Things every woman should think about when choosing a doctor {guest post}

Thursday, June 5, 2014

Heidi blogs over at Notes from Heidi about family, faith, pregnancy, photography, and healthy eating. I'm so happy to have her guest post as baby and I recover :)

The inspiration for this post came a few months ago, and it's been simmering in the back of my brain since then. Now that Erika asked for guest posts and given her chosen profession, I am so excited to be able to write for her blog. The title is a little bit mis-leading, since I'm not exactly going to give you a list of questions. Rather, I'm going to tell you a story and offer a few suggestions, and you can pick "salad bar style" what you like and don't like.

When I was pregnant with my son, me and my husband planned pretty much from the get-go that we would have a home birth with a midwife. I saw a family practitioner when the midwife discovered an irregular heartbeat. Unknown to me, an irregular heartbeat is fairly common, and the doctor put my mind at ease when he told me so. But then the rest of my interaction with him gave me cause to question my choice in a doctor. When he asked me about my prenatal care, I told him I was planning a home birth with a midwife, and showed him my chart, which I had brought along with me. A lot of doctors give women a very hard time when they choose to have a baby at home. He did not give me a hard time, and the next time I saw him was at my baby's two week checkup. At this point, me and my husband were still researching vaccination and I asked about an alternate schedule. From the doctor's perspective, there was no discussion. No alternate schedule, and bring him back at two months old, please.

I was disappointed. I had really liked this doctor and was looking forward to developing an ongoing conversation and relationship regarding my child's medical care. When he put his foot down, we decided to find another pediatrician.

Based on the recommendation of several friends, we found a pediatrician who has a strict policy which requires all employees to listen to parents. She has an alternate vaccine schedule and doesn't bat an eye when she meets people who want to do more research (as me and my husband did). She teaches preventative healthcare to parents, encouraging them to use probiotics, vitamins, and to build their children's immune systems through good nutrition. Lastly, she answers any and all questions. She's still a doctor; she still wants to do the normal tests and well visits. But we have a relationship and she listens, and because of this she is one of the most popular pediatricians in the city.

What impresses me most is that of all the questions I bring up, she has an answer. I love exploring natural health and home remedies and I have never brought up a remedy she has never heard of, or mentioned a "health nut fad" that she was unaware existed. She is very obviously on my family's side and sees her role as more of a resource than as the one in charge of my family's health. Moreover, she likes learning and is willing to learn from her patients, just as much as she is willing to teach them.

Based on this experience, here are a few suggestions. Whether you are looking for the "right" doctor or just going in for a checkup, having high standards for your doctor will ultimately help you have a good experience.

  1. Develop a relationship. Even if a pediatrician like ours is not available, you should be able to ask questions, express concerns, and be respected as the primary caretaker of your family. To be respected, you have to give it too. No matter if the advice he gives is, to you, crazy, that person has been through a heck of a lot of school and has a lot of experience under their belt. Respect that. Even though we moms can learn a lot and take care of a lot of things ourselves, most of us are not doctors and need a healthy dose of humility. Disagreements may arise, but if your patient-doctor relationship is founded on that respect, odds are you'll have their support and respect when it comes down to the wire for you, too.
  2. Be aware of your diet and your general health. If you come to your doctor saying "I have bad headaches all of the sudden" and can't give him any information beyond that, he has no choice but to start from the beginning and put you through a whole rigmarole to diagnose you. But if you say "…and we've been to several parties and have had a lot more dessert and dairy than usual", he's got a bit more to go by and can have you looking for a food allergy. A general awareness of your "normal" state of health and your diet will go a long way in helping your doctor help you.
  3. Do your own research. I tried several home remedies for my son's ear infection before taking him in and putting him on antibiotics, so I was able to tell the pediatrician all of the things that didn't work and she was able to discern two important things: 1) I can be trusted to take care of my kids, and when I've exhausted my knowledge, I will come to her for help, and 2) antibiotics were definitely necessary. This was really important in our relationship, because it established me as trustworthy mother. Now, the first question she asks me when we go in is, "what have you tried so far?"...because she knows I'm not sitting on my hands!
  4. Write down your questions ahead of time. Before your appointment, write down your questions and if you have time, see if you can find some answers and ideas online before asking your doctor. This allows you to have much more of a discussion ("I heard that excess sugar can cause headaches; is this true?") and helps both of you learn in the process.
  5. Find a doctor who likes to learn. If your doctor seems disinterested in what you know or jumps immediately to correcting what you've studied or just plain isn't willing to talk, it might be that there is a conflict waiting for you down the road. Find someone open to learning, or at least open to discussion.
  6. Lastly, when it comes to fertility and childbirth, educate educate educate yourself. Learn all of the standard procedures, learn what questions they might ask you in the delivery room, come up with your own individual birth plan, and never be afraid to ask those awkward questions: "can you please come hold my gown so I can pee?", or "I'm having goopy spotting; is this normal?". Doctors see a lot and aren't phased by the gross stuff, so don't be afraid to ask. When it comes to the natural-hippy-home-birth-crazies versus the scheduled-c-section-all-I-want-is-a-baby-people…look at both sides honestly. There are really good things about both.

For the record, I didn't get my home birth. We ended up needing to go to the hospital and…well, it's a long story. Things happened the way they were meant to; God was watching out for us. In the end, I was so thankful for the invention of the epidural and the fact that we had access to immediate hospital care. I wanted the all-natural-home-birth, but I also recognize that I'm not in control…and sometimes, when God doesn't give us "what we want", it's for a good reason. Ultimately, we have a healthy 16 month old, a wonderful pediatrician, access to lots of information and support…and those are the things that really matter.


  1. Thank you Erika! :) Congrats again on your baby and I hope your recovery is going well and you get in a groove soon.
    And a little update: "Notes from Heidi" has moved to it's own new website, at
    And our healthy 16 month old is now 20 months old and going in for a well visit at the end of this month! :) It's so CRAZY how fast time flies! :)

  2. From KevinMD:

    Often what makes a patient (in your case, parents of the child) most “satisfied” isn’t what is best for their health. Patient satisfaction-obsessed medicine has been linked to higher mortality rates.

    Here is the JAMA article in case you want to read it:

    It reads: “Conclusion: In a nationally representative sample, higher patient satisfaction was associated with … increased mortality.”

    Do high patient satisfaction scores correlate with better health? Or higher quality care? So far, the answer is no. A recent study of hospitalized patients showed that many patients prefer “shared decision-making” with their physicians, but it results in longer inpatient hospital stays and 6 percent higher total hospitalization costs. A prospective study of over 50,000 clinic patients showed that the 25% who were most satisfied with their care had higher odds of inpatient admission, greater total expenditures, greater prescription drug expenditures, and–perhaps most surprising–higher mortality.

    Forbes writer Kai Falkenberg, in her article “Why Rating Your Doctor Is Bad For Your Health,” concluded that “giving patients exactly what they want, versus what the doctor thinks is right, can be very bad medicine.”

    Evidence based medicine is good enough for Medicare, private insurers and malpractice lawyers to demand it, yet it’s not good enough to stop the harmful practice of satisfaction-obsessed medicine.

    There is unwelcome pressure to treat viruses with antibiotics to keep patients happy, irradiate the brains of children with unnecessary CT scans to satisfy anxious parents and prescribe medications to people seeking to fuel dangerous addictions.

    But what happens to doctors who try not to prescribe narcotics for every complaint of pain, or antibiotics for every viral upper respiratory infection? They’re likely to run afoul of patient satisfaction surveys. (“The mandate is simple: Never deny a request for an antibiotic, an opioid pain medication, a scan, or an admission.” )

    The current system pressures doctors to violate their oath to “do no harm.” It forces doctors to consciously and regularly make this decision, “Should I do what I think is best for my patient and possibly lose my job, or violate my oath and practice bad medicine to boost patient satisfaction?”

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  4. Re: Kevin MD's comment: I can understand (I think) the dilemma of doing what the patient wants vs. what the patient really needs. . . . My RN sister gripes sometimes of requests like "please refill my ginger ale, and make it 2/3 ice, 1/3 ginger ale," when her real job is to keep people alive in the ICU . . . What concerns me is that "higher mortality" is lumped together with "higher odds of inpatient admission, greater total expenditures, greater prescription drug expenditures." HIgher mortality is a big problem. Greater expenditures are a problem, too, but not in the same way or in the same degree. . . . Having a high deductible plan, I'm always aware of the cost b/c I pay for almost everything out of pocket. But I don't want a doctor discouraging me from a certain procedure b/c it might be more expensive. Please just lay out the alternatives--and their price--and let me choose. . . . I realize this isn't the way it works w/ most insurance and with Medicare, Medicaid, etc., where the patient doesn't pay. But that's a problem with those payment systems, not with the general concept of patient satisfaction. . . . Anyway, great article Heidi, on an always touchy topic!


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