Meet the Pediatrician

Meeting a Pediatrician is an awful lot like an awkward first date.  You want to like them.  You want to be swept off your feet and hear violins…but you’re distrustful because you know they’re on their best behavior and want to impress you so you keep looking for their fatal flaws.

It’s enough to drive a Mommy crazy.

That doctor is too old.  That doctor would push me to circumcise my son (if I had one).  That one is too cautious about food allergies.  That doctor is the wrong biological sex for the primary pediatrician for my daughter.

You’d think this would be easy.  After all, we’re not interested in messing around with the vaccination schedule, which seems to be many people’s biggest stumbling block.

But it isn’t.

If I could conjure up a dream pediatrician, she would be my friend L.  Who *IS* a pediatrician.  Who can’t treat my daughter because of conflict of interest, damn it all to hell and back.

L is young.  She is fairly freshly minted out of her residency, and as such is VERY up to date on the most current research and practices.

L is a skeptic at heart about the whole food allergy culture of fear.  When we talked about food allergies, she said that after treating kids on both coasts in three major cities and one wealthy suburb, it seemed odd to her that the rate of “food allergies” diagnosis was particularly high for a specific area/socio-economic class near me.  She mentioned the high number of false positives of RAST tests.  She wondered aloud if some of these diagnoses were brought about by parents who read a lot, got freaked, demanded tests, and basically just beat on doctors until they got the diagnosis they wanted or got a (potentially false) positive RAST tests without actually testing the actual allergy.  Having had some of these parents in my classrooms, I can attest that this isn’t actually out of the realm of the possible.

L has an AWESOME bedside manner.  Not just good, but awesome.  With adults as well as kids.  She even has the patience to deal with me and I’m not even the mom of her patient.  She will even point me towards resources to learn more about topics I’m interested in, and will even send me to conflicting reports.  She explains why and what and how.

Since I can’t have her, I guess it’s easier to say what I do want…

-On the younger side.  I wouldn’t rule out a pediatrician because of age, as long as I could see that they were definitely reading up on current research and staying on top of stuff.  However, most doctors I tend to get along with are of an age that they could have been my babysitters if not my contemporaries.  We tend to have similar values and cultural references.

-Pro-Breastfeeding, but not rabidly so.  Someone who isn’t going to critique me if I hate it and want to stop.  However, also pro-breastfeeding enough that they can provide support in terms of finding a lactation consultant, or have a nurse on staff who can help with latch issues etc.

-Neutral on circumcision-or at least wouldn’t recommend it as a matter of course.  Knows that the AAP takes a neutral stance on it.  Would understand that I personally am very anti-circumcision, as is my husband and that we would not take well to hearing it advised to us were our second child to be a boy.

-Pro-Vaccination, including Gardasil (this one hasn’t actually been an issue)

-Comfortable with the idea that we aren’t attachment parenting types.  Will not give me advice consistent with the AP approach like advising me to use cloth diapers (unless the child had a medical reason to need them like a skin allergy) or baby wear or anything like that.  I’ve met one pediatrician who was obviously an AP type and it annoyed me fairly quickly.

-Has a way to get ahold of them or another doctor after hours.  I don’t want to go to an ER unless I really have to.

-Has at least one night a week with appointments on the later side.  Because we’re near a big city, we’ve found plenty of practices with this, and it’s kind of nifty.

-Has electronic records and can do electronic prescriptions.  Our PCP and my OB do this and it makes life SO MUCH easier than paper prescriptions and when multiple doctors need to see and add to records.  A doctor who I could email non-emergency questions to would be a bonus (several doctors around here do that).

-Good beside manner for both me and my child.  Understands that I’m the type of geek who will have already researched what is supposed to happen at an x-month well baby visit and will have questions about stuff.  Who will be tolerant of the fact that I’ll get a second opinion if I get a diagnosis that concerns me.  Who will talk to my kid and explain to her (once she’s old enough) what’s happening and why.

-Who is okay with prescribing my 11/12/13 year old birth control.  This is a super controversial topic, but… I’ve had pregnant 13 year olds in my class…I don’t want one in my house.  I would prefer that Emby not be sexually active until she’s 16/18/older but that may not be the case.  Beyond that, she may need them for the same reason I did–excruciatingly irregular painful periods.  I don’t want the pediatrician giving her shit for asking about it or having reservations about prescribing them.  Yeah, this is a decade away, but it’s a values thing.  Luckily I live in what is probably the most liberal state in the union so this hasn’t been a stumbling block for me yet.

-Is okay with my breastfeeding on anti-depressants.  I haven’t asked anyone about this yet, so I don’t know how it will play out for me, but I’ve heard many pediatricians are very negative about this.

Maybe I won’t find the perfect match.  Maybe I’ll find someone who looks good at first, but isn’t great in practice.

The thing I try to keep in perspective is that it’s not a permanent decision.  I have great health insurance and I live near easily 30 pediatric practices in less than a half hour drive (probably more) so I can change dr’s as much as I want to/need to.

But it’s one of my first big decisions as a Mom, and I want to get it right.

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4 Responses to Meet the Pediatrician

  1. Interesting list. The way the pediatrician relates to children is extremely important. But I think you are missing the most important thing–does the doctor over-diagnose and over-prescribe, or misdiagnose or underdiagnose or not check thoroughly? A young doctor fresh out of med school may be up to date, but not have the experience to realize when a cold is likely to turn into pneumonia (I just threw that out as an example–I have no idea if a doctor can predict something like that).

    And I also think that it is way too early to look for a doctor who is okay with talking about b/c with pre-teens. You want a doctor who is good with babies and possibly toddlers.

  2. Taking a Chance on Baby says:

    I absolutely disagree with your premise that it’s too early to talk about B/C because it’s a fundamental moral disagreement. I wouldn’t want to know I’ve been trusting my child to someone for 13 years who wouldn’t consent to giving her BC at her request or mine. It would be like finding out my OB was voting for McCain (she isn’t)–it would signal a fundamental difference of opinion that would make me completely distrustful of their basic values and how they approach life and medicine.

    I don’t really worry about over/under prescribe…I’m a FIRM believer in medical intervention and medication. You noted that you would want someone who wouldn’t send your kid to the ER too much…too much intervention is the last thing I’m worried about…I just don’t want to go to the ER because they’re not in the office enough themselves.

    Besides…a “new” doctor already has 4 years of supervised experience, including at least a year as a pcp under the direction of a supervising practioner.

  3. Weren’t you just complaining about overdiagnosis of allergies?

    Overuse of antibiotics isn’t a “crunchy granola” issue. I’m surprised it’s not on your list of concerns. There’s also the larger concern of overuse of medical resources that lead to higher health costs.

    And unnecessary ER visits needlessly expose children to illness.

    For the record, I vaccinate my children and give antibiotics when the doctor convinces me that they are required. Sometimes I get a second opinion.

  4. Taking a Chance on Baby says:

    I am human, and as such, not always consistent.

    The thing is, I have had a LOT of positive experiences with antibiotics over the course of my life. I have never felt like I’ve been given one too quickly, or that I was given too high a dosage. I’m the first person to take a tylenol when my head hurts, or a motrin when I have period cramps. Zofran has SAVED MY LIFE during this pregnancy. So antibiotics are not something I worry about.

    To be honest, the most frustrating experience I ever had with an antibiotic was when we had to go through 4 rounds of increasingly stronger penicillin to clear up a really bad case of strep in 7th grade in that I still kind of wish they’d upped the strength sooner.

    I guess I’m also not worried about the ER, because I don’t remember being in the ER more than 5 or so times in my childhood. There was the time I tripped over a shoe and my head met the corner of the door (the door won) resulting in 70+ stitches as the wound went all the way down to the skull (and 2 emergency rooms, the second being necessary as the first hospital didn’t have a plastic surgeon, and as the scar is on my face a PS was the right person to sew it up to minimize the scar…which 20ish years later is not even noticiable unless you know where to look). There were one or two weekends I got really sick (which isn’t so much an issue as all the pediatricians around here are open on weekends for sick visits). And I remember one or two other experiences, but not the specifics. It could be more than 5, but I highly doubt it. With the hours and availability of pediatricians around here, the chances of needing an ER unless it’s an out and out EMERGENCY are fairly slim.

    On the other hand, when I’m being told that something MIGHT just harm my child…maybe…we’re not sure…maybe…so why not get rid of all nuts for like 4 years and then we’ll think about it….or maybe we can give her this test with a HIGH false positive rate….that makes me suspicious.

    The bottom line is that if my kid is diagnosed with something, I’ll research it including the usual courses of action. If I see something strange or inconsistent, I’ll call up L, my friend who is also a pediatrician. But it’s not something I really worry or think about going in.

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