One of the most important decisions facing new parents might be one they overlook: how to choose a health care provider for their baby. Pediatric health care involves more than just routine checkups and vaccines. These days, a child needs coordinated care from a "medical home" that takes a comprehensive approach to his or her well-being, from diaper stage to high school graduation.
But how do parents decide on a primary care provider? This month, Dr. Lewis First, chief of pediatrics at Vermont Children's Hospital at Fletcher Allen Health Care, offers tips for selecting one that's right for you and your child.
KIDS VT: How early do parents need to start the selection process?
LEWIS FIRST: It's important that parents begin three to four months before the baby is born. Hopefully, babies will go to term, but if they're born prematurely, it's preferable to not just use the hospital's neonatal team, but also have them working with your own provider. If you suddenly need to pick a pediatrician or family physician because the baby has been born sooner than expected and you have not looked into whom you want to use, you may not feel as comfortable with the choice you make.
KVT: What's the difference between using a family practitioner and a pediatrician?
LF: A family practitioner will be able to follow you and your baby together as a unit because of their training in health care for both children and adults. On the other hand, family physicians don't specialize in advanced training for children's health care but will partner with pediatricians if those needs arise, which is what pediatricians do. Family physicians will still turn to a pediatrician if they feel they need added expertise for a particular problem.
KVT: What about nurse practitioners?
LF: Pediatric and family physician practices may also have, as part of their medical home, nurse practitioners. NPs also have special training in pediatrics, and many people like using them because they can have added expertise in specialized areas such as breast feeding and nutrition. Nurse practitioners can also write prescriptions, order tests and follow their own patients, but also know when to refer a patient to a general pediatrician or pediatric specialist.
KVT: So how do parents start searching?
LF: The best kind of searching begins with word of mouth recommendations from other friends, neighbors, and coworkers — especially if they share parenting philosophies that are similar to your own.
KVT: What if parents are new to a community?
LF: Obstetricians can often make recommendations. These days, there are also other background checks you can make. For example, you can go to the Vermont Board of Medical Practice website, which lists doctors for whom complaints have been registered. The American Board of Pediatrics website lists which doctors are board-certified and who has recertified within the required amount of time. The American Board of Family Medicine also lists family physicians who are board-certified in each state.
KVT: Is it appropriate for parents to interview a prospective physician?
LF: I strongly believe that you should pay a visit to the practice and meet the doctor, nurse practitioner or health care provider who will be primarily responsible for your child. This lets you know whether this is someone you're comfortable with and whose style and personality work well with you and your child. It also lets you take a look at the office. Look at the staff who greet you. Look at the parking — its availability and accessibility. A prenatal visit also allows you to judge if your provider is credible, affable, reliable and knowledgeable and meets your needs. Then parents should ask questions.
KVT: What are the best questions to ask?
LF: Ask about their training, experience, who else works in the practice and how they provide coverage when they're not in the office. Who else may see your child? Is this a teaching practice? This would mean that medical students and pediatric residents also will see patients in that practice. How long are typical visits? What happens if you call after hours? Are there evening and weekend hours? How are calls returned and how quickly? Other issues to talk about include how much time they spend discussing safety, nutrition, fitness, the environment other non-illness-related topics such as sleep and behavior.
KVT: What are some questions parents may not think of?
LF: Does this practice use email? Does it have a website? What hospitals is it affiliated with? How strongly does the practice advocate for and help with breast feeding? What's their opinion on alternative, complementary and integrated medicine? What's the practice's approach to antibiotics? How do doctors explain the importance of vaccines? What's its philosophy on circumcision? What do they advise regarding issues such as co-sleeping and vegetarian diets? Families need to find a practice that will be respectful and supportive of their lifestyle and maximize the health of their child.
KVT: How else can parents prepare for the meeting?
LF: It's a great idea to write down your interview questions in advance so you don't get flustered when you meet. There's no such thing as a stupid question to ask your health care provider. If parents feel uncomfortable asking questions about anything that concerns them about their child, that practice is probably not the right fit.