doctor, choosing a

Here are some factors I think you ought to consider carefully in choosing the physician who will care for your children.

The first thing to do is to ask around. Meet and talk to mothers. Ask them specifically what they like and don't like about their child's doctor, and inquire about the general reputations of the physicians you are considering.

Qualifications are difficult to judge from diplomas. Just about everybody nowadays is board certified or board eligible - the HMO's generally require it. And what do you really know about the Mount Saint Elsewhere pediatric training program? I think you will get better input from your friends whether the doctor knows what's what.

 Does he or she have children? How many and how old? Is it all just theory or has the doctor's attitude toward the difficulties of parenthood been tempered by the cruel fires of actual experience? Does the doctor seem flexible and practical-minded, or does he or she suffer from rigidity and "hardening of the categories."

How does he or she do with counsel for common childhood behavior problems? Believe me, this is where the rubber hits the road in pediatrics. Anybody can diagnose an earache... but can they deal with sleep problems, toileting problems, or biting at the daycare? Does his or her advice work for parents or just get them out of the office? Does the parent wind up feeling blamed and inadequate or does she feel the doctor understands and cares and will work with the parent to solve the problem in a common-sense way that the parents can actually accomplish?

Look at the following list and ask about some of the things mentioned. Sure, these "kid-friendly" ideas are just my prejudices - your doctor is certainly free to do whatever she desires and everybody has his own "style" - but I think you will agree these are important issues in determining how comfortable your young child is with his or her physician.

  • I examine children six months old and older - that is, once they can sit - on mother's lap if at all possible. It certainly helps keep the office quieter. Small children have an innate fear of going up on the table. In my humble opinion, routinely holding small children down on the table is pretty much a disqualifier for serious consideration as a child's physician.
  • I leave as much of the clothing on as possible. With little children, it really is not necessary to strip them naked to do a decent exam.
  • Most physicians know enough to give the kids a little treat of some sort at the end of the visit. For me it's sugarless lollipops and stickers. The treat is not conditional on good behavior. It is not bribery. It is a gesture of love and acceptance, the only message small children really need to get. My little patients know exactly where the suckers are in the exam room and talk about getting one (defusing the anxiety of the visit) long before they get to the office.
  • I often sing to the child as I examine the chest and heart. "Itsi Bitsi Spider" works wonders. If a doctor is too stuffy to do that or something similar for a child - draw your own conclusions. A pediatrician has to have a solid enough self image to not worry about acting a little silly from time to time for the good of his or her little patients.
  • Any office that cares for children needs a good supply of appropriate toys, books and games in every exam room to entertain and distract while waiting.
  • Does the doctor talk to the child (even the very young child) or just with the parents about the child. Even small children are calmed when I talk directly to them in a soft voice. I tell them "we'll do a little baby checkup, very gently and softly," and often that alone calms a young child. I have found that telling even small children in a soft voice that we must be very quiet during the exam "because the little babies are sleeping" is also often amazingly effective.
  • If calming techniques don't work and the child is still being a pill, the doctor should be able to get through the exam without losing composure. After all, we are the trained professionals.
  • Does the doctor seem to really enjoy being with little children? I know it seems trite to say, but there are some physicians who seem genuinely uncomfortable around small children. You'll know them when you meet them. Switch doctors if possible.

And last but certainly not least, does he or she remember to wash his or her hands either before or after every patient?

See also talking with your doctor.

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