I was that nurse in the pediatrician’s office, the one whom you expected to see when you brought your children in for their appointments... year after year. I would answer your phone calls about scrapes and scratches, constipation or diarrhea, fevers, persistent crying and accidental poisonings. I gave your kids their vaccines and took their blood, earnestly and oh so patiently, trying to convince them that they would survive the ordeal.  I taught you how to breastfeed your baby.  A generation later, I taught your baby how to breastfeed her own baby.

You may have noticed that I didn’t title this article Choosing a Pediatrician. Of course, you must be diligent. You must search for an experienced diagnostician and get recommendations from people whose opinion you value, to find the best pediatrician or pediatric/family nurse practitioner available to you. Currently, it is a luxury to have the choice of several practices; many new parents are limited by insurance, location and money. You want the best medical care for your child.

You want the best nursing care right alongside it.

It would be ideal if you could set up a prenatal visit to the office. Many practices offer this consult as a courtesy to new parents. Here is your opportunity to meet the nurse practitioner or physician, the RN who will take your phone calls and treat your children, and the front of the house support staff - before you arrive with your newborn for her first visit on day 2 or 3 of life... At your prenatal visit you will be able to determine if you and your health care providers can communicate well, if there is a dialogue as opposed to a lecture, if you are given the opportunity to speak and be heard.

Important questions to ask are:

• What happens if I call when the office is closed? 
  
• Who will speak with me when I call with a concern during office hours?
  
• Do you have a lab here in the office or where would I have to go to have a CBC (complete blood count to determine whether an infection is bacterial or viral) or a newborn bilirubin (causes jaundice) level checked?
  
• Is there a separation of sick from well children while waiting to go to an exam room?
  
• Do you have a lactation consultant on staff and if not, to whom do you refer?

There are less than obvious things to look for surrounding this prenatal visit... important, under-the-radar signs of how the office functions and how it is going to affect your child’s experience as well as your own.

Let’s start with your first phone call to set up the appointment for your prenatal interview.  If it is a busy practice you may get a recording.  There MUST be an option here for you to get through to the staff immediately if you ever have an emergency. You should be able to make an appointment at a time that fits your work schedule, with a friendly receptionist who told you her name when she answered your call.

So far, so good.

Now you’re at the front door of the office or office building for your appointment.  Were you able to park easily? Is it well lighted for evening or night visits?  Consider getting in through the front doors and climbing any stairs with a new baby, bags and stroller. Okay, now you’re in. And you’ve found the reception desk.

You are greeted by a smiling receptionist-gatekeeper who asks you to fill out a simple form with contact numbers, due dates and such, if she hasn’t already taken this information during your first phone call, and directs you into the waiting room, also telling you knowingly where the lavatory is located. Look around the inner office behind the front desk.  An orderly space, without stacks of unfiled papers and charts, personal cell phones and food, is a sign of professionalism...

You want proficiency and focus.

Ask the receptionist:

• How long can I expect to wait when I come in for an appointment?
  
• Do you call to confirm appointments? 
  
• Do you call if my appointment will be delayed?
  
• Are sick appointments offered in the early morning hours before I have to be at work and are well child appointments offered in the evenings after work?
  
• House calls?  Yes, some practices offer house calls.
  

The condition of the waiting room and the restroom are major indicators of the cleanliness and efficiency that will be maintained throughout the physical space. These areas should be spaces offering comfort, the buffer zone before the exam rooms.

The waiting area should provide comfortable seating for at least 6 people. In pediatrics, each patient has a caretaker or 2 accompanying him or her.  The space should be well maintained and softly lit. There’s a closet for your coat, plenty of colorful books (in good condition) in the bookcase, current magazines and no plush toys.  Any puzzles or building blocks must be unsoiled. Are the electrical outlets safety proofed?

The lavatories must be clean and smell clean. If they are not, that should be a deal breaker. If there are urine specimens in there when you go in, that’s a deal breaker too. There should be a soap dispenser, paper towels or air dryer and room to move around, in the event there’s two of you in there someday. If they’re out of soap or towels when you, a prospective client, go in to use the restroom...

Yup, deal breaker.

How long did you have to wait before you had your consultation?  The examination rooms continue to provide more information, ask to see them.  Artwork on the walls, furniture in good repair and each room should have a well-balanced newborn scale that will measure in fractions of ounces.

After speaking with your prospective NP or MD think about how you feel... 

• What is your gut telling you? 
  
• Do you think you will be comfortable and confident here? Remember that your child will sense your feelings...you have to be sure that your family’s needs are going to met.
  
• If you feel energized... feel empowered... feel relieved?
  

Then you are in the right place.