Conference moira::parenting

    
    re .0
    
    Time to go doctor shopping! Good luck. 
    
    
    Eva
    

    Sounds like you have other concerns with your pedi and his staff but,
    regarding the ear infections - the way it's been explained to me (by my
    pedi and others) is, a child can be checked out in the morning and his
    ears are clear....by that evening an infection can start.  On more than
    one occasion I've had my pedi tell me that my childs ears were ok at
    that moment but he may see me tomorrow.  Sure, he could prescribe an
    antibiotic as a precaution but then the child could be getting medicine
    they may not really need.
    
    You may want to have a talk with your pedi when he isn't checking out
    your child.  Tell him your concerns.  
    
    Linda

         As far as the wax goes...in all of the ear checks that my 2 have
    had (5 year old and 2.5 year old) wax was only removed once.  It is
    not always an issue.
         
    				Mary

    My pediatrician came highly recommended, best in his field...I still
    changed.  My daughter did not respond well to him and I did not feel
    like I was getting the level of responsiveness I needed.  So, at 2
    years, I switched!  Change for the better and hopefully you will both
    feel more comfortable for the many more years of pediatric medical
    services you will need.

    I'd say if you don't feel you can trust him and, even worse, you feel
    like you are not being heard, this is not the right doctor for you.  	
    I'd find another very quickly!
    
    Irene

While you probably have little faith in your Dr. right now, I'll offer
these words in a little defense of your Dr.

Tugging at, and batting the ears is a non-specific symptom of ear and other
sinus problems and can result from congestion from colds.  It can often be
indicative of a blocked eustachion tube ... not necessarily from an ear
infection.

A change from clear ears to a visible infection can occur in under 8 hours.
Really, that fast!

Remember that, when looking down the ear canal, they cannot see much past the
eardrum, so an infection starting deep in the ear may not show.  It could
be, from the construction of your child's ears that there is a cavity that
doesn't drain well, allowing an accumulation of fluid, out of sight of a
normal ear exam.

Also, the fact that the Dr on Thursday had to clear ear wax to get to look in
the ear is also not really significant ... Ears normally generate a small amount
of wax normally, and when inflamed, such as with an infection can produce
lots of wax quickly.  My ears can generate enough wax to go from clear to
plugged in about 12 hours when suitably inflamed.

So, I wouldn't totally blame the Dr. but at the same time, it sounds like he
was maybe in a little hurry to dismiss the possibility.  Some Drs have become
paranoid about the business of over prescribing anti-biotics that they want
to be 100% sure of what they are dealing with before doing so.

So ... if he hasn't given you cause for concern in other areas, I would stay
and give him the benefit of the doubt ... one would think that he could have
seen this earlier, but it is very possible he didn't.

Stuart

    I think it's very important to be comfortable with your doctor.  The
    personalities make a world of difference along with their expertise..
    I recently had to bring my son to a different doctor in the same
    practice since he needed to be seen that day and I was very
    uncomforable with this doctor.. he was very cold, hardly looked at me
    and answered my questions as if I was asking something very stupid.. 
    
    In defense of the ear infections though, I had a similar experience
    just last week.  I took Matthew, 14 mo, in for a follow-up visit last
    tues at 4:00pm.  His ears were fine.. great..  however, he did still
    have a cold.  I took him back to the doctors at 2:30 on Thursday
    because I was concered with his chest and he had 2 ear infections!!
    This was less than 48 hours.. however, my regular doctor, whom is
    GREAT.... assured me that yes, an infection can surface that quickly.. 
    
    This doctor plays with Matthew, lets him sit on me when he examines
    him, let me look in his ears so I know what he's looking at.. explains
    things to me... It makes a world of difference.  
    
    

    Follow your instincts!
    
    Although it may be that both ear infections came on fast, your gut
    feelings tell you that they were there all along for the doctor to see,
    and he missed them.  Change doctors.
    
    We still tend to put doctors on another level and are reluctant to make
    the break, but we really are consumers in this field, and deserve the
    best care we can find!
    
    Interview potential practices - find out how they feel about phone
    calls and "silly" questions, up front.  The nurses are just as
    important as the doctors in your everyday dealings, so get some feeling
    as to how they deal with parents.
    
    There are two areas in which (mostly) mothers get experience in
    sticking up for themselves and their kids: medical care and day care. 
    It makes us better parents and stronger people, but it's not easy!
    
    

Hi,

I can understand fully how you can feel as though you've "lost faith"
in your pediatrician. That is a very uncomfortable feeling. However,
I do agree with the points made in .6.  My older son, who's had his
share of ear infections, used to play with his ears all the time when
he was a baby. I was always suspecting an ear infection, yet this so-called
classic symptom never was a tip-off for us. Turned out he played with his
ears when he was tired, and he outgrew that habit after a while. I can also
remember only _once_ that he woke up screaming in pain, and that was when he
was over 4 years old. Yet he had ear infections well before that incident.
So much for classic symptoms! Plus, our pediatrician had to clean wax
from his ears only once.

I think a key element here (aside from how well your pediatrician cares
for your kids) is that you are able to TALK to this doctor. Your first
concern is the welfare of your children, and understanding what the
pediatrician is doing for them is vital, in my opinion. I have no qualms
about asking many questions of doctors, and any doctor worth using will
welcome questions and answer them thoroughly and nondefensively. It is your
right to question things, even if only to understand them better. It will
be empowering for you as a parent, and it will let the pediatrician know
that you are "watching." It could even strengthen your relationship with
him and cause him to be more diligent in his examinations and in his dealings
with you.

Most important, if your pediatrician _is_ defensive, or gives you 
unsatisfactory answers, or treats you with arrogance, THEN I would
reconsider and look at other practices. 

Good luck!

    I agree with the noters who advise that an ear infection can come
    on very quickly, so perhaps your doctor didn't miss it.  But,
    it's clear that you are not happy with the doctor or the practice.
    Even though 9 months in your baby's life seems like a long time
    (it's his whole life!), the next 12-17 years that he'll still use a
    pediatrician are even longer - better to find a doctor you're more
    comfortable with.
    
    Many practices will sit with you prior to your choosing them - I
    interviewed two, and had the opportunity to sit with another if
    I so chose, and I think one charged for the visit and the other
    didn't (and the third wouldn't have).  So, ask some of your friends
    who they use, and check your HMO directory for doctors and practices
    nearby, for ideas on who to interview.
    
    I think the book "What to Expect when you're expecting" includes a section
    on questions to ask a potential pediatrician.
    
    I chose a doctor who was part of a practice, have since seen most of
    them, like them all, they are available 24 hours a day, and they have
    a nurse line during the day for ANY questions about your child.  I
    see the pediatrician I chose for all her regular check-ups.
    
    Good luck,
    
    Jennie

We do not and have never used a paediatrition ... 

We use a family doctor ... several reasons ...

1.  Ailments go round and round in families ... why visit 3 doctors ... one
	for the kids and one for each adult.

2.  There are no surprises in the way a doctor treats your family.  You
	develop a much closer rapport with the Dr.

3.  The family doctor tends to take the parents' concerns more seriously ...
	after all he usually sees members of the family more often.

4.  What does a paediatrition really know above a true family doctor ?  So
	why pay their specialist inflated fees /

I have no problem when a family doctor recommends a paediatrition for something
special ... but all the Family dr's we've had so far have been great with kids
and haven't made any such recommendation.

When our first was born, the hospital appointed a paediatrition ... on
preparing to leave the hospital, he set up an appointment to see the little
one at about 6 weeks.  Well ... we looked at it and asked ... "Why would we
want to trek across the city ... 30 minutes to see the Dr  if our family
Dr. was willing.  We called him and he was more than happy to look after
our newborn ... as it happnes his first child was born a few months before ours
so he was going through all the things we did just before us!!!  So we
told the paedi to take a hike.  (At the time we were in Ontario Canada, and
they allowed Drs to charge above what the health insurance covered ... and
the amount this guy wanted for a Dr's visit would be crazily expensive!)

Stuart

While I understand and accept your reasons for using a family practitioner
rather than a pediatrician, I disagree with this point:

>>4.  What does a paediatrition really know above a true family doctor ?  So
>>	why pay their specialist inflated fees /

I do believe that pediatricians in general have more extensive knowledge about
the medical needs of children.  I am not aware of pediatricians charging more
for their services than general practioners; certainly, I don't consider a
pediatrician a "specialist" in the usual sense of the term, and their charges
have not been in the same range as those of the more typical "specialist"
doctors.

The family doctor is a wonderful thing when it works, and I'm glad it does for
you.  For us, we have separate doctors, and have switched doctors several
times.  If you are likely to switch doctors, requiring that everybody goes to
the same doctor makes a switch a very difficult decision, frequently with no
fully acceptable resolution.

						Brian

    We stick with our HMO's pediatricians because they see the "kids"
    illnesses first.  While I see a family doctor (as does my husband), he
    doesn't always seem to know about every virus and bug floating through
    the schools and daycares.  If you call the pediatricians and give the
    symptoms, 9 times out of 10 you'll hear, "Oh yeah, we've seen 10 cases
    of that today.  Do xyz and it will pass in xxx amount of time."
    
    

    We see the pediatrician for Aaron as well.  I think it depends on your
    families needs.  We felt we had to make a choice.  We could get a
    family practitioner closer to where we live and my husband and I could
    switch from our dr to that doctor, or we could get a pediatrician a
    half hour away from our home that offers "urgent care" in evenings and
    on weekends and we could keep our doctor and Aaron would have a doctor
    who only deals with babies/children/teenagers.  We feel that Aaron gets
    better care with the pediatrics team than with he would have with the
    family practitioner.
    
    A case in point, a little over a week ago Aaron had a reaction to his
    MMR shot (he had received it 8 days before that).  On Friday afternoon
    he was running a mild temp.  I phoned our pediatricians office to make
    sure I knew what to look for (and verify when I should panic!).  On
    Saturday the temp rose to 103.8 and my husband decided to take Aaron in
    to make sure it wasn't an ear infection.  By then Aaron was starting to
    get a rash on his back.  We saw one of the family practitioner's who
    was in rather than a pediatrician.  He looked at Aaron's back and said
    it looked like insect bites...  I told him he may not watch his kids
    well enough to know they have gotten 20 or more bug bites on their
    back, I'm a little more observant.  This is a rash!  He pretty much
    dismissed what I said...  This is the second time we had a less than
    satisfactory visit (out of at least 10 urgent care visits due to
    Aaron's ear infections) and both were with "family practioner's".
    
    I think if I were the noter who questioned her child's pediatrician,
    just the fact that she didn't feel her child is getting the care he
    needs, I would change.  However, I have to agree that ear infections
    come on very quickly.  We could take Aaron in on Tuesday morning and he
    would be screaming all night Wednesday night because of a massive ear
    infection.
    
    sandy
                   

We've been luck now with 5 family doctors and their practices in the 4 different
places we've lived since moving from England.  (5 because of insurance company
games ... they ditched a doctor because he also served another particular
insurance group!)

Curiously, in England, a paediatrition IS a specialist in the very truest
sense of the word ... and to a somewhat lesser extent in Canada, and I gather
it was that way here at one time ... but pedi's as a child's GP became
fashionable.  I hate doing things because they are simply "the thing to do".
The hospital pedi was quite shocked when we told him we were using our gp!
Tough luck buddy!

I guess the GPs we've been to have all been family doctors in the truest
sense because they all do the "this is the nth case of this I've seen this
week" ... also they know when you come down with something that it was
because of child contacts because of their exposure to what is going around
everywhere.

I'd go for a good family doctor anyday if you CAN find a good one ... we
have avoided "clinics" for that reason ... often you go to a clinic and
you'll see Joe Anyolddr.  All the Drs we've had have had a max of 4 in the
practice ... and you only see others if you ask or it is an emergency.

Don't berate the GP / Family Dr. just because Paedi's are the typical way
to go.

Stuart

    I used a family doctor with my older son (now 8).  He was part of a
    large medical group with offices all over Southern Calif.  This
    particular group partnered all the doctors into suites of two
    physicians.  
    
    I often had that "he isn't listening to me" feeling with him, but felt 
    that was more indicative of HMO care than anything personal about the 
    doctor or his group.  I will say, howeve,r that the FP I chose had 
    specialized in Pediatrics in residency, as had his "partner" in
    practice.  Therefore, a large part of my doctor's family practice was
    school age and preschool children, which increased my comfort level
    with him. 
    
    Through a coincedence of policies, I wound up with a pedi for my
    younger child, about the same age as .0's daughter.  It turned out that
    my new FP (I moved last year) doesn't do hospital visits to babies, so
    I had to choose a different doctor for Jake.  In the end, it has worked
    out well, because the pediatric group I chose is terrific.  They *are*
    large, 9 doctors and two NP/PAs, but they are very attentive to detail
    and have taken great care of both my little guy and my older boy.  I
    will agree with the prior noter who stated that a pedi tends to know
    "what's going around" right now, but a good FP with a large percentage
    of children in his/her practice will, also, as did my former FP.
    
    I haven't a particular preference between a good FP and a good Pedi.  I
    think the key here is to find a good doctor, whom you feel is
    sympathetic to you family and your concerns, either way.  If the base
    noter isn't comfortable with the doctor anymore, this needs to be
    addressed with the doctor.  Doctors are often unaware of how rude their
    staff might be, too.  I have been forced to address customer service
    issues with my current FP, my old one, and my current pedi.  Sometimes
    things get better if you discuss them.  If they don't, it's time to get
    references from friends and neighbors.
    
    I would also like to note that my not-quite-10-month-old, Jake,
    (9-5-95) goes through long periods of ear batting that have nothing to
    do with infection - he is teething very hard, with the 4 upper center
    teeth coming in all at once, and the teething pain is causing pain and
    itch in his ears.
    
    Regards,
    
    M.