Quitting Time: How to dump your family’s pediatricianKate Tuttle
It was almost like a breakup, beginning with the grinding unhappiness of a bad relationship. After nearly a year with my daughter’s first pediatrician – that endless first year of parenthood that encompasses dozens of well baby visits – I found myself unhappy, dissatisfied, worn out.
My daughter’s first pediatrician had co-authored a well-known book with a famous, beloved pediatrician. What’s more, he took my insurance and was accepting new patients. Doctors have been picked for far worse reasons. In retrospect, I wish I had chosen the most reliable path to a happy doctor-patient relationship and asked for recommendations from people I knew, but as I was the first in my group to have a baby and lived far from family, I had nobody to ask.
The first hint at a bad fit was that he never remembered my daughter’s nickname (he always called her by her longer formal name, which nobody uses), but this was a small irritation. Worse was his warning, at every visit, about her size – totally average at birth, she had become plump and round on a diet of breastmilk, only breastmilk, for her first six months. Her father and I come from slim people, and I knew that exclusively breastfed babies are often chubby but rarely obese – still, the doctor’s constant cautions made me doubt myself, and his tone brooked no questions. Fat cells laid down now, he said, would never, ever go away. Twenty pounds at six months? She was sure to face weight problems as she grew, he promised. I would love to introduce him to her now, a slender athletic teenager with a still-healthy appetite and, thankfully, no insecurities about her body’s shape. (Overly aggressive admonitions against infant obesity, it turns out, are a common theme among mothers who ditch their first pediatricians.)
In the end, quitting was shockingly easy. A year of sing-alongs and park visits had introduced me to a crew of moms and kids, so I asked around and got names of the doctors other mothers cherished. I think the new doctor’s receptionist even handled the file request from the old office. If I had had to face my daughter’s first pediatrician to deliver the news in person, I might have said, “it’s not you, it’s me.” But that would have been the same lie it always is.
It’s been years now, but I remember fantasizing for weeks about sending the first doctor a Dear John letter, letting him know why he lost our business. I never did. As much as I had hated him, for years afterward I felt vaguely guilty – for quitting, for waiting so long to quit, for having chosen him in the first place. The whole mess seemed a rookie mistake, and something I was certain other, wiser mothers would never do. After all, my brothers and I had gone to the same doctor until we were grown. Surely, I thought, it’s a rare and shameful thing, to quit your pediatrician.
I was wrong. The next time you’re with a group of parents, ask around – you’re certain to find other quitters. Perhaps you’re one yourself. We are everywhere, it seems. And though there are surely a few parents who see themselves as medical consumers, just shopping for the best product, and more who have to change doctors due to relocation or changes in insurance plans, many are just like me: parents who’ve suffered a pediabreakup. As with all breakups, the details vary, but most seem to boil down to breakdown in three big areas: communication, respect, and trust.
How to dump your family’s pediatrician.
by Kate Tuttle
October 7, 2009
Amy, a mother of two in St. Louis, chose a pediatrician recommended by her midwife, a woman who routinely appeared on her city’s top doctor lists, a local star who donates her free time to overseas medical service. Other mothers on the playground would express their envy at Amy’s having snagged such a prestigious doctor. But prestige doesn’t translate into bedside manner, and in the office the woman was difficult – when Amy could get an appointment in her jam-packed schedule. “I found her brusque and told myself she was ‘no-nonsense,'” Amy said. “She was sometimes rude and I told myself she was ‘direct’.”
“At first I liked it that she asked intrusive questions, because they were aimed at my husband: did he help with the baby? Did he do the dishes?” said Amy. “But when she quizzed me about my child-rearing, her manner left me feeling guilty and ashamed. I lied about co-sleeping; I could just tell from the way she asked that she frowned upon it.”
Three Bad Reasons to Quit (But Good Reasons to Talk)
You and the doctor disagree – respectfully – about a single parenting topic
Reasonable people can differ about when to introduce solids, or whether to use time-outs. If she’s a good doctor overall, ignore behavioral advice (just as if she were your mother-in-law).
The pediatrician doesn’t do what you ask
Your child has a fever and the doctor won’t prescribe antibiotics? Well, she went to medical school and you didn’t – can you admit she may be right? (On the overuse of antibiotics, she almost certainly is.)
The office is chaotic
Face it: pediatric offices, especially those that are popular and well established, are busy places. If you’re facing long wait times or a tough time booking appointments, be persistent but polite.
Sometimes the communication problems between doctor and parent go beyond ego-bruising. “Our first pediatrician was short with us,” said Valerie, a Boston mother of two, “just her manner, I think now.” The doctor made negative comments about breastfeeding and accused her newborn daughter of “testing” her by crying at the breast, but the worst, Valerie said, was when she prescribed Zantac for a fussy infant, even though she told the parents that the baby “didn’t need it.” There’s nothing a nervous first-time parent likes less than confusing medical advice: who wants to give their baby a medicine she doesn’t need? Valerie found a new pediatrician soon afterward.
Madeline, a California mother of three, ditched her kids’ first doc for a couple of good reasons: the aforementioned fat baby warnings (which veered into uncomfortable territory when her older daughter, naturally slim, was relentlessly praised for her body shape in front of both kids) and another common complaint: sneak attacks with the immunization needle.
“My older one hates shots, screams and screams, even now,” said Madeline. “She turns pale, you can feel her heart beating, it’s awful.” Despite multiple pleading that the doctor keep both mother and daughter posted on the need for any shots at the girl’s six-year-old checkup, this pediatrician and her nurse bum-rushed the pair and gave the shot without warning. “Of course, she’s crying and screaming and it all happened so fast I was stunned! That’s NOT how we do things at home,” said Madeline, who says the family is happy with their new doctor.
Worst, perhaps, are those doctors whose own prejudices get in the way of providing good care. Thato, originally from Botswana but now living in New England, said her sons’ first pediatrician wasn’t her choice. “He was the only one accepting patients,” she said – a common reason we end up with the doctors we do – “and he was young, geekish and awkward. I don’t think he had ever been around people of color. He was just weird and always uncomfortable around us and he never made my son feel comfortable.” The doctor’s lack of cultural intelligence went even further, according to Thato. “He once said that some kids have more mental capabilities than others and some have more physical capabilities . . . and he explained that my older son just happens to be more physical than mental.” To assign any child one particular trait – he’s just athletic, she’s just verbal – is bad enough, but to blithely judge a young black boy as ‘more physical than mental’ can do as much damage as a botched prescription.
Pediatricians have a delicate role to play, of course, and there are surely as many difficult parents as there are awful doctors. Among medical specialties, pediatrics confronts doctors with uniquely complicated demands – there are the tiny, often nonverbal, irrational patients to be examined and treated, and with each one comes these large, terribly verbal, also irrational parents. Parents of small children call too often, worry too much, and are quick to blame the doctor for anything that goes wrong. And because of the way the profession has developed over the past century, pediatricians find themselves called on for not only physiological expertise, but also information and advice on developmental and behavioral issues – some of which are so controversial they divide families. Navigating these waters has got to be hard.
“. . . telling her that I was leaving seemed harder than staying.” So how do you know when it’s time to quit? A doctor-patient-parent relationship only works when all three feel comfortable. A lack of trust, unfixable failures of communication, and any hint of medical error should be enough to send a parent off in search of a new doctor. Yet many stay years longer when their initial instincts tell them to flee. “I kept going to her for years because I was afraid of her,” said Amy, the St. Louis mom, “and telling her that I was leaving seemed harder than staying.”
Breaking up is hard to do. But once it’s over, these mothers report, they wonder why it took so long to make the move. Happily cared for by doctors they trust and like, they feel they’ve crossed an important parenting milestone. Are these families’ second pediatricians objectively better than the first? In most cases they are, but the parents have changed, too, have grown into themselves as veterans, no longer the scared rookies they were in those early days and weeks.
Amy, the St. Louis mom, provides a clue about the different relationship one has with the second pediatrician. Her kids’ new doctor doesn’t ask many probing questions, she said, “but then, the kids are five and ten. Evidence suggests that I’m able to keep them alive and well.”