How to choose a pediatrician.

THE OTHER NIGHT on a popular TV show, two distraught parents confronted their pediatrician with a problem: Their baby was crying every night and waking them up, they complained. As the young couple argued about the pros and cons of picking up a crying baby or leaving it alone to “cry it out,” the rather stiff and perturbed pediatrician couldn’t manage to squeeze a word in edgewise. Finally, when the argument subsided enough for him to speak, the doctor told the parents bluntly: “The problem is with you -not with your baby.”

The parents smiled politely and somewhat sheepishly in the face of this professional opinion. But as soon as the doctor was out of earshot, Mom and Dad forgot their own argument and reached a quick and unanimous agreement: “I don’t like that guy,” hissed the husband.

“Neither do I,” snapped the wife.

On TV, the incident was designed to add a touch of levity to a make-believe melodrama, but in real life the lack of communication between parents and their pediatricians is not a laughing matter. The choice of a doctor for your child is one of the most important decisions you will make as a parent. The pediatrician you select may serve your family for 15 to 20 years or even longer, not only as a physician but as an educator, advisor, counselor and friend. Just knowing that a well-trained, understanding professional is at hand can be a welcome comfort in times of crisis or emergency.

Pediatrics is one of the oldest medical specialities; it is also one of the most popular among physicians. This means that there are scores of pediatricians to choose from. And this is why several leading local practitioners advise putting considerable time and effort into selecting the right pediatrician for your family. “Some people will take the advice of someone they don’t know well about the most precious thing in their lives -their children,” says Dr. Robert I. Kramer, a North Dallas pediatrician and associate professor of pediatrics at the University of Texas Health Science Center at Dallas. “They would spend more time selecting a refrigerator.”

How can you find a pediatrician?

If you’re pregnant, the months before the birth of your child offer an excellent opportunity for checking out pediatricians. Ask your obstetrician for the names of several, then visit each of them. Your internist or family practitioner may also be able to provide recommendations.

Newcomers to Dallas or persons with no other referral source can call the Dallas County Medical Society at 526-5090 for recommendations. If you are planning a move, ask your present pediatrician for the names of fellow practitioners in the city to which you’re moving.

Another obvious way to locate a pediatrician is by talking to close friends who have children. But make sure you’re asking someone whose judgment you trust and respect.

Can a family practitioner take care of your child?

Family practitioners see patients from infants to the elderly. Because of the varied population they serve, family practitioners usually spend only a few months in pediatrics training. “To be perfectly honest,” says one pediatrician, “a good family practitioner can take care of a child as well as a pediatrician insofar as ordinary problems are concerned. It’s the out-of-the-ordinary problem that calls for a pediatrician.”

What specialized services does the pediatrician offer?

Besides taking care of the routine medical problems that confront children, pediatricians are also skilled at detecting developmental and behavioral problems, counseling families and offering nutritional advice on the diets of growing youngsters – all of which may help prevent serious future problems. The pediatrician is also especially well-equipped to treat the major illnesses of childhood, to recognize a potentially life-threatening condition and to know when hospitalization is required to safeguard a child’s health.

How important is preventive medicine in pediatrics?

An important thrust of pediatrics has always been preventive medicine. During regular checkups, the pediatrician usually counsels parents about developmental milestones and impending behavioral changes. He or she can be an indispensible source of educational information on everything from taking an infant’s temperature to holding and feeding a newborn to helping a teen-ager control acne. The major habits of life -both good and bad – are usually formed in childhood and adolescence. Thus, the pediatrician’s preventive measures can help not only to insure a healthier childhood, but also to establish patterns for good health through later life.

How important is communication between parent and doctor?

Even a thoroughly trained, totally dedicated pediatrician may be ineffective if he is unable to adequately communicate with the parents of the children he treats. This means communicating unpleasant as well as pleasant information. Remember the doctor on TV? If he had had a good line of communication established with the parents, they probably would have accepted his opinion gracefully, even though it smarted a little.

If you have questions or problems, be sure to talk to the doctor about them. A concerned pediatrician will take the time to answer you – even if he has to make time. “Some people need a great deal of interaction with their doctor on a personal level,” says Ashworth. “Others feel that a professional relationship is all they want.” The intuitive pediatrician can usually sense what type of relationship a parent wants and act accordingly.

“Decide if you’re happy with the person – if you like the way he or she is doing things,” says a longtime Dallas pediatrician. “We can’t please everybody and be all things to all people, but if you don’t like the doctor you have, you have a perfect right to switch.”

If a switch becomes necessary, how do you handle it?

If you’ve talked with your doctor about the problems you have in the relationship but you still feel the problems are irreconcilable, make an appointment with another doctor. The new doctor will ask you to sign a release for your child’s medical records, and the previous pediatrician will then transfer the records to the new doctor. This is the tactful, comfortable way to switch pediatricians. As a formal but friendly indication that you have decided to discontinue your relationship, you may also want to send a letter to your former pediatrician thanking him for his services.

How often should your child see a pediatrician?

Although the number of visits may vary slightly depending on the doctor, pediatricians usually see healthy babies from five to eight times during their first year of life. Another two or three checkups are usually done before the child’s second birthday. From age 2 on, children usually have routine checkups once a year if they have no medical problems. Some pediatricians, however, prefer to see children every two years unless an illness occurs. Immunizations, for the most part, are completed by age 4.

How long can a child continue to see a pediatrician?

By definition, pediatrics is the management and treatment of children from birth to puberty. However, most pediatricians will now continue to see patients of long standing up until the age of 21 or until the time of their premarital examinations.

What should you tell (or not tell) your child about the pediatrician?

“Honesty with children about going to the pediatrician is the best policy,” Kramer says. “Help kids learn that doctors are their friends. Untruths not only destroy children’s confidence in doctors and nurses but in parents who have told untruths as well.” Kramer and other pediatricians offer these suggestions:

-Don’t tell your child you are takinghim for a treat and then sneak him to the doctor.

-Never tell your child that he isn’t going to get a shot since you don’t alwaysknow this for certain.

-Never say a shot won’t hurt; it’s betterto say, “This won’t bother you much.”

-Respect your child’s dignity by notlaughing at him or otherwise embarrassinghim in front of the doctor.

-If the doctor needs help with a wriggly child, be firm, but don’t yell “shut up!”That could make the child scream louder.

-Be understanding about hurts, but don’t prolong the agony with too much sympathy.

– Never threaten your child with a shot or a trip to the doctor for crying or misbehaving.

How much should you expect to pay for a pediatrician’s services?

The initial visit and consultation may range from $25 to $40, which usually includes a complete history on the patient. Each subsequent checkup may cost anywhere from $10 to $25. Some pediatricians offer telephone consultation free of charge during office hours; some don’t. You may also want to ask if the pediatrician provides literature and counseling on home treatment of common childhood problems. Many pediatricians offer such services to save their patients time and money, but you shouldn’t assume anything without asking. Some pediatricians charge a fee for telephone consultation outside of office hours, but not during office hours.

What are some of the problems of pediatrics?

According to Kramer, many young medical students choose to go into pediatrics because it is a very exciting area in medical school. “You see very sick children who can be cured and you are able to develop a strong rapport with parents,” he says. “You really feel a part of a team.”

Once those same young doctors get into private practice, however, the euphoria of medical school fades all too quickly with the routine of private practice. “There is a greater exodus from pediatrics than any other field,” Kramer says, attributing that exodus to these factors: (1) It is hard to regulate a pediatrics practice because pediatricians are usually on the staffs of more than one hospital, requiring more travel than most other medical practices; and (2) pediatrics is the least remunerative of specialties, and a pediatrician’s office is among the most expensive to run. More people are required to staff the office and take care of the large volume of patients the pediatrician must see to produce a suitable income.

What are some other keys to a successful doctor-patient relationship?

Learn your pediatrician’s office hours and make sure you know when to call for appointments and advice. Keep writing materials available for noting instructions if you call for help. ,

Ask about your doctor’s emergency procedures before an emergency arises. Remember, most pediatricians send critically ill or injured children to Children’s Medical Center, 1935 Amelia Street, where specially trained doctors are on duty 24 hours a day. Otherwise, the pediatrician will send the child to the hospital with which he is affiliated, if hospitaliza-tion is necessary. Emergencies at Children’s Medical Center’s Freeman Clinic are handled between 8 a.m. and 4 p.m. After 4, you must take your child to a hospital that has a 24-hour emergency room. If you have strong preferences about which hospital your child goes to, ask the pediatrician about this on your initial visit to avoid any misunderstanding later.

Read the literature your doctor provides. It can often help you to know when you can handle your child’s problem and when you can’t. And it can help you avoid both a 2 a.m. panic and an unnecessary – sometimes expensive -after-hours phone call to the doctor.

If your pediatrician occasionally runs behind on appointments and keeps you waiting, try to give a little thought to what kind of doctor he is before you storm out in a huff. Consider how he treats you and your child. If he is patient and takes time to answer your questions, he may be behind because he also offers this courtesy to others. If he rushes you through and always seems in a hurry, he may be cramming in as many appointments as possible to boost his income. But whatever your complaint may be, talk to him about it, don’t just fume in silence.

And don’t expect a pediatrician -anypediatrician -to be super-human or infallible. At best, your relationship with himwill be as a partner in caring for yourchild’s health and well-being, not as an adversary or a passive bystander. By workingtogether, communicating freely and openly and striving for mutual understanding,you and he can not only guide your childthrough the physical pitfalls of adolescence, but also make that child a healthier,happier, better adjusted adult.


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