How to choose a doctor for your child

Finding the right doctor to treat your child is an extremely important decision, and one that is not easy for most parents. Just because your child has been diagnosed with a craniofacial problem, does not mean that an operation is immediately necessary.  It is important for parents to take the time to learn what they can about the diagnosis they have been given, as well as to learn about the various treatment options, before deciding how to proceed.

Understandably, parents want only the very best for their child.  In one way doctors are no different than teachers, auto mechanics, carpenters, etc.: the vast majority are going to be good but really fall within the average range, a few should really be doing something else, and a few are truly exceptional.  Normally, parents go to meet a doctor who is closest to their home, they typically learn that this surgeon has an “excellent reputation,” and then go ahead with the proposed operation.  But what are the odds that a family’s local doctor is really one of the best?  Given that only the top 5% of all doctors can be considered the very best, there is over a 95% chance that the local surgeon isn’t one of them. How important is it to have the best?  It can be frustrating to have to take your car back to the mechanic because the problem was never fixed right the first time, but no one wants their child to have to go back for a second operation that could have been prevented.   

So, how can a parent determine the best, especially if they don’t have a medical background? Going to a great medical center doesn’t necessarily mean that all the doctors working there are going to be great. Everyone has heard that you should get more than one opinion, but there aren’t many doctors who care for children with craniofacial birth defects, so typically this means contacting a doctor in another city.  A second opinion can give parents some idea of the level of care offered by their local doctor, and parents might be surprised by how much treatment recommendations can vary from doctor to doctor. Although the best second opinion involves personally going to see that doctor, sometimes just a simple phone conversation with another surgeon can be of great help.  Parents should expect a different result between: “yes, I know how to fix this problem,” and “yes, this problem is my special interest.”

Below are some points that parents may wish to consider, along with some potential questions to ask:
 

• Search the Internet for your doctor’s web site(s): does this doctor seem to be more focused on cosmetic surgery or craniofacial surgery?  How much time does your doctor devote to reconstructive work, and how much time is spent doing cosmetic procedures?  Has your doctor published articles on your child’s condition and in other related craniofacial areas (you can check by typing in your doctor’s last name, space, and first initial in the search box at: www.ncbi.nlm.nih.gov/pubmed/, or ask your doctor for a list of publications)?  Or, does it seem to you that your doctor is more interested in problems that are different than the one your child has?

•  Prepare a list of questions in advance (see below for some suggestions), and then make sure that you get them all answered.  If you feel rushed during your appointment, and it seems that you did not have enough time with your doctor, then get another opinion.  Doctors who rush through an initial office visit, may rush through the planning phase of your child’s care, hurry through the surgery, and barely follow your child after the operation, all leading to a poorer result. It’s okay to be selfish and to ask yourself: “what does this doctor have to do that is more important than treating my child?”

• How well were your questions answered?  Doctors who don’t directly answer your question, or speak in generalities, may simply not have sufficient experience.  However, if your questions are clearly answered, and the responses makes good sense to you, then it is more likely that this doctor has the necessary experience to treat your child.

• Ask if your doctor’s office would be willing to ask other families, with children who have the same problem that your child has, to contact you and share their experiences.  Check Internet chat rooms.  Have other families had positive experiences with this doctor? 

• Finally, listen to your gut feelings.  A “prima donna” attitude in a doctor can be a sign of insecurity (perhaps about their own ability). Any doctor who discourages second opinions, or acts insulted if you consider this option, is most likely the wrong doctor.  Does your doctor seem to truly care about your child? 

 
Here are some sample questions to consider:

1. What is the best time (or age) to perform the surgery that has been recommended?  How long can the operation be safely delayed, and what problems can happen if we delay?

• This question will help you to understand the urgency of your child’s condition and how much time you have to research your options.  It is important to realize that in the case of growing children, sometimes if doctors wait a little longer to operate, later operations may be avoided.  If your child’s condition doesn’t seem urgent to you but the surgeon is recommending immediate surgery, try to understand the cause for urgency and consider a quick second opinion.

2. Besides the operation that you propose, are other doctors doing different operations for my child’s condition?  If so, what are they, and why are you not recommending these operations?

• Although the risks of a child having a serious complication are likely to be lower with a more experienced surgeon, experience isn’t everything.  A doctor’s judgement is equally important, and doesn’t always go hand in hand with experience.  This question may help you to get a sense of your doctor’s judgement. For most problems there are often more than one solution.  The very best doctors will try to plan for the smallest operation that will provide the greatest benefit, with the least risk.

3. Do you get to choose your anesthesiologist, or do you work with a group of anesthesiologists that assigns you an anesthesiologist for my child’s surgery?

• The difference between a very experienced anesthesiologist, and one with little experience, can make an enormous difference.  Parents typically first speak with their anesthesiologist over the telephone the night before the operation, and do not actually see this doctor until the day of surgery.  Ideally, your surgeon has the ability to personally select the anesthesiologist, and the doctor who is going to put your child to sleep is not left up to chance.  The above question gives parents a sense of how much control their doctor has in putting together the team that will care for your child.

 4. Will students, interns, residents and fellows be looking after my child?  Can you define their roles in my child’s care?

•  Parents certainly don’t want their surgeon insulated from their child, with doctors-in-training making important medical decisions on their own.  If residents and fellows are going to be involved, then consider planning surgery in the spring, as far from July 1 as possible (that is when all new interns, residents, and fellows start the year).  It is okay to tell your surgeon that you expect him or her to be present for the entire operation and actually performing (and not delegating) all the critical parts of the operation.

5. Besides you, who are the other top three surgeons for treating my child’s condition?

• If you ask this question to multiple surgeons, you will probably start hearing one or two of the same names over and over.  If you want the best, seek their opinions and see if their treatment recommendations are similar to those that you have already heard.

Take the time to do your homework and don’t feel rushed; there are almost no true craniofacial emergencies, so usually it is okay to delay operations for a couple of weeks in order to allow parents to “get their bearings.”  Decide for yourself, what level of care you want for your child.  There are capable doctors in most major cities in the U.S.; however, in order to have your child treated by one of the very best, will probably involve traveling to another city.  Craniofacial problems are unusual enough, that most surgeons just don’t see these conditions all that often.  Don’t let insurance companies tell you that you must stay home, or “in-network;” it may take a lot of work but persistent parents almost always get what they want for their child.  Also, don’t be afraid to tell your doctor that you are also seeking care that will be affordable to you and your family.