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How to Get the Most From Your Pediatrician

During my 32 years as a doctor, I've grown to appreciate that pediatrics is a partnership between me and my patients. That's why several years ago, when my two oldest sons joined our practice, I gave them the doctorly and fatherly advice to be humble enough to learn from the parents of the babies and kids they care for. Parents teach me how to be a better doctor and, in doing so, play a huge part in making sure their children get the best I have to offer. To do the same with your child's pediatrician:

Start off on the right foot. At your first visit, let her know that you're seeking a high level of medical care. When Jim and Deborah, a couple who were expecting their first baby, interviewed me as a prospective pediatrician, the first thing out of Jim's mouth was, "Doctor, this is a well-researched baby." From there, he politely drilled me with questions, including the usual "What are your hours?" and "Are you always on call?" as well as more probing ones, such as whether I had a lactation consultant on staff in case Deborah had any trouble with breastfeeding, and how much time they could expect from me at well-baby visits.

It was obvious that picking the right pediatrician meant a lot to them, and they'd done their homework. Most doctors will deeply appreciate this kind of approach  -- and they also appreciate politeness. Even a few kind words about their practice goes a long way in establishing rapport. And call me old-fashioned, but I do enjoy getting personal notes from parents (or even the kids themselves). In fact, I still have a letter posted on my wall from a 7-year-old who didn't like being examined. It reads: "Dear Dr. Bill: I'm sorry I kicked you. I was having a bad day. Love, Isaac."

William Sears, M.D., a pediatrician, author, and a dad of eight, is a Parenting contributing editor.

You're the Expert

Be the expert. As part of this doctor-parent team, your role is to be a keen observer and accurate reporter of any worrisome changes you notice in your child because you're the top expert on his body and temperament. My favorite example of this involves a blind mother in my practice who brought her baby to my office to check out a rash. Though I couldn't find anything wrong with his skin, because of her persistence, I asked her to bring him back the next day. Sure enough, when they returned, her infant had an obvious viral rash covering his entire body. Because his mom was so used to the normal feel of her baby's skin, she actually felt the rash the day before I could see it.
It's this simple: You're with your child day in and day out, and no one else is as invested in his well-being. That's why it's important to trust your instincts and never let the doctor dismiss your concerns or observations.

Play doctor. Make sure you can clearly express what those concerns are. Before going to the pediatrician's office when your child's sick, imagine you're the doctor. Ask yourself what you (as the pediatrician) would want to know: When did he become ill? How did it begin? Does it seem to be getting better or worse? What home treatment have you given? Write down the answers to these questions.

Do your own physical exam too. Undress your child and look her over from head to toe. Make a bulleted list of all your worries. I love it when parents get right to the point, pull out a list, and volunteer what they think the problem might be. More times than not, they're right  -- and I value their natural ability to see subtle changes and hidden clues in their children that I may not notice.
Remember: The more information you can give your pediatrician, the more likely it is that you'll leave the office with the right diagnosis and treatment plan. But don't stop there. In the same way you keep a record of your child's immunizations and illnesses, make a "what works" list too. When prescribing advice or medication, your doctor will rely heavily on what has worked well for your child in the past. For instance, if he's deciding which antibiotic to give her, you might remind him, "The first antibiotic you prescribed gave her terrible diarrhea, but the last one seemed to work better."

Stick to the point. If your child wakes up with a sore ear and your pediatrician manages to work you in between already-scheduled checkups (doctors leave open short time slots for such spur-of-the-moment cases), don't try to squeeze in a "doorknob" question. That's what I call those queries that come at the end of an appointment, after I've diagnosed the problem, prescribed treatment, and have my hand on the doorknob of the examining room, ready to exit. Then a parent interjects, "By the way, Ryan's teacher says he might have ADD. What should we do?" Complex medical problems don't have quick and easy answers, and shouldn't be brought up during an impromptu visit for an entirely different issue.
Instead, schedule a more extensive appointment for another day. To make sure you get enough time for an in-depth appointment, tell the receptionist the nature of the problem and request a longer visit, or ask if the doctor reserves certain hours or days of the week for extended consultations. An insider tip: The first appointment of the morning and the one following lunch are those in which she's typically not running late or concerned about a full waiting room, so you're likely to get a few extra minutes from her.

Nice and Comfy

Help your kids feel comfortable. Trying to examine a screaming patient is difficult for everyone, so it's best if you can prepare your child for her visit to the doctor. This way, the doctor will be able to make the best use of his time while you're in the office. To help ease her mind, if she's old enough, read a book about going to the doctor or role-play with her favorite doll or stuffed animal. (You can even try bringing it along to the appointment, and ask the pediatrician if he might first give Mr. Teddy Bear a quick checkup.) Once there, greet the doctor with enthusiasm. Mothers mirror the state of their world to their kids, so if you're apprehensive, your child is likely to be too (this includes babies)! If he clings to you like a little koala bear at the first sight of the doctor, immediately put on your happy face and, rather than reinforcing his fear by holding him tighter, loosen your grip. If from previous experience you know what settles your child best, by all means, let your pediatrician know. Even little things may help ease her tension. For instance, "Lauren, really enjoys the exam better if she sits on my lap," or "Tommy would like to listen to his heartbeat."

Tell it like it is. Like any relationship, the one between you and your doctor may not always be perfect. But you don't necessarily need to find a new pediatrician the second something she does (or doesn't do) bothers you. If you want more from your doctor than she's giving, let her know. A longtime patient of mine once wrote me a letter telling me she felt rushed during her baby's exam. After reading it, I realized that since she seemed like such an experienced mother, I'd assumed she didn't require that much time with me. I was wrong, and the fact that she cared enough to speak her mind motivated me to be more attentive to her needs.
One of the most common complaints that I hear from patients who've transferred to our practice is, "I liked my child's pediatrician, but we just didn't agree on parenting styles." If you have a doctor whose medical advice you trust, you might stick with him, and try to explain to him why your chosen parenting method works for you. Point out how well your child is growing and how well-behaved she is, and let him know that you've researched your choices thoroughly. Once he understands how important a particular issue is to you, and he sees how healthy your child is, he may very well come to understand your perspective  -- or at least accept it.

Build healthy lives. Don't assume that whatever's troubling your child can be remedied with a prescription for antibiotics; a doctor who relies too much on pills probably isn't your best choice. Of course there are times when antibiotics are necessary or are the best treatment option, but feel free to ask whether there's an alternative.

Use the opportunity of well-baby visits to talk about things like nutrition, mental health, family exercise, and hygiene, and ask the doctor to help you develop a personalized health plan for your child  -- specific day-to-day ways to care for her unique body, with its unique strengths and challenges, be they colic, asthma, food allergies, or obesity. Update him on each visit about how the plan is going, and whether you've seen any improvements in your child's health.

As I stroll around my office, I'm constantly reminded of the many children I've had the privilege of caring for. But what comes to mind just as often is the parents. Their confidence in me, and in their children and their own parenting skills, has helped keep me on my toes. I wouldn't want it any other way  -- and neither should you.

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