Choosing a Doc

Today little Lakshman has his fourth visit with the pediatrician (Newborn, 1 month, 2 month, and now – four month!).  Yes, kids go to the doctor a LOT, and this is all just for preventative visits!  He was actually supposed to have a weight check when he was tiny but we stayed home for wintry weather . . .  a nice time to be on maternity leave!

I digress. The doctor.  Last visit went just fine until the terrifying reality of giving a baby immunizations. It hurt so much to see him in pain – not from the shots themselves, he gets some relief from the initial shock because I nursed him immediately afterward, so that soothed him slightly.  But for the remainder of the day he was completely inconsolable. My parents initially teased me at my sorrowful reaction but they were with me for the afternoon and had him for the evening and by the time they  had spent even a few minutes with him they knew he was feeling different.  Just not his normal contended self and just sniffing and hiccuping in angst. I remember the day so much and now that day is returning! He is just so playful this morning.  Awakens with soft cries but once he is alert and changed he just give me this grin and shining eyes. He is grabbing at everything and sucking on it, chewing on it, finger to mouth and all that. And I’m amazed at how well he holds his head up while sitting and how he lifts his head off the ground with his hands pushing his chest up. How they grow and develop with me doing so little myself! Just a little magician he is.

Today the pediatrician will ask all that and will ask me if I have questions. No, no questions today. He seems to have gotten over the gassy nights which plagued us so.  And that itself gives me relief. But Dr. W goes through so many things in such a short period of time, and the office is so efficient in how they go through patients – something I’m a bit envious of being a slow turtle of a pediatrician myself.

Finding a doc who is a good fit for you is an important aspect of parenthood.  A friend asked me recently how I would go about it, being a pediatrician myself. Every parent wants something different when it comes to a doctor, but choosing physicians for my baby boy seemed a relative no-brainer, considering that I ended up choosing the practice that I originally wanted very much to join as an employee.

But why was my practice so compelling? Was it the Electronic Medical Records (EMR)? Well, if my practice HAD EMR that would be nice but they don’t.  You should make sure that your physicians trained at reputable residency programs and that they have kept up with board certification. There are many other factors that played into it, and here are some issues that struck me as important:

What other practices does the doctor share call with? This signifies a much larger question – is your physician in a group practice or does he/she practice alone? This affects many things: continuity of having the same doc each time, how quick your emergency response is, who cross covers on days the physician is off, as well as general rapport. Some doctors’ offices share call among 4-5 offices so you’d want to make sure that the other offices and physicians were just as reputable as your doctor and who you think you’d trust in a pinch when you had to call in the middle of the night.

What is the office policy on evening and weekend hours? If you work full time and it’s important to you to have a doc with evening hours, this is important. Our doctor
doesn’t have evening hours but does have hours on saturday and sunday for sick visits.

What is your office’s philosophy regarding standard medical treatments for common ailments?  Do the physicians in the practice have a similar attitude? Does your office use antibiotics routinely or do they recommend them less often?  Are their any treatments they do not agree with?  Make sure that your doctors’ recommendations to coincide with your own beliefs and attitudes towards medicine, because if you can’t find common ground there you may never trust your pediatrician. It is also helpful to know if other docs in the practice have the same methods and attitudes as your doctor; I work in a practice where we all conduct medicine very differently, and I am not in a position where we can really change each others’ practice.  Other physicians work in groups where their approaches to diseases are discussed on a regular basis and things like antibiotic choice for ear infection change based on evidence. It is nice to know how your doc fits into this model because there is nothing more irritating to a patient to have one doc tell you one thing and another doc to tell you something different!

What hospital should the child go to in case of emergencies, and is your doctor an attending there? It is becoming increasingly common for physicians not to have duties in local hospitals. Instead, outpatient doctors and inpatient doctors now each have distinct roles – and different jobs. In fact, some practices are finding that it’s a lot easier to do one than both, and an inpatient doc may be able to do a better job of following a patient than an outpatient doc – who has to follow the patient from afar and isn’t always in-house when emergencies happen. So it is good to know what role your doctor plays in this, and if they don’t admit the patients, get an idea of who their patients admit to: whether it be a general hospitalist service or a specialized service within the hospital.

How is the office staff and what is the makeup? I love the office staff at my pediatrician’s office. They are prompt, helpful, friendly, and always ready to help. I love that when I call my doc’s office it would be the same nurse who answers every time. Some offices have strictly registered nurses and others also depend on medical assistants – who can be extremely good – but it’s good to know who you’re dealing with, so ask! Ask who does phone triage – do you speak with a nurse at the office, when is the answering service on, and how easy is it to get to speak to a doctor if that is what you really need?

Also, finally, know what your values are regarding modern medicine. Some people are not fans of immunization or request them to be administered according to the Dr. Sears model of two immunizations per visit.  I myself use the regular CDC-recommended model but again, see if your doctor is flexible to the “Dr. Sears” one if that is what you’d want.  Also, if you are completely against immunizations (I am totally FOR immunizations) you should make sure that your doctor is willing to work with you, and find out how they handle it.

I am sure that I have other things to think about but these are some of the initial thoughts that came to mind in my conversation with my friend. Time to move on with the day and get prepped.  T minus 4 hours till doctor’s appt!