Conference moira::parenting

    Hi Jane,
    
    	I live in Merrimack, New Hampshire.  I am very pleased with
    my pedi group.  I can call anytime during the hours of 8:30 -
    7 or 8 at night (with the exception of an hour during lunch)
    and speak with a nurse immediately.  Sometimes I have to hold
    for a few minutes while she takes the call before me, but they
    always ask if I can hold and tell me how many calls are before
    me.
    
    	They have evening and weekend hours and I once asked why they
    were open so much and the pedi said, "children don't only get
    sick between 8 and 5."  
    
    	If I request that a doctor call me back, he or she usually
    does so within the hour--immediately if it's fever related!
    
    	Also, just two weeks ago, I called and told the nurse
    about my daughters symptoms and what I thought I needed.  The
    nurse told the doctor (who saw my daughter - 2- the week before)
    and HE called and left a voicemail telling me what he prescribed
    (which was the med. I had requested) and why.  
    
    	All in all- I couldn't ask for a better group of doctors!!!
    
    	Contact me via mail if you want their names!
    
    Sheryl

I have been with two different pediatricians practices in Massachusetts (one
HMO, one private practice).  My expectations are pretty high, and I have
not been disapointed yet.

In both practices, there was one hour each morning when you could speak directly
with your doctor.  If he/she was on another call he/she always returned the call
withing the hour - usually sooner.

In both practices you could always speak to a nurse during office hours.  I never 
had to wait more than a few minutes.  Whenever I asked to speak with a doctor,
the doctor always returned my call by the end of the day (unless it was morning
call hour when I got through right away, or a serious problem when he called me 
back within 15 minutes)

The few times I have called after hours, a doctor always returned my phone call
within a half hour.

    .2's experience has been our experience as well.  Our pediatrician
    is a Nashua practice.  We're so pleased with them that we're
    keeping the boys there and paying the extra even though we've now
    switched to an HMO that doesn't cover the full cost of such
    visits.
    
    --bonnie

    Boy, this is making me stop and think.  Maybe I'm not expecting enough
    from my pediatrician's office and should make a change....
    
    First, when I go in for an appointment, it is not uncommon for them to
    keep us waiting a full hour after the scheduled time.  I realize that
    emergencies do occur that cause a doctor to be behind schedule, but in
    my case it seems as though they are just over-booked and can't squeeze
    everyone in.  
    
    When I call to ask a question during the day, I never get to talk to
    someone immediately.  They take my name and number and say that a nurse
    will call me back.  This can often take 5-6 hours.  
    
    Why do I stay with them?  It's a group of pediatricians in my home
    town.  It seems as though almost all of the children in this town go
    this to office.  I like that they are in touch with the community and
    know about what diseases are going around in the town's school system
    at that time, etc.  Also, they are 2 minutes away from my day care
    center so, if necessary, my day care people could get my son to the
    doctor very quickly in a non-hospital emergency.  Finally, once I do
    get my son in to the examining room with one of the doctors, I feel
    that the doctors are very qualified and good with children.  
    
    Also, truthfully, I have become used to this kind of slow service from
    my own doctors.  My obstetrician usually was running 2-4 hours behind
    schedule.  And not because he was delivering babies, but just because
    he was overbooked.    
    
    I live in Massachusetts. 
    
    (another) Jane
                  

    re: .4
    
    Those are important advantages, and probably worth putting up with 
    a little slowness over.  
    
    --bonnie

    re: .4
    
    I've experienced the same thing with our Pedicatric Practice.  We moved
    to Mass. from Texas.  Our Ped. in TX was very responsive and I never
    experienced any delay in service (either a scheduled appointment or
    a telephone question).  Now we've gotten used to an hour delay in
    appointments and a full day to receive a call back when I phone in
    with a question.  
    
    I've always felt a bit uncomfortable about this level of service, but
    we too go to a large practice that seems to be in touch with the
    community.  I'm happy with the doctor's participation in the treatment
    of our child when we see the doctor, but I wonder if I wouldn't be
    just as happy with another Ped. office.
    
    The problem is finding a Dr. that offers the type of service you  
    desire.  When we selected our current practice, we requested a
    meeting with the DR. (sort of a prenatal interview).  We did meet
    with the Dr. but felt like he thought we were wasting his time
    with our questions.  
    
    Sometimes I think I'm too quick to equate behaviors to the region I'm
    in...in Texas I always expected courteous, timely service and received
    it.  Here in Mass. I guess I expect to be put off, delayed and
    challenged...and I get it...
    
    Must be a self fulfilling prophecy!

Our pedi's office has several nurses which will answer any questions within a
few minutes. If you request to talk to our doctor (non-emergency) then it may
take anywhere from a few minutes (doctor on site) to a few hours (not on site).
We can always talk to another doctor on site, or wait until our doctor calls us
back later in the evening from his home. He always calls back.

More important to us was the pedi's philosophy, and the consistency of this
philosophy across the doctors and nurses in the practice. In this regard the
practice has been exemplary. It can be a pain waiting during busy times but this
is a small sacrifice to get the type of care we agree with.

Chris

    I'm in California.  Our pedi is in our home town, as is our day care.
    It would take only minutes to get to his office from either my home
    or my day care provider's.  But I also receive the level of service
    I desire - that is, little or no waiting for appointments or returned
    phone calls.  The Dr. usually call himself, I only speak to the nurse
    practicioner (sp?) if I cannot wait for the Dr. to return the call.
    
    I no longer put up with long waits for medical care.  I switch Drs. if
    I feel they overbook.  I have HMO elect, and I have not yet found an 
    HMO primary care physician who is not overbooked, but I go to the Drs
    of my choice and pay the 30% - it is still cheaper than the Digital
    plan 1 which I used to have.

    We have my husband's Blue Cross Blue Shield for insurance thus I choose
    my doctors.  Our pedi group has satisfied our needs.  Most of my
    questions are directed by me to the nurse first.  I figure they have
    almost the same amount of training for those fevers, coughs, colds, etc
    as a doctor.  Just yesterday I called about a cough in my 5 year old. 
    I called the office at 10:40 and the nurse returned my call at 11:15. 
    When I left a message, I told them it was a cough, no fever, etc. so
    the nurse would have all the details.  She recommended an over the
    counter cough supressant and a few little extras to do for him and
    that's all I needed.  Now this was information I already had, but
    because of the length of time the cough has persisted I wanted to be
    sure it was still "just a cough".
    
    When we take the kids in (we have been extremely lucky here) it's
    usually for their physical.  We have a 15-20 minute wait at the most
    and are handled with professionalism and given enough time to ask
    questions of either the nurse or the doctor.
    
    In the other practice I was associated with (before we moved) we had
    more ocaission to use emergency services.  We were taken immediately if
    that's what I needed (twice) or our calls were returned within the hour
    (both during office hours and at night/weekend).  They, too, had office
    hours on the weekend for emergencies only (no physicals, etc).
    
    Now if I could just get my OB/GYN in line.  I had to wait over an hour
    recently and I will not be going back.  He was OVERBOOKED no
    deliveries involved.  To me that is a problem that can be remedied.  I
    refuse to wait that long again.
    
    -sandy
    

    Sometimes it may be the physician that your dealing with and his or her
    support people, not necessarily the entire practice (for offices with
    more than one doctor, of course). I never had to wait for the first
    pediatrician we used when our daughter was born, but he proved his real
    worth through his rudeness and failure to diagnose and treat a few
    problems correctly (fortunately they were minor). We sometimes have to
    wait for our current (and second) pediatrician--but never more than 20
    minutes AND he gives us all the time we need with him and responds to
    phone inquiries promptly (and makes the right diagnoses promptly). I
    also like his support people and their work, although the support
    people for our first pediatrician weren't too bad (these doctors worked
    on different teams within the practice).
    
    Overall, our experiences with the first pediatrician made me realize
    that if you're not comfortable with the overall situation, you can and
    should work to find an overall situation in which you feel most
    comfortable. No situation will be perfect, but if there are things
    about your current physician/practice that bother you enough, you might
    consider looking into other options.
    
    Nancy-

    My pedi's officce is very good.  I have had no problems with them since
    I switched to him in May when my first pedi retired at the ripe old age
    of 72.  
    
    The pedi I have know has callin hours from 8:15 - 9:00am.  You can call
    and speak to him (not a nurse) between these hours for emergencys or
    just questions regarding your childs health (cold symptoms).  He is
    also good about seeing my son if I call him when my son is sick.  He
    also switched his schedule around one day to stich my son's knee
    when Alex fell and got a rock stuck in his knee and needed stitches to
    close the wond.  If I call after 9:00am for something I usually can
    speak to the nurse right away unless she is busy.  If she is busy she
    will call me back with in a half hour, if she is really busy.  If it is
    fever related she will speak to me right away.  My pedi also belongs to
    group of pedi's who cover for one another after hours.  To let you know
    how good these people are.  My son got sick over the weekend and Monday
    night around 7:30 he had problems breathing and needed to be seen by a
    doctor.  I called my pedi's office and got the number of the doctor on
    call.  Called them and they saw him immediatly, instead of having my
    take Alex to the hospital.  They checked him out and gave him a
    perscription and told me that besides his virus he had a double ear
    infection and a sinus cold which was the reason why he had problems
    breathing.  He is doing better and I would not changes pedis for
    anything.
    
    Liz

    Re .9 and in general:  If a doctor's office makes you pay the
    bill anyway if you break an appointment without 24 hours' notice,
    why can't YOU bill the doctor if you're kept waiting more than
    one hour?  Just asking.  Seems that what's sauce for the goose
    should be sauce for the gander.

Even though this note hasn't been active in a while, I'm hoping people will
respond with their experiences and tell me if my expectations are
unreasonable.

I have been taking my 2.5 year old daughter, Rachel, to the same
Pediatrician since she was born.  When she was born, she initially had a
heard murmur.  Her Pediatrician was wonderful (and has always been extremely
nice to us), calling me after he'd seen his patients at the end of the day
to make sure I was okay, that I didn't have any questions after seeing the
cardiologist, etc... Fortunately, the murmur went away when Rachel was 9
months old so she didn't need any "special" treatment any more.

This past Fall and Winter, Rachel has had a seemingly never ending bout with
ear infections, the flu, colds, etc...  I've had an impossible time getting
her in to see her Pediatrician.  I don't think it's his fault, I think it's
the administrative staff.  I have to call voice mail whenever I call and am
told to leave a message and the nurse will assess if my child should be seen
or not.  On average, the nurse calls me back within 1-2 hours.  Each time
they've "granted" a visit, Rachel has been seen by a Nurse Practitioner -
not her Doctor nor another Physician on staff.  I don't have any objection
to Nurse Practitioners per se - but I'd like to see her Doctor who knows
Rachel's history occasionally.  

Usually, I'm told that Rachel has to have had a fever of greater than 
102 for 3 straight days (meaning I have to call on day 4) in order for for 
someone to just look in her ears and throat and check if she needs to have 
antibiotics.  

Is this reasonable/the norm?  Am I expecting unreasonable responses from her
Pediatrician?  Her Pediatrician hasn't seen her since August.  I don't have
back up care so I'm usually out of work using up my vacation time during the
3 day waiting period.

Thanks --

Alison  

    Granted my 'baby' is now 22 years old... but I experienced the same
    thing when I had my first child... my pediatricians were a husband and
    wife team with a full administrative staff who would book double
    appointments 15 minutes apart... when I brought the baby in for a check
    up I always felt that I was in an assembly-line process... the doctors
    were always good with the baby, but out of the 1.5 hours that I was
    there, only 5-10minutes were spent with the doctor.... when the baby
    got sick... it was always on the pedi's day off, or holiday, or weekend
    and I would end up at the doctor who was covering for them or the
    emergency room.  
    
    Shortly before my son was born, my daughter developed strep throat...
    as usual, my pediatricians were not available.  On the advice of a
    friend, I called a pediatrician who had an office by himself.  He was
    terrific ( and still sees adolescent patients at 82), was on call 24
    hrs a day/7 days a week.  He was in the office for a couple of hours
    every day and also made house calls in an infant had a high temp in the
    winter months.  
    
    My grandson goes to the clinic that absorbed this pediatrician's
    practice (but he is still on the board) and sees the same doctor each time
    he goes for a physical.  On an emergency basis, he sees whichever
    doctor is available at any of 3 locations, usually the same day or is
    taken into North Shore Children's Hospital after hours.
    
    
    
      

    A fever of 102 for 3 days in a row!!!  You are not being unreasonable! 
    That is unfathomable to me.  Aaron doesn't get fevers with ear
    infections until they reach the "raging" stage.  You are the mother,
    you are with this child and able to observe if she is sick or not, it
    should be your call whether or not she is seen by the doctor (or nurse
    practictioner).  In spite of what they might think, MOTHER KNOWS BEST!
    I would make an appointment with the doctor (or at least insist on
    speaking to him on the phone) to discuss the office practice and if
    they continue to be that way I would move my child no matter how
    wonderful the doctor is.
    
    Of course this is just my opinion!
    
    sandy
    

  Your experience does not sound like the "norm" to me.  At our pediatrician
I can always schedule a sick child same day appointment.  In the 6 years
since my first child was born there have only been 3 times that they were
so busy I had to speak with the nurse before scheduling.
  Our practice has 2 physicians and 2 physician assistants.  For a sick
appointment you never know who you will see.  For physicals you can request
whomever you like.  This practice is in Methuen, MA 


Elizabeth

	I don't think you're being unreasonable.  Our practice has 2 doctors,
	2 nurse practitioners and 2 nurses.  When I call, a nurse can always
	call me back and if I request it a nurse practitioner or doctor
	will call me back.  My children always see the same doctor for their
	scheduled apt.  If it's a sick apt. they may see any of the four
	but they try to schedule it with the girl's doctor if she is in that
	day.  

	It sounds like they have unreasonable rules.  I'd speak to them
	if you like the doctor and maybe they will change their way, at
	least with you.  But if you don't get satisfaction, switch.

	Good Luck,
	Karen T.

Noelle is another who doesn't develop the fever with
an ear infection until it's already really bad.  NO WAY
would I wait 3 days!

    I like the advice to meet with your *doctor* about the Visit Prevention
    policy :-) because I suppose it's possible that he isn't aware of 
    the hurdles you're being forced to jump.
    
    1.  Voicemail - normally I love this technology, but I think one to
        two HOURS is too long for a medical callback.
    
    2.  Nurses screening your eligibility for a visit - I guess this is
        a form of triage, I guess this is "crustimony proseedcake" as
        Pooh would say, but
    
    [flame on]
    
    3.  Waiting til the end of 3 days of 102 degree fever for sore throat/
        ear infection?  This is MADNESS imo, especially given the relation-
        ship between strep, scarlet fever and RHEUMATIC FEVER.
    
    4.  Diagnosis and treatment by [not-a-doctor]?  No way, uh-uh.  I know
        they're medical professionals... but they are NOT DOCTORS.
    
    [flame off]
    
    I *have* called my pedi's staff and discussed symptoms, etc., with the
    nurses, and I do value their opinions.  However, I do not place their
    experience and training on a par with doctors'.  If I encountered an
    impenetrable wall of staff self-importance, I'd switch practices.
    
    Leslie

Well, I won't repeat what everyone else has said, but I do agree with them!

The last time I had to call was for conjunctivitis.  The nurse tried to tell me
to wait another day to see if the symptoms were worse (they were already classic
with puffiness, puss, etc).  I asked what she expected the delay to accomplish
other than making me miss a day of work and exposing others in the house to the
infection.  The drugs were ready at the pharmacy within the hour.

Irene

    
    We went through a period of ear infections with my daughter and I
    know that I learned the symptoms well enough,(crying after laying down,
    103 temp) that I would call after the 1st day and ask for an
    appointment. Where we go (Acton Med) you usually speak to a nurse first
    and if you just say I WANT HER SEEN! they don't argue. If you tell
    them what's happening they usually try to convince you to wait it out.
    
    But for $3 and an hour of my time I'd prefer to be proven wrong,(which
    only happened once), than to wait until it's a raging ear infection
    rather than the beginning of one.
    
    All our visits are with a pedi, they don't have nurse practioners or
    physician assit for pediatrics. I'm very happy with the quality
    and timeliness of the care my children receive. No way do I think
    you're being unreasonable. As long as you or your insurance is paying
    for the care you should be seen (within reason) at your request.
    
    
                   good luck
    
                   Barbara
      

   Yeah, I can see it now... I call down the street to my friendly
   neighborhood mechanic...
   
   me:  Hello... yes, my car is running very hot - the temperature gauge
        is a lot hotter than is usually is.  And the engine smells
        different - a lot hotter, if you know what I mean.
   
   them:  Well, if its not in the critical range (the red section on the
          gauge), why don't you run it for 2-3 more days to see how it
          works out.  If it is still a problem after that, call us back,
          and we'll schedule an appointment.
   
   *I don't think so!*
   
   Yes, its a little silly, but taken in this context, the (medical)
   service provider's request makes no sense at all to me.  No reasonable
   person would accept this answer about their car... why do medical
   folks think we'll accept it about our kids?!  (yes, I know the body is
   self-healing sometimes, but still...)
   
   No, I do not believe you are being unreasonable.  

   imo,
   
   - Tom

    Add me to the group - I always see my kids pedi if I request him
    (sometimes they ask if I mind seeing a PA, depending on my reason for
    calling often it's not a problem).  As long as my pedi is in the
    office, we see him - and we're even in an HMO!
    
    Definitely check this out!!!
    
    Linda

I'm glad I'm not alone in my concerns.  Granted, there are a lot of viruses
going around, but my daughter has a history of ear infections and I would
rather catch them early on than wait and have to lose day after day of work.  

I called the office today and left a message on their voice mail system that
I'd like to speak with the Doctor in person and left my home and work
numbers for his use.  One hour later, one of the nurses called me back to
ask "If there was anything she could do to help and would I be willing to
explain the problem to her?".  I came right out and told her that "no, she
couldn't help instead.  That I was evaluating whether I should leave the
practice and wanted to express my concerns to the Doctor first."  She
promptly put me on hold.  When she came back, she informed me that the
Doctor was on vacation until next week and that I should call back then.

I really feel that the Doctor has no clue this is going on.  He must be
under the impression that my daughter is incredibly healthy as he never sees
her.  

I do plan to call back next week, explain all of my concerns to him
and request a referral if I don't get any satisfaction.  I know that for
some folks who responded to this note, my experience is the norm.  (are we
in the same practice?).  However, it's not working for me and my family.  I
need to change to a practice that is more sensitive to our needs.  

I'm also glad to see that such practices do exist and will find the right
one for us.

Thanks to all who responded.

Alison 

    
    	Ten days ago, I took my 3 year old in to the doctor for
    	a sick visit.  I made the appointment in the morning, and
    	was debating whether or not to have them also see my son.
    
    	I decided no, but by the time our 4:00 appointment rolled
    	around, I was starting to wonder about Andrew.  He'd been
    	fussier than normal during the day, and hypersensitive.  Our
    	pediatrician requests that you not ask them to look at additional
    	children, but the nurse agreed they had time to look at both
    	kids.  I told the nurse practitioner that his only symptoms were
    	his behavior and a cough that he'd had about a week.  He turned
    	out to have chest congestion, bronchitis, and an ear infection
    	(Andrew is virtually asymptomatic with his chronic ear infections,
    	and when they get to the "raging" stage, they seem to not respond
    	well to treatment, taking several rounds to clear up).  I was
    	thankful that I'd gone ahead and asked them to check.  I
    	don't think he's ever had a fever for longer than a day, and
    	he's had around ten infections in his 22 months.
    
    	I do let the nurses do "triage", as I've come to respect their
    	advice (and in many cases, they consult with a doctor and call
    	me back, or consult with a doctor while I'm on hold).  Also,
    	we frequently agree to see the nurse practitioners at this office.
    	They are very knowledgeable and thorough.  YMMV
    
    	Karen
    

    Aaron didn't sleep well at all last Thursday.  He had been a little
    stuffy through the week but on Thursday night he had major drainage
    from his nose and down the back of his throat.  I'm pretty sure his
    throat was sore.  Anyway Friday he had a little fever that went away
    pretty quickly.  I decided that I'd see what he was like on saturday
    before I took him to the doctor (our practice has weekend hours).  He
    seemed to be much better except for a runny nose.  On Sunday we noticed
    that he seemed to topple over a little more than usual so yesterday I
    called the doctors office, told the person who handles the phones that
    I was bringing Aaron in for an ear and chest check (oh, yeah, he's been
    coughing through the night) and who would be available to see him in
    the later afternoon.  She didn't question me or suggest I speak to a
    nurse, she gave me an appointment with a nurse practitioner (it's the
    first time we've seen her, but I trust the practice I'm with).
    
    Aaron has another ear infection, the right ear is worse, but it's in
    both ears...  He doesn't show the typical signs, if I had described his
    symptoms to the nurse she probably would have suggested I hold off on
    bringing him in.  As far as I'm concerned you know your child the best,
    if you feel there's something wrong and you want the doctor to see your
    child, then the doctor should see your child.
    
    sandy

    
    Yikes!!  I don't think any of my kids has ever had a fever for 3 days
    in a row (maybe because I usually bring them in on day 1 or 2, since
    they NEVER get fevers anyway - they're REALLY sick when it's fever-time!).  
    
    I have Matthew Thornton, and have for 9 years, and have been very
    pleased with them. (Nashua).  I just called today, actually, needing to
    have my 10 yr old seen.  They USED to try to put me off a little more,
    but when I call, I say "I need to make an appt to have my son seen",
    and they don't question it.  I ALSO think that they do a little less of
    the put-off stuff, ,and just let you come in.
    
    In this case, I wasn't really sure  -- he had either pulled a muscle in
    his chest/upper arms (most likely) or having a heart attack (not at all
    likely, but symptoms were enough to question it).  I told the
    phone-answerer that I wasn't sure if I needed to have him seen, and
    could I speak to a nurse.  There's almost always a nurse immediately
    available.  She picked up the phone, we talked about it a bit, and
    decided that since it was killing him just sitting still, not moving at
    all, it was better to have him checked out.  I had an appt with HIS Dr
    w/in 3 hours, or could have an alternate Dr. within an hour.
    
    This is not uncommon with them at all.  They typically book one doctor
    for "on call" throughout the day, so if you call and want to see a Dr.
    they seem to have reserved a single Dr for all those 'walk/call-in'
    type visits.  
    
    My sons' pedi seems to only half-book her days, so that she always
    seems to have room to see the kids.  It's really wonderful to be able
    to see the SAME person almost all the time.
    
    ... pulled muscle, and we're back on track again ....
    

Patty -

I agree with your previous reply.  I also have Matthew Thornton Nashua.  The time
they tried to put me off was on a Sunday afternoon with urgent care.  As I 
stated earlier, they ended up just calling in the prescription and not even seeing
my daughter.

As with you, I normally am seen with no questions.  Also, I too have talked to
the nurse with even something as vague as a child not "behaving normally" 
as far as sleep and eating patterns.  They saw her with no question.  Quite
often I do see another doctor (mine only works 3 days a week, but his wife
works the other 2 so it's often her).  I've also seen their nurse practitioners
quite a bit and have been really happy with them.  In some cases, I'd rather 
see them than a couple of the doctors.  The one on my team seems to believe
in the concept that mothers know when a child is not acting normally and puts
a lot of weight on that.

Irene