A pediatrician treats children from birth through their late teens and sometimes even into their early twenties. A large part of a pediatrician's job is to educate parents about their children's health and to help them deal with behavioral issues that may have little to do with illness. Both you and your child need to be able to trust and feel comfortable with the person you choose. So in addition to finding a doctor who is a good clinician, it's important for you to find a person you and your children click with.
Regular visits to the pediatrician are a key part of preventive health care. During each check-up, the doctor should give you tips on keeping your children healthy and safe, answer your questions and listen to your concerns, and fully examine your child to:
* Make sure he is well nourished.* Update immunizations if needed.* Track growth and development.* Find physical problems before they become serious.
Although pediatricians complete a three year residency in the treatment of children, they're not the only physicians who see children. General and family practitioners can treat the entire family--from infants to seniors. In either case, you should try to select a doctor while you are pregnant. This way, he or she can keep abreast of any health issues that arise during pregnancy that may affect the child and be on hand to give the baby a check-up right after birth.Ways to Find a PediatricianYour first step is to gather names. Here are a variety of sources you can try:
* Physicians. If you are pregnant, ask your obstetrician for a referral. Otherwise, ask your primary care physician or any doctor you respect and have a good relationship with. Tell them the qualities you are interested in. Since they know you, they will be able to recommend someone they think you can relate to. If you have recently moved, call your former physicians and ask if they know anyone in your new area.
* Other Parents. Referrals from people you know, including friends or relatives, are usually based on trust and confidence, which is certainly a top consideration. Remember, though, your contacts' opinions may be largely based on how they hit it off with the physician's personality and style. Only a visit with the doctor will reveal if these qualities suit your own preferences.
* Hospitals. Reputable hospitals usually offer a referral service that can provide you with the names of staff doctors who meet certain criteria you may be seeking, such as specialty, gender and location. If there is a children's hospital close to you, it may be your best choice for a referral. But keep in mind that a hospital's referral service gives a list of names. It cannot vouch for quality of care.
* The American Academy Of Pediatrics. This professional organization can give you a list of member doctors in your area. To become a Fellow of the AAP, pediatricians must meet certain criteria, including being board certified in pediatrics (which means a doctor has completed a prescribed period of residency in the specialty, passed oral and written exams and handled a minimum number of cases). The doctors must also provide "evidence of high ethical and professional principals" as evaluated by AAP members in the district where the doctor resides. For the names of AAP members in your community, send a SASE and a note indicating the city and state where you are searching, to the American Academy of Pediatrics, Department C-Pediatrician Referral, 141 Northwest Point Blvd., P.O. Box 927, Elk Grove Village, IL 60009-0927.
* Your local medical society. These organizations frequently offer directories of its members to the public. Similar to a hospital referral, these publications only provide names, addresses, telephone numbers and specialties.
* Your managed care plan. If you belong to a managed care plan, find out what pediatricians are affiliated with it and what information the plan has available on them. Some plans will let you look through their folders, which give information on each participating doctor's background and services. You can also take a list of an HMO's pediatricians to your regular physician and ask which he or she would recommend.
* Health Pages' listings. See our exclusive comparative charts for information on local pediatricians, including their training, office services and fees.
Considerations in Making a ChoiceOnce you've gathered some names, use these tips to help you check out prospective doctors. You can find out certain information about professional qualifications and practice arrangements by calling the doctor's office staff. Here are some additional details you might want to find out:
* Professional credentials. Any physician you consider should have graduated from an accredited medical school. Although "big-name" institutions are not necessarily the best, you might find that, in general, the most highly qualified physicians have completed their residencies in major medical centers.
One way to evaluate doctors is board certification. Although this is no guarantee of quality, the American Board of Medical Specialties (ABMS) notes that doctors who've passed their boards have met standards above and beyond those required to get a medical license. To find out if a doctor is board certified, you can search Health Pages' doctor directory. You can also check the ABMS web site or the Directory of Medical Specialists, which is available in large libraries. This multi-volume directory also details doctors' training and professional affiliations. You can get the same information by calling the ABMS hotline at 800-776-2378.
Doctors who have completed the residency period and are still waiting to take the boards may call themselves "board-eligible" for a few years after completing their training. But beware: Established doctors who have failed their boards or never took the tests, might try to hedge their way around the certification issue by continuing to say that they are board-eligible.
* Professional Affiliations. The ideal doctor probably has admitting privileges at a large, well-equipped hospital. Without such an appointment, you'll have to see another doctor if your child needs to go into the hospital.
A teaching position at a medical school is a further indication that a doctor is both well trained and up-to-date. However, you will have to find out if the doctor's teaching schedule will make him or her less available for routine appointments or in an emergency.
* Practice Arrangements and Location. Years ago, virtually all doctors were "solo practitioners"; they had private practices and when they were unavailable, usually had another doctor respond to their patients' calls. Today you may choose a solo practitioner or a group practice, in which two or more doctors in the same specialty or different specialties share the same office. They also cover for each other on weekends and vacations. If you choose a group practice, make sure you know and trust all of the doctors who might be taking care of your child. In addition, meet the office staff since you will be interacting with them frequently.
It's important to take into account how convenient the doctor's location and office hours are when making your choice because even healthy children need to see their pediatricians more often than most adults.
Also find out if the pediatrician specializes in a certain age group or field, such as pediatric surgery or cardiology. After all, if your child is 13 years old, you will not want to take him to a doctor who specializes in kids under 10.
* Has the pediatrician ever been the subject of a professional peer review, been sued for malpractice or had his license suspended? According to the Federation of State Medical Boards, the total number of serious disciplinary actions against doctors across the country was 3,375 in 1995--that's about 0.5 percent of all doctors. To find out if a particular doctor has been disciplined by your state, call the agency that licenses physicians in your state. Call the Federation of State Medical Boards for the number to call in your area (817-868-4000). In addition, the Public Citizen's Health Research Group publishes a book titled Questionable Doctors, which lists physicians in each state who have been sued for malpractice, had their licenses revoked, or had some other type of action taken against them. It is available in many public libraries and you can get a state supplement for $15. To order, call 202-588-1000.
Getting AcquaintedA pediatrician's interpersonal skills and ability to communicate (once called "bedside manner") are particularly important. After all, this doctor has to be able to relate to both you and your child. In addition to being a good communicator, the doctor should treat you like a partner in your child's health care by explaining diagnostic procedures, test results and medications, and by answering your questions. In addition, you may prefer a doctor who shares your cultural background, religion and/or views on certain ethical and moral issues, such as life-support measures.
When you've narrowed your list to two or three pediatricians, schedule a get-acquainted appointment to evaluate their personal manner. Some pediatricians won't charge for an interview visit, others will. It's a good idea to ask about these charges first. You and your spouse should go alone to this first visit unless your child is a teenager.
Prepare a list of questions about issues that concern you so you won't forget to ask the doctor about them during your meeting. These can include:
* What is your pediatric background?
* Do you have a subspecialty?
* If I have a minor question, when is the best time to call? Some doctors separate some time for telephone consultations. Others take or return calls whenever they are able to. Any doctor who "does not talk to patients on the phone," should not be your doctor.
* How much emphasis do you put on proper nutrition?
* Will I get reminders in the mail for immunizations?
* Are there separate appointment times for well and sick children? Some doctors schedule healthy-baby appointments in the morning and non-emergency illness appointments in the afternoon so that diseases aren't passed around the waiting room. Some even have two separate waiting rooms.
* Do you use any physician assistants? Some doctors manage large practices by delegating routine tasks to Nurse Practitioners. NPs generally have a master's degree and are permitted to give physical exams, order and interpret tests and manage common illnesses. In some states, they are even permitted to write prescriptions.
In addition, if your child is not a newborn, bring a summary of his or her medical history, including childhood diseases, chronic illnesses, hospitalizations and medications (which you can request from your former doctor). This is also the time to discuss any chronic conditions, such as asthma or diabetes, that your child may have. Be prepared to go over your family's health history since it directly affects your child's risk factors. Observe how attentive and interested the doctor seems as you discuss this topic. Does the pediatrician take notes and ask you questions?Is This the Right One?Knowing when you have met a doctor you can trust is really a gut reaction. A few tip-offs that indicate you have found "Dr. Right" include: The doctor's staff is courteous and helpful; you are seen by the doctor within a reasonable time of your appointment; telephone calls are not accepted during the consultation (unless it is an emergency); you aren't rushed through the visit assembly-line style; the doctor asks probing questions about your family's medical history and listens to the answers; the doctor is well-informed about preventive health measures (nutrition, exercise and screening tests); the doctor can explain medical procedures, therapies and test results, thoroughly in lay-man's terms; you are encouraged to call with any concerns.The Final WordThe next step is for your child to meet the doctor that you have chosen to see how well they get along. Such an introduction may help diminish a child's fear of going to the doctor.
Even though you may like and trust your doctor, in the end you are the one responsible for your children's well being. You can never become complacent about the quality of care they are receiving. If after you've made your choice, the relationship doesn't develop as you'd hoped or you are not satisfied with the care given, it is time to move on. Here are some warning signals:
* Your child's apprehension of going to the doctor is beyond the normal fear of getting a shot.
* Your child is sick and has been treated in a couple of ways but is not getting any better. Of course, some medical problems are hard to treat or diagnose, but a lingering illness is definitely a warning sign. If your child isn't recuperating, ask if you should see a specialist. It is better to have a doctor who admits he does not know what the problem is, but tells you how he is going to go about finding out than one who pretends to know all the answers.
* The doctor makes you feel "stupid" or "annoying" when you ask for more details or call with a medical concern. For your child to get the best care, you have to feel comfortable enough to discuss anything with the physician.
* The doctor doesn't take enough time with your child. Do you feel rushed through your child's check-up? Do you not get a chance to ask everything you wanted to know? Click here for recommendations from the American Academy of Pediatricians on the care of children
* The doctor over-treats your child. Does the physician order a battery of tests for the sniffles?
* The doctor ignores your concerns and observations. If the doctor isn't interested in a description of the child's symptoms, doesn't want to explain the details of an examination or give reasons for certain tests, reconsider your choice.
* The doctor is unwilling to explain a diagnosis or treatment thoroughly or brushes off your questions with platitudes such as, "Don't worry, its just routine." Your children's well-being is not routine and you have the right to know exactly what will be done to them.
* The doctor objects or gets annoyed when you seek a second opinion. Physicians who refuse to admit they are fallible (as are all human beings) are dangerous. By the way, don't ask your doctor for a referral for a second opinion. He or she is likely to refer you to someone who similar views and practices. You can get other names from the sources mentioned under "Ways to Find a Pediatrician".
Meet the TeamRemember, you will have a lot of interaction with the physician's nurses. So once you are at the doctor's office, you can assess the staff and general efficiency of the practice by asking them some of the important questions you need answered, including:
* What are the office hours?* Are there any walk-in hours when appointments are not necessary?* In which hospitals does the doctor have practicing privileges?* How can I reach the doctor after hours or during an emergency?* Who covers for the practice when the doctor is absent? (You may never get to meet these back-up physicians, but it is wise to check up on their credentials anyway.)* How does the office handle billing and what are my responsibilities?* Is payment immediately due at the time of the visit?* Will the pediatrician accept my insurance and process my claims?* How are insurance claims handled?* Are there any testing or diagnostic facilities on site? If not, who does the office usually refer to?
Preventive Health Care for ChildrenThe following recommendations from the American Academy of Pediatricians are designed for the care of children who are receiving competent parenting, have no significant health problems, and are growing and developing satisfactorily.
The most general preventive care for newborns, infants, young children, and adolescents includes:
* A medical history taken during an initial visit and updated at various intervals.
* Height and weight measurements taken during regular office visits.
* A developmental and behavioral assessment.
* A thorough physical examination.
* Guidance on injury prevention.
* Vision and hearing should be tested periodically by standard testing methods. Testing is more frequent if required by a child's individual history.
* Head circumference should be measured through 24 months of age.
* Immunizations are recommended for newborns and at various intervals during infancy and childhood up to about the age of 11.
* An initial dental referral is generally advised at age three.
* Regular blood pressure screening should start at age three.
* Lead screening is suggested at nine and 24 months of age.
* A blood test for hematocrit or hemoglobin levels is suggested at around nine months of age and at age 15 (all menstruating adolescents as well).
* A urinalysis (urine test) is suggested at ages five and 15.
* Tests for sexually transmitted diseases (STD) are recommended for sexually active adolescents.
* Pelvic exams are recommended for sexually active females.
* Screening for tuberculosis for those with high risk factors.
* Cholesterol screening is recommended for high risk patients. If family history is unavailable and other risk factors are present, screening should be at the discretion of the physician.