Marla Minder* was worried about her baby, Sarah: The day-old infant had been born more than a month premature and developed a mild case of jaundice. On top of that, she didn't seem to have much of an appetite and was sleeping almost round the clock. "I called the pediatrician's office every day that first week, because I couldn't tell how much milk she was taking in when I breastfed her," says the mom from Philadelphia. "The nurses who fielded my calls told me that as long as she was wetting her diapers regularly, she was fine."
By her one-week checkup, Sarah had lost a whole pound (more than a 10 percent loss of birth weight is considered cause for concern). "The doctor started yelling at me for not feeding her enough, and I just broke down, crying," says Minder. "He told me it was my fault and made me feel terrible. He didn't even give me a chance to explain that I had called his office, but nobody had taken me seriously. Then as he was leaving the examining room, he asked if at least I'd had the sense to use a car seat to drive the baby over, since he'd seen me carry her into the office in my arms." That was the last straw, says Minder: "I never went to that pediatrician again."
Should she have given him a second chance? No, says Charles Inlander, president of the People's Medical Society, a consumer advocacy group, in Allentown, PA. "A doctor should listen to your concerns, not belittle you or make you feel uncomfortable." Even in a situation such as Minder's -- not to mention one less drastic -- it can be tough to know when to drop your doctor. Because looking for another pediatrician or family physician can be such a hassle, many parents stick to the one they have. Also, some parents are afraid of hurting their doctor's feelings. "But you should pay attention to your doubts," says Inlander. "You wouldn't put up with an accountant, no matter how nice, who made mistakes on your tax returns. And the last thing you want to do is shortchange your child."
Here, 10 signs it may be time to part with your pediatrician, or at least think about making a change:
*All parents' and children's names have been changed
1. You have trouble booking an appointment
Arlene Fontana was shocked that she couldn't get an appointment to see her pediatrician when her 3-year-old son, Sal, had a 103-degree fever and kept gagging on his saliva. "The doctor was completely booked that day," says the mother of two in Orange County, CA. "I called back later to see if anything had opened up and was told that my son didn't sound 'sick enough' to be seen right away. I ended up bringing Sal to an after-hours clinic, and sure enough, he had strep throat and needed to be put on antibiotics."
If you're worried about your child, he should be seen the day you call, says F. Lane France, M.D., a clinical associate professor of pediatrics at the University of Southern Florida School of Medicine, in Tampa. Young patients who should get priority: those who have trouble breathing, cry inconsolably and clutch their ears, pass bloody stool, vomit for more than 24 hours, or run a fever of 103 or higher.
For the best care: Find out your doctor's policy for sick-child visits. Some may reserve specific time slots for sick kids; others work them in as soon as they can, or rely on staff nurse-practitioners or physician's assistants to handle the overflow. If the office regularly can't squeeze in your child, consider switching to a group practice, where there are a number of doctors.
2. The doctor doesn't return your calls promptly or arrange for coverage when she's not available.
Carol Falk thought her pediatrician would give her extra attention because her twins were born premature. She was wrong. When one of her 2-week-old daughters developed a severe case of diaper rash and started throwing up, Falk called to find out what she should do. The doctor was tied up, so Falk left a message. When she didn't hear back from anyone, she left another message, then another. "The doctor finally called six hours later, but I could tell she had no idea who I was," says Falk. "She also kept taking care of other business while I was still on the line trying to get some answers."
So how fast should you expect a call back from a doctor? "Within three to four hours," says Chip Harbaugh, M.D., a spokesperson for the American Academy of Pediatrics. And if she can't get back to you within an hour, a nurse should call and try to assist you.
For the best care: Ask your doctor how she fields both routine and urgent phone calls. Some set aside a regular "call time" early in the morning to answer parents' questions. You also might want to find out if she ever corresponds with parents by e-mail. Finally, ask how calls are handled when her office is closed and who covers for her while she's on vacation.
3. He doesn't take your concerns seriously.
"When my daughter, Terry, was 9 months old, she had a terrible cold with lots of congestion," says Deborah Salley, of Athens, GA. "The pediatrician gave her antibiotics and sent us on our way. That night, Terry started coughing uncontrollably, so I called the doctor to tell him that she was getting worse. He pooh-poohed it and acted like I was overreacting." She wasn't. Salley consulted another pediatrician, who diagnosed respiratory syncytial virus (RSV), a potentially serious infection; Terry had to be hospitalized for three days.
Luckily, Salley had trusted her instincts. But many parents are reluctant to question their pediatrician; even when they do, research shows that doctors frequently interrupt them before they've finished. And most people don't bring up their most pressing concerns until the very end of the conversation, when the doctor may be only half-listening.
For the best care: Get right to the point. "Explain your concerns at the very beginning of your phone call or visit," says Barbara Korsch, M.D., a professor of pediatrics at the USC Keck School of Medicine, in Los Angeles. "Don't be afraid to come across like a pushy parent."
4. She doesn't take your child's complete medical history.
Your pediatrician should review your child's records at the start of each visit, so she's reminded whether he suffers from any chronic conditions, such as allergies or asthma. She should also ask if his health has changed since his last visit, and make sure he's up-to-date on his vaccinations. Otherwise, she'll have an incomplete picture of your child's health, which can affect the quality of care he receives.
For the best care: Give your pediatrician a quick rundown of your child's medical history every time you see her. And tell her if he's seen other health practitioners since his last appointment, and offer to forward those records.
5. He doesn't fully explain his medical decisions.
If a doctor keeps you in the dark about what's involved with a particular procedure, diagnostic test, or treatment, you won't know what signs to look for if something goes wrong.
For the best care: Keep asking questions until you're satisfied with his answers. If you'd like more information than he has time to give, ask him to recommend articles and books on the subject.
6. She doesn't make an effort to develop a rapport with your child.
A doctor needs to establish a good relationship with a child at a young age, so he feels comfortable talking to her later on (particularly as he reaches adolescence).
Gabriela Howe, of Los Angeles, CA, was mortified at the way her son's doctor treated him. When it came time to examine the 6-year-old's groin for hernias, the doctor plunged her hand down his pants without any warning or explanation. "I was shocked that a doctor could be so insensitive to a child's feelings," says Howe.
For the best care: If you think that your doctor hasn't bonded with your child, discuss it with her. Suggest ways she can improve their relationship: Let her know the things that he's passionate about (soccer, dance, art), or clue her in to his favorite TV show. That way she can bring it up the next time she sees him. If your child still doesn't take to her after a few visits, or the doctor isn't making enough of an effort, consider making a change.
7. He doesn't talk to you in a language that you understand.
Your doctor should be able to explain even the most technical medical tests, treatments, and procedures in a clear and simple manner. If you don't understand his medicalese, you could misinterpret his instructions.
For the best care: Speak up. If you don't understand what a tonsillectomy involves, for example, ask your doctor to explain it to you in layman's terms. Write down the medical jargon he uses, and look it up on the Internet or in a family health guide later.
8. She doesn't alert you to the potential risks and side effects of treatments that she prescribes.
Your doctor doesn't need to warn you about every possible risk, since some are very rare. But she should tell you about the most common ones, so you know what to expect.
Alison Patch, of New York City, was upset when her doctor didn't warn her about the side effects her 2-month-old might experience from his immunizations. "It was really scary, because his temperature shot up that night," says Patch. Only after she phoned her doctor was she told the fever could be related to the shots.
For the best care: Explain that you'd like to be warned about the risks involved in any treatment she recommends. Ask about potential side effects from medications she prescribes, and what you should do if they occur.
9. He doesn't discuss the latest developmental and safety issues.
Many pediatricians today are taking a more active role in children's health -- asking families everything from their diet and exercise habits to how much television their kids watch and whether they keep any guns in their home.
For the best care: Bring up any concerns you have about your child -- whether it's his language and motor skills, his mental state, or how well he's doing in school. Tell your pediatrician that you'd like more guidance in these areas.
10. She balks if you tell her you'd like to get a second opinion.
A doctor who has your child's best interests at heart will encourage you to consult another, says Dr. Korsch. She may even recommend a specialist, particularly if your child's diagnosis is uncertain, if he has a life-threatening condition, or if surgery is advised.
For the best care: When you want another expert's advice about a particular treatment, ask your pediatrician to recommend someone she trusts, to show you still value her opinion and want her to be involved in your child's care. If you'd rather not consult her, get a referral from a friend or a local hospital or university.
Above all, trust your gut. If things still aren't working out after you've talked to your pediatrician about any of these problems, don't hesitate to switch doctors. In the end, you're the one who knows what's best for your child.
CAN THIS RELATIONSHIP BE SAVED?
What if you have one or two gripes with your pediatrician, but are otherwise happy with her? Say so. "Your doctor probably isn't even aware there's a problem," says Charles Inlander, president of the People's Medical Society. You could say, "I think you're a terrific doctor, but sometimes I don't feel like you're listening to me. It also bothers me when my calls aren't returned promptly. How can we work this out?" Then see what she has to say. If you don't see an improvement in your relationship within the next few visits, look for a new doctor.
IF YOU FIRE YOUR DOC
Before you kiss off your doctor, it's important to line up another one. Ask yourself whether this time you'd prefer someone in a group practice (where you're more likely to get an appointment when you need it) or on his own (where you're guaranteed to see the doctor you want). You'll also want to make sure his office is clean and cheerful, and has a helpful staff.
Once you've found a doctor you like, consider calling your previous doctor to explain why you're leaving. You might say, "I think you're very competent and caring, but I can never get an appointment when I need one." If you don't want to bother with explanations (you're under no obligation to give one), just drop him a note to get a copy of your child's records sent to you or the new doctor.
STACEY COLINO frequently writes about children's health and safety for PARENTING.