Q&A: finding a pediatrician

Mary writes:

"Everyone tells us we need to go out and start interviewing pediatricians (I'm 30 weeks pregnant).  Ok, fine, but what do we ask them?  And how do we find ones to interview?  A coworker recommended one that she used to work with but other than that, we're kind of clueless, as we are with most of this baby stuff."

Choosing a pediatrician is a lot like planning a wedding. There are a hundred things to think about, and things you have strong opinions about will be completely unimportant for other people, and vice versa. The trick is to figure out what you care about. Then you can ask those questions and just not worry about the other things.

To find doctors to interview in the first place, ask everyone you know who they use(d). Also go to your insurance company's website and get a list of names. Once you've figured out what you're looking for (which I'll cover below), call up and ask your first level of weed-out questions over the phone. You may not have to interview more than one or two people in person.

The first thing I'd think about is your parenting style. Are you going to be laid-back or highly managerial? When my son was maybe 10 weeks old he had some rash that I asked my doctor about. He told me, "Squirt some breastmilk on it. At this point breastmilk, either in him or on him, is pretty much the cure for every problem he could have." I was happy with that answer (and the breastmilk did clear up the rash), but a more highly managerial parent would have been upset that there wasn't a definite diagnosis with a clear treatment path including a plan for contingencies. If you call and ask a question, do you want to know exactly why things are happening, or just that they're normal? A mismatch between your style and the pediatrician's style will leave you feeling inadequate and judged or frustrated and angry.

Don't confuse this with the parenting philosophy you follow, which is another thing you should ask potential doctors about. If you have definite opinions about things like scheduling, feeding, sleeping, pacifiers, vaccinations, circumcision, etc. you want someone who's going to support you, not someone who makes you feel like a bad parent for choosing those things. Your pediatrician doesn't necessarily have to agree with you about everything, but s/he does have to support you without being judgmental. If you say, "We intend to cosleep. How do you feel about that?" the correct answer should be something like "There are a number of families in my practice who cosleep" at a minimum (because it doesn't necessarily imply endorsement, just familiarity and acceptance) or "I think cosleeping is wonderful for babies and parents" as an ideal. If you hear "I don't recommend it. You'll end up with a 5-year-old in your bed," move on to the next doctor on your list. (Obviously the same thing goes if you want to have your child sleeping in a crib and you get a less-than-enthusiastic response from an interviewee ped. Next.)

There are, of course, going to be some things you don't care about. Just don't ask about those. If you have someone who matches your views on the things you are most concerned with it doesn't really matter if you match on the other things. Make sure you take into consideration the style issue, though.

Breastfeeding is another thing to ask about. Every pediatrician (unless s/he's stupid) will claim to be supportive of breastfeeding. But claiming to be supportive and actually being supportive and having the knowledge to help with common nursing problems are two vastly different things. How many mothers in the practice nursed for 6 weeks? 6 months? 1 year? The answers to those questions are going to tell you how much emotional support the doctor gives to breastfeeding and how much practical help the doctor gives (that includes being able to recommend and partner with a good lactation consultant). Medical school still does not teach much about human lactation, so what pediatricians know about breastfeeding is what they've chosen to learn. A good ped either has made the effort to become educated about breastfeeding (beyond the info pamphlets the formula companies send--at a minimum the doctor should have taken the same 3-hour class you took) or recognizes that an IBCLC lactation consultant is an expert on breastfeeding and treats her as a colleague and not an underling.

Antibiotics are another hot issue. Some doctors prescribe them at the drop of a hat, some are more circumspect, and others only prescribe them under duress. Here's a pretty concise overview of why overuse of antibiotics isn't a good idea. You want someone who will reserve use of antibiotics for when there's an actual bacterial infection present.

I'm sure you've heard the old chestnut "What do you call the person who graduates at the bottom of his or her med school class?" "Doctor." You should also use interviews to try to weed out doctors who are ignorant or just plain stupid. A friend of mine (who is 5 feet tall with a husband who's 5'6") was told by her pediatrician that her daughter was "too short" and that he was concerned because "We want every child in our practice to be in the 50th percentile." Where do you even start with a doctor who doesn't understand the basic concept of a bell curve? Or that a child with short parents will probably be on the short side of the curve? He then continued by telling her that he thought her "extended" breastfeeding (their baby was 9 months old at the time) was stunting the baby's growth, and he wanted her to cut down on nursing and feed the baby more apples and green beans to make her grow taller. Um, yeah.

You don't want to end up with a doctor who's so ignorant on so many levels, or one who's overly concerned about things that are normal. If your baby is likely to be particularly short or tall or skinny or fat or pale or of Asian descent (and thus prone to those birthmarks that can look like bruises) or bald or hairy or a carrier of a genetic disease or whatever, bring that up at the interview and ask the doctor what s/he thinks. Any answer like "Someone's got to be in the 95th percentile, so someone else's got to be in the 5th percentile" or "It would be ridiculous to expect that a child with parents as tall as you are won't be off the charts" or something else that recognizes that kids are all different and should be taken on a case-by-case basis is what you're looking for.

Any answer that starts with "We want all the kids in our practice to" is bad news. My friend's pediatrician got all worried because her son wasn't walking at 18 months (the range of normal is around 9-16 months for walking, so he was late). The ped gave my friend the "We want all the kids in our practice to be walking by 18 months" line (to which I said, because I'm a smartass like that, "I'm not really sure that it matters what she wants, now, does it, if he's not walking?") and sent him to be evaluated for cognitive developmental delays. In the meantime, the child was drooling constantly and his speech was extremely hard to understand, but his responsive language was way ahead of his chronological age and he was ahead of the curve with imaginitive play and stuff like that. It turned out that he had low muscle tone in the jaw and chest (which explained why he wasn't walking yet, was drooling, and couldn't enunciate) which was treated easily with regular physical therapy. The pediatrician absolutely missed the boat and focused on the wrong thing because she was so concerned with what she "wanted" all the kids in the practice to be doing.

Another thing to consider is whether you want to go with a pediatrician or a family doctor. There are advantages to both. A pediatrician is going to be more focused on specific childhood illnesses and conditions. A family practice doctor is going to have more of a long-range view and might not be as concerned about things that are only issues for a short time. A pediatrician is going to be dealing with huge numbers of kids so s/he'll have a real picture of where your kid is compared to other kids. A family practice doctor will be able to treat your entire family. Think about which model you prefer.

There's an excellent list of questions to ask your child's doctor here. It covers things like whether the doctor will come check out your newborn in the hospital or wait until the baby comes home (a hospital pediatrician or intern will check out your baby in the hospital if your own ped doesn't--it's routine and no big deal). It also covers procedures for scheduling appointments, after-hours problems, and getting sick kids in for emergency visits.

Often times these things are a balancing act. I love my doctor (a family practice doctor who treats me, too) because he's very laid-back and treats me like a true partner in care (not someone who needs to be told what to do). He asks things like "Are you happy with the kids' sleeping arrangements? If you're not, I can help you troubleshoot" and he gets my jokes. But the downside is that he's only in the office a couple of days a week and he's always overscheduled. For me it's worth it to be so happy with what he does for us when we need him that I just accept the burden of scheduling way in advance. We've also been lucky in that our only emergencies have been off-hours so he was pageable. Other parents are going to want easier, more immediate access and will put up with more editorializing from their doctors. As long as you know what you want and choose a doctor based on that, you'll be happy.

Another thing to think about is where the emergency room your doctor admits to is. All other things being equal, you should go with the doctor who admits to the closer ER. (Within reason. If there's only a few minutes difference in travel time, go with the better ER.) When your baby can't breathe from croup in the middle of the night, you don't want to have to drive 30 minutes to the ER.

The bottom line, though, is that you have to feel good on an interpersonal level with your doctor. A doctor can be brilliant and knowledgeable, but that doesn't mean s/he's kind or humane. If there's something you don't like about the doctor don't go with him or her, even if everyone you know raves about the doctor. You don't want to feel any hesitation (ever) about calling to ask a question or bringing your child in to the office. So it's important that you feel good about the person professionally and personally.

Again, read the list of questions from The December List here. Other than that stuff, is there anything we forgot?