Tuesday, May 27, 2008

how to choose a pediatrician

Before Thumper was born, I dutifully researched the Internet for list of questions to ask potential pediatricians. I dutifully called one up (based on a recommendation of a friend) and chatted w/ her for a few minutes. The doctor seemed nice over the phone. I found out a few things about what happens after birth, and basically didn't ask most of the questions they tell you to ask.

I just don't feel right asking questions when all I'm going to do is just accept the answers they tell me. Until I'm educated on a subject, how would I know that their answers are good? Therefore, I tend not to have opinions until I see that there are options; in this case, different doctors approach things differently. Yes, so intuitive for some people, but not me!

We're sticking with our pediatrician for now because they are a 5 minute walk from our house. But I'm on the look out for another pediatrician who can offer me what I want, now that I know what I want.

Anyways, here are a few things I've learned about pediatricians.
  1. You need to choose a pediatrician before you give birth so they can discharge baby from hospital. If you don't, I think they use the hospital pediatrician.

  2. Different peds have different views on vaccines. I didn't even realize that before I picked mine. So I'm really glad I found one that was willing to let me go on an alternative vaccination schedule. Apparently some doctors will drop you if you want that. I think it's the pediatrician's job to play the devil's advocate and try to convince me to get vaccines, without using scare tactics. But I now know that I want one will is open to a different schedule. I think what that tells me is that they're willing to listen to my concern as a parent without dismissing it.

  3. The ped office should follow good isolation protocols. Once you have your kid, you start to realize how easy it is for kids to get sick and how important it is to have good hygienes. Our ped office doesn't have an isolation area. But once, when I called and said that Thumper has a rash, they told us to wait in the parking lot when we come so someone can come take a look.
    I think a good way to ask about this is to say, if my child is really sick, or has a rash, what would you have me do?

  4. After hour care: I did not realize that our pediatricians are not on call 24x7. If your kid gets really sick, they may just tell you to go to the emergency room. For after hours, we call this hotline and they direct our calls, or something like that. I think I would really like a doctor who is available as much as possible. This one doctor I found makes housecalls!

  5. Another thing I did not realize is that most of the time I can just call the office, leave a message, and a doctor or nurse will call me back and answer my questions w/o me having to make an appointment and go in. Quite handy and an option I didn't realize I have!

  6. Who do you actually see? Our ped office has 3 doctors and 1 nurse. We actually just saw the RN for the first few appointments because we didn't know better. Nurses are great for wellness checkups as they are willing to spend time with you. But I've found that they don't have all the answers. Especially important if you're a curious type and a first time parent and have lots and lots of weird questions!

  7. How long are wellness visits? What is the average wait?
  8. During each of our visits, we have ended up waiting 30 minutes or more for a doctor. The nurses are usually on time. When the doctors are late, they start rushing through the appointment. They ask questions on development, tell you a few things, and then kind of push you out the door. I always feel rushed and don't have enough time to ask follow up questions. Also, the longer you're waiting in an office with potentially sick children, the more likely it is for your child to catch it!

  9. What kind of bedside manners do you want your doctors to have? I've gone through 2 of the 3 pediatricians, and 1 nurse, in the office. And after a few visits, numerous phone calls, I think I know have an idea of what kind of doctor I want. Of course, you can't tell until you've actually seen a doctor but I think there are some questions you can ask.

    I now know that it's important to have a doctor who you click with, someone who goes with your personality. This means that you need to know what kind of a patient you are. Do you like to ask questions? Are you a worrywort? Do you tend to just trust and follow what your doctor says? Are you the shy type who will do will with an outgoing doctor? Or are you an opinionated parent who needs a laidback doctor?

    One of the ped we met was able to answer all our questions and did the checkups fine. But she made me feel really rushed and I did not like that. It makes me feel like my questions aren't important. The other ped talked slowly and calmly, smiled a lot, asked us lots of questions and waited for our answers. We liked him much much better. It was only after the fact that I realized that he didn't actually do all the checkups that the nurse and other ped did. The nurse was nice but her answers to our questions weren't very helpful.

  10. What kind of office staff do they have? This might not be important to some people. But for a perfectionist like me, I dislike office staff that are disorganized. It irks me that they ask me at EVERY visit for $15 when my wellness visits are covered. It irks me that they don't ask me for my vaccination card at the end of each visit to update it. It irks me that they're not friendly or helpful at all.

  11. Good office hours. Our ped office have hours of 10-12, 2-5. That's it. Any other time you call, they've got their phone turned off so they can do other stuff. It's hard for a worrywort parent to have to leave messages on a machine and wait for someone to call you back.

    Another parent I talked to told me that their ped office had a welcome meeting between them and the whole staff. I thought that was very cool. Basically, I want good customer service. For our ped office, I did not get any information about the office till after I gave birth. And the info we got was on a sheet of paper. Noone talked to us. In hindsight, I didn't like that.

So here are the things I'm looking for in a doctor:
  • accepts alternate vaccine schedule
  • tells me facts and info w/o me asking; such as what the next developmental phase is, what I should do for feeding, for playing w/ Thumper, etc. I want them to be my reference instead of a book. Sometimes you don't have questions until you're told some information!
  • spends as much time as they can during each appointment. It takes a special ped to do this. Because of the healthcare system, pediatricians have to form groups and see lots of patients every day to make money. Only a few will buck that system and spend as much time as you need.
  • clicks w/ me personality wise so that I feel comfortable asking them questions instead of feeling like my questions aren't important.
  • Have good phone or after hour care. Ideally, I'd like a doctor that I can call anytime and even better, make house calls!
  • follow good isolation protocols. If you don't think this is important, read up on that California measles outbreak we had a few months ago.
  • someone who explains things well. I don't tend to accept answers I hear unless the how/why is explained to me.
  • someone who will take any of my concerns seriously. For some people, it's better for them to have a doctor who dismisses their concerns as they worry too much. As a worry wort, the only way my worries are alleviated is when they can explain to me, in detail, why my concern isn't valid.
  • An efficient and organized staff.

Monday, May 26, 2008

reference books for new parent

Here are the books I bought after Thumper was born. I borrowed a bunch of books from the library and then bought the ones that I thought would actually last.

The Vaccine Book (0+ months)
This is the book I bought to learn all about vaccines.

Playful Parenting (1 year+?)
I'm reading this book right now and I really like it. It's about how you can use play to communicate and build relationships with your child. It totally makes sense to me and the author also gives a lot of scenarios of when you use play. I'm not quite sure what age this book is good for yet though.
Mother Food: A Breastfeeding Diet Guide...(0+ months)
I really liked this book even though I only read a few pages on Google books. It's on my Amazon wish list to buy and read through. I wish I'd read this book while pregnant so I'd know what to eat. I found this book when I was looking into info about DHA and all those other brain-building food. It's on my wish-list because there was a section also on what food to eat/avoid when your baby has eczema. I didn't even realize that you could change your diet when that happens! Not that Thumper has eczema....

Friday, May 16, 2008

Newborn vaccines information link

Some links for vaccine related stuff.
Other people's alternate vaccine schedule
I actually came across a lot of blogs but I didn't save their links. Will update as I find them.

Monday, May 12, 2008

Things you can adapt for baby use.

Since I don't like buying things, I've discovered that I can adapt other items from the house for baby use.

  1. Grater

  2. We use a regular grater to puree apples and pears. It's not in pure puree format but it's darn close. Saves me the trouble of getting a food mill.

  3. Blender

  4. We've been using the blender to puree bananas, mangos, strawberries. Our blender comes a small container for making smoothies. And it's perfect for pureeing Thumper's food. I'm foregoing buying a food mill for now.

  5. Measuring cups

  6. Replaces baby stacking cups. Used as a regular toy or bath toy.

  7. 1/4 teaspoon

  8. Just the right size as a baby spoon. We ended up buying real baby spoons because ours was metal. But if you had a plastic shallow (not the half moon size ones) measuring spoon, they probably could double as a feeding spoon.

Friday, May 2, 2008

California measles outbreak

There was a measles outbreak in San Diego, California earlier this year. A 7 year old child went to Switzerland and brought back the disease. He then gave it to his siblings, 5 children in his school, and 4 children from his pediatrician's office. 3 of those children were infants too young to get vaccinated. The rest were children who decided not to get vaccinated. 70 children in all were exposed.

The CDC website description of the outbreak is actually pretty easy to read. It has a lot of info that most news stories didn't mention. As I was reading this, several things crossed my mind:

  • These diseases are really like STDs!

  • I know I've said it before and I'll say it again. Some infectious diseases are just like STDs. It's not who you come in contact with, it's who those people came in contact with, ad infinitum.

  • Why don't people talk about the fact that none of the kids came down with something really serious?

  • The concern with measles (I had them as a kid) is that it'll develop into something serious and life threatening. But none of these kids had it. So having an outbreak itself isn't that bad right?

    Then I read that the outbreak in Switzerland "resulted in hospitalizations for pneumonia and encephalitis". eep!

  • Most of the kids infected chose to not be vaccinated, including the carrier

  • I guess you really have to understand the chances you're taking when you decide not to vaccinate. I wondered if the parents thought about vaccinating their kid before they traveled? Switzerland has a 86% vaccination rate for children under 2 while the US has 95% vaccination rate for children between 1 1/2 to 3.

  • You need a 90% vaccination level!

  • I read about this before. But the importance of it didn't hit home till now.

  • The choice to not vaccinate comes with responsibility

  • I'm okay with parents choosing not to vaccinate their kids. I'm doing an alternate schedule myself. Their choice, their risk. But like second hand smoke, it seems somehow wrong when you affect the health of other children. Not sure what the solution would be since CA allows children to be in school and not be vaccinated. Maybe just more awareness on the parents part? Wherever we go, I think about how Thumper could get infected from people she comes in contact with, and think about who she could infect if she got sick. I tell people with really young children that I hang out with that Thumper is on an alternate schedule.

    The good thing is that since Thumper isn't in day care and doesn't actually come in contact with lots of people, I'm not too worried. But if I started going into daycare, I'd be more concerned and want her to be vaccinated.

  • Why didn't the pediatrician office take precautions?

  • When my daughter came down w/ a rash and I called the ped's office, they said that I could come in but I'd have to wait in the car and wait for someone to come out just in case. According to the article, the office in this case didn't take any precautious measures. I wonder if this is something you could ask your pediatrician about. Ask them what kind of preventive measures they take.
I really hate the fact that Thumper needs to go into daycare soon. I just don't want her to get infected w/ all these diseases and then infect me. I'm starting to look into nanny-care instead, esp if it makes financial sense.