Medical Decisions at Age 18

It suddenly seems that I have been in a time warp and so many of my patients who should still be little are showing up for their pre-college physicals.  It was hard enough for me to realize that my own children had grown-up, but I am now realizing that my own patients are growing up as well. With many of them now being 18 years old, they are now also in charge of their own health care decisions. This became apparent the other day as I was seeing a long time patient for her 18 year old check up, and I was filling out her college health form as well. 

When I got to her immunizations I realized that she had not had the HPV vaccine series, and I then remembered that her parents had decided not to give her this vaccine. (I had discussed the importance of the HPV vaccine with her mother and father every year for the last 4-5 years). As I started to say, Oh I forgot you did not get the HPV vaccine, she chimed in with now that I am 18 years old I want to get that vaccine. 

I paused for a few seconds and then she said, I always thought I should get that vaccine and I listened to you every year, but my Dad just didn't think I was old enough to get it.  Now that I can make that decision, I think it is a good vaccine and something that I want to have.  Can I get it today, and can I come back at the end of the summer and get the second one before heading off to school? 

Now I am thrilled that she had been listening to our discussions about HPV and the need to vaccinate, but it also felt a bit weird that she suddenly could make her own decisions about vaccines.  In reality, she could make all sorts of decisions now, even though her parents were actually still the holders of her health insurance benefits and would be until at least she was out of college. 

I thought about asking her to call her parents one last time to see what they thought she should do, but then decided that she wanted the vaccine and at her age needed the vaccine, so she had the legal right to sign off on it herself---lets get the vaccine. 

This is really not about HPV, but rather it is about children becoming adults and getting to make decisions about their own health care.  It is also about having a long-standing relationship with patients and hoping that you can help them make good decisions about taking care of themselves and the need for preventative medicine. 

She got the shot, she signed, she was happy, I was glad she was going to be protected (once the series of 3 was completed).  It was a good day, I just wonder what her parents thought?