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Dear Dr. Lanny:
Our family's pediatrician retired and now we're faced with finding a new one for our sons, ages 4 and 9. It's been such a long time since we had to see a new doctor, I'm at a loss. What questions should I ask and what should I look for in picking a new physician for our boys?
A: So, your children's doctor has retired or left town. Or you've been transferred to a new community. The latter is even harder, as you may know little about the neighborhoods, commuting times, emergency rooms or hospitals.
Periodically newspapers or magazines will have articles about how to choose a doctor. These articles usually start with the local medical society, or possibly Internet sites on doctors’ malpractice history. The medical society might have information on credentials and hospital associations, but all doctors have the proper credentials, even if they didn't all go to Harvard. The Internet can tell you if a doctor is one step ahead of the law but very little about what, I believe, you really want to know.
What makes a doctor, and a practice, attractive, varies from person to person. However, most of us would agree on several qualities you should look for.
What is the phone system like? Is it always busy? Do you need to navigate a human-less set of options, or do you get a real person? Does that person say, "Can you hold?" and the phone clicks. Or does he or she wait for you to say, "Yes I can"? And if put on hold, does the person return in a reasonable amount of time? Can you talk to the doctor--if not at that moment, at least later on?
What are the hours of operation? Can they accommodate your schedule? What is the waiting room like? Always mobbed, or just during the winter, when illness reigns supreme? Pediatric patients, unlike their adult counterparts, are often accompanied by several siblings, a relative or two, and the children mom baby-sits. Consequently a few waiting families may seem like an army.
Do the receptionists acknowledge your presence, or is MySpace just too important? Is the practice consistently way behind schedule or relatively on time? Please remember that a medical office is inherently hard to keep on time. (I can defend that statement if you wish to discuss it.)
Having made it into the exam room, does the doctor listen to you, and your child? Do you feel like he is in a rush? Does he give you an opportunity to ask questions? Does he seem to begrudge questions? Does he anticipate your questions--and answer them before you ask? That's pretty desirable.
How do you answer these questions before choosing? I believe that personal recommendations are by far your best bet. Ideally a conversation with other parents who share similar values, who still have children at home, as practices can change over the years. Ask them your questions. They can also add their perspective, which may include topics you hadn't considered.
I remain unsure of the value of personal interviews, as the doctor is on his best behavior and may not accurately represent himself. An interview, however, is usually a free service and I cannot see any reason not to give it a try. Come prepared with questions.
I would welcome readers’ suggestions and comments on choosing a doctor as my perspective may be limited by my being in the business.
Dear Dr. Lanny:
My 14-year-old daughter is starting to show signs of interest in the opposite sex and in dating. We've had "the talk," and she knows I think she's way too young and immature to get involved with anyone physically. However, I'm a realist. I want her to be protected against disease and unwanted pregnancy, and I wonder when is the time for her to see a gynecologist instead of a pediatrician. What do you think?
A: As with many medical questions, there is no absolute answer. Traditionally there are three circumstances that lead to the first gynecology visit: finishing high school; problems with periods; sexual activity.
Finishing high school and going off to college, the military, or perhaps entering the work force are all major moves into adulthood and independence, and certainly suggest the need for a "woman's doctor" even if sexual activity is not immediately anticipated. This is also the usual time children move onto adult medicine physicians. Internists are unlikely to deal with gynecology, but family practitioners, by definition, treat the whole patient including gynecologic issues.
Although there are pediatricians who feel comfortable dealing with abnormalities of periods--late onset, irregularities, heavy or painful-- most do not have a sense of expertise and will usually refer to gynecological colleagues. Ask your doctor.
Obviously many adolescents become sexually active without consulting or telling their parents or doctors. Your pediatrician will usually take the opportunity of the annual physical to ask your daughter if she is having any sexual relations. If the adolescent shares this information, there will hopefully be some conversation as to the use of any type of protection from disease as well as birth control.
Whether it is your pediatrician or gynecologist, this is confidential information. This confidentiality is a potential source of great friction between doctor and parent. Please understand that confidentiality is the only way many adolescents will tell the doctor anything about their sexual activity, and ultimately we can only help if we are told what the young person is doing. Doctors are not trying to withhold important information from you. If health problems are noted, or if the doctor does not choose to prescribe contraception for sexually active adolescents requesting such service, she will try to offer recommendations to appropriate practitioners within the community.
One last complication is finding a gynecologist whose practice is welcoming and comfortable with adolescents. As with the first question, check with friends and friends’ daughters. Bad names and good names will get around.
Dr. Alan Freshman, father of two grown boys, practices at Syracuse Pediatrics. Consult your own physician before making decisions about your family’s health care. Send e-mail to him at firstname.lastname@example.org.