Q&A: finding a pediatrician

Mary writes:

"Everyone tells us we need to go out and start interviewing pediatricians (I'm 30 weeks pregnant).  Ok, fine, but what do we ask them?  And how do we find ones to interview?  A coworker recommended one that she used to work with but other than that, we're kind of clueless, as we are with most of this baby stuff."

Choosing a pediatrician is a lot like planning a wedding. There are a hundred things to think about, and things you have strong opinions about will be completely unimportant for other people, and vice versa. The trick is to figure out what you care about. Then you can ask those questions and just not worry about the other things.

To find doctors to interview in the first place, ask everyone you know who they use(d). Also go to your insurance company's website and get a list of names. Once you've figured out what you're looking for (which I'll cover below), call up and ask your first level of weed-out questions over the phone. You may not have to interview more than one or two people in person.

The first thing I'd think about is your parenting style. Are you going to be laid-back or highly managerial? When my son was maybe 10 weeks old he had some rash that I asked my doctor about. He told me, "Squirt some breastmilk on it. At this point breastmilk, either in him or on him, is pretty much the cure for every problem he could have." I was happy with that answer (and the breastmilk did clear up the rash), but a more highly managerial parent would have been upset that there wasn't a definite diagnosis with a clear treatment path including a plan for contingencies. If you call and ask a question, do you want to know exactly why things are happening, or just that they're normal? A mismatch between your style and the pediatrician's style will leave you feeling inadequate and judged or frustrated and angry.

Don't confuse this with the parenting philosophy you follow, which is another thing you should ask potential doctors about. If you have definite opinions about things like scheduling, feeding, sleeping, pacifiers, vaccinations, circumcision, etc. you want someone who's going to support you, not someone who makes you feel like a bad parent for choosing those things. Your pediatrician doesn't necessarily have to agree with you about everything, but s/he does have to support you without being judgmental. If you say, "We intend to cosleep. How do you feel about that?" the correct answer should be something like "There are a number of families in my practice who cosleep" at a minimum (because it doesn't necessarily imply endorsement, just familiarity and acceptance) or "I think cosleeping is wonderful for babies and parents" as an ideal. If you hear "I don't recommend it. You'll end up with a 5-year-old in your bed," move on to the next doctor on your list. (Obviously the same thing goes if you want to have your child sleeping in a crib and you get a less-than-enthusiastic response from an interviewee ped. Next.)

There are, of course, going to be some things you don't care about. Just don't ask about those. If you have someone who matches your views on the things you are most concerned with it doesn't really matter if you match on the other things. Make sure you take into consideration the style issue, though.

Breastfeeding is another thing to ask about. Every pediatrician (unless s/he's stupid) will claim to be supportive of breastfeeding. But claiming to be supportive and actually being supportive and having the knowledge to help with common nursing problems are two vastly different things. How many mothers in the practice nursed for 6 weeks? 6 months? 1 year? The answers to those questions are going to tell you how much emotional support the doctor gives to breastfeeding and how much practical help the doctor gives (that includes being able to recommend and partner with a good lactation consultant). Medical school still does not teach much about human lactation, so what pediatricians know about breastfeeding is what they've chosen to learn. A good ped either has made the effort to become educated about breastfeeding (beyond the info pamphlets the formula companies send--at a minimum the doctor should have taken the same 3-hour class you took) or recognizes that an IBCLC lactation consultant is an expert on breastfeeding and treats her as a colleague and not an underling.

Antibiotics are another hot issue. Some doctors prescribe them at the drop of a hat, some are more circumspect, and others only prescribe them under duress. Here's a pretty concise overview of why overuse of antibiotics isn't a good idea. You want someone who will reserve use of antibiotics for when there's an actual bacterial infection present.

I'm sure you've heard the old chestnut "What do you call the person who graduates at the bottom of his or her med school class?" "Doctor." You should also use interviews to try to weed out doctors who are ignorant or just plain stupid. A friend of mine (who is 5 feet tall with a husband who's 5'6") was told by her pediatrician that her daughter was "too short" and that he was concerned because "We want every child in our practice to be in the 50th percentile." Where do you even start with a doctor who doesn't understand the basic concept of a bell curve? Or that a child with short parents will probably be on the short side of the curve? He then continued by telling her that he thought her "extended" breastfeeding (their baby was 9 months old at the time) was stunting the baby's growth, and he wanted her to cut down on nursing and feed the baby more apples and green beans to make her grow taller. Um, yeah.

You don't want to end up with a doctor who's so ignorant on so many levels, or one who's overly concerned about things that are normal. If your baby is likely to be particularly short or tall or skinny or fat or pale or of Asian descent (and thus prone to those birthmarks that can look like bruises) or bald or hairy or a carrier of a genetic disease or whatever, bring that up at the interview and ask the doctor what s/he thinks. Any answer like "Someone's got to be in the 95th percentile, so someone else's got to be in the 5th percentile" or "It would be ridiculous to expect that a child with parents as tall as you are won't be off the charts" or something else that recognizes that kids are all different and should be taken on a case-by-case basis is what you're looking for.

Any answer that starts with "We want all the kids in our practice to" is bad news. My friend's pediatrician got all worried because her son wasn't walking at 18 months (the range of normal is around 9-16 months for walking, so he was late). The ped gave my friend the "We want all the kids in our practice to be walking by 18 months" line (to which I said, because I'm a smartass like that, "I'm not really sure that it matters what she wants, now, does it, if he's not walking?") and sent him to be evaluated for cognitive developmental delays. In the meantime, the child was drooling constantly and his speech was extremely hard to understand, but his responsive language was way ahead of his chronological age and he was ahead of the curve with imaginitive play and stuff like that. It turned out that he had low muscle tone in the jaw and chest (which explained why he wasn't walking yet, was drooling, and couldn't enunciate) which was treated easily with regular physical therapy. The pediatrician absolutely missed the boat and focused on the wrong thing because she was so concerned with what she "wanted" all the kids in the practice to be doing.

Another thing to consider is whether you want to go with a pediatrician or a family doctor. There are advantages to both. A pediatrician is going to be more focused on specific childhood illnesses and conditions. A family practice doctor is going to have more of a long-range view and might not be as concerned about things that are only issues for a short time. A pediatrician is going to be dealing with huge numbers of kids so s/he'll have a real picture of where your kid is compared to other kids. A family practice doctor will be able to treat your entire family. Think about which model you prefer.

There's an excellent list of questions to ask your child's doctor here. It covers things like whether the doctor will come check out your newborn in the hospital or wait until the baby comes home (a hospital pediatrician or intern will check out your baby in the hospital if your own ped doesn't--it's routine and no big deal). It also covers procedures for scheduling appointments, after-hours problems, and getting sick kids in for emergency visits.

Often times these things are a balancing act. I love my doctor (a family practice doctor who treats me, too) because he's very laid-back and treats me like a true partner in care (not someone who needs to be told what to do). He asks things like "Are you happy with the kids' sleeping arrangements? If you're not, I can help you troubleshoot" and he gets my jokes. But the downside is that he's only in the office a couple of days a week and he's always overscheduled. For me it's worth it to be so happy with what he does for us when we need him that I just accept the burden of scheduling way in advance. We've also been lucky in that our only emergencies have been off-hours so he was pageable. Other parents are going to want easier, more immediate access and will put up with more editorializing from their doctors. As long as you know what you want and choose a doctor based on that, you'll be happy.

Another thing to think about is where the emergency room your doctor admits to is. All other things being equal, you should go with the doctor who admits to the closer ER. (Within reason. If there's only a few minutes difference in travel time, go with the better ER.) When your baby can't breathe from croup in the middle of the night, you don't want to have to drive 30 minutes to the ER.

The bottom line, though, is that you have to feel good on an interpersonal level with your doctor. A doctor can be brilliant and knowledgeable, but that doesn't mean s/he's kind or humane. If there's something you don't like about the doctor don't go with him or her, even if everyone you know raves about the doctor. You don't want to feel any hesitation (ever) about calling to ask a question or bringing your child in to the office. So it's important that you feel good about the person professionally and personally.

Again, read the list of questions from The December List here. Other than that stuff, is there anything we forgot?

Comments

[Jen (yup, another one)]

Around here, several of the practices which are MOST supportive of breastfeeding have a lactation consultant on staff, which means that you can see an LC for your regular co-pay. If you are interested in breastfeeding that may be something to ask about. It's been really helpful to us.

[Kate]

1. I can email my son's (new) doctor questions and she emails me back detailed responses. I have used this feature only three times in six months (twice when he had the stomach flu and once when he had a mysterious rash) but I LOVE it! I hated waiting by the phone for his previous pediatrician to call back and then having to process everything he said at the speed at which he said it, if that makes sense.
2. Evening and early morning hours, in my case, mean that my husband can come with me to appointments, which I also love. Totally not necessary, but nice.
3. One final BTDT-type comment, don't panic too much about picking a pediatrician while pregnant. It is very nice to have someone nice whom you trust to take you through the first, frightening weeks and months, but it is also true that if you're not happy you can switch. We did, at 15 months, and although it was a bit awkward, it was also very okay. (My son's first pediatrician was very supportive of breast feeding in the beginning but less so after the six month mark (e.g. suggested a bottle of formula a day to me, a pumping-my-brains out crazy lady, since then I wouldn't have to worry that the baby might not be getting enough iron). And we had other nagging concerns about him, that just added up over time.)

[Rach]

One thing I didn't think to ask about (but luckily my pedi brought it up) was how they handled sick/emergency appointments. The fact that they make sure they see you in the same half day (i.e. call in the morning, get seen before noon) has proved helpful with a kid who gets sick a lot!

[Anon]

My ped practice has an "after hours/weekend" walk-in clinic for kids who get sick late in the day or who are sick when you pick them up from school/day care. I like that if I realize at 4pm that my kid really does need to see a doctor, it can be done that day. They also make sure that the nurses are always available to talk to parents -- sometimes all you need is to talk to a nurse.

[Carrie]

You can definitely change pediatricians later on. We switched to one in the same practice (which is a little awkward if you care). We had interviewed our pediatrician and thought she was helpful until we actually needed help. The other one in teh practice would not take interviews from prospective parents, which I thought was a little arrogant, but he is old-school and wonderful. He is supportive of breastfeeding (not so supportive of day care, but whatever).
They have urgent care hours until 8 pm every day and on weekends, which we have used numerous times (staffed by the different doctors in the practice, so you don't always see your pediatrician, but if there is excesive vomiting on a Saturday, you get seen without going to the ER).

One other thing: most of your routine questions will probably be answered on the call line by the nurse. The nursing staff can make all the difference. I LOVE my new doctor's nurse. I love Charlotte. She is the best. She is probably the number 1 reason we like our pediatrician.

[AmyinMotown]

I asked my OB, the nurse that did our childbirth classes, and anybody else I could think of and ended up seeing the family practice doctor who shared an office building with our OB (both recommended him). Nice, convienient and I was already going there all the time. Except, not. We could never get them on the phone for
routine questions, SCHEDULED appointments were running as much as two-hour waits, and they were keeping sloppy records of whhat vaccines she had and hadn't had. Like the doctor would order it in his fancy computer and the nurse would come in to give it and say "We don't have that today, come back next week" and if we didn't, it would stll be entered in as given. None of this would have come out at an initial interview. So I switched and just vowed to keep doing so until I was happy. And luckily, I really like the second practice we've seen! So don't panic about picking the perfect doctor while pregnant, some of the things that might bug you while you're actually bringing your baby there wouldn't be as obvious in an interview..

[foodmomiac]

One thing that I was really concerned about in looking for a pediatrician was his/her opinion about alternative medicine.

I've treated my kids with herbs, acupuncture and homeopathy, and before I even had them, I knew that I'd be doing this. I was very eager to find a doctor who would be supportive of these alternative methods, and who read the latest research on them, without discounting them wholesale.

[Kate]

Wow, a staff LC? Cool!

My comment would be to remember that a relationship with a pediatrician (or any dr) is not like signing a contract to stick with them forever and ever until your baby turns 18. If you find one that seems ok but it turns out down the road you don't see eye to eye with, switch.

It may be that your parenting journey takes you in directions you didn't anticipate, and that precipitates a change.

I had this exact experience. I started going to a ped in my neighborhood, used by lots of friends. It was great (and convenient) for several months. But once my parenting positions got clarified, I realized we were a bad match. Finally at 10 months I was "instructed" to nightwean dd (still waking several times)--I refused. And it turned out a big reason was her (undiagnosed) dairy sensitivity, so the push for yogurt and cheese on his part was a huge mistake. And the cosleeping got a big thumbs down. We started looking elsewhere.

The second time I got recommendations from friends out of the neighborhood but who had similar parenting styles. I was a lot more selective (because now I knew what to ask for *me*), and we landed with an amazing ped, who has been enthusiastically supportive of extended breastfeeding, tandem nursing, cosleeping, and infant sign language. When I was pregnant, she encouraged me to nightwean because I indicated I didn't think I could handle night-nursing two kids, but she understood that any kind of weaning is a process...and was thrilled that it was successful in two months.

Anyway, just a story to remind you that when it comes to health care (barring insurance issues or the like) you are a consumer; if you don't like the "product," you can exchange it for something that works better.

[Beth]

My son is 4. The thing that I like best about the practice we chose has been there response to emergencies. When my son is sick or hurt, they return my calls quickly, give clear, concise instructions and outline next steps. They don't suggest that I bring him into the office unless they really think it is necessary to see him. I REALLY appreciated that as we dealt with things like his first fever, stomach bug, earache, etc.

I consider this to be more important (for me) in the long run than their views on issues that I consider "parenting" and not medical such as co-sleeping.

[Brooke]

We have a family practice doc which I really like (the idea of family practice and the doctor herself). Plus she has a baby 6 months(ish) older than Sanna and our parenting styles seem pretty similar. And she is available by email.

Our big concerns beforehand were about being vegetarian and being lesbians. We didn't want a doctor trying to make Em or the babe eat meat, and we certainly didn't want a doctor who didn't understand that Sanna has two moms.

[Sherry]

Our Ped also has an LC on staff.

We found our doc through our OB/GYN office and they offered a group information session with all the doctors in the practice once a month for new parents. The setup was wonderful and informal and they even served snacks! Honestly, they answered most of my questions during the presentation, and I only had to ask specifics about twins later.

I love our doc, too. She's young and amazing and absolutely adores our kids.

It's a big decision, but I think Moxie just about covered everything in her post.

[heather]

All great advice Moxie. We had a lot of recommendations for a certain pediatrician, but unfortunately, we never got to meet her before delivery (she was on maternity leave for the birth of her first son too.) We loved the practice and decided to see her anyway and I have never been happier. First, she has the new mom perspective too. Her son is exactly three-months older than my son, so she was just coming out of whatever phase we were going into. She was breastfeeding herself, so in addition to a staff LC, she was able to help me out herself. All of our other philosophies were so eerily similar that I find myself stalking her so she will become my new best friend. O-kay, that got a little weird.

The only drawback is that she only works 2 1/2 days a week. This means that our well-baby check-ups can run 2-3 weeks past the average date. She is also pregnant again, so she will be out for at least three months coming up soon. Luckily, it is the time between two well-baby checkups, so I'm not too bothered. The other physician that she partners with had a baby at the same time and works the other 2 1/2 days. I like her a lot too and she is also you and a new mom.

Good luck to you.

[Anne]

One thing that really helped me to decide to go with my son’s ped. Was that he specializes in pediatric oncology. Not that I’m concerned that my son will have cancer or anything like that but I knew that having a specialty meant that out of necessity my son’s doctor was going to be more up to date on medical literature related to his filed. Just something else to consider.

Oh and if you get a chance try to meet the nurses/staff that work in the office, you could have a doctor you love but a nurse you dislike and they will be the “first line of defense” and they act to filter things back to the ped..

[Linda]

I chose my ped because he was recommended by a midwife, has a LC as a wife, and told me at our first meeting: "I don't know everything, but I have a list of specialists-some of whom are in this office-that I call regularly." If my kid has some freaky thing, I want to be referred out, NOT have my ped piddling around, afraid to admit he doesn't know what's going on. The fact that he admitted fallibility (sp?) right off was a big turn on for me.

When I asked him about his parenting beliefs, he said that he's open to anything as long as physical/verbal/emotional abuse is not included.

Also, when I mentioned cosleeping, he said he's heard Dr. Sears speak a few times and then skipped out of the office, returning with info on how to cosleep safely. He gave me oodles of info when I was struggling with breastfeeding, including having his wife (!) call me at home. I adore him.

Oh, and there are females doctors in his office for when my girls go thru that "no boys allowed" phase.

[MelG-F]

I was wondering about advice for selecting a pediatrician for older children. My daughter turned 4 yesterday, and we moved to a new city and state. And I don't have a good network of parents here to ask for recommendations. There are a lot of things I know I want in a doctor -- but does anyone have any tips for what to ask?

[Shelley]

We went with the ped that taught the newborn-care part of my prenatal class -- I liked what he said, I liked his demeanor, and I liked his attitude when we went to interview him later. I was further reassured that I had the right guy when, after the sixth question during my daughter's first of many croup episodes, he said, "you always ask such good questions." As a new mom, reassurance that you're doing the right thing even if you're feeling neurotic as hell -- what an empowering feeling.

[Bihari]

This may sound incredibly obvious, but as a family nurse practitioner, one of the things I look for in pediatric providers for my own children is whether they genuinely enjoy being with the kids. Some providers are tickled by children, just really enjoy them. Some seem to be disenchanted. It means a lot to me when a provider really notices who my child is and appreciates his strengths and problems.

I try to remember this when dealing with my own pediatric patients, and I am amazed at what a difference it makes. I work in an ER, so I deal with families in high-tension, urgent situations late at night, and something as simple as my saying, "Geez, he's got such great diction, and at 22 months no less!" can really break the tension and ease the atmosphere.

[liz]

Different waiting rooms and examining for sick visits and well visits. I love not being worried that my son will pick something up when he's just in for his regular check-ups.

Also, one of the doctors we rejected had to ask someone else in the office if they had a watch with a second hand. Isn't that standard equipment?

Mostly, go with your gut.

[Rivka]

Our pediatrician was recommended by a friend whose child has a life-threatening chronic illness. I figured that, if Keith was happy with his pediatrician, it must be a good pediatrician. And I was right!

One of my screening questions was "At what age do you think that most breastfed babies should wean?" The doctor I didn't go with said that all families were different and had different needs. The one I did go with said, "Well, I'm only going to really push you to breastfeed for the first year. After that, it's however long you would like. There's no point at which breastmilk stops being beneficial."

The best advice I got about choosing a pediatrician came from the woman who taught my childbirth class. She said, "the most important thing is to have someone you would feel comfortable crying in front of, because there probably will be a point in the first year when you call your pediatrician in tears." I picked the warmest person on my list, and I have not been sorry.

[Melissa]

Something that I never thought to ask, but something I really like about my ped is that she does all exams with the kids on my lap if she can. Even with my four year-old, she still gives her the choice: "do you want to sit with mom or hop up on the table?" It keeps my kids relaxed and happy, I can talk to the pediatrician without having to talk over a whining, crying child who already isn't feeling well. So I would think it worth it to ask how they conduct their exams.