Parents' Rx: Ask the Doctor : Parenting: The family physician is the one many moms and dads turn to when they need child-rearing advice. To a lesser extent they rely on synagogues, churches and schools.

SPECIAL TO THE TIMES

Marcus Welby probably hasn't made a house call since the Johnson Administration, and he hasn't been seen in reruns in who knows how long, but his character is impossible to kill off.

Welby was the sage GP of TV who could dispense antibiotics and worldly advice with equal ease. He healed both flesh wounds and marriages between commercials. He was the consummate generalist. He fixed it all: body, mind and heart.

And Orange County still loves him. He--or, rather, the family doctor--is the person most Orange County residents say they turn to first when they need help and advice in raising their children.

In a recent Times Orange County poll, 51% of the 600 respondents said they often or sometimes turn to their family doctor for child-rearing advice, followed by 37% who turned to their churches and synagogues and a third who said they ask their schools for help.

A fourth group of professionals fared substantially worse in earning parents' allegiance, even though they are arguably the best trained to provide the advice the parents seek: family therapists and other mental health professionals. The least number of poll respondents--13%--said they often or sometimes turn to counselors, while nearly three out of four said they never do.

"I don't have a lot of faith in (mental health professionals)," said Kathy MacDonald of Cowan Heights, who indicated in the poll that she often turned to her family doctor, but never to counselors, for advice about her two daughters, ages 9 and 16.

Henry Filtz of Anaheim also said he often consults the family pediatrician--but never a counselor--when he needs child-rearing advice.

"We trust our doctor's judgment as the first course when a child is having a problem," he said. "We've never needed a counselor for the children."

Said Sherrie Filtz: "If I had questions (on child-rearing) I'd ask the doctor first, and I'm confident that he'd refer me to a psychologist if it was needed."

This sort of loyalty--and the stark delineation in the poll between doctors who treat the body and those who treat the mind--doesn't surprise David Dooley, a professor of social ecology at UC Irvine who specializes in health research. National surveys that examine patients' preference for medical doctors or mental health professionals have shown similar results, said Dooley.

"In general, if there is a survey of people with personal problems, a fair amount don't receive treatment of any kind, formal or informal," he said. "And among those who do, the lion's share are seen by family physicians, at least initially, and a small percentage get into the hands of mental health professionals.

The family doctor, according to statistics provided by the American Academy of Family Physicians, not only gets more business than the psychological counselor, he outstrips all other physicians as well. Of all office visits to doctors, said the AAFP, 30% are to family physicians, more than to any other medical specialists.

It apparently isn't so much a question of a refusal to acknowledge emotional issues as it is a question of loyalty, habit and earned trust.

"Most people don't ordinarily have everyday, regular commerce with specialists in mental health," said Dooley, "but most have a family physician. It's natural that if a problem emerges in a family, they would consult perhaps the professional that they know best, or that they go to most frequently, and that naturally will be the family doctor."

It is easier to bring up an emotional parenting issue with the family doctor as a kind of afterthought during an office visit, said Joseph Scherger, a family physician from Dixon, Calif., who was named National Family Doctor of the Year and California Family Doctor of the Year in 1989 by state and national family practice associations.

"With a mental-health provider," he said, "there is often an assumption that there is a problem in the family and they're going to that person because something is wrong. With family physicians, we very frequently get asked about parenting issues. All you have to do is ask the question 'How are things going?' to trigger questions about feeding and sleeping and various behaviors."

Benjamin Spock's classic book on parenting "set the tone" for parents seeking advice about their children, said Scherger. And still today parents think of raising children as a health issue, he said.

"Parenting, if you explore what it means--how do you discipline your child, how do you know whether spanking is appropriate, how do you find that balance--it seems to have health overtones," said Scherger. "You want to parent for good health, and we provide counsel about matters of daily living with respect to health. You don't have to have a behavioral problem to raise questions with the family doctor."

Also, said Justin Call, director of the division of child psychiatry at UCI Medical Center in Orange, parents are often confronted with a blizzard of choices apart from the family doctor when they cast around for advice.

"There are lots of people involved with children out there who want to help," he said. "Apart from the family doctor, there are developmental specialists who can measure developmental changes over time, there are child psychiatrists, there are marriage and family counselors, clinical psychologists, social workers, specialists in drug abuse and child abuse, and nursery school teachers. Essentially, you have a very large group of people who all want to save the baby. That's one of the reasons people start with the family doctor: all these other voices in the community."

Parents, said Call, form "a bond of trust and loyalty" quickly with their family doctor or pediatrician not only because the need for a doctor's help is immediate and absolute when a couple start a family, but because the family physician may provide a stabilizing influence on the family.

"This bond is especially meaningful in these days when family structures are unstable and when society is rapidly changing and when extended families are usually not relied upon or available to help people resolve their problems as they have been previously in this country," Call said.

"It may be very much more difficult for a patient to go initially to a psychiatrist," Call said. "They're hesitant because there is so much ignorance and fear on the part of patients of getting one's mind manipulated. They just don't want to have to be accountable for their deepest secrets. Denial is a very strong factor."

Some parents, such as Linda Heffington, buck the tide: when faced with a parenting question, she said, she turns sometimes to the family doctor but often to counselors.

"I have a circle of friends who are psychology-oriented," said Heffington, "and my brother's a pastor with a major in psychology. This bunch then hangs out together, we all have teen-agers and we call ourselves Group Therapy."

The probing of a psychologist holds no terrors for her family, said Heffington, who lives in Santa Ana with her husband, her mother and her 16-year-old son.

"Not at all," she said. "I believe in it so much. I go to the family doctor just for physical advice. I find physicians are too busy to talk to you. I'm not sold on the medical side of things unless my bones are broken. Doctors can be very fallible. They'd rather give you a prescription for your emotional problems and send you on your way. A psychologist will delve into it."

Regardless of parents' choices of where to turn for child-rearing advice, Scherger said that turn they must. Being a parent, he said, is not a job that should be learned exclusively by trial and error, and asking for some sort of professional help is, at one time or another, essential.

"Parenting," said Scherger, "is the hardest job we do that we're never trained to do."

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