Should my pediatrician have visited us in the hospital?
September 5, 2016 6:29 PM   Subscribe

We spent Friday through today in the hospital with my 6 week old, who was running a high fever. (Everything turned out fine.) Our pediatrician is part of a bigger practice with a dozen other pediatricians, all of whom are affiliated with the hospital and are regularly at the hospital, on the same floor, to see new babies after they are born. Am I wrong to be bothered that none of the pediatricians (neither the specific one we see, nor any of her colleagues in the practice), came to visit/check on my baby the entire weekend?

Other relevant info: I called the nurse line for my pediatrician group on Friday night to let them know little one had a fever and we'd be going to the ER. The pediatric ER doctor spoke to someone at my pediatricians office on Friday night as well, and the nurses and residents in the children's ward were also in touch with our pediatrician throughout the weekend. I mention this so there's no question that our pediatrician and the practice knew we were at the hospital. I repeatedly asked through the nurses and residents if our pediatrician or anyone else from the practice could/would come see us and was finally told no, that the pediatricians from the practice we go to only make rounds to see brand new babies.

Is this insane? No visit, not even a phone call from my pediatrician or anyone else in the practice, with a 6 week old hospitalized for fever? I don't expect flowers and balloons, but do doctors really care that little? I'm thinking of switching pediatricians over this but want to know if my expectations are out of whack. What do you think?

We are in the northeast US.

Thanks in advance for the perspective.
posted by curtains to Health & Fitness (35 answers total)
 
It was the weekend and sounds like the on call staff had it under control. It's no big deal.
posted by COD at 6:33 PM on September 5, 2016 [56 favorites]


My Dad (who is basically the closest to the best old school doctor you can get) would come visit. He'd have been by at least twice in this date range. However - he also does house calls to his elderly patients and still has admitting privileges at the hospital (both are super rare for family practice doctors) so YMMV. The only other thing I'd say - my Dad owns his own practice. It does seem like people who are part of larger practices feel a little less personal accountability. However the holiday weekend also likely played a role. I'm wondering if your primary ped is on vacation this weekend and whoever is on call checked in, saw things seemed like they were ok-ish, made a note and got back to his/her weekend plans?

Glad your six week old is feeling better. If it were me, I'd change doctors, but I'd also be looking for the kind of doctor experience my Dad provides (which is tough to find - I struggle to find providers like him and when I do I don't give them up).
posted by arnicae at 6:35 PM on September 5, 2016 [1 favorite]


I would say it's not insane that they didn't come - they (presumably) reasonably relied on the hospital staff to do what was necessary, and probably didn't have any real personal knowledge to add. But also it is reasonable that you want to have your kid in the care of a practice that has a more personal touch. If this leads you to ask around your area to find a practice with a "vibe" that you like better, that seems reasonable to me. But these days you might have a hard time finding such a practice in a big or biggish city.

Also: hope your baby is feeling better!
posted by sheldman at 6:38 PM on September 5, 2016 [1 favorite]


My daughter was hospitalized several times her first year, and only once did our pediatrician stop by to see us - while she was literally rounding on the same unit and would have seen us anyway. No one else from the practice stopped in during any other hospitalizations. And our practice is not just affiliated with the hospital, it is actually inside the hospital itself, and no one came.

I think your expectations are out of whack, honestly. When hospitalized, the patient is under the care of the doctor on the ward. What exactly is your pediatrician going to do? Even if they are affiliated, they don't have the ability to override the doctor on the unit, and discharge documentation is usually quite good. There might be liability issues for the hospital had their opinions conflicted. In my experience, the ped visit right after the baby is born is to ensure continuity of care for new parents who are otherwise at risk of not following through - not as a convenience for parents of means, and house calls and hospital visits by an internist or pediatrician is just not the way things are done anymore.
posted by peanut_mcgillicuty at 6:40 PM on September 5, 2016 [85 favorites]


Your expectations are not realistic. Respectfully, this is just not the done thing anymore for the vast majority of primary care physicians in the US (for a very long list of reasons, none of which I would attribute to people just not caring enough), and you will only be generating extra work and headaches for yourself if you try to change practices over it. If you've been otherwise happy with your pediatrician and the practice in general, I would be happy your kiddo is doing well and move on.
posted by telegraph at 6:41 PM on September 5, 2016 [42 favorites]


Am I wrong to be bothered that none of the pediatricians... came to visit/check on my baby the entire weekend?

Yes. The doctor's priority is to make sure the patient gets better; if that is under control, that is enough. On a holiday weekend especially, you can't expect them to just pop in. It doesn't sound like you made any specific request of your regular peds team that they stop by - if you had and they refused that would be one thing, but I expect they would also have explained that decision so who knows. Again, if the situation was under control with staff on hand, that is enough.
posted by Joey Buttafoucault at 6:43 PM on September 5, 2016 [3 favorites]


Our pediatrician practice (6 doctors) has a relationship with a hospitalist who handles a lot of their practice's inpatient visits. The pediatricians would spend all their time at the hospital if they needed to visit every sick patient of theirs there.

I'm actually surprised your pediatricians visit new babies at the hospital after birth. We took our babies to the pediatrician for their first checkup after the baby was home.
posted by LoveHam at 6:44 PM on September 5, 2016 [6 favorites]


Our (amazing) ped called to check on us several times when my one-week-old was in the NICU, which I really appreciated and did not expect. It definitely happens!
posted by marmago at 6:47 PM on September 5, 2016 [3 favorites]


That sounds really scary - I'm glad your baby's recovered and back home.

I don't think it's a big issue that your pediatrician didn't stop by to see you at the hospital, and it doesn't mean they were insensitive or neglectful. You were already in capable hands, and it's not something the doctors typically do; maybe they just can't visit patients in the hospital other than new babies for liability reasons. Maybe the pediatricians only go to the hospital for long enough to meet the new babies, and spend the rest of the time at their practice with checkups and non-hospital sick visits. Maybe if your pediatrician visited and their opinion differed with the hospital team's on even the slightest thing, it would have caused a lot of unnecessary conflict/confusion/paperwork.

I would expect the practice to call once you were home from the hospital, though, to make sure everything's okay and possibly schedule a follow-up appointment if needed.
posted by Metroid Baby at 6:51 PM on September 5, 2016 [2 favorites]


Outpatient providers going into the inpatient hospital unit is not standard practice in many places anymore. Part of this is the sheer volume of knowledge and specialization that happens, both in training and from being in practice for a long time. If a normal primary care provider doesn't do much hospital work anymore, they will be very good at outpatient level of care, which includes 'when to send to the hospital' - where inpatient specialists (hospitalists) who almost only do inpatient level of care, are doing their thing. Over time we've differentiated inpatient care from outpatient care funds of knowledge.

Also, part of it is billing and time.
posted by cobaltnine at 6:57 PM on September 5, 2016 [6 favorites]


I think your expectations are out of line a little :-) I'm 31 weeks pregnant right now and my experience has been that there are very firm hierarchies to the hospital structure. My OB is in a joint practice with 17 others, any of whom may be on call when my actual birth happens, and all of whom can access the same records and perform the same procedures. I was told that after a certain point in the pregnancy, I should only call her office to book appointments. Any other questions go to a triage line who will advise me to either call her for an appointment, or come in immediately, at which point whichever of the 17 of them are there will handle it.

I imagine it will be much the same for pediatrics. When I'm in the hospital, the hospital pediatrician will handle things. When I have my own pediatrician, there will be a triage procedure and it will be book an appointment and come in, or go to Emerg, at which point the doctors there will handle it. Why would it be otherwise?
posted by ficbot at 7:01 PM on September 5, 2016


I fired my peds office for skipping us on rounds multiple times (they visited all other sick babies from their practice except us). Vomiting, dehydration, usual rotovirus fun for my nursling. I never saw a single ped from the practice the entire visit.

The way the hospital was set up your peds office was required to sign off on releasing the patients from the hospital. After another couple series of skips (nurses would tell us they were in the hospital making rounds) we were ready to go home (72+ hours in) and the hospital finally had to use their in house ped to discharge us because no one from the practice could be found.
posted by tilde at 7:10 PM on September 5, 2016 [1 favorite]


I work at a children's hospital (in an area related to the clinical side of things, but I am not a clinician) and as others have said above, outpatient is outpatient and inpatient is inpatient. We have a network of outpatient peds offices that are part of the same system as us, but those physicians do not round in the hospital. I feel like there's a professional courtesy thing here too- while in the hospital, you were under the care of a physician and it would have been odd and inappropriate for your regular pediatrician to pop in and actually *do* anything. At the very least, there could be continuity of care issues and confusion over who's in charge and who nurses etc. should contact with questions.
posted by MadamM at 7:11 PM on September 5, 2016 [20 favorites]


Hospital medicine is its own specialty now, and the section of pediatric hospitalists is quickly growing. Doctors who practice solely in the hospital are the best experts in dealing with hospitalized patients. I look at it this way - my primary care physician is great when it comes to ear infections, bronchitis, and yearly physicals. But if I'm super-sick, I want to be seen by a doctor whose job it is to deal with super-sick people. It's not an issue of caring, and I wouldn't be surprised if you got a call from your ped's office sometime this week.

I'm glad your baby is better!

IANAD, but I work for the Society of Hospital Medicine so I'm used to this type of question.
posted by kimberussell at 7:12 PM on September 5, 2016 [8 favorites]


This is oncology, not pediatrics, but my oncologist, whose practice is across the street from the hospital, does visit me and any of his other patients every single day we're in the hospital, and I find it enormously comforting. He also does have some kind of affiliation with the hospital, though, so maybe ask your pediatrician next time you see them what the reasons for them not visiting are. There could be a perfectly sound bureaucratic reason, as people have mentioned above.
posted by MsMolly at 7:47 PM on September 5, 2016


I am clearly in the minority here, but I would feel the same way you do. As you said, they are already in the hospital visiting newborns. And this isn't a six-year-old kid in for a routine procedure, like a tonsillectomy. If a six-week-old has a fever high enough to be hospitalized, that is serious. I would have expected at least that your pediatrician would contact you by phone, and really, that they would stop by to see your baby in the hospital.
posted by merejane at 7:54 PM on September 5, 2016 [5 favorites]


What exactly would the pediatrician have done that the doctors already there didn't do? I think you will most likely find there is some paperwork reason why he wasn't there, possible reasons range from insurance to billing to miscommunication to it wasn't his weekend on.

I understand it's your child so you're concerned, but in an emergency situation in a hospital a family practitioner type of doctor might not be the best choice anyway.
posted by wwax at 7:55 PM on September 5, 2016 [2 favorites]


I'd feel the same way you do. When our newborn was having issues, as the situation changed, my doctor clearly wanted to be consulted on whether or not to go to the ER. Another time, they sent us to the hospital for tests but were the ones to call us with results. So if we were to go to the hospital, I'd still think of them as the doctor I had a long term relationship with and believe that they would be in communication in some way. In your shoes, I'd at least ask them about it and maybe consider seeking out a more old school practice. (But maybe my expectations are out of line as well.)
posted by slidell at 8:03 PM on September 5, 2016


Our pediatrician would have called us, but not come in. What she does do is stellar follow-up, communication, etc. so it's not so much about showing up as information exchange with the team there. When my son was hospitalized at 4 months I didn't see her but as soon as we were discharged, she called and clearly was on top of everything.

I'm sorry you went through the whole experience.
posted by warriorqueen at 8:15 PM on September 5, 2016


I'm a primary care doctor--the outpatient pediatrician would literally have just been stopping by to say hello, since when the hospitalist team is in charge the outpatient doctors don't bill for hospital visits, write notes in the hospital chart, or even have much input in to the management of patients unless it's a very complicated patient the outpatient pediatrician knows extremely well. Remember, one reason the kindly old-fashioned family doctor would come to the hospital to see patients is that he was both directing their care and billing for those visits. (I believe outpatient peds CAN bill for nursery visits, although I'm not totally sure).

It can actually backfire when you go see your own patients in the hospital, since often the patient and his/her family have questions about their care that you are not able to answer because you don't know all the nitty-gritty details, like when a particular test is going to be done or whether they can eat. This gets even less useful when you don't actually know the patient in question because they're one of your partners' patients. Since the practice where I work is right next to the hospital where I admit, I do try to go say hi to patients I know well, but only when I'm already at work. Definitely not over a holiday weekend, and I certainly wouldn't go say hi to one of my coworkers' patients. I will note that "going and saying hi" is usually at least a 30 minute process since I also need to review the chart beforehand to see what's going on with my patient, and sometimes check in with the inpatient team as well.

There are certainly practices that still operate on the old-school model of the individual physician rounding on their hospital patients and then going to the clinic, although these are usually either concierge practices or very rural.
If this kind of attention is something you want, I would encourage you to look into a concierge pediatric practice or a solo practice, as that's the sort of thing they do well.

Are you wrong to want your child's doctor to come see him/her in the hospital? No. Is it something you can expect as a basic courtesy from a competent practice? No. It's definitely "above and beyond."
posted by The Elusive Architeuthis at 8:25 PM on September 5, 2016 [61 favorites]


(I'll add that a specialist like an oncologist or a cardiologist coming to the hospital to visit patients who are being cared for by hospitalist primary teams is a little different--the specialist is typically asked to consult on the patient to provide input on their area of expertise. They get paid for these visits. They may not always bill for every visit but they are actively involved in directing the patient's care and have responsibility for the patient while they are in the hospital in a way that the outpatient primary care provider does not).
posted by The Elusive Architeuthis at 8:34 PM on September 5, 2016 [9 favorites]


Highlighting the excellence of The Elusive Architeuthis' answer. Since you are a mom as well, let me put it to you this way - I'm not sure if you have a job, but if you did, and let's say it was a high powered job that you spent 50-60 hours per week on such that you often missed out on time with your family, and that you routinely have to do work on some nights and holidays.

Would you then want to add on to your work hours significantly in the name of making customers incrementally happier, doing something that would take you away from your family on holiday weekends, to do tasks you would not be paid for that would not improve the outcomes of your business? I'm guessing the answer would be no for almost everyone in the world. This is also the reason why the vast majority of docs now leave care of hospitalized patients to hospitalists except in special circumstances. It definitely doesn't mean they're callous or rude, there just isn't enough value added in doing this to make it worth doing.
posted by treehorn+bunny at 9:23 PM on September 5, 2016 [24 favorites]


If I had a newborn, I would be really ticked off if the pediatrician had just visited a baby with a fever. This is how disease spreads. With all due respect, I could see many reasons why they would want the doctors in the ER to be focused there and the doctors doing rounds be focused there - and not intermixing as much as possible.
posted by Toddles at 9:52 PM on September 5, 2016 [6 favorites]


I would have wanted a quick phone call to see how little fellow was doing and how you were doing. I do not think stopping by is appropriate or necessary. Maybe the practice could have made it clear when you joined it or when your child went to the hospital for the first time.

To me, this is a communication issue more than a non caring issue.
posted by AugustWest at 10:10 PM on September 5, 2016


My son has a long and very unusual medical history. When we go to the ER/ICU, the hospital doctors call the ped to help make a treatment plan. They wouldn't do this is he had a long but usual list of issues. I wouldn't expect my GP to come by if I were in the ER.
posted by Kalmya at 5:49 AM on September 6, 2016


When my then 9-week-old was in the hospital for an unexplained seizure, our family doctor did stop by to see us and him. He went out of his way to do so.

So, it's not unusual in my experience for that to happen, but apparently it is unusual in the real world. Granted, he was the only doctor in the practice, and he was a family doc and not just a pediatrician, but that's the level of care we received for 20 years.

No wonder I'm having a hard time finding a replacement for him (he retired in December, sadly)!
posted by cooker girl at 6:31 AM on September 6, 2016


I don't think the only problem here is that the pediatrician did not stop by, but that you did not even get a phone call. I would look to switch to a smaller practice, with six or even fewer docs.
posted by merejane at 7:35 AM on September 6, 2016


We go to a practice like yours, where there is a large group of physicians, affiliated with the hospital, who round on new babies in the hospital.

I would like to gently suggest that your level of upsetness over this may be related to the stress of just having had your 6 week old baby in the hospital for something potentially very scary.

As many others have described, the reason that outpatient pediatricians visit newborns in the hospital is that, in case the parents don't already have a pediatrician lined up, they now have someone to call. This was me, for example. I was admitted to the hospital in premature labor on the day I was supposed to have my meet-the-pediatrician meeting, and long story short I ended up not having a pediatrician lined up when my baby came, so we had our 2-day-later-followup with the pediatrician who rounded on us in the hospital.

Once the baby has established care, the pediatricians handle outpatient work and the hospitalists handle routine inpatient work. (Specialists handle both, but that's a little different). The advantage of being at a practice like yours (and mine) is that the hospitalists are likely to know the pediatricians and already be in the habit of communicating. Indeed, it sounds like the hospitalists kept your pediatrician apprised of your baby's condition during the weekend.

Now: I've been in your situation before and I understand just how badly you wanted your pediatrician to come visit. Our pediatrician has visited Nanopanda in the ICU before, but not every time she was there. It has always been a purely social visit, on her own time. She gets the actual medical information from the chart and from talking to the hospitalists, and the sole purpose of the in-person visit is to cluck sympathetically. It meant the WORLD to me the times she came, and I was SO SAD the times she didn't. But it wasn't about not caring, or not paying attention to what was going on with my baby, and her visiting wouldn't have changed anything about Nanopanda's care. I wanted her there mostly for me to cling to? Because I was so tired from having to be brave and stay on top of everything going on in the hospital and I just wanted someone else who had both medical knowledge and a relationship with my baby to be there and ... make it better. Also, I think the reason she did make the extra effort to come had a lot to do with Nanopanda having had a prolonged series of increasingly severe illnesses and increasingly urgent office visits culminating in a spectacular decompensation - so the ped had been intimately involved with this course of illness and felt more personally invested in it. I think she'd be less likely to visit in the hospital if, say, my elder child broke his leg.

But she has been very caring and involved in other ways: She's worked with us to help navigate triage-desk bureaucracy that was making it difficult to get messages to her. She filed a complaint to hospital on our behalf against a specialist (the details aren't important here but the complaint was absolutely warranted). She worked with hospitalists to get an alternate hospitalization plan approved to avoid future contact with said specialist. She had the practice's office staff navigate the insurance permissions on our behalf to get extra medical equipment at home. And most importantly, she bends over backward to make time to see my child when she urgently needs to be seen in the office, regardless of what the schedule says. Many of these are things that happen behind the scenes and are how I KNOW she wants the best for my kids.

You've just been through a tough and exhausting experience and it's completely reasonable to be freaking out. New babies are hard and scary enough without being admitted to the hospital for potentially awful things. Being in the hospital with a baby is draining. I feel your hurt at not being visited - viscerally - but there are real benefits to staying with a practice where the type of behind-the-scenes communication you described above routinely happens.

Hang in there. Your nerves may well be rattled for awhile, but time does usually help. I'm glad to hear that baby curtains is on the mend.
posted by telepanda at 7:43 AM on September 6, 2016 [8 favorites]


You're expecting too much.

I come from clinical science and research. I've only rarely encountered a scenario in which a physician has the time and capacity to stop their practice to visit a patient (pediatric or otherwise) during a very brief institutional visit unrelated to an appointment of theirs. Physicians schedules are as overbooked as a winter flight from La Guardia to Miami. It doesn't sound like your child's visit was associated with any unusual urgency (a fever is not unexplained respiratory distress, for example).

And in case you're in the U.S., and you're referring to this past weekend, it was a national holiday. There may have been even shorter staffing than usual, leaving even less time for these sort of care visits.
posted by late afternoon dreaming hotel at 10:29 AM on September 6, 2016


Previous answers notwithstanding, when my 12 week old was hospitalized with a fever for several days, we had daily visits from the on-call doctor from the pediatrician's practice and our own pediatrician called me daily to discuss what was happening.

It may have been that there was some ambiguity (turned out to be a UTI, but it wasn't clear right away), or because my baby had been a (late-term) preemie and had been borderline Small for Gestational Age, and so she was small. My visit was Sun-Thurs. May also have been that the practice has a very strong presence at this Children's Hospital, though it's not close by. No idea about standard protocols, but I would have expected a phone call or a visit. That may be above and beyond and it may have just been bad luck that it didn't happen this time, but you should have a pediatrician you like.

If you happen to be in the Berkeley/Oakland area, send me a message and I am happy to refer you to our practice. We have been VERY happy with this practice: they were recommended by a friend and then my specific ped was recommended by the NICU doctor when I delivered, as I hadn't picked one out yet when my baby was born a month early.
posted by vunder at 12:23 PM on September 6, 2016


It's possible I'm off base here, but vunder's comment makes me wonder: In our practice, the hospitalists are considered part of the pediatrics group we see, even though you would only interact with them if you were admitted to the hospital. So, by that definition, "one of our pediatrician's colleagues" was in fact rounding on our child every day and then filling in the pediatrician as needed.

It makes me wonder if vunder's group had their on-call pediatrician rounding precisely because they aren't the primary pediatricians for the hospital (though clearly they do have hospital privileges).

I do agree with all who say you should have a practice you like and are comfortable with. I'd just encourage you to see how your follow-up visit goes, assess how you otherwise feel about the practice, and give yourself a little time to breathe and recalibrate before you dump them solely based on this incident.

I would also strongly encourage you to say something to your doctor at the followup, like "I was surprised that nobody from the group came by while babycurtains was in the hospital. How does that usually work?" How they respond and how you feel about their response will be telling.
posted by telepanda at 1:14 PM on September 6, 2016 [2 favorites]


Our baby was in hospital for a week last year, when he was one month old and we had no contact with our pediatrician during that time... It's normal.

When my mom had cancer her doctor had hospital rounds- but that was different.
posted by catspajammies at 1:18 PM on September 6, 2016


Also wanted to add- we are in Europe and have a hebamme (midwife) visit to check the baby almost every day the first few weeks. We were still on her watch when the baby was admitted to hospital, but once he was in hospital we didn't hear a single thing from her. We were really surprised as we felt quite close to her and had expected a call or visit. Anyway, when we eventually saw her again after it was business as normal and she was just as wonderful as she had always been- so much so we employed her (and we're lucky to have her!) for our second. We're glad we didn't get our nose bent out of shape and fire her! But when your baby is sick you are in pieces... It's easy to feel seriously offended.
posted by catspajammies at 1:43 PM on September 6, 2016 [1 favorite]


My kid has his own medical team (with specialists) and is in the hospital a lot. His pediatrician is on faculty at the hospital we go to but primarily works at another. We got one phone call from her after a hospitalization and no visits. When we're in the hospital, we generally get visited by whichever doctor from the specialty is rounding that day/week. Last time we didn't even get visited by the specialist, they were just in touch with the attending doc via phone. I've filed complaints about the specialists not rounding in person or even calling me because that's lame and against hospital policy (so I've learned). But we literally see the pediatrician for well child checks/vaccines at this point.
posted by Maarika at 5:46 PM on September 6, 2016


Glad to hear everything's okay. It was Labor Day Weekend this weekend; even if your doc would USUALLY have stopped by, perhaps they were on a limited/vacation schedule?
posted by Charity Garfein at 6:07 PM on September 6, 2016


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