Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

From pizza pans to pain plans 


For young adults transitioning to adult care, building trust and rapport is crucial. With permission, it may be helpful to continue involving parents in care plans to improve health outcomes.  

“The pizza here sucks.” I’d just entered my patient’s room and it wasn’t clear if she was telling this to me or her sister on FaceTime. I looked over at her tray and agreed, the pizza looked subpar.  


Earlier that day, I received an inbox notification that one of my primary care patients was admitted to the adult medicine unit for a vaso-occlusive crisis. She was a young woman with dreams of becoming an engineer, but her depression and increasing frequency of unmanageable pain episodes kept derailing her plans.  


I met her about two years prior when I expressed an interest in caring for young people with sickle cell disease (SCD). She hadn’t had a stable primary care doctor since recently transitioning to adult medicine and I had an open patient panel. For young people with sickle cell disease, transition to adult care is a high-risk period marked by increased mortality and pain episodes. 


Our visits focused on routine medical care but evolved into check-ins about her family and career. I felt deeply connected to her experiences because we shared an identityambitious young Black woman. Each clinic visit felt like an opportunity to build a therapeutic relationship.  


“Hey sis, this is the doctor I’ve been telling you about!” she waved her phone in my direction. I smiled and sat at her bedside. “They want me to try this bupe medication, but I’m not an addict. What do you think?” This time it was clear she was talking to me. I’d been reading over the inpatient hematology notes when I was walking over to see her. I thought a switch in her pain regimen would be beneficial. We discussed her current pain plan, how she had to reschedule her school exams again, and what life looked like at home.  


I listened and answered her questions. “Will it make my teeth fall out?” “How much will it cost?” “Will I need this forever?” “Am I going to get better?” She wore her exhaustion as a faint smile and said she would read more about buprenorphine.  


I hope to dedicate my career to caring for young people with sickle cell disease and have learned the following: 


1. Build good relationships. 

There are multiple forms of stigma attached to being a young (often Black) person with chronic illness who may require opiate medications as part of their pain plan. Learning who our patients are can help us align clinical plans with their hopes and dreams.  


2. Patient care is a team sport. 

Caregivers play an integral role in the delivery of care in the pediatric setting, and this shouldn’t stop at age 18. Ask if your patients have family or friends that they lean on for support and work to find ways to involve them in care. 









This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.