presented by Angel J. Miller, MSN, CNM
The following is an excerpt of a chapter from the book Raising Your Child in Washington, DC, a resource for parents available in local bookstores. by Dr. Michele R. Berman
One of the most important tasks a parent must undertake is the selection of a pediatrician for their baby or older child. Besides being a place to take a sick child, or a place to get “baby shots,” a pediatrician’s office is an important resource for new or experienced parents. Today, many families find themselves without the traditional support systems that their own parents had available to them. Family members are often separated by many miles. For these families, the pediatrician provides advice and encouragement, as well as basic child-care knowledge. Many pediatricians see patients from birth through adolescence, so picking the right pediatrician may well be the beginning of a “long term relationship.”
Pediatrics, in general, is a preventive health care specialty. Well-care visits provide the framework of information to keep your child happy and healthy. A typical well-care visit starts with weighing and measuring the child and plotting those measurements on a growth chart to follow their progress. The pediatrician will then ask several questions about your child’s eating, sleeping, and bowel habits, and about what new developmental milestones have been passed. Then it’s your turn to ask the doctor about any questions or concerns you may have. Write them down as you think of them at home, and bring the list with you. After examining the child, the pediatrician may discuss a variety of topics, such as immunizations, safety issues, or behavior issues. Some will also have handouts to supplement the discussion. On average, there are seven well visits in the first year, three in the second year, and one every one to two years thereafter.
The Prenatal Appointment
If this is your first child, the decision as to who the baby’s pediatrician will be should be made well in advance of your due date. (Remember – babies often come earlier than expected!) This allows the pediatrician you choose to give your newborn its very first exam in the hospital, and to support you during those joyful, yet overwhelming first days. Although all pediatricians are dedicated to helping you raise healthy, happy children, each has his or her own approach. You will, therefore, want to meet with several pediatricians so that you can pick the one with whom you feel most comfortable and whose approach is most consistent with your own ideas about child raising.
Most pediatricians encourage parents to come for a prenatal appointment. This is your opportunity not only to meet the pediatrician but look at the office itself. If possible, both parents should be present, so you will both agree on your choice. When you set up the visit, find out who you will be seeing (one or more doctors? Office staff?), about how long it will last, and if there is a charge for the visit. If the visit consists of a quick hello by the pediatrician while the office staff shows you around, there may not be a fee. However, there may be a charge if the pediatrician sets aside a block of time specifically to talk with you and answer any questions you have. Many insurance companies will pay for this, but check with your plan first.
During the interview you should first find out about how the practice works. What are the office hours? Do they include evening or weekend hours? How are after-hours calls handled? Who are the doctors in the practice and what are their qualifications? Can you see any of the doctors in the group, or are you assigned to one doctor? How far in advance do you have to call to get a well child appointment? A sick child appointment? To what hospitals do the doctors admit their patients? Do the doctors come to the hospital where you are delivering? Who handles phone calls during the day and after hours? What is the schedule of visits and immunizations? Most pediatricians follow the guidelines of the American Academy of Pediatrics for these.
Secondly, try to get a feel for the pediatrician’s personality. How does he/she respond to your questions? Does he/she seem open to your concerns or does he/she seem to shrug them off? Are they stiff or relaxed? Distracted? Do they have a good sense of humor? Observe how he/she interacts with the patients that may be in the office at the time of your visit. The feelings you get during your visit will set the time for the relationship you will develop with the pediatrician you choose. You want to feel comfortable and confident about someone who is going to help you take care of that special baby of yours.
Ask the pediatrician questions about topics such as: What is their thoughts about circumcision, breast feeding, or the use of antibiotics or other medications? If you are going to breastfeed, what kind of support can they give you? What is their philosophy about the role of a pediatrician?
Lastly, look around the office. Does it seem inviting to children? Are there things for the children to do if they have to wait to see the doctor? Will older children and adolescents also feel comfortable here? Are there ways to separate sick from well children? What kind of feelings do you get about the office staff? The nursing staff and front desk personnel are also important in making a trip to the doctor a pleasant experience.
Looking for Dr. Right
So, where do you find your dream pediatrician? There are several ways. First, ask your friends and neighbors who they use. Are they happy there? What do they like about the office? Is there anything they don’t like? Next, ask your nurse-midwife for a list of pediatricians they frequently recommend and on whom they have gotten positive feedback. Your internist, family practitioner and other medical professionals can also be good resources.
Increasingly, families find themselves as part of health plans that limit their choices to physicians who are members of the plan. In this instance, start with the list provided by the health plan and see which physicians are available in your area. Then ask the resources listed above what they know about those physicians. Make an appointment with the pediatricians you’d like to know more about.
Pediatrician’s fees may vary widely. Don’t be afraid to ask about fees before you go to the office. Ask if you will have to pay for services at the time of the visit, or whether they will bill you or submit the insurance claim for you. If you are a member of a health plan, and the pediatrician is a provider for that plan, they will file for you, but you must usually pay a small co-payment at each visit. Look at your health plan or insurance coverage carefully. Not all insurance plans cover well-child care, or you may have to meet a deductible, or they may only cover a certain number of well visits. For these financial matters, it’s best to know what the office policies are before you get there. If you anticipate a problem with payments, many offices will work with you, as long as you talk to them up front.
As mentioned earlier, many families find themselves using the same pediatrician for many years, so you want to choose one with whom you feel comfortable, and in whom you have confidence. Shop around. Ask questions. Use and trust your instincts. Remember, your decision does not have to be a final one. If you are unhappy with your choice, there are many other fine physicians in the area. Good luck, and happy parenting!
Dr.Berman practiced pediatrics in the Washington, D.C. area until the year 2000 She currently is co-founder with her husband of www.celebritydiagnosis.com.