By Victor H. Chou, M.D.
You come home from work at 4 o’clock to find your three year old has severe ear pain. You call the doctor’s office but they can’t see you right away. The next available appointment is tomorrow at 2 o’clock. You make the appointment anyway even though you will need to take time off work. For the rest of the night, you try to ease the pain with Tylenol and Motrin.
The following day, you take your child to the doctor. Although your original appointment was for two, the doctor doesn’t see you until three, requiring you to take even more time off work. When the doctor finally comes in, he doesn’t even sit down to talk with you and barely examines your child and leaves. After sitting in the room for an additional 15 minutes in stunned silence, the nurse finally hands you a prescription and rushes you out the door. At no point has anyone told you what’s going on or what’s wrong with your child. As you’re driving home, you’re equal parts confused, angry and exhausted.
Does this story sound familiar to you? If it does, then you’re not alone. More and more patients are reporting shorter office visits, longer wait times, inability to be seen quickly when illness happens and poor communication with their physician. However, the news is not all bad. There are still many caring, conscientious doctors out there. You just have to know what to look out for.
Choosing a good primary doctor
For all children, it is critical to have a primary doctor that communicates with you and who you can trust, but who is also available when you need a doctor. It’s no good to have a great doctor if you can’t ever get an office visit. Your primary doctor should serve as your guide through the medical process, ensuring that issues like preventive care, well child checkups, developmental evaluations and immunizations are performed at the appropriate times, as well as providing care and comfort when the occasional illness or mishap occurs.
Unfortunately, most people spend more time test-driving their next car, choosing a daycare, or tending to their lawn than deciding who is going to be taking care of their children. Choosing a doctor’s an important decision and you need to make sure that the doctor you choose will meet you and your family’s needs and expectations for many years to come.
Just like buying a car or watching a movie, get recommendations from people you trust. Ask your friends, family and neighbors for the names of doctors they use. Once you have a list of three to five doctors to work from, it’s time to do some research of your own. You might ask why you can’t simply choose someone from your list since they all come highly recommended? Well, just like some people like SUV’s, others like pick-up trucks and still others prefer convertibles, there might be some characteristics of a particular doctor that appeals to some people but not to you.
So what are the important questions to ask?
Find out about the doctor’s board certification.
One of the most important things to assess is the physician’s skill and knowledge. Unfortunately, it’s also one of the hardest things to determine. We’ve all had experiences with co-workers who were outgoing and friendly, but not necessarily the sharpest tool in the shed. Unfortunately, the same is true of doctors as well. Probably the best way to assess a doctor’s knowledge is to find out if he is board certified in his specialty. Most of the top physicians for children are board certified either in pediatrics or family practice.
Check to see if the doctor is on your insurance plan.
Most doctors take a variety of insurance plans. I’ve seen a few instances, though, where smaller insurance plans aren’t accepted by some doctors. Also, patients with Medicaid or CHIP may have more trouble finding a doctor that takes these plans.
Ask about specific age limitations.
Most doctors that see children are able to provide the wide range of preventive and acute care that kids require. However, there are a couple of notable exceptions. While most pediatricians will see newborns, they won’t usually see patients older than 18 or 21. On the other hand, family practitioners usually will see patients after they turn 18, but may not see children below a certain age. Every doctor’s age limitations are different so be sure to ask before making your first appointment.
Find out about the practice’s walk-in policy
Most children don’t see their doctors for chronic illnesses; instead they are seen for acute problems, like viral infections, pink eye and ear infections. Since these problems happen randomly, it’s important that your doctor is able to see you when illness occurs. If not, then you may end up making numerous, expensive trips to the local walk-in clinic, which defeats the purpose of having a regular doctor.
Inquire about after hours options
We don’t choose when we get sick. Therefore, it’s important to ask about after hours options. Many doctors will simply tell their patients to go to the nearest walk in clinic or emergency room if they get sick on evenings or weekends. Other doctors are available to their patients 24 hours a day by telephone. Still others offer extended evening hours or are open extra days on the weekends. Decide what after hours options fit your needs and find the doctor who provides them.
Ask if the doctor takes care of his own patients in the hospital
Many doctors no longer make “hospital rounds.” That means that they only take care of clinic patients and not patients in the hospital. Instead, they rely on a specialist, called a hospitalist, to take care of their patients in the hospital. While this is an accepted medical practice, you’ll have to decide as a parent if this practice is acceptable to you. In addition, some doctors will see certain patients in the hospital but not others: for example, they may take care of their hospitalized newborn patients but not their hospitalized older patients.
Do the doctor’s practice style and communication methods suit you?
Not too long ago, you could set up a meeting with a doctor, tour his clinic and ask him these questions personally to decide if his practice was a good fit for you. Unfortunately, very few doctors now have the time to do this but it is still possible to meet with a practice’s office manager or head nurse and tour the clinic. While you probably won’t be able to assess the doctor’s communication and practice style directly, you’ll often be able to discern the doctor’s personality by the attitudes and behaviors of those working with him.
Are there special questions that I should ask if my child needs to see a specialist or surgeon?
In addition to asking the above questions to any prospective specialists, there are a few key points to highlight.
Insurance coverage
This is a very important question because many specialists perform very expensive procedures and tests that could bankrupt a family if you had to pay for the costs yourself. Even though it may be challenging to find a specialist that takes your insurance (again, Medicaid and CHIP are two of the most difficult), you should almost always try to see in-network specialists to avoid racking up huge medical bills.
Emergency coverage
If your child is referred to a specialist, it is usually because he or she has a challenging medical condition beyond the knowledge of his regular physician. If you can’t reach your child’s specialist 24 hours a day, then your child isn’t receiving the best medical care.
I’ve personally experienced a situation where a specialist performed surgery but then went out of town for the weekend without leaving an on-call number. The patient wasn’t able to reach the surgeon for the entire weekend and ended up suffering from a severe, preventable complication that required many additional painful surgeries and hospitalizations.
