How do you choose a first pediatrician?
While it would be great to be able to just use the doctor we were raised with...
assuming that's not possible:
How does one not merely locate a good first pediatrician, but evaluate them? What are good and bad things to watch for? How do you schedule an evaluation visit?
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"It depends", on a lot of different factors. I hate to suggest something as negative sounding as "trial and error", but well, that seems to be the best way. To get through med school, and then go back to specialize in pediatrics... that seems like it's going to weed out the ones that just aren't any good at the base medicine. So really what you're left to base a selection on is people skills. Some of the key points that have turned me off of pediatricians. (and for that matter one of the OB/GYNs in the rotation... we were happy when my wife went into labour and we got to the birth center and didn't see his name on the board.)
Do they seem to spend more time looking at your kid or their chart? (ok, I like a bookworm... but not during the limited time we have together. And not if it's clear you're not listening to the answer I'm giving to the question you just asked. Which is the same question the nurse asked and typed in the chart you're reading right now... in fact I can see her transcription of my answer on screen under your mouse.)
Do they still remember your child's name 5 minutes into the exam? How about at the end? (Seriously, one Dr was particularly bad about it... "The boy will be fine in a day or two, if not call us back." Said with the same amount of interest as if his wife asked if he wanted meatloaf or liver for dinner... "The meatloaf will be fine dear." Contrast that with our current pediatrician who opens the door and immediately says "Hi Q, how are you doing?" or "Oh no Q, this says you're not feeling well!" and ends with saying "Good bye Q!" while walking us out. (it turns out her office is just past the door to the waiting room, and she always goes straight back and types up her notes on the visit, then pulls up the next patient's chart.))
Our son was born at the hospital that is part of the same healthy care network my wife and I both see our doctors at, which made it pretty easy. The very first pediatrician we saw was actually when they came into the DLRP room my wife and our son were staying in to give him his 2 day old checkup. (The previous day's tests had been done while my wife was asleep and I wasn't there.) Both of those pediatricians were on rotation through the birth center from the normal pediatrics offices at their three clinic sites. I liked the dr there, but she worked out of their north clinic (about a 25 minute drive from our house) so when we scheduled his first check-up at 1 month I told the receptionist to pick anyone but Dr. X (who many co-workers had advised against.) Wasn't too thrilled with that pediatrician, but he seemed to be "ok". After maybe 5 or 6 visits with him, we needed to bring our son in in a hurry for an illness... they said Dr. Y couldn't see us for 3 days... but Dr Z. could see us in 30 minutes. We jumped at that chance, and after seeing Dr. Z that one time, we asked the front desk to change us to her as our son's "regular" pediatrician. We've seen a couple others off and on since then when he's gotten sick and she's not been available... but I can't imagine asking for a different doctor.
Out of curiosity I asked at the desk if it was a problem to change pediatricians, they laughed and said "no problem at all." then commented that they would rather switch us a dozen times than have us stuck with a pediatrician that just doesn't work for our family. Apparently it's a pretty common thing, different parents/kids just work out better with different doctors. They recognize that and don't fight it.
Before he was born, I had asked a number of co-workers with kids for recommendations, they had almost universally said there were two doctors (a husband and wife team no less) that were hands down the best pediatricians in the group. And there was another that got very favorable comments from everyone. All three of them are so popular, that they're not accepting new patients. (unless you already have a child that they see, new siblings were welcomed.)
One idea that I have is to speak with members of the community who are parents with small children, and ask them to share a recommendation, if they feel that they have had a very positive experience with their pediatrician, or if not, ask for the flags.
As far as warning signs go, I can only speak from personal experience, but some flags that got set off for me on our first pediatrician try were:
Young, unprofessional staff - The doctor's office seemed to be full of 15 year old assistants, who were doing everything from weighing our child to preparing vaccines. To make it worse, they often did their tasks incorrectly. An example encounter would consist of assistant weighing, doctor coming in, looking at charts gasping and exclaiming "Oh, he lost so much weight," then looking confused, going to reweigh our child, and finding out that the assistant did not know how to read the scale at all, and then explaining, in front of us, how she should read the scale. Repeat for multiple appointments.
Lacking a sense of doctor really caring (being impersonal) - Check for flag if doctor treats your child like an inanimate object instead of human. If you can instead discern passion and caring, it may be a good sign.
Not sharing thoughts - This may not be for everyone, but I want to know what is going on! Prying doctors in my experience can painful, so if you stumble upon one who is eager to let you know what they really think, it may be a good sign.
Musty office and/or doesn't look that clean - Huge flag to me, easy to spot right away. On the flip side, if both the space and the doctor are very well maintained, it may be a good sign.
In evaluating, I would attempt to gauge the 'space as a whole', as well as the doctor, but honestly, it is a difficult thing for us laymen to do on the fly. Luckily med school is pretty hard, so I would imagine most pediatricians know their stuff. Trusting this, I'll look a lot at how much I liked them as a person.
If they came across to me as genuine, intelligent, passionate, caring, friendly individuals who loved what they were doing, it would be a good sign for me.
Happy hunting!
Another strategy is to survey the nursing staff at the hospital asking who they use for their children. If they do not have children ask who they would recommend. Since they know work in the field, they probably know more about the reputation of the pediatricians. Often times, (at least in the hospitals that I work in) nurses are under utilized as resources and are willing even eager to share information with you.
Aside from asking people with children for recommendations, try asking an OB/GYN. They see a lot of new mothers, and they know a lot of other doctors, and word gets around.
In our case, my wife's OB/GYN (whom she'd been visiting for several years, and trusted implicitly) also happened to be a father of eight . He recommended a local pediatrics office, said that any of the doctors at that office would be fine, and also told us that if one particular doctor had any openings, we should opt for him. We did, and we were very happy with our choice. We've since left the country, but we still call that same office for advice.
The way that we found ours was to make an appointment with who ever was on call the day I called to set up the appointment. We didn't like the first pediatrician we got so when I made the next appointment I did the same thing. The second pediatrician we got is a really nice guy who is laid back but knows his stuff. He gave us his desk number to call if we have questions so that we don't have to try to navigate through the clinic phone system to get a hold of him.
We went through two pediatricians before finding the one we are using now. The first bullied and belittled me because as it turned out, I could not breastfeed. The second wasn't bad but the others in his practice were awful and he rarely had office hours in our location.
Look at your plans about feeding, figure that they may change (they did for me!), and ask your potential ped how s/he feels about breastfeeding (including pumping) and formula. Even then, you may not get an accurate assessment. Our 1st made it clear he was a lactivist, but not to the point where he would refuse to answer our phone calls because we had to switch to formula--we had to learn that on our own.
Figure out where you stand on vaccinating. Ask the doctor his/her opinions. Don't pick one that belittles you. S/He may disagree with you to an extent, but should also be aware that it is your child and you are the final decision-maker on such things.
Ask the doctor about child nutrition, and whether they have a relationship with a nutritionist. If your child has allergies, you may need one.
Ask the doctor about allergies in general, if the practice treats many kids with allergies or if they would refer out to a pediatric allergist.
Bring a general family medical history for both sides, and ask the doctor a few questions about pertinent conditions that run in the family--e.g. asthma, poor eyesight, hearing troubles, etc.
If you use alternative medicine (e.g. chiropractic, acupuncture, massage, etc.) get a feel for how the doctor feels about these things, in case you feel the need to use them for your child.
Figure out the doctor's office hours at that location. If there aren't many, consider interviewing the doctor's other colleagues, lest you end up like we did with our second ped and have to find another practice because the colleagues shouldn't be licensed to practice medicine.
Get a general vibe of the office. Is it clean? Comfortable? Full of sick kids getting snot everywhere? You may be spending a lot of time here.
Get a general vibe for the staff. If they look really busy, consider another practice.
Ask about other doctors in the practice or on call if it's a solo practitioner. As in, there should be others. We had problems with our second ped because of this. His colleague on call was a total quack.
Ask about an answering service. As in, there should be one.
Ask about getting a child in for a sick visit same day. You should generally be able to do this.
Ask the receptionist a few questions, but not as an interview--just in casual conversation. The receptionist is the gateway to the doctor. If you don't like him/her, even if it's just in response to how they feel about the weather, consider a different practice.
Of course, consider the opinions of others and even places like Yelp. But everyone's priorities are different; our first ped was highly recommended and yet he was a total jerk who disregarded my baby's health because he was taking my medical history and its impact on breastfeeding out on me.
Good luck!
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