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Choosing a Pediatrician for Your Baby: The Prenatal Interview

As a pediatrician with 25 years experience, I really enjoy this meeting between parents-to-be and myself. I love it because I get to see the cute little round lady and her proud hubby before their life has been changed by the little alien. They're so bright and shiny, innocent and unsuspecting. Of course we know all that will soon change.

Seriously, the prenatal interview is a good time to meet your new best friend-your pediatrician. I say this because parents and pediatricians spend a lot of time together, both in the office and on the phone. If she's a good pediatrician, your doctor won't mind scheduling an interview with you. After all, if she can't make time for you now, will she have time for you once the baby is born? Here's a helpful rule of thumb: if you call to schedule an interview and you're told that the doctor doesn't do interviews, don't "do" her.

To help you organize your thoughts for the meeting, make a list of questions before you meet the pediatrician. Here are three you should ask:

1. Is the doctor on staff at a hospital, and if so, where?
In the event of an emergency, you would want to bring little Missy to the nearest hospital and consult with her pediatrician then and there. What many people don't realize, however, is that doctors can't treat patients at any hospital they please. To examine your baby at the hospital and to discuss her findings with you, a doctor must be on staff at that particular hospital. This usually means that the hospital feels she is medically competent, is adequately trained, and poses no risk to the hospital or its patients.

Often, though not always, more prestigious hospitals have more stringent criteria for their attending physicians. It may be easier, for example, to get on staff at Main Street County Hospital than to be approved by Major University Hospital. Therefore, if there is a major university-affiliated medical center nearby and your doctor is on staff there, that's usually a good sign. Of course, this is an oversimplification. Your doctor may have elected not to apply to Major University Hospital because it requires attendings to donate too much time to the hospital, in the form of clinic or teaching duty. If she's not on staff there, just ask why.
Here's another reason why hospital affiliation is so important: some babies actually do get very sick. Thank God most childhood illnesses are minor ones. There are, however, exceptions. If Missy does become ill, you will want her to be treated in a hospital with a pediatric unit. Let's face it, anyone can treat a common cold or a stomach virus, but if your child is really sick, she should be treated in a good hospital with specialists trained in childhood illnesses.

Sometimes, especially in rural areas, the nearest major hospital might be far away. In that case your newborn might be cared for in a local community hospital. The community hospital may have an arrangement whereby your baby can be transferred to a larger hospital if some specialized need arises. Now is the time to ask your prospective pediatrician about such a transfer and what part she would play in it.

2. When you call the doctor's office with a question, who will answer that question for you? When you bring your child to the office, who will see you?
I remember one interview with a mother who moved to our town and was shortly due to deliver her second baby. She told me that she loved her old solo practitioner because, when she called him with a question at any time of the day or night, she always got an answer, and it always came from him. He never took a day off and was always on call at night. When I asked her if this saint was in a great mood being on call every night by himself, she replied that she didn't actually speak to him directly, but rather she spoke to his assistant, who then called Dr. Midnight for advice. Armed with information from the doctor, the assistant then called back the mother and told her what to do. A little checking revealed that the assistant was a nurse who never even called the doctor. Instead the nurse would decide what to do herself and then call the mother back, attributing the advice to the omniscient and insomniac sainted doc. This probably wouldn't be so terrible, assuming that the nurse was well trained, but don't you think the mother deserved to know from whom the advice was coming?

Sure, there are times when a nurse or a receptionist can answer a quick question. Most pediatricians will allow their receptionists or assistants to remind a parent about a dosage of Tylenol. Similarly, a simple question such as "When is my child due for her next checkup?" can be answered without the doctor's participation. And nurses and nurse-practitioners are certainly well trained to answer many questions that arise. Some doctors no longer take after-hours calls and instead have phone calls answered by an on-call pediatric resident or intern. This might be fine for simple advice about treatment of a cold, a diaper rash, or a mild case of diarrhea. Yet you, as the baby's parent, are entitled to know who is making decisions about your child. If these decisions are coming from someone other than your pediatrician, then you have a right to know this. You, as the parent, must have the option to speak to your doctor when you feel it is necessary. If you feel that it is an emergency, your doctor must be available to you.

This brings up the issue of covering doctors. Let's face it, the days of the wise old solo practitioner are over. Any pediatrician will take a day off now and then. She'll also probably not be on call each night and weekend. Do you really want to see a tired, annoyed, overworked doctor with your fresh new baby? Doctors can arrange to take time off and have vacations in one of several ways.

ΓΆβ?¬ΒΆ Group practice. In a group practice, two or more pediatricians share an office. If your doctor is away and you have a question, you will usually speak to one of her partners. If your child must be seen for an illness, she will see one of the partners in the office.

ΓΆβ?¬ΒΆ Cross-covering. A solo practitioner can arrange, on her days or weeks off, to have her practice cared for by another pediatrician (or group of pediatricians). Not infrequently, several solo doctors in a neighborhood will cross-cover each other's practices, thus allowing for ample time off. If you call your regular doctor at night, and it's a night when she's at the movies, your call will be answered by a covering doctor. Keep in mind that, with a covering doctor, as opposed to a partner in a group practice, the physician will probably not have access to Missy's records. If Missy has an allergy to a medication or hates green-colored medicine, the covering doc won't know this. You will have to tell her. Also, if Dr. Jones is covering for Dr. Smith and you want him to see your child, you will probably have to go to Dr. Jones's office, a place that will be new to you and to Missy.

ΓΆβ?¬ΒΆ Cross-covering groups. Just to make things confusing, some group practices cross-cover with other groups. Sunnyvale pediatrics, with their five pediatricians, might decide to share coverage with the five pediatricians from nearby Cloudyvale Pediatrics.

This may all seem confusing to you, but just remember this. As much as you may like your primary doctor, and no matter how much she assures you that she's "always available," your child will, from time to time, be treated by someone else. Your phone calls, even those middle-of-the-night emergency calls, will often be answered by someone else. Make sure you know who is covering for your doctor. Ask her. If she says nobody ever covers for her, she's probably less than honest.

3. What is all this going to cost?
Make no mistake, baby care is expensive. Of course, some medical insurance plans take a good deal of the sting out of the costs of care for your child. Make sure you know just what your insurance will cover and what it won't. If your doctor participates in your health care plan, your visits may cost very little. If she is a nonparticipating doctor, you may have to pay more. Just one word: if you feel that one pediatrician is much better for your child than another, cost, while always important, should not be the only factor in making your decision. Here's a common child care myth:

Myth: All doctors are fine. Just pick one who's on your plan. After all, your insurance company will only allow a doctor into its plan if she's capable.
Truth: Don't let your insurance company pick your doctor for you. That's your job.

Unlike most university hospitals, many insurance companies do not screen their physicians very carefully. There may be doctors in your insurance company's book who shouldn't be there and, conversely, some excellent doctors who aren't listed there. The reason a doctor chooses to join a particular health care plan will usually have a lot to do with how the company pays her as well as how free she is to order the tests and procedures she feels are appropriate.

Consider this. If one doctor costs you $20 more each visit, because she's not fully on your plan, and you see that doctor twenty times during the first year, you'll be paying $400 extra that year. If you really feel this doctor is better for your child and you can afford the $400 difference, consider it a worthwhile expense. After all, you were willing to go for the more expensive TV-the one with the picture-in-picture-that cost $400 more. Similarly, the laptop you chose wasn't the cheapest model either, was it? There were some options you wanted, and you were willing to pay extra for these. Well, your baby's doctor is a pretty important "purchase," too. If you want the best care and you feel that it may cost a little more, go for it. Of course, if you're deciding between two doctors, both of whom are on staff at excellent hospitals, and both of whom have great reputations, and one doctor will be free for you while the other will cause you to go bankrupt, go for the cheapie.

4. There is no question number four.
Only these three. Magazines often prepare lists of questions to ask a prospective pediatrician. All other questions are unnecessary, and I'll show you why. Here are some of these unnecessary questions:

Myth: Ask the doctor if she has a call-in hour.
Truth: Your doctor will probably be available to you any time she's in her office.

Call-in hour is a system whereby your doctor allows one hour each day to answer parents' routine phone questions. What if call-in time is from 8 to 9 a.m. and you have a question at 9:15 a.m.? Are you supposed to wait twenty-three hours and forty-five minutes to ask your question? Forget that. As long as your doctor is in her office and not at home, she should be able to return your routine phone call within a reasonable amount of time. And she will, too. So whether or not you call within that strict period of time, your call should be (and probably will be) answered.

Myth: Ask the doctor if she has a separate waiting room for sick kids.
Truth: It's hard to separate kids into "sick" and "well."

If your child has a high fever, is vomiting yesterday's Happy Meal, and has a rash that looks like a topographic map of the moon, then she's a sick kid. She should, of course, be isolated from other waiting patients. If you have a one-week-old newborn, fresh out of the hospital, then that's a healthy child, and she should be kept only with other healthy, pristine kids. But what if Missy is your average 5-year-old, with the usual bubbly nose and chocolate stains on her jeans, in the office for her yearly checkup? Where does Missy sit? Surely Missy's mom would prefer she stay away from the vomiter. On the other hand, our new mommy wants no part of Missy's runny nose. What's a mother to do? What's a doctor to do? Where does little Missy sit? The answer is this: use common sense. There are too many in-between cases to simply divide a waiting room in half. Most waiting rooms have enough nooks and crannies, corners and alcoves, so that you can maintain some reasonable amount of separation. Besides, most receptionists will want to get the vomiter out of the waiting room and into an examining room as quickly as possible. Who do you think cleans up the mess? Don't get too uptight about catching germs in the doctor's office. It's a lot easier to pick up a bug in a classroom or at the local baby "gym," where thirty kids are all drooling over the same blocks for two hours at a time, than in a waiting room.

Myth: Ask the doctor if she believes in breast-feeding.
Truth: Now, who's going to answer no to that question?

No doctor would say she's against breast-feeding. Why? Well, first of all, who is against breast-feeding? Even if she's ambivalent about nursing, why impose that opinion on you? All pediatricians will help you if you decide to nurse your baby. They will also assist you in bottle-feeding, if that's your choice.

So what else should you do during your interview after you've asked the three smart questions? After all, that may take all of two minutes. This is what you do: talk.

Talk about yourself. Unless she's an egomaniac, the doctor will ask you about yourself, your family health history, your background, and so on. Don't be afraid to chat about other things as well. Ask her what she thinks about a particular health-related article you read in a magazine or a health issue discussed on TV. Talk about the weather. Talk about your trip to the office and how you got lost three times. Talk about your husband, if he was unable to make the visit with you. Comment on the pictures on her desk of her funny-looking kids and husband. And observe. This will give you a window into the personality and disposition of the doctor. Does she listen to you? Is she rushing you out of her office after five minutes? Does she seem tense? Does she act as though she's God and you're a peasant? Do you feel comfortable talking to her? Much of the advice your pediatrician gives you will not be engraved on stone tablets. Remember, she may have trained at Mount Sinai, but she didn't descend from there. Many of the decisions you make as a parent are made in partnership with your pediatrician.

So chat with your new friend. Get a feel for her manner. Make sure she seems comfortable with you and you feel comfortable with her. She should be personable and flexible, not abrupt and rigid. And while you're at it, ask friends with children what the doctor is like when they bring their kids to her. Any doctor can have a bad day, but if a friend tells you that she dreads seeing her doctor or fears being ridiculed about a question she asks, her doctor is not for you.

What if you don't know whom to interview in the first place? Ask a friend for a recommendation. Ask her how she gets along with her pediatrician. Ask her the three "smart" questions, about hospital affiliation, about whom she speaks to when she calls and sees when her doctor is away, and about costs. Ask her what kind of personality her doctor has. Is she easy to talk to and flexible? If your friend is a lot like you, you'll probably agree about the doctor. Better still, ask your friend if you can come along with her at her next visit.

I've spent a lot of time discussing how to choose your pediatrician because it's a very important consideration. You will probably spend more time in just the next year with this person than you have with all other doctors so far in your life. You'll speak to her more on the phone than you will to many of your good friends. Also, although this book will guide you through the next year, it is only a guide. Most of your questions will be answered by the pediatrician. If your child is sick, you will want to speak to someone you trust. If your child is very sick, you will need to see someone you trust. Every day another mother says to me, "I speak to you more than I do to my husband." This is close to the truth. There is a gradual bonding process that takes place between a pediatrician and a parent. It will take a while for you and your pediatrician to feel completely comfortable with each other, but eventually, and ideally, the relationship becomes a friendship. Most of the parents in our practice become our friends. We get to share in their good news and to help comfort them when the news is not so good. As their kids grow to teens and even adults, these kids become our friends too. Good friends are hard to find, but once a friendship is established, it's a very valuable commodity. So take your time and find a good pediatrician who, hopefully, will become a new good friend.

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