Picking Your Baby’s Doc: The Prenatal Visit

In pregnancy, there is always something going on. And, the choices! Who knew all the choices put before expectant parents? Did you want a birth plan? Midwife or OB/GYN as your provider? Natural childbirth or not? While the little one boots up within, up and coming moms and dads (first time or not) face a need to download so much information in so little time. Inevitably then, you’ll be asked: “Who’ll be your child’s primary care provider?” While it may not be the most important decision of this new one’s life, it does matter.

Fortunately, and lest any hormone-fuelled panic arise, let’s recall nature gives you a few months lead time (usually), and there are some basic thoughts to help you think it through.

What is the point of a prenatal visit?

If nothing else, a prenatal visit for an expectant parent, gets a daunting process started. And, while even gestating presents its challenges, it is the time afterward, the childrearing and the parenting where the work really begins. Prenatal visits are not required in most practices (and they aren’t where I work), but I think they are a really good idea. They can be done several ways. For example, some parents never do them, while others seem to prep with the same fervor as one might for a college interview. For most folks, the right balance seems to be in the middle.

The idea of interviewing a child’s primary care provider may apply for families already with children who are changing practices, due to moves, new insurance or a desire to see someone new or different. The American Academy of Pediatrics updated a thoughtful policy paper on prenatal visits last fall. I second the authors’ recommendation that these initial interviews with possible pediatrician (or, I’ll add, family medicine docs) are appropriate for families with more complicated circumstances: families with children with chronic illness, including special needs or premature infants, parents with high risk pregnancies, parents who have suffered loss of a child or difficulties in the care of their child, and also, parents who may intend to adopt. In all of these cases, a sit down with a care provider is a chance to check her out, pick her brains, case out the practice and to gutcheck if it all feels right.

How does one prepare? As in many things pediatric, I advise people to do what works for them. Some come in cold, without notes or having done reading. Others have consulted one or several pregnancy or childhaving guides, and are bristling with queries. Wanna make a list of questions or concerns? Great idea. I myself suffer from a certain amnesia at my doctor’s office. If writing stuff down helps crystallize thoughts and keep you focused, so much the better. Keep in mind, powerpoint presentations, submitting medical papers drenched in highlighter, or using your laptop to fact check statements the doctor makes during the encounter may be a bit offputting. Truly, there are no dumb questions. Having a child is a humbling, profound thing. Among other things, think of this encounter as a long teachable moment.

You have a choice, but how do you pick?

The nice part is, most folks will have a menu of choices in terms of their child’s future primary care provider. I find most expectant or established parents have a sense of what kind of clinician they are seeking, and they find it. Pediatrician? Family Medicine? Physician? Nurse Practitioner? A Solo or group practice, health center or hospital based gig? For those who are uncertain, I find the recommendations of friends and family are often insightful, and help winnow down what can feel like a dizzying list of possibilities.

And then there’s Google and the web. Empowering on the one hand, caveats on the other. State boards of medicine may list individual providers credentials and contact info. Small and large scale websites may offer reviews or comments on some docs. As for this latter resource, private websites or community chat sites can be helpful, but flawed. The veracity or intent of web reviews on docs can be difficult to interpret (was the rave review scripted by the physician’s mom? or is there someone trashing a doc who has an axe to grind?). All food for thought.

In some areas, sought after providers or busy clinics may report they are ‘closed’ to new patients. While different docs work different ways in this regard, many I know will gladly open the door for those who diplomatically and/or determinedly seek to join a closed practice. Time to work your rolodex? Maybe.

Remember, for all the stress this seems to present to some investigating parents on the front end, picking a primary care provider is not a covenant, nor a lifelong commitment. Parents have the right to change and to choose; there is always a market of care providers out there. And while we docs do well to remember this, sometimes it doesn’t work out or fit right, and families may find a better fit elsewhere. A key part of any clincian’s job will be to make that transition as seemless as possible, if needed.

How do you meet? and when?

For most practices, a simple call to the front desk suffices. Families can then arrange a meet and greet. More and more, practices and clinics provide downloadable forms or communication portals on their website, to allow new and established patients to set up appointments. We get most calls from expectant parents around the seventh month of pregnancy. By then, the impending New Arrival is physically evident, and folks start getting the itch to ready their nest and get things set up. Putting the visit off to the 9th month starts to get tricky for obvious reasons. So check ahead, and query about a potential clinician’s availability.

Some providers will set up appointments for anywhere from 15 minutes to an hour. Scheduling challenges may make a face to face gatherings daunting. While I haven’t Skyped one of these sessions yet, I’ve done my share of ‘phone meeting’ with prospective families, conference call style. While not as intimate or personal, it works. Email prenatal visits? Not so much. At present, email is too time intensive and doesn’t lend itself to discern whether or not a doc is a good fit. We’ll see if 3D TV changes that in the future. To date, that’s a ‘not yet.’

At present, most insurers don’t cover the cost of meeting for a prenatal/new patient provider interview. Some practices and organizations will charge you for the time. Make sure you check! In some places, clinicians will have group meetings of prospective parents. This works well at busier, larger practices, but probably isn’t feasible in smaller shops.

What are important topics to cover?

For the expectant parents and for new patients, there are some key elements to cover when we meet the first time. While these will vary with the pecularities with each practice (and maybe, even between doctors at the same clinic), there are some universal ideas to touch during your chat.

The Top 9 Issues to Cover:

1. How does one book an urgent appointment or well child visit?

2. How are after hours phone calls and concerns handled?

3. How does the clinic arrange for examining the newborn and/or establishing the first appointment?

4. What resources does the practice have for nutrition, including breastfeeding?

5. Are there any special policies or family concerns around vaccination?

6. Can the practice accommodate children with special needs, including neurodevelopmental issues, such as autism or developmental delay?

7. How does the clinician feel about the use of complementary or alternative therapies in kids, such as herbs, acupuncture, homeopathy or chiropractic?

8. Do they have a sense of humor, and seem to like kids?

9. See #8

Call that a good start. Now, get to it!

A visit is worth a thousand words!

(photo above by Drjeeeol; cartoon below by me)

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