What To Look For In A Pediatrician.

When young doctors are about to go into practice, they often ask older physicians what they need to do to be successful. For many years the standard answer has been: "Demonstrate the three A's." They are, in order of i
William Feldman, MD

When young doctors are about to go into practice, they often ask older physicians what they need to do to be successful. For many years the standard answer has been: "Demonstrate the three A's." They are, in order of importance, ability, availability, and affability. When you're choosing a doctor for your child, these are three essential qualities to keep in mind.

What exactly do you mean by ability?
In Webster's New World Dictionary, "ability" is defined as "power to do [something]; talent; skill." The powers, talents, and skills your child's doctor should have can be categorized into four broad areas: prevention, diagnosis, treatment, and rehabilitation.

In the field of prevention, your child's doctor should be aware of which preventive measures work and which don't. For example, certain screening tests for newborns are very effective in preventing mental or physical disability, and should be performed on all newborns. "Well-baby visits" -- routine medical checkups when nothing seems to be wrong -- provide immunization and advice that can prevent life-threatening problems later on.

Diagnosis means discovering the root of a problem such as fever, pain, difficult breathing, or disturbing behavior. The physician should be skilled at reaching a diagnosis by various means. The first and most important is simply asking the parents (and children, if they are not too young) for a description of the problem: whether it's getting better or worse, what makes it better or worse, how it's affecting the child's (and family's) life. The answers often go a long way towards identifying the cause of the problem. The second means of diagnosis is the physical examination. The third is laboratory tests. In general, the more experienced physicians are in diagnosing and treating the medical problems of children, the less they depend on lab tests. There are, of course, problems that require certain tests or X rays, but the most able diagnosticians rely heavily on asking questions and on physical exams.

The fourth means of diagnosis is referring the child to another doctor for consultation. Some doctors are so busy seeing large numbers of patients that they don't have time to ask the extra questions or to do the detailed physical examination needed for a diagnosis; they tend to refer too many children to consultants. Other doctors are overly confident of their own abilities, and they may not refer enough children to consultants.

Questioning treatment
Modern treatment has changed dramatically in the last hundred years. In the old days doctors didn't have a lot of effective medications or surgical procedures to offer, so they were much better at diagnosis than at treatment. In the last century, however, we have developed a host of effective treatments, as well as more sophisticated diagnostic tools. However, just as the treatments have become more powerful, so have some of the side-effects become more serious. Therefore, the most able physicians are those who use treatments that have been shown to do more good than harm. Fortunately, modern physicians -- and increasingly aware consumers -- are asking for proof that a treatment is necessary, and that the outcome is likely to be better than it would have been with no treatment.

Rehabilitation is the fourth critical area of skill. Some problems, like asthma or cerebral palsy, are "chronic" and can't be cured--we just have to live with them. An able doctor tries to rehabilitate a child with a chronic problem, to enable the child to live with as few limitations as possible. In the case of asthma, medication given when the child is well will usually prevent attacks and allow the child to attend school and play sports. In the case of cerebral palsy, the doctor should know which medical and non-medical consultants can help the child lead as full a life as he or she can.

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