Choosing a Doctor for Your Baby
Choosing a baby doctor is something that many parents don't think much about. They spend hours picking out a crib and push a dozen different strollers before settling on one, but they barely consider the person who will be a vital part of their child's development.
But nothing could be more important. The doctor who gives your baby her first set of immunizations could very well be the same doctor who administers her pre-college physical.
Friends, your personal physician, obstetricians, or nurse-midwives are good people to ask for recommendations. But even if your best friend gives her child's doctor a rave review, you and your partner should interview the doctor yourselves. At that initial meeting, your instincts will probably tell you if the doctor is a good fit, if he or she is the kind of doctor you feel comfortable asking anything.
Linda Corrado, 36, learned the hard way the problems that can happen when that fit is missing. After moving to the West Coast from New York, she took her then 1-year old daughter, Caterina, to a popular practice in San Francisco. Barely two minutes after meeting her, the pediatrician made a hurried assessment of her daughter's persistent cough. What most disturbed Corrado was the pediatrician's rushed manner and his refusal to stop long enough to listen to her.
That haste was the reason, she charges, that he failed to diagnose an advanced case of croup. Twelve hours later, Caterina was rushed to the hospital for an emergency respiratory treatment.
"The doctor really discounted what I was saying," Corrado says.
David S. Geller, M.D., F.A.A.P., a pediatrician in Bedford, Massachusetts, and a clinical instructor in pediatrics at Harvard Medical School, says first-time parents may feel like they're badgering their pediatrician, notes Geller, but they shouldn't.
"There's no such thing as a stupid question, he says. "If you feel like you can't really talk to the doctor, it's a useless relationship."
What are some good questions to ask?
The doctor's staff can answer many basic questions, including those about insurance and billing. Instead of calling in the morning when they are busy, call in the afternoon and ask when someone in the office can spend a few minutes answering your questions. Among the information you should be able to get on the phone:
- Obtaining an appointment, the physician's availability by phone and/or email, and the types of insurance plans they accept (this information may be online as well).
- Billing procedures. If the office doesn't take your insurance, ask about fees. (Check with your insurance company beforehand to find out whether you'll be reimbursed.)
- Office hours. Is the office open in the early morning, evening or on weekends? And are these hours available for well-child visits or reserved just for illnesses? Does the office have calling hours? (Some pediatricians have a specific time each day during which they are available directly by phone.)
- Phone calls and messages. In general, how long does it take to return a phone call? Will the doctor or a nurse call back? Don't assume that nurses and other medical professionals in your doctor's office aren't qualified to answer your questions, but if you want to talk to the doctor, you should have access to her.
- Vacations and holidays. How would your phone call be handled when the office is closed or when the doctor is on vacation? Who would cover for the doctor when he or she is on vacation?
- Emergency medical care. How are emergencies handled? At which hospital(s) does the doctor have privileges? Will you have to go through a pager or answering service? Will the doctor meet you at the hospital if there is an emergency?
When I visit the doctor's office, what should I look for?
When you visit the office for the first time, pay attention to the way business is done. Was the front-office staff courteous when you arrived? Do they seem accommodating to the other families in the waiting room?
Pay attention to whether ill children are shown into exam rooms quickly to minimize the spread of germs. A few offices have separate waiting areas for sick and well children, but this is a rare set-up since no matter how ill her child is, no parent wants her child to wait in the "sick" room. If you feel comfortable doing so, ask a couple of parents what they like and dislike about the office; you can also look at online reviews. But in the end, trust your instincts.
What are some questions I should ask the doctor about his/her philosophy?
If you're satisfied with the answers to your first round of questions, ask if you can schedule a get-acquainted visit with the doctor. Some doctors don't bill for this initial interview, but many charge what they do for an office visit.
The interview should give you a sense of the physician's philosophy and policies on treating illnesses and raising children. You can ask the doctor about how she conducts well-baby visits or treats specific conditions that concern you, her stance on antibiotics, prescribing psychoactive drugs, or readiness to refer your child to a specialist.
Most importantly, the interview will give you a sense of the rapport you can develop with the doctor, how the doctor addresses your concerns and how thoroughly she answers your questions. You'll know if you feel comfortable with the pediatrician or family practitioner and the office, which ideally should have a waiting room that includes toys and books to occupy children, as well as educational booklets and brochures.
"Doctors should hear and respect their patients' concerns, instead of saying 'that's ridiculous'," says Mary L. Gavin, MD, a pediatrician at Alfred I duPont Hospital in Wilmington, Delaware. and a medical editor for KidsHealth.org. "If parents want to know the pros and cons [of a certain treatment], the doctor should be open to discussing it."
Here are some issues you might want to discuss with a potential doctor for your child:
- What is your position on breastfeeding? On circumcision?
- How do you feel about the routine use of antibiotics?
- What's your position on co-sleeping?
- How do you feel about children being on a vegetarian diet?
- If I choose to consult practitioners of alternative medicine, will this upset you?
- If my child has disabilities, will you be able to address them, or be willing to help me find specialists if you can't?
These are all issues that could cause tension between a doctor and parent. Even if you and your child's doctor don't agree on every issue, you can still make the partnership work, but it's better to know from the onset whether your philosophies are similar. "As long as you respect each other and can communicate your differences, you should be able to have a relationship," says Geller.
Whether or not you're in a rural or under-served area, you may want to consider taking your child to a family practice physician or a pediatric nurse practitioner. These healthcare professionals are trained to handle common childhood illnesses and to know when they should refer patients to pediatricians or other specialists, Gavin says. Pediatric nurse practitioners practice under the supervision of a doctor, who may or may not be present in the same office, to provide guidance for more difficult cases.
What can I expect during the first few visits with my new baby's doctor?
You will probably see your baby's doctor more during the first year of her life than at any other time. The baby's first exam will take place immediately after she is born. After that, she'll visit her doctor monthly or bi-monthly until her first birthday (but do keep in mind that your child's physician may do things on a slightly different calendar). Here's what your child's physician should do at these routine visits:
- Administer immunizations (at specific intervals)
- Measure your baby's height, weight and head circumference
- Evaluate your baby's vision and hearing
- Evaluate your baby's physical, motor and cognitive development (this includes asking you questions about her activities)
- Discuss your baby's diet and sleeping habits
- Ask you about any special concerns you may have.
Interview with David S. Geller, MD, clinical instructor in pediatrics, Patriot Pediatrics.
Interview with mother Linda Corrado, San Francisco
Interview with Mary L. Gavin, MD, a pediatrician at Alfred I duPont Hospital in Wilmington, Delaware and medical editor of the Nemours Foundation's KidsHealth.org
The American Academy of Pediatrics. The Complete and Authoritative Guide: Caring for Your Baby and Your Child, Birth to Age 5. Bantam Dell Publishing Group. New York.
The American Academy of Pediatrics. Finding a Pediatrician.
American Academy of Family Physicians. Finding a Doctor for Your Child.
American Academy of Family Physicians. Medical Care and Your Newborn/1-to-3-Month-Old/4-to-7-Month-Old/8-to-12-Month-Old.
AskDrSears.com. Choosing a Pediatrician. http://www.askdrsears.com/html/10/t110204.asp