Picking your pediatrician
By Marsha King
Knight Ridder News Service
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| Look beyond credentials to find a match in parenting theories and bedside manner.
Illustration by Greg Taylor • The Honolulu Advertiser Tips on finding a pediatrician Dr. Jennifer Trachtenberg, a New York pediatrician, teamed with the Web site iVillage.com to suggest tips for parents looking for doctors who will be a "partner" for their families: Don't wait; start looking early. It's wise to begin looking for a pediatrician during the second trimester of pregnancy, allowing enough time to interview several candidates. Get recommendations. The best way to find a pediatrician is to ask your friends, relatives and neighbors. If you are new to your neighborhood, it's a good idea to ask the local hospital, your obstetrician-gynecologist or your insurance company. I Don't settle. In many ways, your pediatrician will become one of your most important healthcare advocates. Choose the one that best matches your childcare philosophies, complements your personality and offers practical advice. Determine what your preferences are. Would you rather work with a solo or group practice? A new practice or an established one? What's the physician's hospital affiliation? Is the pediatrician a member of your insurance plan? How far is the office from your home or workplace? Interview. Ask questions about a doctor's philosophy on child rearing, breastfeeding, circumcision, sleep habits, antibiotics, prescription drugs and immunizations. Then ask yourself: Can I live with the doctor's answers? Learn about the doctor's office and staff. Ask about hours, scheduling, who returns phone calls. Weigh a doctor's philosophy, qualifications and bedside manner. The American Academy of Pediatrics also recommends considering these questions in choosing a doctor for your child: Is this doctor accepting new patients? Is the doctor covered by your insurance? What are the office hours? What happens if your child is sick and the office is closed? Who will answer calls and give advice? Is there an after-hours answering service linked to a hospital? Is there access to specialists and intensive care if needed? — Advertiser news services |
Instead, the Seattle first-time parents simply took a recommendation from a doctor at the hospital after the birth.
Even so, they were satisfied with the pediatrician.
It was the nurse and administrative staff who presented problems.
One day Porch called for advice on how to overcome her son's temporary reluctance to breastfeeding.
"Some babies don't like to nurse. Just switch to the bottle," the nurse replied brusquely.
"That was a little bit jarring," recalled Porch, who'd already had difficulties with billing errors and unreturned calls.
Finally, when Toby was 6 months old, the couple decided: "We had to go elsewhere."
One of the most important decisions you face as a new parent is finding the right doctor for your child.
"In essence you're choosing someone who's going to watch your child grow and develop over the next 18 to 21 years," said Dr. Rob Nohle, chief of pediatrics at Group Health Cooperative in Seattle.
Finding a fit
That expert care encompasses far more than diagnosing the causes of fevers, rashes and diarrhea.
Today's pediatricians — and their nurses — frequently are viewed as parenting partners who can help sort out the latest theories and research on child rearing.
In addition to strictly medical concerns, it is common for parents to ask their pediatrician questions like: Should we pick up a baby who cries in the middle of the night? Is it OK to sleep with the baby? Or should the baby always stay in his own crib? What if an infant is behind schedule in trying to crawl?
It's important that the doctor take time to really listen and to give sound advice.
"You have to totally trust your doctor. ... The bedside manner is key," said Sandra Wallace, an administrator with the Program for Early Parent Support, which sponsors discussion and support groups for parents of young children in King County, Wash.
Quality care isn't hard to come by.
"It's not a problem finding a good doctor," said Dr. Bruder Stapleton, pediatrician-in-chief at Children's Hospital & Regional Medical Center in Seattle.
But it may be hard to find a comfortable philosophic and personality fit.
So it's best to settle on a doctor before the baby is born, pediatric-medicine experts advise.
Starting out
A logical first step is to decide whether you want a pediatrician — a doctor who specializes only in children — or a practitioner who will care for the whole family.
Pediatricians should be board certified, said Nohle. That means they've attended four years of medical school, taken an additional three years of residency in pediatrics and passed a national test on core competency in that specialty.
Beyond that, a parent may want to consider a pediatrician who is a fellow of the American Academy of Pediatrics, a specialty professional society. This means a doctor has met certain standards and been endorsed by other pediatricians who also are members.
On the other hand, someone need not be a pediatrician to be an excellent children's doctor. Family-practice doctors, for example, also receive training in pediatrics. Their focus, however, is treating people throughout the life span.
"It really is a very personal decision," said Kathy Kirchner, manager of Children's Hospital consulting nurses in Seattle.
Parents should also evaluate the type of practice. Some physicians are more knowledgeable about alternative and complementary therapies — the use of herbs, massage and special nutrition, for example. Others may have a subspecialty such as asthma.
"You want to match your child's health condition to the expertise of the provider," said Susan Kline, a pediatric nurse practitioner at Public Health-Seattle & King County.
Know what you want
The next step is to decide what qualities are most important in the doctor who will treat your child.
Katie Porch and her husband, Joshua, drew up a list of what they disliked most about their first experience and what they hoped to find the second time around.
Continuity of care was critical: The staff should remember her son's developmental and medical history.
"I wanted to know that if we walked back in two months later, they wouldn't look at me blankly," said Porch.
The Porches also were looking for courtesy, a welcoming feeling and inviting exam rooms.
Third, get referrals: The Porches began their search by gathering a few names word-of-mouth.
A recent national survey says many mothers start looking for a pediatrician before their child is even conceived. They talk to friends and family, peruse the Internet, call referral lines.
Fourth, make contact. To get acquainted, Porch initially called six doctors when their offices were closed to test how promptly phone calls would be returned. She used the call back to assess the administrative staff's responsiveness and attitude.
Friendly, helpful nurses also often end up being as important as the doctors to mothers, said Wallace. Nurses are the ones who screen phone calls, give shots and, when the doctor isn't available, counsel, reassure and advise.
Meet-and-greets
Finally, conduct interviews: Many experts recommend interviewing the pediatrician in person before making a decision.
These so-called "meet and greets," even if only 15 minutes long, are a chance to assess the fit between the parents, the doctor and the staff.
Doctors can explain their philosophies on hot topics such as breastfeeding versus bottle feeding, as well as circumcision, immunizations and antibiotics. Parents should ask about such things, if they feel strongly about them, to prevent distress down the road.
A good physician develops a philosophy and model of practice over years, and it's not likely the doctor will be receptive to changing that practice just because new parents bring in a newspaper article or Internet comment about a new therapy, said Stapleton.
The Porches finally chose a pediatrician at the Polyclinic in Seattle.
At a short get-acquainted session, they discussed diet to make sure the doctor agreed it was fine to let Toby eat certain foods such as tomatoes and eggs before he was a year old. The couple are laid back about what their son eats and believe he's at low risk for allergies.
They also assessed the doctor's reaction to the idea that Toby be allowed to use a pacifier "until he throws it away." They feel it's important he not be stressed by having to give it up before he's ready. They watched the doctor interact with their son, to make sure she was genuinely interested in children, not just medical problems.
In the one visit since, the doctor has been friendly and low-key.
Since the Porches were the first in their group of friends to become parents, they're now advising others about how to find the right doctor for a child.
Sometimes, a friend's reassuring advice is more valuable than research a parent might do on dozens of expert opinions, said Porch.
