2torial #0529:
Learn2 Choose a Pediatrician

The doctor is in

Choosing a pediatrician is one of the most important decisions you'll make as a parent. You're looking for someone who'll be an involved and knowledgeable advisor throughout your child's development. In fact, a large part of a pediatrician's job is to educate you about your child's health and help you understand and deal with behavioral issues that may have little to do with physical illness.

Children's health is unpredictable. That's why you should start looking for a doctor as soon as you know you're going to need one. If a move is in your future, don't wait until you arrive at your destination to begin your search. Have the screening process well under way when you get there to limit the time your child goes without medical support.

If you're expecting your first child, begin looking for a pediatrician during the third trimester. Although pediatricians aren't typically present at a child's birth (unless complications are anticipated), they will give the newborn its first checkup within days--sometimes hours--of birth (usually before the baby leaves the hospital). Making a decision well in advance of labor and delivery allows for an informed--not hasty--choice.

Note: In the U.S., many health care choices are dictated by insurance carriers. If you belong to a health maintenance organization (HMO) or a state- or federally-sponsored health plan (such as WICC), your first step is to get a list of doctors in your area who participate in your plan. Contact the patient services department for your plan and ask for a physician referral list.

Assess your priorities

In addition to regular checkups, a pediatrician is responsible for treating illnesses, monitoring your child's physical and psychological growth and development, diagnosing and treating acute and chronic disorders (including providing needed referrals to specialists), and coordinating care if your child is being seen by more than one doctor.

For these reasons, it's important to choose a pediatrician who shares both your child rearing and health care philosophies. Make a list of parenting issues that are important to you (circumcision, immunizations, or toilet training, for example). Bring the list to interviews you set up with your final candidates (see Step 4).

If you feel more comfortable with a younger (or older) physician, that's fine--just be sure you don't base your decision solely on this characteristic. Likewise, consider carefully whether you'll feel more at ease with a doctor who's friendly and flexible or one who's more authoritative and clinical.

Finally, some studies indicate that, as children mature, they tend to feel more comfortable around doctors with whom they feel a bond. In some cases, this can translate to a gender or racial preference. If you're seeking a physician for an older child, let him or her take part in the decision-making process.

Get recommendations

Once you know generally what you're looking for, talk with family members, friends, and neighbors whose parenting styles seem similar to your own about their pediatricians: Do they like their doctors? Why or why not? Are they comfortable with the medical advice they've been given and the care their children have received?

Note: Don't forget to talk to the kids. Ask if they like their doctors and why or why not. Their opinions can differ greatly from their parents'.

Ask your obstetrician and your general practitioner whom they recommend. And don't forget their office staffs, who can sometimes offer not only personal insight but the opinions of other patients as well. Likewise, nurses on hospital maternity and children's wards interact with many pediatricians and may offer some helpful advice.

If a move is prompting your search, ask your existing pediatrician for a few names in the area where you're relocating. Or try calling the medical school nearest the town where you're moving and asking the chief resident in pediatrics for a referral.

Once you have a few names, call your regional medical review board (find the number in the government section of a phone book) to check for any disciplinary actions that may have been filed against your candidates. Sometimes these organizations can also provide information about a physician's education or special training.

Visit offices

Once you have a list of candidates, it's time to arrange some interaction. Make an appointment with each doctor, explaining that your child is a potential new patient and that you'd like to ask a few questions. Some doctors have special hours set aside for such meetings, and all should welcome the opportunity to meet with you in person. Note: Some doctors charge for this visit, others don't. Likewise, some insurance companies cover the expense, some don't (contact your insurer to find out).

Of course, your primary goal is to meet the doctor, but while you're at it, consider the complete package. Was the staff friendly and helpful? Were you able to make an appointment within a reasonable amount of time, or were you placed on a waiting list? Is the office location convenient for you? Do the doctor's office hours fit your lifestyle?

Arrive a few minutes early for your appointment and spend some time appraising the surroundings. Is the waiting area clean? Is the decor cheerful? Does it offer toys and games for impatient children? Are there separate waiting rooms (or does the doctor schedule different hours) for sick and well children?

Finally, talk to other parents while you wait: Are they happy with the care their children receive? Why or why not?

Interview doctors

Doctors are busy, so have a list a questions prepared and don't demand more than 20 minutes or so of their time. And remember, while you're technically on a fact-finding mission, this is also a chance to see how comfortable you feel talking with this person. If your child is involved in the selection process, bring him or her along to this meeting. Some issues to consider include:

Medical approach. While it may seem natural to ask about a doctor's education and training, you can usually find this information elsewhere (looking at diplomas on his or her office wall, calling a medical review board). Asking why he or she chose to specialize in pediatrics can often offer more insight into the doctor's bedside manner and medical approach.

Like any competent health care provider, a good pediatrician should emphasize prevention and education as well as offer general medical services. Beyond that, ask about some of the specific parenting concerns you identified in Step 1, and compare the doctor's ideas with your own. You may also want to ask how the doctor keeps abreast of new developments and procedures. Note: Don't forget to ask about subspecialties if they're of concern to you.

Emergencies. Does the doctor make house calls? Who covers for the doctor if he or she is unavailable? What is his or her on-call schedule? Who dispenses advice over the phone during office hours or if the office is closed? Does the doctor follow up on these calls? What hospital(s) is he or she affiliated with?

Office practices. Is the doctor part of a group practice? If so, can you request appointments specifically with him or her, or will you be directed to whomever is in the office on a particular day? How far in advance should you schedule routine visits? What is the average length of an office visit? Can a child be seen on the same day he or she becomes sick?

Fees. What are the standard charges for office visits, regularly scheduled tests or vaccinations, and missed appointments? Is there a charge for phone advice or after-hours consultations? If appropriate, check with your insurance carrier for information about co-payments and billing procedures.

When your time is up, thank the doctor and conclude the interview. By this time, you should have a sense of whether or not this is a doctor with whom you can feel comfortable.

Once you've talked with all your prospective pediatricians, it's time to make your choice (with input from your child, if he or she is old enough). By taking the time to choose wisely now, you can rest assured that your child will be well taken care of for years to come.

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