adults in order to maximize function in everyday life. History has taught us that patients are in danger of being lost to medical follow-up in the gap between pediatric care and the adult healthcare system. This is due to three factors: 1) a poorly organized or sparse local healthcare delivery system; 2) lifespan influences, such as moving out of the family home to attend college; and 3) patients’ lack of self-empowerment to become active participants in their treatment planning.
By mapping out these variables, the clinician may be in a better position to help a young adult acquire the knowledge and insight to assume responsibility for following through on a plan of action, secure and use planned services, and broker the support necessary to develop independent living skills.3
The clinician must adopt an approach to care provision that encompasses a complex array of developmental, environmental and personal dynamics that potentially impact a patient’s ability to lead a meaningful and joyful life despite the presence of chronic disease. Further, the clinician should think critically about one’s own approach to the young adult patient. This may aid the clinician in finding an approach that best prompts the young adult rheumatology patient to improve their understanding, attain informed decision making and air their concerns. This will result in an enhanced self-regard.
