Conference moira::parenting_v3

Whether it is a group or private practice, you should never feel badly calling 
them at off hours!

A doctor on call is expecting calls whether they are in a group or he/she is 
covering for other private practice doc's.  It's part of the job and they know
that.  

The first rule of medical practice is people never get sick or hurt from
9 to 5.  9 to 5 is for paper work, and seeing people that are just getting 
better from having gotten sick on the "off hours"!

Whenever my father beeper goes off, none of us say, "Oh, Jeeze!  
There goes another person who doesn't know the rules!  It's past 5 or we're out
to dinner, or at a play!  How dare they disturb my Dad!"

By the way, Questions or concerns are the best kinds of calls!  My dad who is 
really nice all the time says he gets nicer when he finds out it's just a 
question!!

    
    I guess I have fond memories of my favorite doctor when I was a kid
    (went to the same pedi. from about age 4 'til 18), so that might have
    colored my decisions. Take the following FWIW ...
    
    I think it's hard enough for most kids to feel comfortable with their
    doctor (especially as they grow out of the infant stage), so one of
    my pedi-search criteria was that I wanted a private practice for my 
    daughter. So, she always sees 'her' pedi. when it's a scheduled visit 
    (and of course would see whoever was on call if it was an emergency..
    where speed and medical expertise are the only criteria...knock on wood 
    we haven't needed this. But, I did check out the credentials of each of
    the doctors in the practice and their 'back-ups'). 
    
    For your info., don't assume just because it's a 'private practice' that
    you'll have a 'dedicated' primary care physician. Some private practices
    do not operate this way (as I found out when I was interviewing pedi's
    while I was pregnant with my daughter). I know of one practice in the 
    Littleton area that alternates between it's 2 pediatricians and their 
    head nurse for all well-baby visits. This is true whether or not you
    are in an HMO. As this was unacceptable to me (and I felt that 1 of
    the partner doctors was a little too 'cold'), I didn't choose that
    particular private practice. So, I'd ask alot of questions when you
    contact them. The pedi's I called either met with me for a short
    scheduled appointment (not sure if my HMO got billed or covered this)
    or at an informal evening 'meet the pedi' session.
    
    FWIW, it turns out that the 'cold' doctor mentioned above, attended at
    the birth of my daughter (minor complications), and I still felt that
    he was 'cold' (I had to ask twice how she was...and everything was
    fine...you think they'd want to tell the mom that just delivered her),
    BUT he did a very thorough job in checking her out and pronouncing her
    healthy. I guess only you can decide how important bedside manner is in
    your choice. As new parents, we wanted a doctor that all of us felt very
    comfortable with.    
                                                  

    It is very much the 'norm' in Canada to have a Family Practitioner
    or G.P. as the doctor for the whole family.  Some have their
    specialties ... our previous Dr's was maternity, our current is
    orthopaedics.  They refer us to specialists as an when required.
    One advantage of this is that you don't have to update each Doctor
    with family histories every time something new comes up.  Once you
    have found a Dr you are comfortable you can be generally satisfied
    that your children will have the same care level.
    
    In England, the GP is the RULE.  Unless you can afford private medicine
    then you see your GP ... and in many areas you have little choice about
    who you see.  They often operate in group practices and you have little
    control over the Dr you end up seeing.  There are rarely more than 2
    doctors offices serving a given area, and often just one.  The GP will
    when necessary refer you to a specialist who usually practices out
    of on eof the hospitals, but the GP generally handles more of your
    primary care than you might wish at times.  A paediatrician is just
    that ... a specialist ... not just a Dr for children.
    
    One advantage of the group vs individual practice is that the Drs in
    the group know each other and can communicate one with the other more
    freely increasing the "group" knowledge, and if you should happen to
    see one of the other Drs for some reason.  On the other hand the
    group where you never know which Dr you might see is a disaster.  Add
    to a group like that a blockade of nurse/receptionists who consider
    their sole duty in life is to stop you from seeing the doctor and
    you might prefer individual practice.
    
    Stuart

    After reading some of these replies I have to think that it depends on
    the type of group practice that is selected.  I wouldn't want one where
    you never know which doctor you will be seeing at any given time.
    
    My pedi belongs to a group at a clinic, and we have no trouble getting
    appointments with him specifically, even when I have called when my
    daughter was sick and he wanted to see her that same day.
    
    When I call after hours or on weekends I get the Doctor on call, and
    have been pleased with the response for the most part. Personally I
    like having the other Doctors as backup, as long as they share the same
    general philosophy.
    
    Mary
    

    I am a resident of New Hampshire, and subscribe to Healthsource HMO,
    which has subscribing medical practices rather than a clinic.
    
    We were "forced" onto the HMO when the costs for John Hancock went up
    so high.  But.  We've some problems with the plan and may reconsider
    during reenrollment in January.
    
    One problem:  In the Londonderry area, no pediatricians subscribe to
    Healthsource.  There are only family practicioners.  We all go to a
    family practice.  I've been satisfied with the individual doctors
    there.  But I wonder if she would be better off with a pediatrician.
    
    Any other Healthsource subscribers dealing with this issue?
    
    Do other people use a family practicioner rather than a pediatrician?
    
    Laura

    I just would like to say that just because you're with a "private"
    practice, doesn't alwasy guarantee your doctor will be available.  In
    fact when I was pregnant my OB was in practice all by himself, when he
    went away on vacation he gave me a list of the covering doctors, and
    offered to arrange a meeting for me wiht each "just in case".  I
    declined and fortunately never needed them.  My internist doesn't work
    any weekends, and when my gall bladder announced its presence at 5am on
    a Monday morning, (that's still part of a weekend I guess), it took 2.5
    hours for the covering doctor to call me back, which felt like 2
    MONTHS!  He pretty much said go to the hospital ER since I don't know
    you.  (fortunately by the the "weekend" was over and my own doctor met
    me at the ER)  I got pretty much the same reaction in another occation
    when I developed a UTI on a Saturday, but then I had to meet a strange
    "covering" doctor at the Hospital ER.  Guess I only DO sick on
    weekends!
    
    My son sees a pedi which is part of a "group", but we chose one of the
    many doctors within the practice.  The only time we don't see his own
    pedi is if she's either not working late that day, or off or doing her
    once every so often day at their other office.
    
    At one point, due to difference in opinion, I asked to be reassigned to
    another doctor within the group and was told this couldn't be done if
    it were a personality issue, only if I was requesting a change so that
    my son could have a doctor of the same gender.  I have had one bad
    experience with one of the doctors in the group, wrong diagnosis, and
    have made it clear that if that doctor is the only one available I will
    take my son to the Hospital ER instead.  They can usually find someone
    other than the one I don't like for us.  This group practice, and the
    doctor came highly recommended by my OB, Internist and several of each
    one's staff.
    
    They take our John Hancock, as well as Central Mass, welfare
    receipients, and several other insurances. They will bill my insurance
    before asking me to pay the balance, in fact the doctor has been quite
    nice about not asking us to pay the difference several times,
    especially since some weeks we've been there up to 3 times.  They won't
    charge for an office visit if you end up going to the hospital for
    further evaluation, and the office has the capability to test
    blood,urine and strep so you don't end up going to the hospital or lab
    if further testing is needed.
    
    Just my experiences....
    Lyn

    I'm on the John Hancock expensive plan (!) and we use a private
    practice of 3 pediatricians.  Alex is registered as the patient of one
    of the three, and sees that doctor for regular checkups; the others
    fill in as necessary in an emergency or for off-hours questions.  I
    like our pedi a lot, and the other doctors pretty well, which is 
    probably why I like the overall setup.
    
    BUT!  I don't like the absolutely sap-draining chore of dealing with
    the practice's support staff.  I called them about a week and a half
    before school started, since I was nervous about the kind of medical
    records our school system (or Massachusetts) might require.
    
    [Alex is starting first grade (today!) and her school hadn't said a word
    about what they needed; halfway through the parents-of-first-graders 
    meeting I asked, and found out that Alex would not have been allowed to
    enter the school without a record of her immunizations.]
    
    The snippy pedi staff person (SPSP): We don't mail out medical records.
    Leslie:	[thinking, At $65 per visit you can't afford a 29 cent
    		stamp?]  OK, then when can I pick it up?
    SPSP:	Do you have a form?
    L:		No, that's why I'm calling you.  I need whatever it is that
    		Massachusetts requires.
    SPSP:	Well you'll have to call back later.  I don't know when we
    		can get that done.  School is starting and we have a lot of
    		requests.
    L:		That's why I'm calling you NOW [a week before school
    		starts].
    SPSP:	Just call us before you come over to make sure it's ready.
    L:		When?
    SPSP:	The day before school starts.
    L:		Tuesday the 3rd?  Will you be open then?
    SPSP:	Yes, we're open.
    L:		All day?
    SPSP:	Yes, all day.
    L:		Because I had to drop something off a while back and when I
    		drove over there, on my lunch hour, you were locked up
    		tight.
    SPSP [incredulous]: Well we were at LUNCH!
    L:		ALL of you?  All at once? [Aside from the pedis, they have
    		the SPSP I was talking to, someone who takes the money, and 
    		at least one nurse.]
    SPSP [indignant]: Of course!
    L:		OK.  When is your lunch hour....?
    SPSP:	12 to 1!
    L:		So you're open from when until 12?
    SPSP:	What?
    L:		You are OPEN from WHAT TIME until 12?
    SPSP:	9:00!
    L:		OKAY!  How do I know what time you open?
    
    ... So on Tuesday I called around 10:15 and was treated, again, as 
    though I'd just stepped from a green spaceship ("do you have a form?"). 
    This time the SPSP pretended not to understand what I meant by "medical
    record", so I said "A list of all her immunizations from birth to the
    present.  Okay?"  SPSP said it would be ready at 1:45.
    
    We arrived at 1:50 and had to wait 10 minutes for them to fill out A
    STOCK FORM (with their letterhead on it).  Reminds me of "The Boys in
    the Band" ("who do I have to %#&@ to get a [form] around here?!").
    
    Leslie

    
    When we were living in NH, we went to a group of 4 pediatricians,
    3 of them were great, one was so-so. Their hours were very good,
    they open till 9 pm.
    When we moved to MA, I looked into a group practice and put off by
    the receptionist's attitude. We stayed with the NH group until a really
    nice doctor opened his own practice 2 blocks from my house.
    I think the most important thing is the doctor(s) him/themselves, not
    the style of practice.
    
    
    Eva

    Hey Leslie, (.11), have you considered being an Erma Bombeck Fill In?
    
    No offense, I think your writings look like some of the things I've
    read in her books....GREAT!!
    
    Lyn
    (too bad life can be so funny and trying at the same time!)
    

    
    When I was pregnant with Matthew, My OB gave me a referral list
    with Pediatricians on it.  I started selecting Pediatricians that were
    close to my area, and on my HMO, Central Mass list.  I came across a
    family physician that was in the same town, and decided to check him
    out.
    
    I'll tell you, it was the best move I've ever made.  He's wonderful. 
    My son has a low white blood count, which has led us back and forth
    many times to the Dr.  He always calls me back within minutes of my
    calling the office.  And if he's on call, the longest I've waited for a
    call is 15 minutes!  And he's wonderful with Matthew!  His diagnosis
    has always been right on target, and he's fought, with success, to get
    CMHC to approve Matt to go to Childrens Hospital.  I wouldn't change
    him for the world.  On top of that, he has knowledge of our family
    history.
    
    Only downfall is when he's not on call (he's a workaholic, and it's
    doesn't happen often) when we have to go to another Dr. that were not
    to thrilled with.
    
    I think with a private practice, your able to gain a better
    relationship with your Dr. 
    
    Ellen

    I like a pedi who has a private practice, just for the reason taht he
    is the only one that my son see's and that he knows everything about
    Alexander.  One reason why I like a private practice pedi is because
    Alexander is prone to getting colds and usually ends up getting
    tonsillities or strep along with it.  So when this happens his pedi and
    the pharmacy knows what to do/give him for it which is usually a sulfer
    based medication.
    
    I have a friend who goes to a group practice for her daughter and she
    tries to make her appointments with the one she likes.  If she can't
    or he is on vacation then she unwillingly takes her to the other pedi
    how is just as nice.  But she has gottend to like the other one better
    for some reason.
    
    But like they say to each his own.  So good luck pedi hunting, but use
    your own judgement on picking a pedi.
    
    Liz

    We have a family practice doctor, and we're *very* happy with him.  I like
    feeling that he's treating the whole family, so that when I bring the kids
    in for their checkups, he also asks how *I'm* doing, and I can easily
    ask him any minor questions I have about my own health, rather than
    making a phone call or scheduling another office visit.  It also means
    I don't have to build a good relationship with multiple doctors - just
    the one.  It also seems to me that our family practice doctor is more
    relaxed and flexible than the pediatricians that some of my friends' kids
    go to - I don't know whether this is purely a personality thing, or
    whether it's part of the "specialists are more rigid and dictatorial"
    thing that I've also observed with other specialists.  A relaxed approach
    (not sloppy or careless!  just relaxed) is what I like, so it's a good
    match for us.  I have referred several of my friends to him, and they
    all are very happy with him, too (some have kids and some don't).

    Our doctor is part of a group practice, but unless he's on vacation, we
    normally have no trouble setting up appointments specifically with him.
    The people that book appointments always ask which doctor we want to see.

							cheryl

    p.s. Laura, if you want to discuss local doctors, send me mail!

    As I said in a separate note to Lyn, Erma B. is one of my favorite
    writers, so it's an honor to be mentioned in the same Note with her!
    
    Just chronicling a typical confab with that pedi office (me with short 
    fuse, SPSP with gunpowder for brains).
    
    Leslie

    How about a different approach to this whole thing....
    
    What are the thoughts of skipping the Pedi all together?  There is fast
    becoming a large number of general internists who will do "family
    practice".  My internist is an example of this, he treats the whole
    family, regardless of age.  I never gave this approach any thought when
    I was exploring doctors before my son was born, and at this point I
    wonder if it's worth checking into.
    
    Are the "family Practice" doctors able to deal with the issues specific
    to children?  Does anyone out there deal NOT with a Pedi, but a doctor
    who treats your whole family.
    
    I need to say that is was kind of a culture shock a couple years ago
    when I went for an apointment with MY doctor, and found a boy say
    around 8 waiting for HIS appointment. (camp physical I think this was)
    
    Lyn

    
    	As has already been noted, here in the UK a GP is the norm, with
    specialists available as needed. Having been down both routes I'd opt
    for a GP treating the whole family. My GP strongly believes that health
    care is not just about specific treatments for specific conditions, but
    involves the whole family situation, lifestyle etc. From a pragmatic
    viewpoint, because he knows the medical histories of all of us, he's in
    a good position to make correlations between our various illnesses and
    be proactive in dealing with them.
    	I think another plus is that the GP doesn't feel he *has* to air
    his speciality. Many times the only real "treatment" required by a
    patient is a sympathetic ear and some reassurance. I'm not saying a
    specialist can't or doesn't do this, but I tend to feel (irrationaly,
    but I know I'm not alone in this) "Hey, this guy's a specialist! Why 
    doesn't he *do* something?".
    
    		Ian G.

    Well, I originally asked this question because I wanted to narrow down
    the number of pediatricians I needed to interview before making a
    decission.  Based on the responses I have gotten here, and all the 
    specific recommendations I have recieved off line (thanks - and keep
    them coming) this really isn't a pertinent consideration.

    Interestingly enough (to me, anyway), the vast majority of specific 
    recommendations have been for two doctors - one is a member of a group, 
    and the other is a partner in a private practice.