MEDICAL PARENTING How to Navigate Health, Wellness & the Medical System with Your Child by Jacqueline Jones, MD (Book Excerpt)

The marriage you enter into with your pediatrician can last for more than 21 years, so buyer beware: it is important to spend time deciding what type of person you are, and what type of support and availability you will need.

The following story may have played out much differently, had the patient’s parents spent more time finding a pediatrician better suited to their situation.

I reached down and laid my hand on the shoulder of the sobbing mother who sat in my exam chair, her small child nestled in her arms.

“It is going to be okay, we’ll figure this out together,” I reassured her. Her newborn child was having problems breastfeeding and I could feel the anxiety and sense of failure radiating from her hunched shoulders.

She had driven more than two hours from her home in Connecticut to see me, searching for answers and a solution to the escalating daily battles between her and her infant. I had found a tongue-tie in this perfectly formed baby boy, something relatively common in newborns. at paired with his mother’s inexperience with breastfeeding had turned what should have been an enjoyable bonding experience for a mother and child into a frustrating and painful ordeal for them both.

The solution involved a five-minute procedure to snip the excess tissue anchoring the tongue. As I described the procedure, the mother dissolved into tears.

“I can’t do it,” she sobbed. “I’m not strong enough. ere must be another way.”

I gently suggested calling her husband for support, but he was at work and unavailable. Recognizing this fact seemed to make her even more upset. Things were not looking good. And so, I called her pediatrician—a medical practice I was not familiar with—and was greeted with the proverbial phone tree. It rang and rang for minutes until a real human finally greeted me.

“May I speak to the doctor about one of his patients in need of some guidance?” I asked.

The secretary on the other end was curt and brisk: “One minute,” she snapped.

It was not one minute—it was six and a half. But I practiced deep breathing as the young mother’s sobs resonated in the otherwise quiet exam room.

“Don’t worry,” I cooed as I waited on the phone. I tried to exude calm and patience, even though it was truly not what I was feeling at that moment. “Yes,” a male voice boomed in the phone. Finally!

I explained the burden this poor mother was carrying, feeling inadequate and alone in her first few days of motherhood. I discussed my recommendations and asked if she might reach out to him later that day so he could discuss her options.

“Sorry, I’m really busy. Just tell her to go ahead with the procedure,” the doctor barked into the phone before hanging up. Click.

Obviously, that was not what this mother needed. She needed guidance, support, and someone she trusted to help her make the decision she faced. No matter how friendly and supportive I might try to be, I was a stranger, unable to impartially advise on the path to follow.

It is crucial when choosing a pediatrician to recognize if you are the type of parent who needs frequent support and reinforcement as you parent your child, or if you feel confident about your parenting skills and need only occasional advice. Choose a practice that suits your needs in order to alleviate frustration for both you and your pediatrician.

I did the best that I could, but I was not her doctor. I was not who that mother needed.

“Let’s put this off for few days,” I said. “Make an appointment to see your pediatrician and discuss this more fully. It’s not a life-threatening situation. I don’t want to rush you.”

The sobbing intensified and now the baby, perhaps sensing his mother’s despair, began to wail. I opened the door and beckoned my most patient assistant.

“Alison will take you to my office to call your mom or husband to come get you,” I told the mother, still crying in the room. “No rush, please stay with us as long as you need to.”

It was a failure for us all. I had done the best I could to support this mother. The baby did not receive the care I felt would be beneficial in helping him to adequately breastfeed, and this mother obviously was distraught. en there was me, feeling frustrated and annoyed that I could not make a difference for this child and his mother.

Had her pediatrician or a member of his staff been more available for this mother, I believe she would have felt more supported and able to make an informed decision that would have helped both her and her child.

Choosing a pediatrician/primary caregiver is one of the most important decisions you will make as you enter the medical system. A recommendation from your obstetrician is an excellent place to start.

If you had a good working relationship with your obstetrician over the course of your pregnancy, it is likely that they will refer you to a pediatrician or family practitioner with a similar philosophy and style of practice. Ask your obstetrician why they recommend a certain practice and the length of time they have worked with that practice. Recommendations from family and friends are important resources; how- ever, who your mother-in-law feels is the best pediatrician in the area may not fit your lifestyle or expectations for care. Instead, consider asking friends and family members with similar views to yours who they would recommend.

There is no substitute for doing your homework and researching practitioners yourself.

Some things to consider when choosing a practitioner:

• Your personality. It is vital that you and your partner are brutally honest with each other about your needs and expectations.
• Where you live. Your geographic location can be limiting. If you live in a rural area with one large pediatric practice, your decision is likely made for you. If you live in an urban area, there may be 50 or more pediatric practices close by to choose from.

Here are a few of the questions you should ask yourself to determine which practice is right for you.

• Are you comfortable developing a casual relationship with many different practitioners in the practice, or do you prefer seeing your pediatrician for the majority of your visits?
• Do you need a pediatrician with years of experience, or would you like a younger person who might be at a similar stage in life as you and your partner?
• Are you opposed to seeing physician extenders, such as physician’s assistants or nurse practitioners?
• Does the pediatrician participate with your insurance? In the first three months of life, you will need to see your pediatrician at least three times. It is likely you may need to go more frequently. Have your insurance card in hand when you call the office or check the website. Large insurance companies have many different plans and you will need to know exactly which plan you have to assure coverage. Make sure that you have alerted your insurance company that you will be adding your child to your policy. In the event you have chosen a pediatrician who does not accept your insurance, call the office and get a fee schedule so there are no surprises when you are seen in the office on a Saturday or as an emergency. Ask for the fees for routine and emergency office visits, vaccinations, blood tests, and hearing and vision screening.
• Is the phone answered in the doctor’s office, or triaged to a phone bank and then referred to the doctor’s practice? Will it annoy you to not know any of the telephone sup- port staff you will interact with?
• How will emergencies be handled if you have one during the night or weekend? If you call, will you speak to a physician—or a nursing service that screens all calls? Are there office hours on the weekend and how will those hours be staffed? If the doctor is away from the office, will you need to be seen in a different location or will an on-call doctor see you at the physician’s office?
• Is the physician open to the use of alternative medications if that is an area of medicine you feel is important to your child’s health? Does the physician’s office work with any pharmacies or practitioners to ensure you are only giving the highest quality supplements to your child?
• If you are a working parent and cannot attend every appointment, how does the office convey information to you about your child’s visit (i.e., a written report, verbal communication)? Can you join the visit via Skype?
• If you have concerns about vaccinations, is the physician open to considering options for nonessential vaccinations?
• What is the physician’s view on breastfeeding? If you are unable (or unwilling) to breastfeed, will the pediatrician be able to work with you? As you work through your decision to breastfeed or bottle-feed, allow your pediatrician to work with you. Studies have shown that breastfeeding is the best source of nutrition for your newborn child; however, there are excellent formulas available that can be used in the place of breastfeeding or to supplement your child’s feeding. Ultimately, the choice on how to feed your child is yours, and a good pediatrician should respect that.
• Studies how shown there is a slight increase in infection in uncircumcised men but this risk is low. Your pediatrician should be open to discussing these risks and open to your decision. If you do not want to circumcise your son, will the pediatrician support that?
• Can routine blood work be done in the physician’s office, or do you need to go to a commercial lab? If blood work is done in the office, will a doctor or nurse be drawing the blood?
• As your child ages, are there options for switching pediatricians within the practice? Your teenager may feel more comfortable discussing questions about sex with a physician of the same gender, although any skilled pediatrician can help steer your child through this process.
• Would you prefer using a primary physician instead of a pediatrician? A primary care physician has the advantage of following your child into adulthood. They can also provide comprehensive family care by caring for all members of the family.

About the Author: As the mother of two grown children Dr. Jacqueline Jones has navigated the medical system with her own children. Her expertise as a physician and surgeon with over 25 years experience make her uniquely qualified to give parents meaningful advice. Dr. Jones trained as a physician at Cornell Medical College as well as completing her surgical training at University of Pennsylvania and Harvard Medical School. She is listed as one of America’s Top doctors and is an Associate Professor at Weill Cornell Medical College. She is a fellow of the American Academy of Pediatrics and American College of Surgeons. Visit https://www.amazon.com/Medical-Parenting-Navigate-Health-Wellness/dp/1642794503.

Tags: choosing a pediatrician, having children, healthcare, jacqueline jones, md, motherhood, raising a family