By Suzanne Ripley

How do families choose a primary health care provider or pediatrician for their child? Specifically, how do families with a child who may have a disability and/or special health care need choose a doctor? How do families work with their pediatrician for the maximum benefit of their child, to locate appropriate specialists, correctly assess their child's needs, and work with the education system? These are questions many families ask. This paper will explore these questions and discuss some possible answers.

Q: How Do Families Choose a Doctor for their Child?

A: Choice of a doctor may vary depending on the size town you live in, whether you live in a rural area, whether you use a private doctor, health maintenance organization, group health organization, public health center, Indian Health Service, or clinic.

You may live in an area where there aren't many doctors to choose from. In such a situation, the primary care physician may be located in another town and serve as a specialist with whom you consult by phone and to whom reports can be mailed. This doctor can advise the family as well as the local pediatrician on evaluations, medications, and other specialists. Families may see their local pediatrician for all routine baby and child health needs but work in a team type situation with the primary care physician who may be a specialist with the University Affiliated Facility, at the state university medical school or at another major hospital either in the state or in another state. For children with rare syndromes or unique medical needs, a specialist may be located quite a distance from the family but still be actively involved in decision making.

The first step in obtaining medical assistance should be the identification and selection of a primary health care provider. This sounds simple enough; yet, an article in Pediatrics, "First Step in Obtaining Child Health Care: Selecting a Physician," (Hickson, Steward, Altemeier, & Perrin, 1988) indicates that parents included in the study did not spend much time or energy selecting a doctor. According to its authors, this study is the first to evaluate the process of physician selection for children. The parents were asked how they selected their child's doctor and what factors were important in their decisions. Fifty-three percent of the families surveyed considered only two or three physicians in their decision; 34% considered only one. They also indicated that an average of only 1.2 sources of information were used in identifying and evaluating potential doctors. The sources most commonly used were talking to a neighbor or friend (44%) and discussing choices with another doctor (21%). Decisions were based primarily on one of three characteristics: communication skills (willingness to share decision making, warmth, concern), accessibility (return calls quickly, quick appointments), and quality of practice as determined by recommendations from friends and family.

Q: Are Families Satisfied With the Doctor They've Chosen?

A: Parents surveyed in this study also were asked why their families changed pediatricians. The most frequently stated reason for changing doctors was the family's perception that the doctor was not managing a specific illness adequately. The second most frequently stated reason was that parents believed their child's doctor or office staff was rude or unconcerned. Third was that they objected to their physician's lack of interest in their child's behavior. The fact that more than 40% of parents who were dissatisfied with pediatricians expressed this complaint reinforces the notion that parents are concerned about psychosocial health, or that perhaps psychosocial health is not addressed adequately in our health system.

Q: What About the Child Who Has a Disability?

A: All families have unique needs. The above study was conducted with families whose children were not identified as having any type of disability. For the child who may have chronic health problems, developmental disabilities, behavioral difficulties or physical disabilities the choice of a primary care doctor must be made with care and thought. The number of parents who were dissatisfied with their pediatrician's lack of interest in their child's behavior, coupled with parents who believed their child's doctor or office staff was insensitive or unconcerned, substantiate the need for extra thought and planning.

Relating to a child whose needs are distinct or unaccommodating can be difficult. Yet, a child needs to be able to communicate with his doctor as well as develop trust and rapport with him. In addition, the child should be comfortable with his medical needs and care. Even young children need to be able to talk with their doctor. Older children and teenagers need to have more involvement in their medical decisions and concerns, and need to feel comfortable talking openly with a physician who understands them. Therefore, it is imperative that the doctor you select manage a two-way communication with the child, accept the child's unique behaviors and disability, look past such impediments, and treat the child with the same concern shown for other children.

Note: This publication is approximately
12 pages long when printed
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