Tuesday, January 04, 2011

Doctor Dilemma

Let me start by saying that I love my doctor.  Specifically, I love his approach to medicine.  But sometimes? I think about leaving his practice because when I call the advice line, I am not always comfortable with the advice I get.  Then yesterday happened and now I am really not sure if we should stay or not.  Let me back up...

Superman had his one year, well baby appointment. Overall it went fine...or at least ended that way.  The way our doctor's office works is that you get brought into the room by a nurse who takes down any concerns and does the child's weight and height.  Then (on well-baby appointments) the nurse practitioner comes in.  She does a full exam, addresses any concerns, and talks with you about the things you should know about a child at X age. 

Finally the doctor comes in, looks over the nurse practitioner's notes, pokes and prods the child a little bit, talks with the parents about any remaining issues, and then you are done.  (Unless your child needs vaccinations.  Then the first nurse comes back and gives them to your child. Then you are done.)

So everything was going well until the nurse practitioner (or NP as she will be referred to from this point forward) came in.  The one we usually see was out sick, no big deal but thought I should clarify that I hadn't met her before.  Anyway, we talk about some of my safety concerns (Superman is OBSESSED with drawers right now) and she bugged me a little with her condescending response, but whatever, I asked the question.  

I also had a question about the amount of whole milk he should be consuming (he gets about 24 oz per day now).  She says that is too much...should be more like 16-18 oz.  She then wants to know how he is eating.  I tell her that he loves cheese and yogurt and feeding himself.  The he does pretty well with eating in general, but has times when I wish he would eat more but refuses.  She says that he can't possibly get enough food feeding himself.  I tell her that he sure seems to eat till he is full, but that I could be wrong. 

So then we looked at Superman's stats.  At 9 months he was at the 24th percentile for weight and 74th percentile for height (we think they measured his height wrong because up to that point he had always been in the 30-somethingth percentile).  At this appointment he was in the 18th percentile for weight and 33rd percentile for height.  The NP said that this was a concern.  She said that it probably is because he is self-feeding and he can't get enough food. 

I explain that the doctor told me that a dip in percentiles is normal from 9-12 months because they become so much more mobile.  In fact, when we were there for a sick appointment back in December and I brought up the issue?  He told me to stop worrying!  That S looked great and as long as we keep offering him food till he is full, we are good. 

Her response was that maybe it was that he was drinking too much milk.  She didn't address what he said at all.  I was just dumbfounded.  At this point I was exhausted and didn't want to deal with her any more.  I thought about arguing with her about the fact that 1 year olds are supposed to be self-feeding and that it was supposed to be a great thing that he is doing, but decided to just keep silent and ask the doctor.  

 So the doctor comes in and I bring this up to him.  I tell him that the NP thinks I should stop letting him self-feed and that I thought it was developmentally appropriate.  He said that she was wrong and that he was doing just fine.  We looked at the charts again and he said that his weight may be a little low, but given how active S was, it wasn't surprising (Superman did not stop moving the entire appointment.  He was cruising around the room, pulling up on the doctor, trying to climb me...you get the idea.).  He said to keep letting Superman feed himself and offering a good variety of foods, that he will eat when he is hungry. 

So in the end I was fine with the appointment.  I had the information I wanted...although I kicked myself for not asking the doctor about the milk amounts.  But how do I deal with an office where the doctor is great, but some of his staff doesn't give out the same information as he would?  I thought about calling the office manager and expressing my frustration, but my husband pointed out that the main boss is the doctor and since I already shared with him what she told me, there isn't more I can do. 

What would you do in this situation?

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