Picking a Pediatrician: A pediatrician’s advice

posted on 08 Jun 2014 07:11 by joblesspsychopa66


Most people pick their pediatrician based on recommendations (and, these days, based on who their insurance will cover). After all, if they are recommended, they must be good, right? Generally, yes. But there are some problems with this approach:

·        The people making the recommendation generally aren't in the medical field themselves, so they may not be the best judges of medical skill and expertise (if you have friends who are doctors, ask them where they take their kids--that's a useful recommendation)

·        People often don't comparison shop before choosing

·        There can be a herd mentality. Parents sometimes choose a particular doctor because others have chosen him or her, and the part about whether they are good or not can get lost in the shuffle.

It's important that any doctor you have be good, obviously, but pediatricians have a broader job description than most doctors. They are responsible not only for the health and safety of their patients, but also for monitoring and supporting their development and behavior, and for guiding and supporting parenting. It's a tall order--and not everyone can do it well.

Meeting and interviewing prospective pediatricians is crucial. The office staff can answer some of your questions, like about the size of the practice, availability and types of appointments, their systems for emergencies and after-hours coverage, or average time spent in the waiting room. But there are some questions that are better to ask the doctor. Plus, it's important to get a sense of how it feels to interact with the doctor. Every pediatrician I know has some system for allowing people to meet them, either in person or on the phone, at least briefly (some of the best pediatricians are really busy!). Someone who doesn't have a system for meeting people is either extraordinarily busy, has a practice ruled by insurance limitations (you usually can't bill for interviews), doesn't need new patients, or isn't comfortable being interviewed. I am sure that there are some great doctors out there that fall into one of these categories, but it's going to be harder to pick them out.

Before you talk with the doctor, think about what you are looking for and write down the questions that you most want to ask. As someone who has been both a pediatrician and a parent for more than 17 years, here are some questions I'd suggest you ask, questions that don't always occur to people--yet give really useful information:

 

1.      How many patients do you see in a day (or a half-day)? This helps you know how much time the doctor will spend with you. Asking about appointment length doesn't necessarily tell you this, because many practices "overbook", adding extra patients into one slot. It's better to get the total number and do the math yourself (days are usually divided up into morning, afternoon, and sometimes evening "sessions"--ask how long their sessions are). You shouldn't rule a doctor out on the basis of the answer to this question, though; some can do a lot in a short time, and more appointments means easier access to the doctor. Note the information and keep asking questions.



2.      When do you refer patients to specialists? What you want to know is: how comfortable are you with stuff more complicated than ear infections? You want a doctor that can handle complicated medical problems, that uses specialists sparingly or works with them instead of punting everything except the simplest medical conditions to someone else.

3.      How do you handle calls from patients? What you are getting at here is availability. It's normal and appropriate that calls about sick children go to a nurse who can triage them quickly. But parents should be able to talk with their doctor, whether it's during a call-in hour, or by leaving a message that gets answered within a day or two.

4.      What is your approach to behavioral problems? You are looking for someone who feels comfortable helping parents with this, and someone who will work with you to find a good solution as opposed to just telling you what to do (or sending everything to a mental health professional).

5.      How do you keep current with all the changes in medicine? Medicine changes all the time. This is a real challenge to doctors in primary care, who need to know at least a little about all areas of medicine (those specialists have it easy--they just need to know about one area!). In order to keep their license, all doctors need to get Continuing Medical Education (CME) credits, but look for someone who takes ongoing learning seriously and has a few different ways of getting information.

6.      How comfortable are you with complementary and alternative medicine Complementary and alternative medicine includes things like herbal medications, acupuncture, and spinal manipulation. What you are looking for here is honesty (most doctors know next to nothing about this stuff) and open-mindedness. You may or may not be interested in using these approaches for your child, but you'd like your pediatrician to be able and willing to "think outside the box."

7.      What is your approach to _____ (insert a condition your child has or that runs in the family, or something you feel strongly about, like breastfeeding)? Don't assume that all doctors have the same approach. They don't. The answer you get should feel right and be a good fit for you.

The doctor should feel like a good fit, too--you should feel like he or she is listening to you, and like you would feel comfortable talking with them about things that are possibly embarrassing or personal. This person is going to be your companion on the wonderful, frustrating, scary, enlightening path of parenthood; if you choose a good companion, that road may be a little easier.

Are there questions that any of you would add? What has your experience been of choosing a pediatrician?

Claire McCarthy, M.D., is a senior medical editor for Harvard Health Publications. She is an instructor in pediatrics at Harvard Medical School, an attending physician at Children's Hospital of Boston, and co-director of the pediatrics department at Martha Eliot Health Center, a neighborhood health service of Children's Hospital. The author of two books, "Learning How the Heart Beats" and "Everyone's Children", Dr. McCarthy was a regular columnist for "Sesame Street Parents Magazine" from 1995 to 1998 and is currently a contributing editor for "Parenting Magazine".

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