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by Warren P. Silberstein, M.D.
07/21/97
Some of the things you might want to know about your new pediatrician might come from observation rather than specific questions. How does his office look? How happy and helpful is his staff? How willingly does he answer questions and what is his attitude when he answers them?
You would like to know whether the doctor's usual office hours will accommodate your needs. If you work, early morning, evening, or weekend hours may be important. It's one thing to leave work for an emergency, but infants require frequent routine checkups. You shouldn't have to leave work for routine visits.
You want to know what happens after hours. Does the doctor carry a pager? Does he have an answering service? Is there always someone on call? Will the doctor give you advice after hours? Will he see you after hours if your child is very sick, or send you to an Emergency Room? Out of consideration for the pediatrician, patients should learn what the doctor's hours are and try to call about non-urgent matters during office hours, but patients sometimes need a physician's advice in order to know how emergent a situation is. Some things are best handled in an emergency room after hours. Some sick children should not wait until office hours and yet their condition doesn't warrant an emergency room visit. Patients who go to emergency rooms for non-urgent illnesses may end up waiting many hours while the more urgent cases are seen first. Good advice from the pediatrician may help you deal with your child's symptoms until regular office hours thereby avoiding an urgent visit.
How does the doctor handle routine questions and advice? Does he have a call in hour for parents to ask questions? Does he stop what he's doing and get on the phone? Remember, if you're the patient on the phone with a question it may be great if the doctor picks up the phone for every call, but if you're the patient in the office, being interrupted for phone calls might not be so great. When does the doctor return calls if he can't talk to you when you call?
Is the office so busy that the visits will be rushed? Or will the doctor take time to answer your questions? Consider that the doctor who gives patients all the time they need may fall behind schedule. The doctor who stays on schedule may not be able to spend all the time you feel you need. In fact the doctor you love for all the time he spent with you when you had your first child may be the same doctor who drives you nuts when you're waiting in his waiting room and your 3 kids each have to be in a different place at a different time.
If you plan to nurse you'll want a pediatrician who supports nursing. Not all do, so ask. If the pediatrician simply says, "I'm in favor of nursing," that's not enough. See what his responses to certain scenarios involving difficulty nursing would be. If the prospective pediatrician seems reluctant to commit to nursing wholeheartedly in the face of difficulty, he won't be able to provide the support necessary to help the mothers who are having a tough time to have a successful experience. The last thing those mothers need is a pediatrician who says "Why don't you try a bottle" when the going gets tough. If the pediatrician seems committed to supporting your efforts at nursing the next thing you need to know is how knowledgeable he is about breast feeding. Even if the doctor is committed to supporting breast feeding, if he gives bad advice it can sabotage your efforts. I'm not sure what they teach about nursing in medical school these days, but when I attended medical school, they didn't teach anything. Even if the pediatrician is a woman (a significant number are) who nursed her own children, her personal experience is no guarantee of up to date knowledge on the subject. As for the men like myself, our only chance of knowing anything about nursing is to attend conferences taught by lactation specialists. When I attended such a conference recently I was amazed at how much I didn't know about nursing, and I consider myself very supportive of nursing mothers.
Does the doctor handle most illnesses by prescribing medicine? If your child has a fever will he prescribe antibiotics? I don't personally agree with that approach, but as much time as I spend trying to make patients understand what their illness is, what its natural course is, and what treatment (if any) is appropriate, some patients still get mad at me because they think I'm withholding vital treatment and want that prescription. On the other hand, some patients, when offered a prescription would prefer to know what other options they have and if they can avoid taking medicine.
Does the doctor spend the time to explain everything? Not everyone wants that. Some patients want the doctor to take charge. They may find too many facts and choices confusing and ultimately want someone they can put their faith in to make the decisions.
What emergencies is the doctor equipped to handle in his office? This may not determine for you if the doctor you're interviewing is Dr. Right, but it's a good idea to know what your doctor can handle in his office before you show up at the door.
And certainly, what is the doctor's training? What are his credentials? Is he board certified? What does he do to keep his medical knowledge up to date?
Other factors to consider include the age and personality of the physician. These factors make a difference to some people. If you have a brand new infant the best pediatrician in town may not be the right choice for you if he's retiring in a few months or if you feel uncomfortable with him.
What is the size of the group? Large groups may be able to provide a broader range of office hours, but you may have to give up the personalized care that comes with a smaller group if you see a different doctor every visit.
Finally, what insurance plans does the doctor participate in? Unfortunately, these days more patient/doctor relationships start with an insurance provider directory than any other way. With companies changing their insurance plans every few years in order to get the best deal many patients have to change physicians just as frequently. If a physician participates in many major plans there's a better chance of maintaining a long term relationship with one physician. On the other hand, there's no question that the insurance plans can significantly alter the nature of a practice. A patient of mine who was so pleased when we joined her insurance plan once commented, "I liked this place much better before you started taking all these insurance plans!"
The following Web sites have some recommended questions:
Misc.kids FAQ-Potential Pediatrician QuestionsFinding The Right Pediatrician For You - written for adoptive parents but applicable to any parents.
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