Despite the dazzling array of new specialists who populate today's medical world, the most important may still be the most traditional--the pediatrician.
This is the doctor who cares for your child from infancy through teenage years, and deals with everything from immunizations to puberty problems. The relationship is so important that choosing a pediatrician is worth some extra time for the screening process.
If you're a first-time parent, find a pediatrician before the baby is born--don't wait until you have an ailing infant to start scouting frantically for a doctor. "Do it during your last trimester," advised Dr. Loraine Stern of the Valencia Pediatric Assn., an author of child-care books and associate clinical professor at UCLA.
And whether you are a first-time parent, or looking for a new pediatrician because you have moved, or are not satisfied, there are some guidelines. It's perfectly legitimate to make appointments to interview several pediatricians, she said, and most doctors welcome the custom--either with groups of parents or individually--as mutually beneficial. When you call to set up an appointment, ask if the visit is complementary or if there is a fee.
But where do you get names? If you have children in day care, talk to other parents. Recommendations can come from your obstetrician, people in your childbirth class and nurses. Talk to them informally for a candid answer; don't call a hospital nursery.
"The first thing you do, which is not what I used to say 10 years ago, is look in your insurance book to make sure they are on your plan," Stern added.
You'll want to know if the doctor is board certified, meaning he or she has the prerequisite years of pediatric training, she said. "It's nice if they are members of the American Academy of Pediatrics, which helps them keep in touch with what's going on in the field. If you're in a metropolitan area, it's helpful if they are associated with a teaching hospital."
The initial appointment doesn't have to be long. It's helpful to have some questions written down.
Stern still remembers the prospective mother who came into her office with seven pages of single-spaced questions. "It was arduous, but we got through it," she recalled.
On the other extreme, when some prospective mothers confess nervously that "I don't know what to ask," Stern has a comforting reply: "That's OK, I know what to tell you."
What matters during the interview, said Stern, who has practiced for 26 years and now has "grand-patients," is that you feel comfortable with the new doctor. "Everybody in the world may love Dr. X and you walk in and meet him or her and feel blah. We spend so much time together during the first years, the relationship is very important."
While some people want a parental-type authority figure who tells them what to do, with no nonsense, she said, others prefer a nurturing environment for developing their own ideas.
"I had one mother who was a stickler about no one kissing her baby, and I'm a kisser, so I wasn't the one for her."
It's ideal if both prospective parents can participate in the prenatal visit.
Dr. Eyal Ben-Isaac, a general pediatrician on the staff of Childrens Hospital Los Angeles, says he increasingly sees both mother and father.
"The typical first question I get is a practical and a good one: How soon would I be available to see their baby in the hospital?"
Because of health-plan variances, perhaps another pediatrician would have to make the first visit, and this is the time to figure out who it will be, he added. In addition, ask whether the pediatrician is in solo practice or in a group practice. If the doctor is in a group, would you see other doctors in the group or can you request the same doctor each time?
First-time parents have some obvious issues of concern, he said. "On a prenatal visit you discuss how to prepare your home, which are the safest cribs, strollers, car seats, smoke detectors and fire extinguishers. It's also a good time to talk about what is too much--how many sets of clothes does a baby need?" said Ben-Isaac.
This is the time, too, to establish general child-rearing philosophies regarding discipline, toilet training and how to deal with temper tantrums. There are such issues as circumcision, and breast-feeding versus formula, he said.
"There may be different approaches to medicine. Some people really believe in herbs and more natural remedies--they have to make sure their pediatrician is comfortable with that therapy."
Equally important early on are nuts-and-bolts questions such as how the doctor handles emergency calls at night and on weekends and what hospital the doctor works at, should the child need to be admitted.
New parents often want to know his choice of a baby book. "There are a lot of good books out there," said Ben-Isaac, whose recommendation is "Caring for Your Baby and Young Child" (Bantam Doubleday Dell, revised, 1998) from the Academy of Pediatrics. "I like it because it explains all the things you should look for, in terms of caring, and is very basic and written in lay terms."
There's another important aspect of the screening, said Stern, and that's testing the office culture. Judge the way you are treated from the initial telephone call. "A lot of what you do the first years of your children's lives is on the phone and you want to hear a friendly voice." She also suggests getting to the appointment early to check out the waiting room. "A pediatric waiting room should be clean, but not be too neat--it's for kids and should be full of toys and games and fun stuff. At the end of the day, ours looks like Armageddon."
While waiting, talk to other parents and get a feel for the place. "One of the common issues in pediatrics is the wait," said Stern. "On occasion when you are taking care of acutely ill children, it can be a problem, but if people in the waiting room say they always have to wait an hour you might want to reconsider."
And if you do have to wait, she added, someone from the office staff should explain why.
Another glitch in the screening process, Stern said, is that you may be limited because you don't like any of the doctors provided by your HMO. What to do?
"Try and develop a relationship that is as good as possible. Unfortunately this is more common all the time. If you have any choice at all, don't just go by the bottom line."
The American Academy of Pediatrics also has a pediatrician referral service. For a list of names of AAP pediatricians in your community, send a self-addressed, stamped envelope to:
American Academy of Pediatrics
Dept. C: Pediatrician Referral
P.O., Box 927
Elk Grove Village, IL 60009-0927