Planning ahead can help you find the right doctor for your family
by Tara Haelle
There’s an old joke that asks, “What do they call the person who graduates last in their medical school class?” The answer, of course, is “doctor.” Chances are, you don’t think about asking doctors what their med school class rank was when you seek out their expertise and care, and even if you did, that answer would not capture much about their bedside manner, or their way of thinking about, identifying, and treating illnesses, or their values and beliefs regarding different medical interventions.
Few specialties allow for appointments unrelated to a current acute medical need when prospective clients might check out whether a provider would fit their needs, but pediatricians are an exception. Most pediatric offices have time set aside in the schedule each week for new potential clients to schedule an interview lasting anywhere from 10 to 30 minutes. It’s not a lot of time, but it’s enough to get a sense of the practice and to ask questions about that provider’s values, beliefs and practices. To make the most of it, prepare questions ahead of time that will let you discover any deal breakers and get a sense of what you might expect if you choose that provider.
A whole field of research looks at the beliefs of doctors, and that research has unsurprisingly found that those beliefs are informed by both personal experience and by the extent to which the doctors keep up with current research and recommendations — and that those beliefs influence care. For example, a 2010 study out of Canada asked 572 family doctors, urologists, obstetricians, pediatricians and family medicine residents what they use to make their decisions regarding circumcision. Just over three quarters of them (77%) said they base their circumcision decisions on medical evidence. However, the survey also asked the men about their circumcision status and about their attitude toward circumcision: 68% of the 125 circumcised males supported circumcision, and 69% of the 106 uncircumcised males opposed circumcision. This is a fairly small group (and nearly half of the original 1009 physicians contacted didn’t answer the survey), but clearly, male doctors’ own circumcision status may influence their decisions – and recommendations – even if they believe they are basing those decisions only on the medical evidence.
I am not advocating that you ask a prospective male doctor about his circumcision status – that might get just a little awkward – but you can craft questions that will provide insight into that doctor’s beliefs and knowledge on issues that matter to you. Start with any of the dozens of online lists of questions to ask pediatricians, and then incorporate into that the recommended questions here that appeal to you. It’s not necessary to ask all these questions, and you may not have time anyway, so rank them and ask the most important ones first.
Circumcision is actually a good example because decreasing rates of circumcision in the US mean that some older doctors may be less knowledgeable about appropriate care for an uncircumcised penis. Further, one study found that one in five doctors (family doctors, internists, pediatricians and OBGYNs) did not feel they understood the risks and benefits of newborn male circumcision well enough to advise parents. If your son is uncircumcised or you don’t plan to circumcise a son you’re expecting, you may want to ask a prospective pediatrician what percentage of his male patients are uncircumcised and what their familiarity is with the care of an uncircumcised penis.
Vaccines are another big issue to ask about. Just a few years after the chickenpox vaccine was added to the CDC recommended schedule, less than half of surveyed pediatricians in Washington state were recommending universal chickenpox vaccination, and their willingness to follow the recommendations appeared “influenced by personal experience, perceptions about the potential seriousness of varicella, and beliefs about the societal and medical cost-effectiveness of varicella vaccine.” You probably want to be sure your doctor is keeping up with recommendations based on the evidence.
A great deal of discussion in the pediatric community has also focused on how pediatricians should address parent concerns about vaccines, how much they should entertain “alternative vaccine schedules,” and what they should do regarding parents who don’t want to vaccinate. Kick them out of the practice? Set up special times to visit? Have a separate waiting room? Do nothing? Then there is the anecdata – talk to enough parents and you’ll hear it – about doctors or their nurses who have provided inaccurate information about vaccines or even inappropriately discouraged certain vaccines, which, as several news articles have revealed, can end in tragedy.
Some questions you might ask a doctor regarding vaccines:
- “What is your vaccine policy?”
- “How do you respond to parents who are hesitant to vaccinate?” Especially if the doctor is unaware of your perspectives on vaccination, this question gives you an opportunity to see how the doctor responds to a sensitive issue where they might encounter parent resistance.
- “Are non-vaccinating parents welcome in your practice? If so, are they required to follow any different practices than other parents?”
- “Is your office staff up to date on their boosters, including pertussis? Does your practice require all office employees to get the flu shot each year? Has your staff been tested for immunity to measles?”
One area where pediatricians may particularly differ from one another in beliefs and practices is with regards to breastfeeding, a topic with documented deficits among many pediatricians. A survey in 2004 found that pediatricians were less likely then, compared to a decade earlier, to believe that the benefits of breastfeeding outweighed the difficulties or inconvenience. There were also fewer pediatricians in 2004 who believed almost all mothers could succeed in breastfeeding, and more who reported reasons they might recommend against breastfeeding. Similar to what was seen with the circumcision data, however, pediatricians who had personal experience with breastfeeding were more than twice as likely to recommend supportive policies than those without those experiences. Even if a pediatrician is clearly very supportive of breastfeeding, they may lack sufficient knowledge to advise breastfeeding moms, or doctors and mothers may have different ideas about what “support” means, and that support may or may not extend to breastfeeding beyond one year.
Some suggested questions:
- “What recommendations do you make to mothers regarding breastfeeding?”
- “What kind of breastfeeding support can your office provide?” Some offices have a lactation consultant; others may offer referrals to lactation consultants.
- “How do you feel about breastfeeding beyond one year? Beyond two?”
- “In what circumstances might you recommend formula for a child?”
It would also be wise to ask doctors how often they keep up with the medical literature. For example, another area with substantial gaps in knowledge among pediatricians is prevention of food allergies – an issue in which the recommendations have flipped over the years as more evidence became available. A doctor keeping up with recent research is more likely to be knowledgeable about such changes. While providers may be unable to read all the studies in their field from the big medical journals each week, they should be taking advantage of continuing education opportunities within their specialty and staying as current as possible with new recommendations. The following questions can help assess that:
- “How (or how much) are you able to keep up with new research and recommendations in your field?”
- “Do you attend any conferences throughout the year? Which ones?”
- “What kind of continuing education do you take advantage of each year?”
Doctors are more likely to be in the loop about changes to recommendations if they’re involved with their professional association, generally the American Academy of Pediatrics for pediatricians or the American Academy of Family Physicians for family doctors. A Fellow of the American Academy of Pediatrics (FAAP) means the pediatrician passed a pediatric exam and maintains their certification with ongoing continuing education. Being “board-certified” means a physician has completed a residency after medical school of three to five years in a specialty (such as pediatrics) and then passed an exam in that specialty. (“Board-eligible” means they did the residency but haven’t taken or haven’t passed that exam.)
One question I have always asked prospective pediatricians relates to their antibiotic prescribing habits. Despite the fact that overuse of antibiotics is contributing to the rise of antibiotic resistant “superbugs,” research shows that antibiotics are still being prescribed by some doctors for conditions that are likely viral, even though an antibiotic will only fight a bacterial infection, not a viral infection.
More concerning is one of the major reasons doctors may inappropriately prescribe antibiotics: they think that’s what the parents want. One study, though very small and somewhat old from 1999, found that among 10 physicians caring for just over 300 patients, the doctors prescribed antibiotics 62% of the time when a child had a likely viral infection if the doctors thought the parents wanted antibiotics. Yet they only prescribed antibiotics for likely viral conditions 7% of the time if they didn’t think the parent wanted antibiotics for their child.
Questions you might ask:
- “If a child has an ear infection, at what point do you recommend antibiotics and/or how long do you recommend watching and waiting, if at all?”
- “If a parent wants an antibiotic prescribed, but you’re pretty certain the illness is viral, what do you do?”
Finally, there are a variety of questions you can ask that will give you a more holistic feel for how a provider thinks about problems and about health care in general. Be sure as well to include questions that might relate to any specific circumstances in your family. If your family has a substantial mental health history, or if you have a child with a developmental disorder or other special needs, be sure to ask about the pediatrician’s experiences with that area.
- “If you’re a parent, did becoming a parent affect any of your views as a pediatrician or the way that you practiced as a pediatrician? If so, can you provide any examples?”
- “How do you advise parents on kids’ sleeping issues if they choose practices that differ from the recommendations?” Most doctors will strongly advise against bedsharing, but asking this questions can offer a sense of how doctors respond to parents who do not follow their recommendations.
- “How do you interact with a parent afterward if they have chosen not to follow instructions or advice you gave them that you feel is important but not life-threatening?”
- “Are there any conditions you screen for that perhaps not all pediatricians screen for at well check-ups, such as bullying, substance use, developmental problems or delays, mental health concerns or red flags, etc.?”
Additional Practical Questions
- “Does your practice offer separate waiting rooms and/or exam rooms for well children and sick children?”
- “Do you have a 24-hour nurse line available?”
- “Where do you have hospital privileges?”
- “Can you be contacted electronically? What online presence or services does your office have?”
- “What insurance do you take?”
- “What are the office’s hours for well visits and for sick visits?”
- “Who covers for you when you’re out of the office, not on call, or on vacation?”
- “Can I get a same-day sick appointment?”
- “Who returns my phone calls when I call in with a question?”
- “Will I always see my doctor or will I see nurse practitioners or other professionals during visits instead?”
- “What parenting resources can you offer?”
- “Do you use electronic medical records?” (Electronic medical records can reduce errors, and on-call doctors may be able to access them away from the office.)
Again, you may not have time for all these questions, and there may be ones you don’t care about asking, but having a plan before you walk in for the interview can ensure you cover the issues most important to you.