The perfect pediatrician for one family may be totally wrong for another. Finding that right pediatrician for your family involves not only finding someone who is competent to provide health care for your child, but also someone whose temperament and philosophy mirrors your own. Pediatrician and “Today” contributor Dr. Mark Widome says that most pediatricians welcome the opportunity to be “interviewed” by prospective parents. Such “get acquainted” visits can help parents decide — but only if parents ask the right questions.
Parents typically are in the market for a new pediatrician when they are expecting their first child, or when they are moving to a new community, or perhaps when they find that they need a pediatrician who better serves the needs of their older child or teen.
Ideally, parents want a pediatrician who can handle emergencies, get their child through routine illnesses, and provide advice and guidance as they navigate the sometimes-choppy waters from infancy through the teenage years.
The search for a pediatrician may be complicated by health insurance plans that provide coverage only for a certain list of physicians. Furthermore, office hours are becoming an increasingly important criterion because of parent work schedules.
However, with over 30,000 practicing general pediatricians in the United States, parents in most communities should have a number of pediatric practices and practitioners from which to choose. As with most choices, the process of choosing a pediatrician is made easier if you know what you are looking for and are able to set priorities.
MAKE A LIST:
Start by making a list of the things about your child’s pediatrician that are important to you. Some of the items and issues you should consider include the following:
Philosophy and style. This is the hardest issue, but the most important. Parents generally seek a pediatrician who is a good listener and who is not judgmental. But, beyond that, individual family needs and preferences vary widely.
Some parents seek a pediatrician who is a “consultant,” giving parents wide leeway in deciding how to manage both wellness and disease.
Others seek a pediatrician whose style is more “prescriptive,” offering the equivalent of a medicine prescription for everything from toilet training to deciding about school readiness and counseling teenagers about risk-taking behaviors.
Some parents like an office visit where they can sit and talk. Others prefer brief efficient visits and liberal use of reading materials.
The ideal pediatrician for one family is often not a very good choice for their neighbors. If you’re not sure about style, your best bet is to seek a pediatrician who seems good at recognizing the particular needs of different families and is willing to adapt to those needs.
Your child’s special needs. You will want to find a pediatrician who meets your child’s special needs. If your child should happen to have a chronic illness or problem — asthma, diabetes, a learning disability — you will want a pediatrician with a level of comfort in caring for such children. You don’t need an expert; that’s what consultants are for. But you will want a pediatrician who knows how to use pediatric subspecialists as well as community resources. For example, if your child has learning problems, you will want a pediatrician comfortable with and willing to communicate with schools and schoolteachers, someone who will serve as an advocate for your child.
Comfort with teens. Most pediatricians do a fine job with younger kids, but interest and expertise in adolescent medicine is not as universal. So, if you are seeking a pediatrician for your teenager, you will want to make sure that you find one who enjoys providing health care for teens and who is willing and able to take the extra time that adolescent health care requires. You will want a pediatrician who is comfortable dealing with the confidential concerns of your child, and who can counsel your child effectively and nonjudgmentally.
Gender. Choice of a male or female pediatrician may be of no consequence to most families, yet to some children and to many more teens, whether their doctor is a man or a woman makes a big difference. Choosing a group practice with both male and female members makes sense as long as the practice is accommodating to the preferences of their patients, particularly their preteen and teenage patients.
Small or large practice? There are advantages and disadvantages for both small and large group practices of pediatricians. In a small group, you are more likely to see a pediatrician that you and your child know well, both for scheduled and sick visits. In a large practice, you may occasionally see a pediatrician whom you do not know very well, and who is not familiar with your child and family. On the other hand, large practices seldom need to share night and weekend calls with other practices, so if your child should become ill after-hours, he will be seen by a pediatrician who is likely to share your pediatrician’s approach to problems and who has immediate access to your child’s medical record.
Geographic location. Some families are willing to travel an hour or more to go to the “perfect pediatrician.” That’s okay, but it is important to recognize the downside to such a decision. Many problems that can’t be handled over the phone, require only a very brief visit to clarify the situation. (“I’m not sure whether my child has an earache or is just teething.” or “My 16-year-old is worried about a bump on his elbow that is not going away.”) Having a pediatric group conveniently located helps assure that such seemingly-minor, but occasionally important, problems are not swept under the rug.
Availability. In parent surveys, availability of the pediatrician is routinely rated among the most important contributors to overall patient satisfaction. If having a doctor or a practice that you can speak to on the phone and with whom you can schedule appointments in a timely fashion is important to you, then put it high on your list.
Hospital privileges. While most parents do not anticipate that their child will need hospitalization, it is important to know where your child would be hospitalized should the need occur. All hospitals are not equal in the care they provide for children. On average, hospitals that specialize in the care of children and hospitals with pediatric subspecialists on staff do the best job. The same is true of emergency departments. Those ERs that specialize in the care of children and those that have in-house access to pediatric specialists are the ones likely to do the best job caring for the special needs of infants and children in emergencies. You will want to choose a pediatric practice affiliated with one of the better local hospitals with pediatric subspecialists on staff.
With your list of important items and issues, the next step is to identify some potential choices. While reviewing the list of approved practices provided by your health maintenance organization or other insurance carrier is a necessary first screen, I have not found that such lists screen either for the quality or suitability that most parents demand.
Good pediatric practice choices often come from personal recommendations from friends, relatives and co-workers. Seek the advice and recommendations of people who share your parenting outlook and priorities. If such recommendations are not readily available, you may get a good recommendation from your doctor, particularly your OB/GYN doctor because that specialist works most closely with pediatricians. You might also seek the advice of other adults who interact regularly or occasionally with pediatricians: child care center directors, school teachers, hospital nurses (particularly hospital nurses who work in the newborn nursery or in the pediatric wing of your local hospital). If all else fails, visit the nursery or pediatric floor of the best pediatric hospital in your community and ask to speak to the head nurse or to the chief pediatric resident. Ask either of them for a couple names of practices they could recommend.
MAKE A HOUSE CALL
This is the critical step in the process of finding “Dr. Right.” It is also the step that is most often neglected. You don’t need to sign on to a pediatric practice sight-unseen. Call the office and ask if you can pay a short get-acquainted visit to the office and with the pediatrician. Some practices routinely accommodate such requests at no charge while others charge a modest office fee for such a visit. We have found that many families take advantage of such a “get-acquainted” visit in anticipation of the birth of a new baby, but few families do the same when seeking a pediatrician for their older child.
Such a visit will give you a chance to assess the friendliness of the office staff and to see whether the office waiting area is child-friendly and (especially in the case of teens) comfortable for your older child. It is a good sign when the office has a special reception or waiting area for teens, who will be uncomfortable going to a “baby doctor.”
In 10 minutes, most parents can assess whether a pediatrician is going to be a good fit for their family. Parents should ask the pediatrician or the office staff questions like the following about the issues on their priority list:
“If my child were to become ill on the weekend, who would see her?”
“If my child were to require hospitalization, which hospital would she be admitted to? Which doctor would take care of her in the hospital?”
“What is your philosophy about breast-feeding? Exercise? Diet? The use of antibiotics? Preventing injuries?
“How does your care for teens differ from your care for younger kids? Do you prefer to see teens separate from their parents” (Good idea.) “Do you respect teens’ confidential concerns?” (Essential for good health care.)
If this visit leaves you comfortable with the pediatrician and pediatric practice, and if the pediatrician seems like someone you and your child can talk to — especially if you are worried in the middle of the night — then you have probably found the right doctor for your child. If the visit leaves you with lots of concerns, then you will do well to visit the next pediatric practice on your list.
Excerpted from “Ask Dr. Mark: Answers for Parents.” Copyright © 2003 by The National Safety Council, and available from www.nsc.org. Used by permission of NSC Press.
Mark Widome is Professor of Pediatrics at Penn State Children’s Hospital. He writes frequently on topics of interest to parents and is a regular contributor to “Today.”