Peditrician Meet and Greet

[swrc00]

I am about to start visiting peditrician offices to choose one. I am going to visit four different offices. All the offices were suggested by different friends. What sort of question would you ask the peds to help you decide on one? What aspects of your child's practice do you like or not like? Thanks everyone!

[maestramommy]

I did this for my first and second ped. With the first it was really helpful, not so much with the second. I found that the questions I asked, while they helped me determine the perspectives of the peds (which is important), it didn't help me determine how good of a doc they were. Case in point: I switched when ped #1 recommended me putting Dora on toddler formula when she turned one instead of whole milk because she wasn't growing enough to satsify him. I was pregnant with Arwyn again and I didn't want the bfing to become a contentious issue all over again. He wasn't unsupportive, but he didn't necessarily have all the facts.

With ped #2 she was VERY supportive of bfing. Unfortunately she was not very well informed either and when we ran into jaundice issues with Arwyn I started working with a noted LC. Good thing too because the ped obviously didn't really know what she was talking about when it came to bfing, which was our whole reason for switching.

Now, in comparing the two I really wish I had stayed with ped #1 because he was extremely thorough in all of the exams, always washed his hands before touching Dora, something that didn't really register until one day I realized that ped #2 never did that:32:Also, we declined the rototeq vax with Arwyn, but she never put that down on the records, so at the next appt. the nurse just saw something noted on the chart and gave most of it to Arwyn before I realized what it was (the oral tipped me off). I was so pissed!

Ped #1 was recommended to me by my OB, who is a family friend. He delivered all the ped's kids, and the ped treated all his kids. He said he was very thorough and very careful. That should've been enough to outweigh the difference in opinion we had over bf. Ped #2 was recommended from a local AP group as someone who was conservative about antibiotics and bf friendly. Which is true, but she wasn't as thorough in her exams, and that thing about the vax just really got me wondering. I started to watch very carefully after that.

[SnuggleBuggles]

My preferences have changed since I was pg with my first. With ds1 I was more inclined to ask the ped about everything (well, not that bad- some people are far worse than me! :)) so I wanted a ped that I was on the same page with wrt to the biggies. Now I have come to believe that many peds don't know as much about breastfeeding, for example, so I don't really care all that much if they aren't that well versed there. However, I do want one that is supportive of breastfeeding in general, one that supports bf'ing past a year, and wants bf'ing to succeed. I just know that their opinion and information isn't the be all and end all. :)

Also, I don't look to my pediatrician for parenting advice or information. Plus, I can do my own research on things. I don't need them to hold my hand and walk me through things. I want a ped for baby's health checks and if baby is sick. Otherwise I want a ped that respects that I know my child the best.

That leads me to say that what I would look for most is a pediatrician that respects my role as my baby's mom. I want to be an informed member of my child's health care. That means I want a ped that will tell me what they want to do, why they want to do it, what the risks and benefits of it are- I don't want a ped that just says this is what we do. I'll take their opinions but I don't want that insists that I take it.

Consider if you have any big issues- bf'ing, vaccines,... and ask them what they think about them. If you are planning to bf this article can help you get a feel for how supportive the Dr. is:
http://pregnancy.about.com/cs/breastfeedinginfo/a/aanho18.htm


Sometimes you just get a feel for the practice so follow that feeling.

Some logistical things I have liked, didn't like or didn't care about...
-I don't like specific call in hours. I want to be able to call in any time if I have a question.

-I **love** solo practices! I have been to one group practice (best in the city) and I hated it. I hated that if I had a sick child visit we could see a Dr. that didn't know us at all. Or if I had to call in after hours I would have to talk to a nurse that may not know us at all. With the solo practices we have been to if we had a health emergency or big concern after hours we call and actually talk directly with our peditrician. It is so nice to just have great continuity of care. I have never had a problem as a result of only having one Dr..

-Same day scheduling isn't a horrible thing so if one of the practices has that don't immediately dismiss it.

-If they are willing to email with you about non urgent things that is great. Sometimes it is just nice to shoot off a question like, "when can my baby eat yogurt?" and get a reply that day or the next.

-I love practices that take the time to talk to you before doing the exam. I just left one that would fire questions at me while examining ds so I never really felt like she was listening.

-Same thing goes for any Dr. that has their hand on the door as they ask "any questions?". Yuck.

-One practice we went to (best one ever! still sad that we moved away!) had large, carpeted, totally child proofed exam rooms. The scale was in there too.

-I could care less about a sick child/ well child waiting room unless they actually also have sick child/ well child exam rooms. Even then I just don't care that much.

-Convenience of the location is helpful. Our last practice had a metered parking behind the builing and an elevator. Not biggies but this new practice has a small lot and you are mere steps from the front door when you get out of your car.

-I do not care if the ped has kids of their own. I do care a great deal about bedside manner. The lack of good bedside manner was what drove me out of the large practice we went to.

-One practice used to fill out these little forms for you to take home that had all of baby's stats on them. I really liked that. I could do it myself but never remember to.

I got the recommendation for my current Dr. from my midwife. She uses the same Dr. and loves him. Also, she said that he was very supportive of many of the parenting decisions moms who choose midwives tend to make as well as being very in favor of informed patients and parents. This practice has been great. He doesn't get stressed about things. He doesn't look at percentiles much at all (I'm sure he does but he really doesn't share them unless you ask). He says they stress people out for no good reason. He just wants to see that baby looks healthy and is growing.

I'm sure there are more things I could say but I'll leave it there. Others will fill in the gaps. :)

Beth

[hillview]

Things that are important to me in a pedi:
- wanted someone who was old enough not to be BRAND new (eg not overly worried type -- BTDT) AND young enough to likely still be practicing in 15 years when the kids are older. My pedi who saw me was still in practice -- um no thanks
- I liked that my pedi has 2 boys (as do I) they are about 7 and 9 years old -- this is something for consideration as the boys get older -- pedi is also a male which seems helpful -- these were NOT considerations initally as I didn't know the gender when I was pg and selected him but now seem nice
- he is very pro BFing
- he has 24/7 nursing support (eg an after hours number where a nurse will call you back pretty much immediately) which as a first time parent was AWESOME -- saved me some sleep and a couple trips to the ER doc
- is in a major hospital which when DS #2 was d/x with hydrocephalus ended up being great as all docs were in one place (again not an initial decision factor but in hindsight was great)
- deals with my detailed questions and will draw pictured to illustrate what is happening etc and doesn't rush me out the door etc.

That said he has aspects that I don't love (suggested to turn car seat at 1 year; has a tone that he uses sometimes with me that I don't love etc).

HTH
/hillary

[wendibird22]

I did interview peds too, but looking back I had no clue what to ask/look for. Knowing what I know now:
1. supportive of breastfeeding...not just in word, but in action too. I thought mine was supportive but he sent me home with a can of formula at DD's 1st visit because she was still losing weight (um, yeah, she was 2 days old and my milk hadn't come in yet!).
2. after hours nurse line (agree with PP, this is helpful when you are nervous with your first child)
3. single doc or small practice. Everyone at our peds office knows us and our DD. We always see the same NP (if the doc isn't available)
4. willingness to be flexible with vaccines...in case you wish to delay or skip vax's. I say willingness because a majority will promote full vaccines as recommended by the CDC, but it was important to me to have someone who will state that and still be supportive of MY decision without guilt or disgust
5. scheduling that accommodates you...do you need evening or weekend appointments because of your work schedule? Do you need early morning sick visits to see whether DC can go to daycare or not? Our ped does well baby in the a.m. and sick baby in the p.m....I guess to avoid well and sick kids being there at the same time and so that well kids aren't exposed to a half day's worth of germs. But, this means that if DD is sick I have to wait until after lunch to see how sick she is. Which means I basically miss a full day of work. A friend of mine's ped is open at 7am for "drop in" hours before work/daycare.
6. location, location, location...near work? home? daycare? Our ped is near my work and home, but far from DH's work and DD's daycare. So, it can be difficult if DH has to take her and then get himself to work or if I have to leave work, drive all the way to DCP and then all the way back to the ped.
7. which hospital are they affiliated with and/or have admitting rights at (if there are multiple hospitals in your area)
8. will the ped conduct the newborn exam when DC is born? Our ped is 30 mins from the hospital I delivered at so he did not examine DD, the "staff" ped at the hospital did. Not a huge deal, but still would have been nice to have our ped conduct that first exam.

[brittone2]

I never really interviewed peds, but went by word of mouth recommendations. If I were to interview a ped, I'd ask open-ended questions. For example, if you ask "are you supportive of BFing" 99.9% are going to say yes. If you start asking about what measures they have in place to assist a mom that wants to BF but is encountering challenges, you'll find out more (how often do they give out a phone # for a LC? Do they have an LC on staff?). What are their recommendations/what steps do they take for a baby not gaining well after 2-3 weeks? (are they immediately recommending formula, or talking about exhausting other options first like checking for tongue tie, latch issues, increasing the frequency that mom has baby at the breast, etc. if mom wants to continue). What do they tell moms that are still BFing at 1 year of age (meaning, do they push weaning if mom is interested in continuing. There are peds that willl say there is no nutritional value, no antibodies, all kinds of things that aren't true because they aren't informed. Many don't tell parents that the AAP recommends BFing for a *minimum* of 1 year, and instead treat it as a "max" like they should be weaned by 1). I'd ask open ended questions to figure out if they supportive of a delayed vax schedule if that is of interest to you.

What percentage of babies in their practice are circ vs. intact and what advice do they give parents (there are still nurses and MDs that tell parents they need to retract their intact baby, which is not only wrong/outdated, but potentially damaging). I'd also ask about whether they hand out parenting/discipline advice routinely (I had a former ped that would say "at our next visit we'll discuss discipline strategies" when DS was turning 1, unsolicited. It was part of her standard well-baby visit. Personally, that rubs me the wrong way since I was quite happy w/ our approach and it was working well for us.). I like a physician that respects family individuality. We actually see a family practice doc now and really like him. He held DD at each well baby visit...IMO, you can tell a lot by doing that (muscle tone, development of head control, social skills, etc.). The PT in me liked seeing that *real* interaction. He asked open ended questions. He would really ask about how our family as a whole was adjusting to a new baby (how were things going w/ DH. Was I getting enough sleep? Support from family? Getting enough to eat/drink? How was I feeling? How was big brother adjusting to baby sister, etc.) He was interested in the whole picture, kwim? I wasn't even a patient there at the time, but the focus was on our family, not just a list of milestones.

[infocrazy]

Honestly, I am on my third ped (same practice). I interviewed the first one but I didn't really know my parenting style and what was important to me. I thought he was FANTASTIC, but in practice, he and I just didn't click. He had an interesting sense of humor and if I asked him a question, I didn't always feel like he was listening.

The second one didn't really have a great manner with my boys. Very impersonal...good medically but DS1 was terrified of her and she didn't help that situation. I'm surprised she became a ped honestly. Neither was really that informed about breastfeeding and although they supported it...they didn't really I guess.

I LOVE the last one. She takes her time, asks lots of questions, gives explanations and reasoning for decisions and respects mine. She is very comforting, my boys think she is great! If the baby is crying she asks to hold him. I am really happy with her now. I guess what I am saying is that you should probably look at location, hours, how easy to get an appt, after hours policies, hospital affiliations and board certifications. The actual doctor you may not really know what it is you want yet.

[swrc00]

Thanks everyone! We have visited two peds so far. The first one I loved, but it is not in a very convenient location from work or daycare. The one we visited tonight was good to, but she kinda of put me off about name brand formula. The first ped said choose whatever brand you want to use just make sure it has DHA and ARA. The one tonight says she recommends only Enfamil or Similac. Oh, I wish I could BF!!!! Thanks, again.

[SnuggleBuggles]

I wonder if they are getting kick backs? I know that this is a big deal in the world of OB and pediatrics. They get all sorts of goodies from formula companies so I am a bit skeptical when I hear things like this. Generics are supposed to be just as good.

Beth

[cheri]

I wonder if they are getting kick backs? I know that this is a big deal in the world of OB and pediatrics. They get all sorts of goodies from formula companies so I am a bit skeptical when I hear things like this. Generics are supposed to be just as good.

Beth


Kickbacks? I hope you're (at least half) kidding here. A physician getting a kickback would be incredibly unethical. [I'm not talking about drug rep crap (pens, stethoscope nametags, etc.)]

[SnuggleBuggles]

Kickbacks? I hope you're (at least half) kidding here. A physician getting a kickback would be incredibly unethical. [I'm not talking about drug rep crap (pens, stethoscope nametags, etc.)]

I meant kickbacks like that. They still count, imo. The formula industry pumps a lot of money into marketing.

When parents get goodies and samples from their Dr. they get the feeling that it must be better b/c a Dr. ok'ed it.
http://banthebags.org/?cat=3
http://www.nytimes.com/2008/05/01/health/research/01breast.html?ex=1367380800&en=78e3b00badcb53da&ei=5124&partner=permalink&exprod=permalink

It just seems weird to me that time and again I hear that the generic formula is just as good (many are manufactured by the same people as the original) but this ped is endorsing brand names. It kind of makes me wonder.

Beth