Interviewing pediatrician this morning - what should I ask?

[LadyPeter]

I plan to breast feed for a year, and I don't want an alternate immunization schedule...but I have no idea what's important in a pediatrician, other than:

1. they know what they're doing,
2. they're not mean to me or my son,
3. they're easy to get appointments with
4. they take our insurance

What am I forgetting? Should I just have them tell me about their practice and see what kind of vibes I get?

[clc053103]

Same day appointment accomodations
after hours calls- for example, some calls go to answering service who call the on-call dr to contact you. Others if affiliated with a hospital (like a children's hospital) may go to the hospital's e/r directly so you speak with a nurse and/or dr immediately at all hours. I prefer the latter.

But vibes are also very important!

[jamesmom]

The most important thing to us in a pediatric practice is the office hours and the access DS and DD has to a doctor or nurse practitioner. Our pediatric practice is awesome in that respect. When I call them in the morning when DD or DS is ill, they always offer me a late morning or afternoon appointment on the same day. We've never have to wait more than 20 minutes to see the doctor either. Our pediatric practice has 4 doctors and 4 nurse practitioners on staff, so they have plenty of physician coverage, excellent office hours and great access to medical staff. I have heard horror stories from other moms about the amount of time they spend in the waiting room, and even not being able to make an appointment to see the doctor if the screening nurse deems the child not sick enough.

Another area you have to find out more about is that particular doctor or practice's view towards important parenting issues such as breastfeeding, circumcision, sleep training, etc. It's not too fun having a pediatrician who's unsupportive of your parenting decisions. Good luck! I hope you find a pediatrician you love!

[Katigre]

1. Ask about how long their patients typically bf and how often the dr. recommends formula supplements. IME a badly educated ped can really sabatoge a bf'ing relationship

2. You feel respected as a parent as a partner in your child's medical care. Condescnding or 'we know so much better than you' would make me change practices. You want your confidence as a parent bolstered and nor undermined by your child's ped

3. How they handle a sick child - will they diagnose and offer treatment options over the phone or require an office visit (and copay...) to talk with the dr.? One thing I really appreciate about our Dr.'s office is that I can call about an issue one of the kids is having and they'll give advice over the phone (even the actual dr. will call me back personally) and they only have me bring the kids in if it's something serious I can't treat at home with OTC remedies. I really appreciate this b/c it saves me $$ and gas and the stress of a dr. office trip and has also helped me learn how to care for simple things at home with my dr.'s help.

Also, don't rule out Family Doctors/Family Practice instead of a ped - that is what we use and have been so happy with that option :).

[JBaxter]

Same day appointment accomodations
after hours calls- for example, some calls go to answering service who call the on-call dr to contact you. Others if affiliated with a hospital (like a children's hospital) may go to the hospital's e/r directly so you speak with a nurse and/or dr immediately at all hours. I prefer the latter.

But vibes are also very important!

If its a boy are you planning to Circ? The circ rates are dropping rapidly but sadly not all peds are intact boy friendly

Are you planning to vaccinate on the CDC schedule, Dr Sears or delay. Many Peds will now allow delayed schedules and many are fine with it.

[misshollygolightly]

As another pp mentioned, I'd look for a ped. who is supportive of your decision to circ or not to circ (whichever you decide). I also asked our ped about whether or not she had any kids (she does)--not that it would've been a deal-breaker if she didn't have kids of her own, but knowing that she has three sons made me feel a bit better about having her take care of my son.

It's also good to find out what the practice offers in terms of after-hours care (is there a triage hotline to call? a walk-in clinic? after hours number?).

Also good to find out what other doctors are in the practice, as you may end up seeing one of them if your pediatrician isn't available when you need to come in for something.

[MamaSnoo]

Ask about how long their patients typically bf and how often the dr. recommends formula supplements.

To me, how long their patients BF is not really the issue. That depends a lot on the moms' own preferences. Plus, BF rates vary in communities, so depending on the patient mix and population served, they might not have many people BFing for long periods.

If you are interested in BFing, or in extended BFing, and want to ask a potential ped about it, I would ask it a little differently. I would try asking about if they work with any LCs, or what techniques they use to help support BFing moms. I would also ask about their opinion on EBF (if that is something that interests you).

Other important things that people have mentioned is office hours, same day sick availability, the call structure.

To me, the size of the practice mattered at lot. We go to a group with 2 docs, so I feel like I know them well (and I know who we will see if we go for a sick visit). I know the RN well too, and the other office staff. I like that personal attention. They do not have Saturday hours (that was the tradeoff), but it works for me. Others like larger groups for the opposite reasons. It is just personal preference, but it is good to think about it.

Finally, I would ask them about their thoughts on antibiotics for mild illnesses. I do not want DD to get a Rx for every sniffle. My ped feels strongly about it too, so it is a good fit for our family.

Lastly, on the issue of a ped not supporting your parenting choices. I mostly (80%) am in agreement with my ped about things. The 2 docs in the group are actually not in agreement about everything, which takes some pressure off me, I guess. But, I do not not worry about this a lot. They are parenting choices. The ped is a doctor, not my parenting coach. I do ask for advice on non-medical parenting issues sometimes, and I view it as advice, like I might get from my mom or a friend or a parenting book. Sometimes, I want to follow it; othertimes, a different plan seems better for my family. As long as I am not pushing the envelope medically, this has been fine for us. On some issues, I do not even bring them up if I think the ped won't be supportive (e.g. EBF--one of the docs was for it, one was opposed; we did not talk about it with the second doc). I think that as long as you have a good relationship overall and you trust their medical care, and you feel confident in your choices as a parent---- you do not have to have the ped be in 100% agreement with your parenting choices.

[pantone292]

It's great when a ped has a well child waiting room and a sick child waiting room. An alternative to this is a well child day (or morning, etc) for checkups.

[brittone2]

I think the point of asking questions like how long the doc typically sees patients bfing for is to tease out if he/she will be supportive of extended BFing. Many of us here (me included) never thought we'd nurse beyond age 1. Many medical groups back extended BFing (WHO and American Academy of Family Physicians both recommend a minimum of 2 years). However, sometimes peds will start to pressure moms to wean at 1 (for no medical reason, just because their opinion is that's when you should do it). If mom and baby are happy continuing to nurse, they shouldn't be pressured to stop since the AAP says there is no "upper limit" to the duration of BFing...as long as mom and baby both want to continue.

I think it is important to ask open ended questions. If you ask most peds "are you supportive of Bfing" I'm sure 99% will say yes. But what you really want and need to know is what happens when things don't go smoothly? Are they still supportive? Do they jump right to recommending formula or do they refer out and suggest a consultation with a lactation consultant? What kind of weaning advice do they hand out (supportive of extended BFing? Do they push solids at 4 months or follow the more current research and recommendations to exclusively BF the first 6 months? Some peds sadly try to push parents into solids 2x a day by 6 months when some babies aren't ready for solids at all.

I think you really get better info if you ask open ended questions about BFing vs. saying "are you supportive?" otherwise you won't know what you are dealing with in advance.

eta: I also personally do not like peds who hand out parenting advice unsolicited (discipline, etc.) since I think that is mostly a matter of personal opinion. We had a ped at one point who was great with BFing but would give handouts on how to do timeouts, etc. and we don't really do timeouts, for example. I was willing to overlook it but I think it is fairly annoying. Totally fine if a parent asks IMO, but there are many peds who hand out a lot of parenting advice that isn't really wanted or appropriate for every family.

[MamaKath]

I think it is important to ask open ended questions. If you ask most peds "are you supportive of Bfing" I'm sure 99% will say yes. But what you really want and need to know is what happens when things don't go smoothly? Are they still supportive? Do they jump right to recommending formula or do they refer out and suggest a consultation with a lactation consultant? What kind of weaning advice do they hand out (supportive of extended BFing? Do they push solids at 4 months or follow the more current research and recommendations to exclusively BF the first 6 months? Some peds sadly try to push parents into solids 2x a day by 6 months when some babies aren't ready for solids at all.

I think you really get better info if you ask open ended questions about BFing vs. saying "are you supportive?" otherwise you won't know what you are dealing with in advance.
:yeahthat:
Breastfeeding and extended nursing were interesting questions and said a lot of how supportive they would be of my decisions as a parent. Questions I asked when I was pregnant also related to their views on things that might be important to us like: sleeping arrangements (would they be supportive of co-sleeping or crib sleeping if we found one to work better for us); circumcision (this was a loaded topic I found and ended up choosing someone who felt it was our decision not the pediatricians); solids; sick policy; vaccination scheduling.

I agree with Beth, ask open ended questions and if you can ask without letting your feeling on the topic being known it will give lots of insight to the doctor. DH always called my list "The Loaded Questions" and chose not to go along on interviews after awhile (especially after one doctor made comments that really went against how we felt on one of those topics, he happened to be a family friend at the time).

Hope your visit goes well!

[Kestrel]

We decided in part by the other people in the office. Besides the ped himself, there are four other docs to cover when someone is sick/on vacation/ect, four nurse practioners of which two are certified lactation consultants, and several more RNs and LPNs. They have two billing people, and one woman who's entire job is "insurance co-ordinator" who deals with the insurance company for us! We've never had to call them, not once!
When DS & I were having some pretty extreme latching problems in the first few days, we we in with the lactation nurse twice a DAY for eight consecutive days. They told us - "don't worry about the cost, we will figure it out. YOU concentrate on your baby." What a blessing. They got our crappy insurance to cover all but $25 of those 18 appointments in eight days.

Something you might not think to ask; our peds office has reception turnover issues; that's been a problem. The actual medical staff, though, is solid. But turnover is often a problem, I asked how long so-and-so had been with them.

[erosenst]

If you go to the office for the interviews, see how long people are waiting/how crowded it is at the receptionist desk, etc. If you don't go, ask how long the typical wait is.

We were referred to a practice when we moved here. Went for the intro meeting, and waited 45 minutes. Ped was very slightly apologetic, but that's it. Receptionist area was a long wait as well. Ended up there the next day as well (bee sting that swelled - ped wanted to see it). They had a cancellation, so we had an appt and weren't just being squeezed in. Another 45 minute wait, and another very slow receptionist area. Also found out that she didn't believe in Tylenol for teething.

We switched peds. LOVE this group and office. In almost four years, have waited 30 minutes once (with profuse apologies); otherwise, are seen within 15 minutes of appt. Never had to wait behind more than one person to check in or out. (And, of course, like the peds, their philosophies, etc - but that was covered by PP's.)

Emily

[Raidra]

I'd try to assess whether or not the pediatrician views you as an equal team member in your child's health, or whether you're just supposed to take orders. Maybe a question like, "What do you think the parent's role should be in my child's healthcare?"

You should also try to get an idea of whether the pediatrician will be sensitive to differences or not. For instance.. our former pediatrician would say things like, "Are you wearing a diaper? Only babies wear diapers.." and he said to a friend of ours, "Wow, you and your husband aren't fat, what's wrong with your daughter?"

I used to be of the opinion that it didn't really matter whether your pediatrician agreed with you on things like sleep and discipline issues (I just ignored our old pedi's advice), but now that we've switched to a family practice doctor who is more like us, philosophically, it's made a *huge* difference. I still don't ask for advice (that's what BBB is for!), but I never leave the office feeling weird or abnormal.

The one thing I don't like about our office is that they don't have call hours to speak with the doctor.. you have to go through the receptionist (!), then the nurse, and if that's not enough, you have to go in to speak to the doctor. Our old pedi office had call hours every morning where you could call and speak directly to the doctor.

[brittone2]

We have had great luck with family practice docs in the past as well. Not all of them are great with babies but we had an absolutely fantastic family practice doc in NC. I adored him. Great, compassionate, sensitive care, up to date, ran breastfeeding classes in his office (how many peds do this??), was supportive of extended BFing, gave us his home phone number when DD had laryngomalacia as a newborn and we were worried at first, etc. We often had longish waits which was the only downside, but he was worth the wait, and well visits were detailed and rather lengthy/thorough. Much more so than in several of the ped offices we've used through the years. Obviously there are some great peds and family practice docs and some not great peds and family practice docs. I just wanted to comment since we had a great thing going when we found a wonderful family practice doc.

I know not everyone is comfy with family practice but in the right situation, I think it can be a great option.