advice on establishing care w/ a family dr. for the new little one

Well, first is finding someone who will sit with you for longer than 5 minutes and be interviewed. I found this to be much harder than I expected, but gave me a really good idea of who had the time/made their patients a priority, ya know? Most providers are referred by the insurance company now, and they are not 'chosen' by the family, so I found that a lot of offices were confused on why i wanted to talk to the doctor without having a medical problem. it's also a lot more common for them to work in a large practice (and you are the practice's client, not the doctor) and that they are so busy that they just can't get to know each family. I feel really, really lucky that i stumbled onto our pediatrician, and have yet to find a family practice MD who has given us the same level of respect. D.O.'s have a better track record, at least in my area, since their philosophy is more "whole person" than just treating an illness.

All that said, once you get in for an interview, I would ask them what their thoughts on issues are, before giving them yours. They can easily nod and smile when you say you want to delay vax's and then guilt you later, but if they come out with their opinion first, you are more likely to hear their true thoughts. You can do the same for issues you are concerned about - asking "What is your protocol when an infant has a fever? When do you advise parents to come in/medicate? What if my child has recurrent skin rashes? My brother had ear tubes as a kid, what experience do you have with diagnosing ear problems, and when would you advise surgery?" You're not really listening for their precise answer, but rather, their philosophy. You'll be able to tell if they are a "wait and see" kind of doctor, or a "medicate it ASAP" one. You may also get an idea of where they see the parents in all of this - are you the client, or is your child? How much is your opinion/experience/intuition worth to the Dr.? (Our pediatrician, fwiw, has seen my girls a number of times because i felt like something "wasn't right", and has never given me a hard time about it. He knows that I know my children, and that he is helping me keep them healthy, not the other way around.)

We just did this interview for a doc last week, so this is fresh in my mind.

DH and I came up with some areas that were really important to us and tried to come up with questions that would leave things as open for the doc as possible. However, we didn't want to overwhelm her, and we know that we're pretty well-informed and can/will make up our own minds on minor things. We wanted to hit deal-breakers only. So for us, we asked:

Breastfeeding: What do you recommend for your patients re: breastfeeding? (Of course, they'll say that it's best, but listen to what they say around that.) Follow up was to ask about her recommendations for introduction of solids and weaning. We thought that would get us a bit more detail on her personal beliefs.

Over-medication: We used an example from DD's history. She was brought in to another doc for a well visit (allergy consult). The doc did a quick exam, and noticed that one ear was slightly red. DD had no symptoms or signs of discomfort. What would this doc do? Our old doc prescribed us antibiotics (which, needless to say, we didn't use and left the practice right after). This doc said right away that she would NOT jump to antibiotics, and elaborated well.

Vaccination: We are a delayed/slightly selective vaccination family (no chicken pox, for instance). We wrote out the schedule that we wanted to use and asked the doc if that would be acceptable. We've run into problems at practices because they don't trust you to follow through -- if you say you're delaying for a few months, all they hear is that you won't get it. We wanted something firm to be able to point to. The doc looked over our list, declared it no problem, and reviewed it a second time to see if there was anything that they'd need to order special. She then spoke (unprompted) about being ok with families in her practice who chose not to vaccinate at all.

I'll tell you, though, you'll learn a lot more in those first few visits than you will with the interview. And that's ok. You can always change docs. This is our 3rd or 4th pediatrician since we moved here 2.5 years ago. We just make sure that we're well-informed on DD's medical history, and we use the pediatricians as back-up.

ETA: Regarding family doc vs pediatrician -- our family doc won't take kids under 1 year, so that hasn't entered into things for us.

For our ped, I was able to schedule a prenatal visit. This a real thing that they had actual pre-determined time slots for, so I had at least 30 mins to grill the dr I saw about whatever I wanted. I did only see one out of the five at that visit, but she is also the one I list as my child's dr. At this point, we have seen all five & I have liked them all fine.

I was not really sure what to ask, either, so I took in a pre-printed list like this one: http://www.babycenter.com/0_pediatri...eet_1452019.bc It is good to do b/c you may forget to ask about after-hours call-ins & hospital affiliations. My peds had a new patient packet w/ info about the practice & vaccines. I also had a letter for them from our birth center so that they would know what the baby had already been thru as far as exams & shots before coming in for first visit. Unf, I was ultimately not able to birth there, but still something v nice to have.

I did not ask anything about breastfeeding. I was not going to be contacting them if I had any problems or questions anyway, so I did not see it as important. At wbv's they would ask how much dd ate. I said idk b/c she bfs on demand. They said okay, how long does she nurse on an average session & does she have plenty of wet & poopy diapers? Those questions told me that they were v comfortable w/ bfing on demand. I asked about delayed & selective vaxing. I was told that they really support full vaxing on schedule, but that it was ultimately up to the parent. I would be encouraged to get all vaxes on time & I was okay w/ that. I get some grief now and then about not having the Hep B vax, but since I am negative & will get it for dd eventually, it has not gone farther than that. I refused the MMR (getting it later) & had to sign a waiver. I told them I understood that it is "safe" but my Mama Gut was telling me no & I had to listen to that. They were okay w/ that. I also got dd only two vaxes at a time & would bring her back the next week to get the other two. VERY supportive of this. The one dr said that he actually preferred that method b/c if dd had a negative reaction it would be easier to find the culprit.

I agree w/ Ivory, ask them the questions instead of stating your wishes. I don't unnecessarily medicate my kid, but for things like ear infections, I want antibiotics & I want a dr who will prescribe them (I had many as a kid & they HURT). I chose our ped b/c they are v close to our house & they take our insurance. Thankfully, their philosophies are close enough to ours that I am totally comfortable there. Had I not been, I would have looked at more places. Everyone (even the receptionists) at the office is incredibly friendly and welcoming, which is always a good sign. We have taken dd in when she has been sick before & they are v relaxed. The place is clean, they always gush about our babies, & they just love our cloth diapers. They are also EC friendly! We needed to check dd for a UTI once & the dr was totally fine w/ giving me a cup & going on to another patient while I waited until dd was ready to fill it. Jen is def correct in that you will learn much more after being there a few times. GL in your search, I hope you only have to go to the one!

May I suggest going with your gut in addition to what everyone else is saying. Pay attention to how you're treated. Do they listen to you? Do they act rushed? How is the receptionist? Polite? These things really do add up and can tell you a great deal about a practice.

With our first set of pedis here they totally dismissed my concerns about my son. Concerns that were obviously justified. They also treated us like we were ignorant or unintelligent. They were a perfectly accurate practice, and our children got the care but we always felt sort of insulted when we left. Dh felt it was because they somewhat racist (they third degreed him about Spanish at home as a cause for Umberto's problem when we told them we didn't speak Spanish at home). They also harassed me about nursing with my THIRD and were trying to get me to supplement. They only stopped when I said "Look this is the third child I have nursed and have no problems in the past so I don't see why there should be one now."

Our second pedi. was a total jerk, and I got into a huge fight with him over giving ds the chicken pox booster. I finally lost it and said "Look you might think I'm some ignorant person who is not capable of making decisions but my husband and I are both graduate students who are fully capable of reading research and making smart decisions for our children."

All of these places had indications there would be problems. The staff was very condesending. The drs. never really listened to us. They always were looking at their clipboards not us.

Our new office is wonderful. They are a family practice but they take a lot of children (good thing to ask is maybe how many children they see in their practice). They do take infants, and only the main dr. sees them until they're one. They always spend a lot of time just talking to us. Not just me but to the kids as well. I was very impressed when during the first visit, the PA shook each kids' hand and asked them their names, and introduced himself. He explained everything he was doing to them. He also respected and answered all my questions never dismissing any of my concerns.

As for questions: we mostly asked what others have. We didn't come in with a list of demands but rather asked open ended questions like Ivy's mentioned. In addition, I asked for their thoughts on nutrition as healing (we're very into eating for health) and on alternative treatments.

you're all awesome. as usual. keep it comin'!

ivymae, i figured actually making an appt. to establish care for me and telling them i'm pregnant would ensure time to chat w/ this doctor. is that naive? good advice about being open-ended.

jenfl, good point about picking a few key things. i'm worried about coming across as having a laundry list of demands instead of being interested to see if this is a good fit, which is my real intention.

dogretro, yay, a worksheet , already printed it! those are great details you mentioned too.

greentea, totally you are right about the gut. the receptionist was a little testy when it took a few tries to find an appointment time. i definitely don't want to feel negative every time i go in to the dr.

i think i am going to call and ask, what is involved in an initial visit, make sure the dr. will have time to sit and talk for at least 10 mins or so, and check that she will start care w/ a NB. and i'll see how they handle these questions .

I've never really 'interviewed' a dr. I figured if I went and didn't like the dr, I'd switch. We had a family practice dr until last June when we switched the kids to a ped. We switched b/c we didn't feel like the family dr was taking our second child's speech delay seriously enough. He was 2.5 and didn't have any words yet. Seemed to us like it was more than "He's a boy and boy talk later" by that time. That's not to say that all family drs are like that, but the one we went to was. However, this practice was fine for our first child and we'd been there almost nine years when we left.

I never asked about things like breastfeeding, co-sleeping, etc b/c I don't rely on a dr for advice on that kind of stuff. I need the dr for when my child is sick, not for parenting advice (most of the time). Our first child was vaxed pretty much on schedule. Our second child was delayed vax but I never really asked them their philosophy on that. I just didn't take that child to many well visits. Yes, that's the child who had a speech delay, but we would bring it up at sick visits and would make appts to discuss a specific topic (such as speech delay) instead of b/c he was X number of months old. Our third child is not vax yet and it's more b/c of no well child visits. Again, we bring up concerns at sick visits or make a special appt related just to our concern.

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I'm not really planning on interviewing the ped I've selected, per se. She comes highly recommended to me by a couple of mamas crunchier than I am, and even though the practice as a whole is pro vaccination, this doctor has never pushed said mamas and has respected their delayed and selective schedules. She's apparently also very, very pro breastfeeding and extended breastfeeding. She wants to come meet Cecilia for the first time at the hospital, and then see her a couple of days later, so I'm so far impressed with what I've learned.

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I didn't interview the first three pedis we had and I really wish I had interviewed the last two. Our experiences were so negative. And yeah you can switch but at the time I was working full time with a three year old and a newborn. Not something I needed to stress about. An interview might not have guarnteed me a better fit but I suspect it would have clued me in on things. The interview this time went great, and I really liked the office staff (they gave us a tour and introduced us to EVERYBODY) and it gave us a chance to see if we "clicked."

Of course this office came highly recommended by every crunchy mama in the area. The other practices we honestly picked because of locale. (Well in Maine there were like two pedi offices in our town LOL).

That wasn't a good answer was it? I guess what I'm saying is that you have to think do I want to switch with a newborn or while working? Is that going to be huge stressful or not a big deal? And I also think a lot depends on your personality. Yeah I could have gone with the "who cares about their parenting philosophy" but I found that I really hated lying every time I went in. I was ALWAYS asked "Does the baby sleep on their own for 8 hours straight." And at four months "Is the baby eating solids." And then at a year "You've weaned right?" I mean, the conventional attitude got on my nerves. It's nice to be at a practice where they respect my choices as a parent.

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Maybe part of my problem is that I really haven't had anybody have any issues with the choices we're planning to make? I was really expecting all of this push-back regarding things like the birth center. But even among the MANY PAs that I work with, nobody has said one negative thing. Nobody has told me that I won't be able to breastfeed or that I will give up on CDs. It's kind of baffling, but I'm not going to complain!

We're going to vaccinate, but I might do a more Dr Sears type schedule. I know that the place I'm considering is okay with that, and is breastfeeding friendly. I'm also one to just ignore advice I don't like from drs

The changing while working and with a newborn is something I should considering. Honestly the main reason I am not sure I'll interview drs is because I'm working full time and it seems like yet another thing I'll have to take time off for. But maybe I'm only putting off today what I'll have to do tomorrow.

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When our family dr would ask things like solids, I'd answer honestly but it was really no big deal what our answer was. I suppose if I said something crazy our six month old child slept outside on a cot, the dr may have said something, but not otherwise. Our child was not on solids at four months and the dr just shrugged and said "OK". When asked about sleeping, I'd answer, but I was never given the "OMG the baby must be sleeping through the night by now!" response. I guess ours just didn't ask the same questions. When he found out our third child was born at home, all he said was "On purpose?" and then said his second child was born at home (like 25 years ago).

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I think for me I just like getting along with someone I might have to see a lot I HATED our first few Pedis here in Charlotte, and DREADED every appointment. They were so rude to us for some reason. They really acted like we were some kind of ignorant morons who were unable to think for ourselves. I suspect dh is partially right in that racism played a role (not overt of course but there were likely some stereotypes about hispanics at play) but also because I tend to look alternative. Plus one practice dealt with an upper class neighborhood and most of the mothers were quite a bit older than me at the time (I was only 30 but that was considered a "young" mother in that circle). This is not likely to happen to you

With the previous drs. it wasn't that they were against our choices it's that they assumed we would be conventional. Breastfeeding really isn't that radical until you go beyond a year. Co-sleeping is okay if the baby is in a side car and sleeping through the night. So I found that it was I just a bit too radical to be honest if that makes sense.

The other consideration for us is that we wanted a family dr. that we all went too. Dh really likes to go to the Dr., and being from a country where drs. take time to really listen to you he expects that kind of care. I wanted to find a place where he could get that kind of care. With me I could care less, I HATE going to the drs. and want in and out. It's taken me months to relax with my midwife! If you're not looking for family care it is likely going to be easier.

Plus recommendations are usually good.

I didn't interview peds. With my first two I knew the community pretty well. We moved before my third was born and picked a ped based on recommendations; their office was great and all, but I loved one ped and hated another and was neutral about the rest. We switched because I couldn't always get follow-up with the ped we liked, and I had a near blow-out argument with the one I hated (that ended with me almost-yelling something along the lines of "I'm INFORMED, NO, let's move on.") The practice we're currently with is super tolerant of parents making up their own vax schedules and stuff like that, and also does a home visit after birth. They're too far away and we will probably switch again, to a practice that actually gives out its own parent handbook that includes things like information about why fevers aren't actually dangerous, how to not take meds if you don't need them, and how to avoid using formula.

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It was clear from the way the questions were asked that we were not going to get a tolerant response. When asked in a combative tone you know what's coming

Also I wanted to add that none of the pedis took our concerns about ds seriously. They kept saying dh was delayed verbally because he heard spanish at home even thought we told them multiple times that this wasn't the case. They also dismissed our concerns about other delays. They were all pedis too not family doctors. This time, the family doctor didn't think ds's first seizure was necessary a reason for great concern, but he took my concern seriously and got us in with a neurologist the next day.