1 Mother 2 Another

Madeleine’s coming up on her one-year check-up soon and I’ve been
working on my list of questions to ask the pediatrician. See, I write
down all the things I’d like to ask her so that I 1) don’t forget and
sit there panicking saying, “I know I had a question but can’t remember
what it is!”; and 2) I don’t feel the need to call the doctor once a
week: I write the question down and if finding out whether or not she
needs sunscreen specifically formulated for babies seems urgent I’ll
send it out to my focus group. I’m sure my pediatrician appreciates the
lack of calls she gets from us between visits, though I’m guessing she
inwardly rolls her eyes when I pull out my list every appointment.

She’s
incredibly patient, though, and I realized how lucky we are to have
found her. I know many people who go through two or three doctors
before finding one they are comfortable with. And with so many friends
anticipating a new arrival this year, I thought this might be a good
time to talk about how you go about finding a great pediatrician.

All
that, and because my brother point-blank asked me to write a blog on the
topic. Someone’s wife gets pregnant and all of a sudden Sister’s
website gets a lot more interesting . . .

At any rate, here we go.

 I’m drawing on three sources here for the following information – 1) my
personal experience and observation; 2) the book Baby
411 (more on that later); and 3) my girlfriend who is a
pediatrician and was kind enough to jot down some thoughts on the
subject for me. Thanks, Rebecca!

First off, when should you start
looking? I recommend getting serious by the beginning of your third
trimester. You’ll want your pediatrician selected by 35 or 36 weeks. For
one thing, it’s good to have the pediatrician on record with the
hospital and your OB; second, you’ll want to talk through some medical
decisions like circumcision with the pediatrician before your son’s
being wheeled away; third, if you or your spouse have medical conditions
that may be genetic it’s good to give the pediatrician a head’s up; and
fourth, babies come early. My girlfriend Bev went into labor at 35 weeks
and was stuck with the pediatrician the hospital blindly assigned to
her, whom she disliked; her son’s reflux was not diagnosed until he was
four months old and she ended up having to doctor shop during her son’s
first year, which is no fun.

All this to say, don’t leave the
pediatrician selecting as the last thing on the list.

When you’re
looking for a pediatrician, the best way to find a good one is by
word-of-mouth. Ask everyone in your Lamaze class if they have settled on
one, and why they like him. Ask your girlfriends who already have kids.
And most importantly, ask your doctor. I adore my OB and trust her
implicitly; I’ll call her for a completely unrelated referral, like a
dermatologist, so much do I trust her. So I asked her for the short list
of preferred pediatricians she works with and went no further. If your
doctor is part of an HMO, don’t just ask her who she’d recommend; ask
her who she uses herself. My pediatrician is my OB’s granddaughter’s
pediatrician. That’s a pretty great recommendation. Oftentimes doctors
who are part of a big machine are required or strongly urged to refer to
other people in their group; whom they personally choose to use is a
different matter.

Asking your girlfriends will get you good
names, but will also get you valuable info on people to avoid, or things
to look out for that you may not have thought of. One girlfriend of mine
went to a pediatrician all her friends used, only to find she hated the
group and had specific issues with their service. Hearing that from her
made me realize I need to not just accept a recommendation; I need to
check a doctor out for myself.

As you gather a few names to
pursue further, think about what’s important to you in a pediatrician,
as that will automatically narrow the list down. I asked my OB what the
single most important aspect of a pediatrician was, and she replied,
“Her network. 90% of most pediatric visits can be done by any competent
nurse practitioner. It’s the other 10% that’s going to count, though,
and chances are the pediatrician will be referring you out.” In other
words, you want a pediatrician with admitting privileges to a great
children’s hospital, and a good working relationship with a variety of
specialists like allergists, GI specialists (infant reflux), and so
forth. When you are in the middle of a crisis is not the time to
discover that your doctor can’t work with the one hospital in your city
with a good child’s ICU. And my OB is the perfect example; I go to any
doctor she refers, and when Maddie was breech and we were trying to get
her to turn I was comfortable going to the professionals she recommended
sight-unseen.

I tell you this so that you’ll add some questions
about the doctor’s referral network and admitting privileges to your
interview list (more on that later!), but also to highlight what she did
not say was the most important thing in a pediatrician: location.

I
fully expected location to be high on the list of desirables, since you
visit the doctor so much early on. I had hoped to find one within
stroller-walking distance for convenience sake, and when I told my OB
that she laughed, “If you find a good doctor in stroller distance, don’t
ever move.”

Obviously, if you can find one somewhat close
to you, that’s preferable to having to schlep an hour for every
well-baby visit. I’m simply pointing this out so you don’t eliminate a
potentially hot doctor a friend passes on to you just because of
location.

Another thing that may cut a doctor from the list
before an interview is the insurance factor. I’m all for going out of
network for a lot of things; I’d rather see a good doctor who’s referred
by someone I trust than someone I pick blindly from my HMO’s book. But
you’re going to be doing a lot of doctor visits those first few years,
and paying out-of-pocket and filing for reimbursement (at the lower
rate, of course) can get old quickly. So call around and ask if they
take your insurance. Try to get a feel for what other insurance
companies they accept as well, since your work will probably switch
carriers a few times.

And finally, decide what sort of office you
want to work with. Doctors in solitary practice may be finding subs for
vacations that know nothing about you or your child; likewise, working
with a large group of 6 or more doctors may mean your baby never gets
known by one particular doctor, which is also important.

You’ve
talked to your friends and doctor, made some insurance-related phone
calls, and narrowed the list down to two or three doctors. Tomorrow,
let’s talk about the prenatal consultation, and how to get a feel for
the doctor’s practice.