To switch (pediatricians) or not? (Sorry, kinda long)

[AngB]

With DS, we went with the first pediatrician we interviewed, we liked him well enough, I was emotional and stressed out with a high risk pregnancy after the neonatal loss of our daughter and not in the mood to really thoroughly "shop around" for a pediatrician, my (15 yo) brother has been going to him for years, so it wasn't like a random pick. Back then, aside from having an alive baby, I was mostly concerned with a doctor being okay with us following an alternative vaccination schedule. (And he was/is.)

Now DS is 16.5 months and we are expecting DS2 sometime between any day now and the end of Oct. (Only 32 weeks so hopefully NOT any day, but high risk again and things aren't looking too fantastic so it may be sooner than later.)

The big things I don't like about our current pediatrician are:

-they don't do hospital rounds for babies or kids, ever, even though it's a 6+ person practice. (This is a big deal b/c we had a really hard time in the hospital with DS and the "in house" pediatricians. We dealt with a different doctor every day and one would say one thing and the next day the new one would say the complete opposite even in the same circumstances/info. And they pushed formula on us BIGTIME even though the lactation consultants were assuring me, and them, that breastfeeding was going fine and DS was taking in enough.)
And the point was recently driven home when I was just stuck with a hospitalists in May- because my GP doesn't do hospital rounds either- who gave me meds via IV that I was allergic too because he didn't think I was "really" allergic to them anymore since I hadn't had a reaction (or been given that med!) since I was a kid...when I began breaking out in hives and itching in under ten minutes after the IV was started (while pregnant no less), he then tried to argue with the nurse that it wasn't the med giving me an allergic reaction. So needless to say, we have had bad experiences with "in house" pediatricians and doctors. He also redid a test (that was painful!) that one of the specialists had done only a few hours before, because he waltzed on in without reviewing any of my info or what any of the specialists had seen/done. That was bad enough for me to deal with, it would have been horrible if it had been my child. I'd rather avoid it if there's a pediatrician in our area that is decent enough who *does* do rounds and stuff for hospitalized patients.

- They don't do after hours calls at all, those go to a nurse at the children's hospital who knows only what they can read in the computer records about your kid.

-He talks way more than he listens. He'll ask if DS is doing X, and I barely get a chance to answer just "yes or no" before he launches into what his daughters were doing at that age. I feel like I know more about his daughters than he knows about DS. And I often feel like I leave with questions unanswered because even when I ask it, he gets off topic or doesn't really answer or tells me about his daughters.

The good is that he's laidback in general. He was very supportive of breastfeeding. He doesn't push meds unnecessarily (though DS has never been sick beyond colds), he is laidback about alternative vax, I've never had a problem getting into the office the same day, he is still my brother's pediatrician which is convenient in case my family ever needs to take DS to the doctor for me, etc. He has given outdated or "not the best" advice IMO as far as giving us the okay to start solids at 4 months (though more of an "if you want..") and at DS's one year in the paperwork they gave me it mentioned you can turn them forward facing at a year (with nothing about it being better to leave them rf'ing or the current AAP rec)..I didn't mention it since I already knew better.

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I met with a new pediatrician today who my like-minded friend is using. It is a 2 doctor practice. She is young and new (2ish years in the practice), her partner is very experienced (my friend went to him as a kid), but he will probably be retiring in the next 5-6 years.

-They do hospital rounds for all of their babies and patients, and after hours calls goes to an exchange and then to them, not a nurse.

-She seems much better at listening, even from the "meet and greet", just comparing meeting our current pedi vs. the potential new one.

-She is willing to work with parents on a flexible vax schedule and doesn't seem like she will be pushy about it at all (which isn't different from our current ped)

-I'm not sure she will be as breastfeeding friendly/relaxed as our current pedi., and may try to push formula more than our pedi ever did/would. She seemed super, almost too much, impressed that I breastfed DS over a year. (I don't plan to bf much beyond a year.) But then again, she seems pretty flexible overall, and fingers crossed this could entirely be a non-issue if it all goes well. I'm more experienced as far as breastfeeding this time around and am fairly comfortable standing up for our breastfeeding relationship.

-She only has had one intact/uncirc'd patient (same as our current pedi). She seemed supportive of it, but as this is an area with a crazy high circ rate, not totally up and up on the care of an intact penis. (The other patient is preschool age so she never saw them as baby.) She mentioned that there are virtually "no problems" with keeping it intact except maybe sometimes in much older men (like 60's+) with keeping it clean. She mentioned something about "pulling it back a bit to clean under the tip" (YEESH!) And I said nicely " Well, I am really strongly against wanting it retracted at all by anyone until they are old enough to do it themselves" and she was more than okay with that as long as everything is structurally okay (like as long as the opening is in the right place, etc.)...which obviously that's a different story anyway. That's the biggest part that gives me pause, but I've actually never discussed this with our current pediatrician, (I've meant to...the talking thing), he's never tried to retract DS yet, but DS is only 16 months, he may very well be of the "cleaning under the tip" mindset as well. If I go with them, I *think* I may bring in a printout on care for intact boys, she seems like she would be okay with that and I would mention it as, "this is the approach we want to take"...or does that seem overboard/a bad idea? (Like I said, I don't think we are going to find a very "intact friendly" pediatrician in our area and our own pediatrician may not be as intact friendly either. So I think going with someone young who seems flexible and willing to acknowledge/learn what she may not know, could be a good thing.)

-They had stuff about rearfacing till at least 2 (the AAP recs) on the back of the exam room door. :thumbsup: (I'm not *exactly* a car seat safety guru, but it turns me off when ped's don't at least give out the latest recs on carseat safety, so parents who might not know will at least consider it.)

Sorry for rambling so much, pregnancy brain and a lot going through my head right now!

[sste]

Well, for me new baby hospital rounds are nice certainly but a one-time thing . . . but do they round if your child is otherwise inpatient and work as part of the team in their inpatient care? I wasn't clear on that.

We chose our pedi based in significant part on that inpatient factor and also on general clinical reputation. It is hard to find docs who follow inpatients nowadays.

I personally wouldn't weight the BF part as a "major factor" for an experienced mom/BFer so long as you are comfortable blowing off formula recs. I think it is a very big deal for a first-time mom though.

Do you have any friends in the healthcare field you can ask? I have personally seen parents hook up with some lazy, lousy clinicians who are superb gladhandlers. Not saying anyone you described sounds like that but there is sometimes a big emphasis on like-mindedness that is not balanced by an emphasis on clinical skill, diligence, quality of office staff, continuing education etc.

[Kindra178]

Of all the things you said about the old ped, this is the thing that bothers me most:

They don't do after hours calls at all, those go to a nurse at the children's hospital who knows only what they can read in the computer records about your kid.

Let me preface this by saying that I have two peds in my immediate family and have spent years working in various capacities at a pediatric practice.

Referring after hours calls to a nurse is not acceptable to me. I am certainly not criticizing nurses, but if you need a doctor's advice overnight, you need a doctor's advice overnight. Period.

I wouldn't worry though about the fact that the nurse or doctor with whom you speak to at 2 am has access to your child's records. Most of the time the doc is home sleeping so he or she wouldn't have access to the chart either.

[arivecchi]

The new ped sounds like a big improvement to me. The ability to do calls after hours is hugely important to me, so that alone would be worth it IMO. The fact that she seems more willing to listen and will do hospital rounds would clinch it for me. (I actually did not know that some peds did not do hospital rounds!) Overall, it sounds like a much better fit to me.

[Simon]

I understand and sympathize with your concerns. In your place, I think I would try and change. Although I would not weigh the factors you list the same as you have.

My major concern would be the not listening to you and talking too much about his own child. That would cause me to leave because he isn't really carefully monitoring your child's health. There is one Dr. in our practice who does this and I avoid him like the plague.
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Re: in-hospital rounds. We have used "in-house" peds immediately after birth (including NICU) and then for the 3 in patient hospitalizations we have experienced between my 3 kids. Only once was it a disaster. My first thought is that when you aren't dealing with major issues child health issues while you are post-partum, then you are better able to stand your ground and advocate for your child. Also, you are now a more experienced patient and will be less likely to let them roll over your objections. IME, hospitalists can be very helpful because they know the nurses and other staff, and are more available to you. Your ped has clinic hours and patients to attend to, not just your critical care issue in the hospital.

I am not, personally, comfortable with a very new pediatrician in a small practice. Maybe its just because my own kids have come down with common illnesses only diagnosed through rare symptoms, but too often it has been the older and very experienced Dr. who recognized on sight the illness and then brought in all the newbies to "see" this rare thing. It saved my kids unnecessary testing, misdiagnosis and delayed treatments. She'll have several more years under her belt before her partner retires, I would ask what the plans are then (solo practice or find another partner).

[SnuggleBuggles]

I much prefer a solo practice where, if I call after hours, I talk to my Dr. or the nurse that knows us. So, for that reason alone, I'd be inclined to switch.

Neither boy is circ'ed and I have no idea what the % is in my practice. I wouldn't let that or her inexperience worry you. You can do a simple, "remember to leave the foreskin alone" before exams if you are worried.

[mackmama]

Ok I definitely think the new pedi you interviewed sounds like the better choice. I'm so sorry that you've had such awful medical experiences. Trust your gut - it just doesn't sound like your current male pedi (who your brother uses) is a good fit for you. It would bother me a lot if I felt like our pedi did not listen. That would be my major reason for switching. I can also understand your other reasons. We have a young and new-ish pedi, and I feel really comfortable and confident in her.

[ett]

No after hour calls and the doctor not really listening/talking too much would be the 2 main reasons I would switch.