As a Pediatric (3rd year) resident, would I bring my kids to an FP versus a Pediatrician? Maybe. But it's not really FP vs. Peds for me, it's who's a good doc: i.e one that I'm comfortable with, and who practices good medicine. I'm in the military, and down the street from my own training program, so I have to go there. But if I were shopping around for a practice, the front office staff and facilities would make a difference too.
In regards to comfort level, an FP that sees a whole family may have an edge, but lots of pediatricians are familiar with the rest of the family, even though they don't treat the rest of the family (medically speaking. Socially speaking, we treat the family all the time). Agreed that in a large Pediatric practice, that familiarity may be less able to be maintained longitudinally (but in an individual encounter I try to get a good feel for any relevant family dynamic, even in somebody else's patient). Is it different in large FP practices? Do FP's in large practices not cross cover their practice partners' patients? (I'm ignorant in this matter). But in regards to comfort: does the doc communicate well? Do they speak at my and my wife's level (especially important for the non-medical folk). Do they give me the rationale for why they are choosing to treat or not to treat (if that is more appropriate). I can't see any difference between an FP or a Pediatrician in regards to these. Not to knock on my own profession, but there are those that (sometimes correctly) criticize us for coming of as fairly self-righteous in our roles as caretakers and advocates for children. But I think this is often more personality dependent than profession dependent. When you're in an academic training institution it can be easy to have an "ivory tower" mentality, constantly "Monday-morning quarterbacking" outside providers decisions in regards to treatment or referral (FP or Ped. Wow, two metaphorical idioms in one sentence; how obnoxious). But again, when training in a large FP academic center does that not happen as well? Humility and empathy is something that had develop and grow along with my expanding knowledge set. I think there are many doctors in every field of medicine that fail in this regard.
I think all of the above is the easy thing for even non-medical people (searching for their kids' doctor) to have a grip on. Finding those that practice good medicine may be a little harder. In my residency I've seen or heard about plenty of bad medicine practiced by FP's and Pediatricians (and ED docs, surgeons, anesthesiologists...) and I feel like I'm being well trained to practice good pediatric medicine. I see no reason why an FP can't learn good pediatric medicine. As stated by those above, a good start is an FP who chooses to see lots of kids and is comfortable with them. I can only speak to my own position as a pediatrician looking for a doc for my kids, but if I were shopping around, here are some things I would want to know (some directed at the FP seeing kids): how do they keep up with pediatric medicine? I still like the AFP, but do they regularly do pediatric CME? Are they keeping up with the AAP/AAFP/NIH... guidelines on common pediatric conditions (AOM, bronchiolitis, asthma, obesity, hypertension, autism). Do they feel comfortable treating or NOT treating (when appropriate) common conditions in the acutely sick outpatient child (any of the above, add headache/migraine to the list; or the child who is demonstrating developmental abnormailities) or are they sending every simple bronchiolitic to the ED (that brings up another question: Pediatric sized equipment and medicines in the office to deal with the outpatient emergency prior to transfer?). A few times I've alluded to not treating. One of the big newsmakers of not treating was AOM, but there are plenty of other conditions that are appropriately managed with watchful waiting. And here is where two principles come to mind: 1. Burger King medicine ("you're way, right away") is not always good medicine even though it may make the parents happy, and 2. Communication is key (Duh, didn't I already say that?). The Strep test in the family above is a good example. If this family came to me saying that they have had a bunch of URI symptoms along with a sore throat and so does the child and asking me to strep test the kid, I'm going to try to convince them that a strep test is not necessary and has the potential for harm (15-20% asymptomatic strep colonization in the general population; Strep pharingitis usually goes with headache, fevers, abdominal sx, NOT with URI sx. Lots of viral URI's cause sore throat, a lot due to post-nasal drip. If every URI with sore throat gets swabbed/cultured there is going to be a lot of antibiotic overtreatment. Last I read that had some serious risks. And in a toddler aged child, strep infection is much less common and even when it does occur it is exceedingly rare that it is a rheumatogenic strain. Isn't that why we treat strep vs. changing the duration of illness significantly? This is not a comment on the above case, as I obviously lack the details, but rather a conceivable case). I'm going to look for someone who can communicate the good medicine behind a treatment decision. And bringing a little of the ivory tower with me: since I can't ask about every treatment practice, I can ask about a few (somewhat randomly selected examples): 1. When do you routinely use or not use antibiotics for commonly encountered conditions (i.e. AOM, URTI/LRTI, simple cellulitis) 2. When do you routinely prescribe systemic steroids (there shouldn't be many on this list in my book: asthma, bronchiolitis in a beta agonist responder [esp. with a family hx of atopy]. Lymphadenitis and eczema shouldn't be on this list in my book). 3. Are you liberal in you're prescribing of beta agonist in the setting of asthma or suspicion of asthma (you should be) and do you ever prescribe liquid albuterol (you shouldn't. ever. period). And here is a kink in everything. EBM does not solve all diagnostic dilemmas...are you willing to confess when you don't know exactly what you are treating and are you capable of explaining a course of treatment/non-treatment in the face of that ambiguity backing up you're decision with properly thought out risk vs. benefit and physiology in the absence of clear evidence? If you're an FP or a pediatrician who fits these bills, then you can see my kids.
Believe me, ever since I have put 'family medicine' down on my application, I have neen fending these Qs and strange looks. I can't understand why? Live and let life=specialize and let generalize
