Friday, April 22, 2011

What I want in a pediatrician

With the chaos of switching insurance and doctors for 2011, and somehow several mishaps getting his records faxed over, we ended up doing Lo's 15 month "well-baby visit" late. Then we did his 18 month checkup early (he hits 18 months next month), so I'll just report on both visits in this one post.

For his 15 month visit, we noticed our new doctor's office did things differently than the former one we'd been using. It made me realize how much I liked the old office, so we ended up going back there for the 18 month visit and we will stay there now even though only one doctor in the practice takes our insurance. Here is my list of pros and cons and why we are happy with our current pediatrician:

Original doctor office (the one we used for pretty much all Lo's visits over the first year of his life and who we decided to keep after temporarily leaving):

  • Treats Lo like a little celebrity. Since the office is a family practice office, they don't get a ton of babies in there and hence really appreciate it when an adorable kid comes in for a checkup. The nurses, front desk ladies, other patients in the waiting area, doctor, etc. all make cute smiles and chatting with our Lo. Which puts him (Jerry and me too) in a good mood.

  • Weigh him standing up on "the big boy scale." They have done it ever since his 9 month appointment I believe? Since he was old enough to stand anyway.

  • Weigh him in his diaper rather than nude. They have done it ever since he got big enough that a few ounces of diaper weight would obviously not affect the overall numbers (maybe since he hit 20 lbs or so?) .

  • Measure height and head while he is standing, again having done this ever since he appeared to be happier standing than laying down.

  • Have nurses who are happy to accommodate my wish to do vaccine shots while I hold and/or breastfeed my child.

  • While they are often running late in this office, the staff take time to listen and accommodate our questions, concerns, and requests which makes the wait worth it.

  • The doctor seemed intent on keeping our child happy, even encouraging a nervous Lo Lo to be playful through the procedures--for example, asking Lo Lo to hold the stethoscope on Mommy's chest, then let Lo Lo hold it on his own chest, etc.

  • Calm and respectful about Lo's slightly "off" vaccination schedule--have normal dialogue with me about my thoughts on the matter.

  • Lo ends up being happy/relaxed about 90% of the visit, and stressed about 10% of the visit (pretty much unhappy only during procedures like shots but recovers quickly).

Now then. The doctor's office we attempted to switch to (the one we ended up only using for Lo's 15 month visit):

  • Insisted Lo get weighed and head circumference checked all while he was laying down on the infant scale (He is a toddler, not an infant, thank you very much). He was NOT happy about being forced to lay down. Nor was I, because I had told them he could be weighed standing up and they responded, "No, we don't do it that way."

  • Insisted Lo get weighed completely nude (again, I asked if he could keep his diaper on because he was showing obvious signs of anxiety about getting undressed, but was told "we don't do weighing in diapers here.") Afterward, allowed Lo to put a diaper back on, but as I had left my diaper bag in the car, the nurse handed me a diaper which was two sizes too small because it was all they had available.

  • When the nurse found out Lo was one set behind on his vacs ( I had declined them in the first 2 months of Lo's life because I wasn't finished reading on the subject but then decided to pretty much just follow the recommended routine), she acted uptight about it, telling me I would need to bring him in for a special appointment just to get the additional make-up shots.

  • When she saw me holding Lo (nursing him) when it was time for his vaccination, she said firmly, "I won't do it that way." I told her all of his vaccinations had been given in the past while I was holding him, but she said they would need him to lay down on the table because "that's how we do it here"and she seemed really concerned he might move around. She even had a specific spot on the table where she wanted him to lay. To me it seems more likely he would thrash around being forced to lay on a table rather than while being held in his mother's arms, but apparently I don't know much. I asked the nurse to please get someone else who would do the vaccinations the way I prefer and she left the room, obviously annoyed. I stayed calm, but my heart was pounding. Most unpleasant. :(

  • The doctor came in a few minutes later (he asked, "Is there a problem?") and I explained how I had seen the research that shows both sucking and sugar (two elements of breastfeeding) can be significant for pain management/calming a child during procedures. The doctor said "Yeah, but..." and in our conversation I got the idea he only thought those studies were relevant pertaining to newborns in the NICU who were given binkies dipped in sugar water. When I told him "OK, I'll just go back to the office who does vacs our way," he responded that he was required to have me sign a waiver. The waiver was horrible--I felt like it was agreeing that I didn't care about my child, because the waiver said things like, "I agree that I am endangering my child's life." And in retrospect, I don't think I was required to sign any type of waiver anyway since I have refused vaccinations for Lo at four other occasions with four other pediatricians in the past, including the ones at the hospitals where he was birthed, in the NICU, and then the pedi we saw in Massachusetts and our first Ohio doc. and I don't recall them having me sign anything. I think because I wasn't outright refusing vaccinations at the time...just saying I needed some time about it? Anyway I think having me sign the waiver was meant to guilt me into accepting the vaccinations because it gives the doctor's office better percentages. But I guess that makes me sound a little conspiracy-theorist to say such a thing. Anyway...

  • The doctor did not attempt to make the visit enjoyable for Lo, instead forcing the baby through the procedures rather quickly and telling me, "at this age they just hate the doctor's office and there is nothing you can do about it."

  • On the plus side, this office had virtually no waiting time, and seemed awfully efficient and professional. A little TOO business-like for my taste, apparently.

  • Lo Lo was unhappy 90% of the time in this doctor's office, and content only about 10% of the time (most of the latter time period being in the waiting office before all the unpleasantness began).

So there it is. To sum it up, here's what I want in a pediatrician: treat us as the quirky individuals we are, and be humane whenever possible.

Oh, and in case anybody cares, that Lo's statistics are still off the charts (above 99%) for height and weight, and head circumference is above 90%. Nice to see his head catching up with the rest of him...Must be all that smartness he's been gaining lately. :) And his iron levels, which had been borderline low at his 12 month checkup, are now back up where we want to see them. I wondered since I still can't get him to eat iron-fortified cereal and breastmilk is the majority of his diet still. But apparently whatever we are doing is working fine.


Cami said...

You should leave write-ups about these doctors on your local pediatrician finding websites and review boards. Other moms would love to know this stuff before going to these offices! We have been through lots of pediatricians and some are quirky and some are rude and a few are awesome but I haven't heard of any as set in their ways as that second one you described! That's crazy!! Signing that waiver was ridiculous.

Becca said...

I would have RAN from the new office.....
G's Pediatrician has not weighed him nude since 2 months of age (as long as diaper is dry- otherwise I have to change his diaper first), set up an individualized vax schedule based on me being a SAHM and whether breast, formula, or combo fed, and is playful and happy as well. They do allow nursing during vaccines, but I know a lot of peds are going away from that saying it is a "choking hazard" which I have not read up on since G's allows nursing (and we have weaned now).
I am glad you are back where you are happy. That is very important when it comes to health care. Especially for our little ones.

Valerie said...

I'd be interested to find out the personal lives of these two separate doctors!

TheTamFam said...

Thanks for the idea, Cami.

Choking hazard? That's a new one I haven't heard yet. Crazy.

Yeah, all doctors are not alike, and it totally pays to shop around.

The McDonald's said...

Wow! yeah I wouldn't stay with that second doctor either. Why would they weigh a 15 month old nude! That just sounds nuts. I'm glad you have another option like you like!