Child Health And Personal Care

Family Health, Health

My husband came home a couple of weeks ago talking about a friend and colleague, RS, who is having her first baby. Apparently believing that his experience as a father of two qualified him to give helpful advice, she asked him for suggestions on how to pick a pediatrician. While flattered, he appeared concerned that if she followed his advice she might end up making a serious mistake. He asked me to do a post about how we (but I think he means I), picked our sons’ pediatrician.

I come from a medical family. My dad is a doctor, and my mom is a nurse. So obviously you would think that these medical connections would enable me to know exactly which doctor to pick, right? Well, actually the answer to that question is “no”. It did however help me out with the process of choosing a doctor.

Just about every magazine that I read stressed the importance of interviewing pediatricians. I think if you are able to do it, then great. Why not? I don’t think it’s a bad idea to know the pediatrician’s philosophies ahead of time. Here are some questions that I would ask if I were to interview at this point, now that I have some parenting experience:

1. What are your hours? Do you have evening and/or weekend hours? What exactly do you mean by weekend hours? Are they hours I can schedule an appointment, or are they after care hours? Do I need to be referred? What happens if my child gets sick after the office is closed?

We thought we knew the answer to this question, because we knew that our pediatrician’s practice had weekend hours. We were wrong. Our pediatrician’s weekend hours are after care hours meaning that they require a more expensive co-payment than a standard appointment. More importantly, you have to be referred for a particular urgent medical situation to be able to take advantage of them. We used this after care when my younger son (YS) still had jaundice after he came home from the hospital; the doctor was able to check him out and draw blood. Unlike visiting an ER, because there is a specific appointment wait times tend to be reasonable and the atmosphere is far less chaotic. Also unlike the ER, the pediatrician’s office is not fully equipped. When YS needed to have an x-ray, we had to go to the ER. Some of my friends use a practice where anyone who wants their child to be seen can show up, as long as they’re willing to pay the after hours fee. Some friends can actually schedule their child’s well baby appointments on weekends. For some parents, weekend hours may not be important. For families with two parents who work outside of the home, however, these details may be critical.

2. What’s your view on antibiotics? At what point would you prescribe antibiotics for my child if he has an ear infection? After how many ear infections would you refer him to an ENT? How are food allergies handled? If I, being the parent, have a particular food allergy, how would you recommend that my child handle that food since it’s unknown whether or not he will have the same allergy? At what point would we be referred to an allergist? (same question for skin conditions, eye conditions, etc.)

There isn’t an objectively correct or incorrect answer here. Rather there are answers that make you feel comfortable because they are consistent with your views about parenting. You want to know about their procedures. We thankfully do not have food allergies in our family, but I do know people that do have them. Some pediatricians immediately refer a child to an allergist, even if he has not yet eaten the food in question, solely because a parent has a severe reaction to the foodt. Others encourage parents to delay feeding a particularly concerning food to a child until a certain age. A minor allergic reaction may be treated by some doctors by telling parents to switch to different foods and wait a few months (or in some cases years) before going back to the suspect food. Other doctors treat any allergic reaction as immediate justification for further examination.

3. If I don’t want my child to have his vaccinations on your office’s schedule, how will you accommodate me?

We have given both of our sons their vaccinations at the recommended time, and we frankly still are most comfortable that way. Many parents are uncomfortable with certain vaccinations or the current medical recommendations that involve concentrating several during short periods of time. I have heard of parents working with pediatricians to space them out more. You need to find a doctor who can work with your desired approach.

4. If I need to talk with you about my child, but I don’t want to have a conversation in front of him, how can you accommodate me? Is there a specific procedure for this?

I haven’t had experience with the last question yet. This seems to be a frequent concern, understandably, for parents who are worried about their child’s weight. They don’t want to discuss their concern in front of the child. I have heard of parents who will write a note to the pediatrician and give it to the nurse at check in. Basically the note says “I’m concerned about Johnny’s weight please call me. ” Some people call the doctor ahead of time. I have to say that I’ve never talked to my sons’ doctor on the phone so I don’t actually know her phone policy. If I were choosing a pediatrician now, this is something I would know to find out about up front.

So how did I come up with these questions? Because except for the last one, we learned the answers ourselves to these questions as they became issues for us. And we have many friends who have confronted the same issues. So with such important questions, you may be wondering why I said that it is great to interview a pediatrician if you are able to do so. If it is such a good idea, doesn’t everyone? Didn’t I? The answer is no. When I was looking for a pediatrician when I was pregnant with my older son (OS), I asked my primary care physician (PCP) for recommendations. I didn’t know any other parents in our community at the time, otherwise I would have asked them too. My PCP is the best doctor I’ve ever had, so I trusted her recommendations. My OB also gave me a list of her personal recommendations. I cross listed them and I called the ones they had in common. My number one choice was not accepting new patients, but I was able to find one who was highly recommended by both doctors and was conveniently located.

The interview issue still troubled me. I called my father because I was struggling with the fact that my preferred practice didn’t do interviews. He pointed out that many good doctors have all the patients they need or are too busy to do interviews. That by no means is saying that a doctor who interviews isn’t a good doctor, just simply that you shouldn’t scratch a doctor off your list just because she doesn’t interview.

There are many other factors that go into choosing a pediatrician that are more frequently discussed in parenting magazines. Do you prefer a large practice where there are more doctors, potentially more available appointments, but potentially less personal connection? Do you prefer a smaller practice, where the pediatrician will know your child really well, but may have more limited hours or less available appointments? Or do you find a solo practitioner who intentionally limits the number of patients seen to ensure ease of appointment scheduling, potentially at the expense of more available hours. There is no one answer, as each practice is different and every parent has their own approach.

With everything else said, here’s my most important piece of advice – don’t feel loyalty towards your child’s pediatrician. If you don’t like him, then switch. People do it all the time. Don’t feel bad about it. Choosing a pediatrician is like starting any other relationship; you choose the person who seems most compatible, but you do not need to treat the decision as though it is a life-long commitment.

A. Elliot’s Lesson Learned: Choose a pediatrician with whom you are most comfortable at the time, but feel free to change to a new pediatrician if either your perspective on parenting or on your pediatrician changes over time. Labels: Child Health and Personal Care