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Expecting a Child? Need to Find a Pediatrician? What Questions Should You Ask?

Written by Natasha Burgert MD

“Who is going to be the doctor for your new baby?”

Your OB wants to know. Your friends have asked. Your mother is wondering.

Finding a pediatrician is on the “to-do” list of all expectant mothers and fathers. New families often begin the search for a potential baby doctor by asking for recommendations from their OB doctor, family, and friends.

Some families begin by looking at the American Academy of Pediatrics website.Regardless of how you find a pediatrician, truly determining if a doctor is going to be a good match for your family is often done by interviewing.

I have seen plenty of glowing mothers-to-be sitting in my office with the seemingly standard “interview sheet” from babycenter.com or WhatToExpect.com.

Parents come to my office with a “recommended question list” because they don’t really know what to ask. This is certainly understandable since, for most families, interviewing a doctor is new territory.

But although these lists of questions are a good start, I don’t think they get to the heart of the matter.

What most parents really want to know is if a pediatrician is likable. Is this person going to be someone I can ask questions? Do we have something in common? Are we going to get along?

Compatibility is what most parents are searching for.

Here are 5 questions I would ask a potential baby doctor during an interview.

1. “Tell me about your office.”

Office hours and locations, contact numbers, hospital affiliations, and basic biographical information is fairly standard on every medical practice website. Use the web to get the basics, but let the doctor tell you where he thinks his office really shines.

This open-ended approach gives the doctor an opportunity to say what he thinks is the most important, interesting, or significant about the place where he works.

If the doctor does not cover any specific question you have about the function of the office, then ask.

2. “Why did you choose to become a pediatrician?”

The million dollar question. This is an opportunity for you to learn about the person behind the white coat. Of all the medical specialties, why did she choose to take care of kids?

3. “What are your thoughts on antibiotics and vaccinations?”

For most doctors in pediatric healthcare, antibiotics and vaccinations are common medical interventions.

How a doctor chooses to use antibiotics, and for what illnesses, does vary. With the increasing concern of antibiotic resistance and super-infections, having a physician who can clearly define when antibiotic use is appropriate for your child is important.

Vaccinations are a fundamental building block for child health. A physician’s beliefs and attitudes towards vaccinations will effect the recommendations they may or may not provide.

Also, some physicians will not see patients if the recommended vaccination schedule is not followed. Allowing a doctor to openly express his opinion on immunizations can begin productive dialog about this very important topic.

4. “What do you love about your job?”

Does this doctor have a passion for the underserved? Does he love to see kids with chronic illnesses, like asthma or ADHD? Does she love to teach?

Asking a doctor to share the best part of his job may reveal a common interest. Or, allow you to determine if your family’s needs will be best supported.

5. “What do you like to do outside of work?”

Pediatricians often look alike on paper. We all go to medical school, complete a pediatric residency, and get certified by the American Board of Pediatrics.

Asking the doctor what she enjoys doing outside of work may be enough to make the person on paper become a new partner in the care of your family.

Good luck in your search!

Dr. Burgert is a pediatrician. She works at Pediatrics Associates in Kansas City, MO .  She is a distance runner and enjoys road races around the city. She also has a passion for travel that will certainly lead to many memorable family vacations with her husband and two children. And, of course, she bleeds Husker red. Dr. Burgert regularly blogs at kckidsdoc.com

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Why Our Office Requires MMR Vaccine

Written by Nelson Branco MD FAAP

Vaccines have been a hot topic among parents, pediatrician and in the media for many years. Recently, there have been many news stories about pediatricians who will not care for families who either choose not to vaccinate their children or who do not follow the recommended schedule.

These policies are based on knowledge about the safety of vaccines, the effectiveness of the recommended schedule and concern about the spread of a vaccine-preventable disease in the community.

No pediatrician wants to see a child suffer from a condition that could have been prevented, and we certainly do not want those illnesses to be spread in our offices.

My practice is in Marin County, California – an area that is known for high rates of vaccine delay and vaccine refusal . After much thought and careful consideration, my partners and I recently decided to change our policy related to immunizations.

Starting this spring, we will require that all patients age 2 and older be immunized with the Measles, Mumps, Rubella (MMR) vaccine in order to remain patients of our practice.

We have a responsibility to protect the health of all of the children in our practice, and decrease the risk of vaccine-preventable diseases in our community. We have chosen to require the MMR vaccine because we are extremely concerned about the possibility of a Measles outbreak in our community.

Vaccine preventable diseases are still a threat to the health of our children and our community. In 2010, the Pertussis (Whooping Cough) epidemic in California affected children in Marin County at eight times the rate seen in California overall, in part because of low immunization rates.

There was recently a case of Mumps in a school-aged child in our county, and last year there was an outbreak of Mumps in a dormitory at the University of California at Berkeley.

There have been Measles cases and outbreaks associated with the 2012 Super Bowl, and in recent years in San Diego, Quebec, Indiana and Minnesota. In 2011, there were 222 reported cases of Measles in the US, the highest rate in 15 years. Ninety percent of these cases were associated with air travel, but not all cases were in travelers.

Measles has become much more common in Western Europe, Africa, Asia and the United Kingdom due to dropping vaccination rates. The CDC is already warning us that with the Summer Olympics in London and the Eurocup Soccer Championship in the Ukraine, the possibility of a US traveler to these countries coming back with Measles is high. Because of this, we are concerned that Marin County is at risk for a Measles outbreak.

Because Measles is so easy to spread, in order for a community to be protected from an outbreak, 95% of the population must be immunized. Right now, the number of Kindergartners in our county who are up to date on all of their vaccines is 83%, and there are schools and communities in Marin County where less than 50% of Kindergarten students have had all of their required vaccines.

Certain areas in our community are clearly at risk of a Measles epidemic. In our practice, we have many children who are too young to receive the MMR vaccine as well as many children who have chronic illnesses that compromise their immune system and put them at risk. This policy is meant to protect not only these children, but also our entire community from a Measles outbreak.

We respect that the parents in our practice have the ultimate responsibility for making decisions about their children’s health care, but we have to weigh their personal decisions against the available data and the needs of our community.

In our practice, we feel strongly that communicating and collaborating with our patients and their families is the best way to provide excellent care. We also feel strongly that vaccines save lives and that this policy protects our patients and our community from a preventable disease and all of its repercussions.

Dr. Branco is a practicing pediatrician in the San Francisco Bay Area and is very active with the local chapter of the AAP.

Let’s Talk About Pertussis Also Known as Whooping Cough

Written by Richard Lander MD FAAP

What is pertussis?

Pertussis is an infectious disease caused by bacteria. Sometimes referred to as the hundred day cough, it can be quite debilitating. The cough is persistent and recurs day in and day out. Once you hear this cough, you will never forget it. The cough is repetitive, easily lasting 30 seconds or more and has a whoop sound at the end of it. This whoop is what gives rise to its popular name whooping cough. If you are curious, you can hear the whoop sound on the internet.

Who gets Pertussis?

Many people do-all ages and from all walks of life including: young children, teenagers, adults in middle age and senior citizens.

Is Pertussis contagious?

Yes it is. I have seen Pertussis several times in my practice this year. I have seen it spread from mother to child, among siblings and even from teacher to students.

Treatment of Pertussis

There are different phases of Pertussis. When the diagnosis is made during the first phase of the illness, it can be treated with antibiotics. This may shorten the duration of the disease. Otherwise physicians can offer supportive care and medication to help the patient sleep.

Prevention

Pertussis is preventable by a vaccine. This vaccine, DPT (Diptheria, Pertussis and Tetanus) is typically given during childhood. The vaccine is given as a series of three injections in the first year of life, a booster during the second year of life and another booster before the start of elementary school. An additional booster is given at 11 year of age.

Because this last vaccine is relatively new, many children older than 11 year of age will be receiving it. Additionally the Tetanus booster which has always been recommended to be given every ten years has been change to include the Pertussis vaccine.

Therefore, adults of almost all ages are urged to obtain it even if you received a Tetanus booster a year ago. Many hospitals across the country are giving the vaccine to new mothers right after delivery and in some progressive hospitals the vaccine is being offered to new dads and to grandparents.

With this approach the State of California, which had seen deaths from Pertussis in the last few years, has dramatically decreased their rate of Pertussis. These dramatic results have persuaded many pediatricians to offer this vaccine to parents and grandparents of their patients.

Why talk about Pertussis now?

Pertussis is on the rise in the United States. From January through March in 2012 there were seven times the number of cases seen in Washington, D.C. than in the same time frame the year before in 2011. So why you might wonder: why this rise in Pertussis now? Several years ago we experienced a number of parents refusing to have their children vaccinated against childhood diseases including Pertussis.

These refusals were based on fears of the vaccines and components of the vaccines such as aluminum or mercury. Thankfully, these fears have been proven to have been unfounded. Unfortunately, once people stopped vaccinating their children, herd immunity was lost.

Herd immunity is gained when a majority of people in a geographic area receive a vaccine. These vaccines then protect even the few who were not vaccinated.

As the number of vaccine refusers climbed, we lost herd immunity. Hopefully today with increased knowledge through education, the number of vaccine refusers is beginning to decline and more people are again protected against infectious diseases such as Pertussis. Scientists are working tirelessly looking for clues to currently unanswerable medical questions.

Every day they race the clock in an effort to look for a treatment for currently untreatable medical conditions and diseases. Pertussis is not one of them. Pertussis is preventable with a vaccine It is criminal that there are people living in the United States in 2012 suffering from a disease they did not have to have. Please don’t be one of them. Ensure that you and your loved ones do not get Pertussis. Get vaccinated! Get vaccinated now!

Dr. Lander has been practicing pediatrics for 32 years in New Jersey and is the immediate past chairman of the American Academy of Pediatrics Section on Administration and Practice Management.  He says if he had to do it all over again he wouldn’t hesitate to be a pediatrician.

Vaccines: Truth and Experience Against False Fears From The Internet

Written by Walter Hoerman MD

Now that I am a “seasoned” pediatrician (greater than 20 years in practice), I have seen many changes all directly related to vaccines.

I used to worry about epiglottis with every child that has a cough. Now it hardly ever crosses my mind. I watched a child die of epiglottis, and I never want to go back there…

I used to have to do lumbar punctures at least a few times a year; now I haven’t done one in years and I am getting rusty (which is a good thing).

I have seen children go deaf from meningitis, have disabilities from meningitis, and even die from meningitis, and I don’t want to go back there…

I have never seen a case of the measles, and might have trouble diagnosing it. I don’t want to have to….

My mother used to tell me about terrible summers made tragic by polio. I don’t want to know it first hand.

These are all things I know personally. And most importantly, I can say I have never seen a child permanently damaged by a vaccine.

This is the message we need to get out.

Dr. Hoerman founded Lilac City Pediatrics in 1996. Since completing Medical School and his Pediatric Residency Training at the University of Connecticut, he has been practicing pediatrics in Rochester since 1988. Dr. Hoerman blogs at Lilac City Peds News

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For Pediatricians, Giving Vaccines Is An Ethical Dilemma

Written by Brandon Betancourt, MBA

One aspect of the vaccine controversy that doesn’t get discussed as often as I would like, is the notion of vaccine economics. Vaccine economics has to do with what I refer to as the distribution, consumption, management and cost of vaccines.

I was happy to see a blog post on the NPR that discusses some of the challenges, with regards to vaccine economics, many pediatricians face. Here is what they had to say:

After looking at what insurers paid more than 1,400 doctors for eight different vaccines, athenahealth concluded that almost half the time the payments weren’t large enough to cover estimated costs.

You don’t need to be an economist to know that loosing money isn’t good for anybody and certainly unsustainable; no matter how altruistic your motives maybe.

The blog post also highlighted that the problem might be worse than the research indicated.

The American Academy of Pediatrics came up with estimates for indirect expenses, concluding they range from about 17 percent to 28 percent of the purchase price of vaccines. So at least 17 percent should be tacked onto the purchase price for doctors to have a shot at breaking even, the group concluded.

By that measure, 47 percent of immunizations are money-losers, the athenahealth data show. If the 28 percent figure for indirect costs is used to calculate break even, then it’s an even grimmer picture: 79 percent of vaccination payments fall short.

This puts pediatricians in an ethical dilemma. On one hand, pediatricians will always do what is in the best interest of children. And there is overwhelming scientific evidence that vaccines are among one of the greatest medical innovations of our time.

On the other hand, preventing illnesses like Polio, Rubella and Measles in children cause pediatricians to actually lose money. In other words, pediatricians are in essence subsidizing – at their expense – the wellbeing of children.

The anti-vaccine movement

One of the anti-vaccine movement arguments is that vaccines are a profit center for doctors and that pediatricians are putting profits over the well-being of children. That is simply not true. And the research published by Athenahealth (click here to go the the study) clearly shows that profit is certainly not an issue.

When payment to physicians for vaccines often does not even cover the costs associated with administering those vaccines, this claim is so ludicrous as to be non-sensical.

The benefits of vaccines

  • The rate bacterial meningitis declined by 55%  in the US in the early 1990’s, when the hemophilus influenza type b otherwise know as Hib was introduced. (NEJM 364.21, May, 2011)
  • Varicella mortality declined 88% overall and 96% among subjects younger than 50 years (Pediatrics 128:2, August 2011)
  • Current immunization practice and herd immunity have virtually eliminated many infectious causes of serious morbidity and mortality in the USA.

It’s almost ironic that immunizations have done so much for public health, yet their value has not been recognized.

What is most frustrating to doctors is that immunizations are perhaps most cost effective preventive measure available to the pediatric population; especially when one considers the long term benefit in the equation for payment.

Yet insurance companies, driven by their bottom line, fail to view the long term benefits. For example, they reimburse a doctor for a polio vaccine below the doctor’s cost in an effort to improve the bottom line without considering the cost of a child actually getting Polio.

At what cost?

What would happen if pediatricians, driven by the cost of vaccine and poor reimbursement, decide they can’t immunize children any longer?

The poor and inadequate payment for immunizations could potentially create a public health problem if one considers that the lack of immunizations in children could break our developed herd immunity.

In fact, in the US, we’ve already seen over 150 cases of measles in 2011 and in California there were 9,500 cases of pertusis in 2010; and 10 infant fatalities which are attributed to lower vaccination rates.

As doctor Richard Oken said recently, “immunizations are perhaps the most cost effective preventive measure available to the pediatric population” thus me must consider the “long term benefit in the equation of payment.” Otherwise, “Inadequate payment could force pediatricians to outsource this healthcare benefits and bankrupt our developed herd immunity”

Perhaps more than any other physicians, pediatricians believe in, and focus on, PREVENTION of disease, stopping illness even before it has a chance to strike. If an ounce of prevention is really worth a pound of cure, skimping on spending for prevention today will surely result in spending much more tomorrow–not to mention causing more people, at all ages, to suffer from what are easily preventable diseases.

Brandon manages a pediatric practice in the western suburbs of Chicago. He blogs regularly on practice management issues at PediatricInc.com
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Actually, The Vast Majority of Children Do Get Their Vaccines On Time

Written by Brandon Betancourt

Dr. Ari Brown over at the Baby411 blog had a very interesting post where she looked in to a study, published in a pediatric journal, regarding parent’s attitude towards the vaccination schedule recommended by the American Academy of Pediatrics, The American Academy of Family Physicians and the Centers for Disease Control.

The study concluded that more than 1 of 10 parents of young children currently use an alternative vaccination schedule. In addition, a large proportion of parents currently following the recommended schedule seem to be “at risk” for switching to an alternative schedule.

Dr. Brown had a similar reaction to mine. She thought that the statistics were too high considering that a “vast majority of the families she treats DO follow the recommended schedule.”

In our practice, we too have a very small portion of parents that choose to “alter” the recommended schedule. Certainly well below the 10% mark.

But  Dr. Brown didn’t just settled.  She did what any good pediatrician does, which is, take a look a the data to understand where the numbers are coming from and how the researchers reached their conclusions.

Her findings provide a lot of insight.

She first mentions that the study was done in May of 2010, but it was just now published.

A lot has happened since May 2010 in the vaccine world (besides Michele Bachmann). In the same month that this survey was being done, the British researcher who published the now-retracted 1998 MMR-autism study in the Lancet lost his medical license for questionable practices. With this story, national media sided with modern medicine instead of conspiracy theorists on vaccine safety. That trend has been fairly consistent since then, and I think, has led to fewer parental concerns.

Dr. Brown highlights that the response rate from the study was only 61%; which could very well represent skewed data.

People who choose to vaccinate may have no interest in spending time answering questions about vaccine safety. People who choose to delay or skip vaccinations may want to share their position. It is hard to know what motivates people to participate in a survey, but it may influence the study results.

The first vaccine that parents refused or delayed was the H1N1 and the second, the seasonal flu.

Although there was outright hysteria regarding the H1N1 outbreak and calls for a rapidly available vaccine to combat it, there was also quite a bit of public anxiety about taking a vaccine that had not been field tested prior to use.

I agree with Dr. Brown when she points out that the seasonal flu should not be placed under the same category as other vaccines because with exception of New Jersey, the  flu vaccine is not required for school entry.

While the CDC and AAP recommend annual flu vaccine, it is never included in the national immunization survey done annually by the CDC she adds.

I love Dr. Brown’s conclusions:

The most effective message I can share with you and my own patients is that I vaccinate my own children to protect them, I wouldn’t do anything differently for yours.

Here lies the problem. This study was picked up by many mainstream media outlets including CNN running with headlines like “More parents think it’s safer to delay vaccines,” “Parents Commonly Deviate from Vaccine Schedule,” and “Many parents opt for “alternative” vaccination schedule.”

But the truth of the matter is, the vast majority of parents in the study vaccinate their children on time.

You may read Dr. Brown’s entire article by clicking here

Brandon is a practice administrator, speaker and blogger. He and his wife, whom is a pediatrician, vaccinate their three children. 

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Vaccines: Why Your Pediatrician May Ask You To Go Elsewhere

The Today Show had a really good piece concerning a growing trend relating to the vaccine debate. The piece talks about how some pediatrician are asking parents that don’t vaccinate their children to find another doctor.

We’ve addressed this issue before here at Survivor Pediatrics in our piece “Vaccine Refusal Endangers Everyone”. Dr. Lessin, author of the vaccine refusal piece says:

Prevention of childhood illness is the heart of a pediatrician’s mission. Immunization refusal violates that mission, putting everyone at risk. If we allow families to remain in our practices unvaccinated, we are giving tacit approval to parents that refusing vaccines is just fine. It is anything but fine.

As you’ll see mention in the piece, the notion is that pediatricians are abandoning their patients. But it isn’t like that all. It is about having trust. Here is what Dr. Lessin had to say:

For me, it comes down to whether you can have a relationship with a family when their choice not to vaccinate goes against pediatric core values and puts so many innocents at risk. I don’t believe that I can have a functioning doctor-patient relationship with parents who aren’t willing to accept my advice about such a critical issue as keeping their children safe from potentially deadly diseases.

Click on the link below for the Today Show piece:

Won’t Vaccinate? Find care elsewhere, some docs say