How To Choose The Right Doctor and Advocate For Your Child

Episode Transcript

Dr. Nicole Beurkens: 

Hi everyone, welcome to the show, I am Dr. Nicole, and for today’s episode, we’re talking about choosing a physician for your child and how you can effectively communicate your concerns and preferences to any of the healthcare providers that you may be partnering with for your child’s health. As more parents become aware of options like integrative medicine, functional medicine, holistic approaches — even basic nutrition and lifestyle therapies, it can be a challenge to get pediatricians and other healthcare practitioners onboard. Many parents, over the years in my practice have expressed frustration to me about dealing with physicians, nurses and other providers. They leave appointments feeling unheard, feeling like their questions of preferences were dismissed, or sometimes even just straight up told that it’s inappropriate for them to be researching or looking at other kinds of options for their child. So to help us understand why these frustrations occur and how we can better communicate with all healthcare providers and advocate for our kids, I’ve invited Dr. Joel “Gator” Warsh on the show today. Let me tell you about him.

He is a board-certified Pediatrician in Los Angeles, California who specializes in Integrative Medicine. He grew up in Toronto, Canada and completed a Master’s Degree in Epidemiology and Community Health before earning his medical degree from Thomas Jefferson Medical College. He completed his Pediatric Residency at Children’s Hospital of Los Angeles (CHLA) and has worked in private practice in Beverly Hills before founding his current practice, Integrative Pediatrics and Medicine, in 2018. Dr. Gator has published research in peer-reviewed journals on topics including childhood injuries, obesity and physical activity. He has been featured in numerous documentaries, films, podcasts and articles  and is the owner of IntegrativePediatrics.com and the host of the Integrative Pediatrics Summit. Dr. Gator, welcome to the show!

Dr. Joel “Gator” Warsh:

Thanks so much for having me, I’m excited to chat!

Dr. Nicole Beurkens: 

You and I have been trying to connect for a while and the stars finally aligned and we’re making this happen, and I’m so glad because this is a topic that I think so many parents are going, “Yes! Help me to better work through this.” Before we delve into it, though, I just had to ask a question that I’m sure you get asked a lot in interviews. Okay, Dr. Gator, where does that come from? I was like, maybe he went to university of Florida, but then I’m like no, he didn’t. So give us the lowdown on that. 

Dr. Joel “Gator” Warsh: 

It’s actually from my wife’s last name. Her last name is Intelligator, so people made the joke a little while ago, Ha ha, Dr. Gator, and then it kind of stuck. It has nothing to do with Florida, nothing against Florida, but it has nothing to do with that. I grew up in Toronto, I’ve never lived in Florida, but people always assume it. 

Dr. Nicole Beurkens: 

It’s a great name, and easy for the kids and everybody to say, and I’m sure that as a pediatrician, you have a lot of fun with that, so that’s awesome. So let’s delve into this. You’ve been a pediatrician now for a while, you’ve worked in more traditional kinds of medical settings and now operating more in an integrative type of real. I think it might be helpful to start out by just talking about what the difference is between a physician or any practitioner who focuses on a more integrative approach and what we might call a traditional or regular physician or healthcare practitioner. 

Dr. Joel “Gator” Warsh: 

It’s a great question. And the thing with integrative medicine is there isn’t really one definition. A lot of it is what you make of it, but to me it’s really blending the best of modern western medicine and science with ancient and holistic alternative practices in medicine. So everybody does that in a little bit of a different way, but to me it’s taking the best of what we have learned through science and modern medicine and each day doing whatever is best for the patient, and there are so many natural options that are available that have been done for generations and generations but they are just not really used that often anymore, and that really comes down to what we’re taught in medical school, which is mostly pharmaceutical medicine. I’m not against western medicine at all, I tell this to all my patients all the time, this is usually one of the first questions that I get if a parent interviews me. 

A lot of times they don’t even know what integrative medicine is, they might be holistic or one of their friends said, “Oh, we have this great integrative medical practice that we go to”, and that intrigues people, but it’s not necessarily a term that people are really familiar with. And sometimes it’s thought of more in a way of the woo-woo pseudoscience-y kind of medicine because there are practitioners out there that do things that are way outside of science, and so that gives it a bad name. But when you blend those two things together, it can be absolutely amazing because you can have options for your patients that are maybe more natural, don’t have as many side-effects, and if you can do that first before jumping to medication, then that can be really beneficial for the patient. But the flip side of that it’s also really important to know the science and the medicine because you don’t necessarily want to do something natural if there is a serious issue going on. So that’s where the balance comes in and where it’s really nice to have that foundational medical training because that helps me to identify if something is a little more serious, then maybe it’s not the right time for supplements or something like that. 

Dr. Nicole Beurkens: 

I love that idea of this merging or this blending of the approaches. It’s what really draws me to an integrative approach, both as a practitioner and when I’m seeking out providers for myself or my kids, because in an ideal situation, we get the best of both worlds done. As you said, there are things in allopathic western medicine that are amazing and important and valuable and have their place, and there are things from, as you said, more of those natural or ancient or those types of approaches that also have their place. So to be able to find practitioners that understand the science behind all of that and can merge those things in practice — I mean really, that’s what we should be aiming for, and healthcare, I think, overall, right? I think that should be the goal. 

Dr. Joel “Gator” Warsh: 

That, to me, is the goal. And that’s really why I have taken up the mission to really talk about this and bring this forward. Even when you mentioned the summit, because I think that there really is no reason not to do this. We need to research all the natural options out there because some of them are also not safe, and we need to know that as well. But why, as a doctor, would you not give a supplement before giving a medication if the supplement is going to work the same or better and have fewer side effects? That is science. That’s what we’re supposed to be doing, but the problem is, what makes it really difficult is that pharmaceuticals is where the money is, and that’s where the research and the trials are, and there just isn’t a lot of reason for anybody to do a double-blind control trial on ginger or on turmeric or other things like that because there’s no financial benefit at the end of the day. 

So it’s really hard to get the data that you need for a physician to be able to make that choice. And sometimes we do and sometimes things change, and the best example is acupuncture, I think, where you really have seen it in the hospitals, where it was kind of seen as the woo-woo medicine before, but now, almost every hospital has it in their pain clinics and they do it before opioids because the opioids have had so many side-effects. I think slowly, this is starting to become a little bit more mainstream, but everything in medicine is extraordinarily slow to change. That’s just the nature of medicine, which is good and bad. It’s good because we don’t just make really quick changes, but at the same time, with technology and information, there’s just so much more that’s available these days that can change so quickly, and so medicine is very slow to really get behind anything alternative until it’s really, really well-proven, which is good and bad.

Dr. Nicole Beurkens: 

Yeah. I would agree with that. And one of the things that with technology and all of the immense amounts of research and information and resources available to all of us through a touch of a button on the computer, we have a situation now where sometimes parents have really delved into researching and all of the information out there about their child’s specific condition or options or whatever, and sometimes have more specific knowledge and information about that than their general pediatrician or healthcare provider may have. And I think that creates some challenges, which leads me to the next question of why is, if this is the goal — You and I both agree that hey, an integrative approach, this is what we should be aiming for: Getting the best of both worlds in caring for kids and adults for that matter, why is it that the things that we call integrative medicine or holistic approaches seem to be so taboo, to not all, but many western physicians and sort of the typical providers that parents are bringing their kids to? 

Dr. Joel “Gator” Warsh: 

It’s taboo because we’re not really exposed to it. We’re not trained in it so we don’t know it and you spend so much time learning that the science and the data and the research and all of these things — it really never talks about the integrative medical aspects of it. It becomes a tribe. And what you learn is what you learn and what you know is what you know and anything else is just different. And if you don’t have the knowledge base in something, then it becomes scary and different and you just don’t know how to prescribe it, how to handle it, how to deal with it and it just becomes like me versus them. Everything in society these days seems to be very divisive and it’s become one world versus the other. Allopathic medicine versus natural medicine. 

They’re not one thing, I mean that’s the way that it used to be, everything used to be natural medicine. Everything is natural medicine until becomes western medicine, and for some reason, we’ve just become, I think, almost arrogant in western medicine, like this is the only way and the best way, even though it’s done in so many different ways around the world. And western medicine is new, right? If you really think about it, I don’t know where you would want to define the time point of western medicine — let’s say 100 years, a few hundred years, whereas alternative medicine has been around for thousands of years, many thousands of years. So which one is really alternative? This is the new one! But it’s just what we know. So it becomes difficult for doctors to really get behind it because there is just so much training that you would need and there is such a wide world of what even integrative medicine is and by nature, doctors are already so busy they don’t necessarily want to learn more, they don’t want to do more. 

And anything that’s natural or integrative medicine or anything outside of regular western medicine takes more time. It takes more time and more effort and you’re already so time-constrained as a physician as it is, that for you to sit there and explain the benefits of elderberry syrup or vitamin D or vitamin C for a cold — it’s easier to give an antibiotic and say “Let’s go on and move on with our day.” But it’s not always the best option. Sometimes it is, but it takes a lot more time to discuss natural options and it’s just not always available to every practitioner, or the knowledge base isn’t there. I think if they would learn about it, then they might be more open to it, but we just haven’t really learnt about it yet. 

Dr. Nicole Beurkens: 

I’m glad you mentioned that because I find, as a provider who does a lot of communicating and trying to build bridges with western medicine providers, even in our community: The pediatricians and family practice docs and specialists who are working with our patients, that knowledge-base, first of all, as you mentioned earlier, that we only know what we know. Many times we don’t even realize what we don’t know and what all is out there. But then when we’re made aware of it, I think there’s a segment of physicians and other more allopathically-trained practitioners who get curious and who are interested and saying, “Oh, let me find out more about that. Let me delve into the research.” I think you and I and many other people that we trained with fall in that category. We become aware of it and then we go, “Ha! That’s interesting!” But the time piece is a big one because we have to invest a lot of our own time outside of seeing patients and things to learn all the things that we may be more taught in our programs. So I think that piece of delving into the research and learning for ourselves, it’s a big one and it does take time and it takes a practitioner who sort of has a personality and a curiosity that’s interested in learning more about that. 

Dr. Joel “Gator” Warsh:

Yeah. And I think that’s a really important point because I never want to speak poorly about any of my colleagues because all pediatricians are great people, and they’re here working to treat kids and you know what you know. Most doctors are open to learning about some of this stuff. I mean acupuncture, as I said, has become very mainstream, yoga has become very mainstream, vitamin D is very mainstream, vitamin C — all of these things that were more out there in the natural world are becoming more evidence-based. And you give doctors the research and the data, and if it’s well-studied and well-researched, they will do it. It just takes time but I do think that the younger generation is a lot more open to learning about integrative medicine, from what I have seen. It’s really becoming more and more popular, I think because we have identified that what we’re doing just isn’t working. There’s no question that what western medicine is doing overall is not working on the long term. We have amazing cures for diseases, we have antibiotics if we have pneumonia. We get hurt, we can go to the emergency department and get X-rays or MRI — these things are magical. We’re not successful with chronic diseases and chronic disease rates just keep going up and up and up. There’s different research out there but some say 25%, some say 50% of kids have a chronic disease: Whatever it is, the number is way too high and it’s absolutely alarming and we’re seeing that with autism and everything else, the number just keeps skyrocketing. So there’s just this identification that we need to do more or learn a little bit more and realize where we might not be perfect with all the information that we know and where we can blend in some other information to work on these things. 

And that’s why I’ve really started to see a lot more physicians reaching out, asking questions, but the issue still is there just isn’t great training for doctors on this, there are not a lot of resources on it, there’s not a lot of data out there, specifically for kids. There is more and more coming out for adults, still not a lot, but it definitely exists. But for kids, it’s very hard to get any trials done on children, that’s just not that easy to do. So it takes time and we’re going that way, but still in the beginning phases, I would say. 

Dr. Nicole Beurkens: 

I would agree, and I think you bring up a really good point about research in kids. I think that’s one of the challenges for those of us who work with pediatric populations across the board. Stuff gets studied by and large with adults first, and then there is this assumption, even when it comes to medications and other kinds of treatments, that well, that would apply to kids too. We’ll just lower the dose a little or whatever. I mean even in my field being in mental health, virtually all of the medications that are used for children with mental health conditions, we don’t have good research evidence on children, certainly not young children. So I do think that pediatricians and people focused on kids are in a unique situation, maybe to be a bit ahead of the curve in medicine in general, of being open to some of these integrative things, seeing that, wow! We are having more and more kids with more and more issues, whether it’s physiological issues, brain-based issues, whatever it is, and maybe more of an openness to say, “Well, gosh, we don’t have a lot of research on some of the things we’re doing in general. Let’s look at what some other options are.” So I feel like maybe people who focus on kids, this is just in my own experience, tend to have more of an openness to that. Do you think that that’s true? 

Dr. Joel “Gator” Warsh: 

I think it’s true, but I think there’s also a fear, an irrational fear, I would even say that people are so much more afraid of doing anything on a child, which I think for a newborn baby, yeah that makes sense. But once a kid gets older, to me, kids are generally more resilient. They can handle more. So it should be less-likely they’re going to have side-effects and risks for most of these things. But I think that just nobody wants to do anything that could affect the kid in a negative way, which makes sense and it’s obvious. And if it’s not extremely tested, then who wants to have their child be tested? I think people are more willing to test on themselves than they are on their children, and so it just makes it really difficult if you’re trying a new supplement on something to really get good testing and results except for something that’s chronic and severe, in which case, people are generally willing to try anything because they’ve been through and exhausted all of the medical system and nothing is really giving them the answers that they need or it hasn’t really resolved anything, and so them, they’re willing to try more of these things. And that’s where you do see the pendulum moving, and that’s where I think even in the autism world, the ADHD world, those kinds of things, where we are seeing a lot more movement in natural medicine because there aren’t really good answers in western medicine for those things. There’s ABA therapy and there are other therapies that you can do but there aren’t really treatments for it, so these are ways that parents can at least try things with minimal risk and they’re willing to do it for the most part. 

Dr. Nicole Beurkens: 

Yeah, and I think — so I started out in the field of autism in the mid-90s and that was really just at the very beginning stages of parents starting to congregate online and in their communities to talk about things like dietary changes. Really, a lot of the published studies that we have related to things like the gut microbiome and special diets and even nutritional supplementation have come out of the realm of autism because of people really looking at what else we can do here. So it’s been interesting over the last 25 years to watch that movement grow and really be much more — not fully accepted in the mainstream, but something that is at least talked about a lot more. Dietary changes and things like that and not just for autism now but across the board. And I think that as parents are more about those kinds of approaches, the challenge becomes then, how to raise that with the pediatrician or other providers, right?

Especially if they’re working with someone like you, who right from the outside, it’s clear, this is your approach, you’re open to the things, and you’re actually going to initiate this stuff, but most parents are working with more traditional healthcare providers, pediatricians, family practice docs. So what are some suggestions? How do you think it’s most helpful for parents to raise either concerns that maybe might seem out of the box of western medicine or things that they’ve read about or approaches that they’re interested in trying? What’s the best way for them to raise that?

Dr. Joel “Gator” Warsh:

I think the first way to do it is just to have a conversation. Set up a visit and talk to them about it, bring in whatever data, information that you can. Doctors by and large love data, love information, love research, love studies. And if you can find some of that and bring that with you, then it’s going to give a little bit more validity to what you’re saying to a physician and you might be surprised. Every doctor is a little bit different and there are plenty of doctors that are very open to a lot of it. So certainly the situation depends how out there your questions are in terms of how far away they are from western medicine. But in many, many times, I’m sure that people will bring this kind of stuff to their practitioner and the practitioner won’t even know about it and they’ll be intrigued by it and they might go read about it or research it or they might not want to do it, they might not have any background knowledge in it, but a lot of times what I have seen, let’s say for specialists, that’s a good example: People will bring it to the specialist and they’ll say, “Well, I don’t know anything about this. It doesn’t seem dangerous. If you want to try it, go for it.”

I think that’s always the number one thing, is to talk about the dangers. Do you think it’s dangerous? Because a lot of doctors, that’s where they go first. They’re not so against you trying something if they’re not sure if — if it’s not dangerous, they are usually going to be okay with it. They may not say to do it, but they’ll say it’s fine. But that’s usually with kids where you want to start. Do you think this is dangerous? If you talk about it from the standpoint of “I read about this/I saw this/my friends did this/this seemed very successful from what I’ve read. Do you think this is dangerous?” That’s, I think, a very non-confrontational way to bring something up with a doctor because you’re asking them for their expertise on the subject and that, as opposed to saying, “I want to do this/I read this on Facebook, and therefore —” Those are the kind of sentences where it triggers a doctor, because they’re like, “Well, I went to med school for four years, and then I did residence for another 3 years and I’ve been in medicine all this time and you want to trust Facebook over what I’ve learned.”

You don’t want to go with that approach. You want to take the approach of using their expertise to discuss something that you found and see what you think about it. More doctors will be open to that. Some will be totally open to everything, some people don’t want to hear any of it, and that’s doctor-specific. And if you, as a patient, as a parent are unhappy or your doctor isn’t listening to you, then you can always go to a different doctor or a different practitioner. Some people have a regular pediatrician and then they have a natural doctor that they go to for these specific things, so that’s an option. Or you can look for a different practitioner who is a little bit more open to some of these things. If this is really important to you and you feel like you’re being unheard — and that definitely does happen. I definitely have parents come crying in interviews about how they wanted to bring up x, y and z and their doctor didn’t listen or their whatever practitioner didn’t listen and they just didn’t feel heard and were dismissed. That, for better or worse sometimes, you have to also be fair and reasonable that sometimes what you are bringing doesn’t necessarily make sense to a doctor or it is dangerous and you have to listen to that information too.

But I think by and large, it’s the way that you approach it that really makes a difference for most practitioners because I love people bringing in stuff. I always say, “Please, bring me in stuff!” It doesn’t mean I’m going to agree with it or I even have any idea about it. You have to keep that in mind. Yes, doctors have a lot of knowledge and training, but if you’re bringing something integrative, it is a big world out there. There are so many fields and you can learn about supplements and tinctures and homeopathics and acupuncture and eastern medicine and Ayurveda. There are so many different fields, you’re not going to necessarily be an expert in everything, but you can definitely do some research to look into things. But all this stuff takes time. You’ve got to be fair and reasonable to your doctors too, and you can’t necessarily expect them to do a whole research study on every single question that you have if they’re super busy. So it’s a balance there. 

Dr. Nicole Beurkens: 

I love what you’re saying. Start with a collaborative conversation and bring information so you feel like it’s helpful. Because I have parents who ask me this a lot. Should I bring things in with me? Will the doctor want to read them? And I always say, I think you should bring whatever you have and then they’ll decide if they’re willing to look at it or not or they might surprise you and already say, oh, yup, I’ve seen the data on that. But what you’re saying is that it’s helpful for parents to bring, if they’ve seen a study that they’re curious about in terms of their child or if they have information, to bring that. 

Dr. Joel “Gator” Warsh: 

Yeah. I think it’s very helpful and doctors love research and science and data. And if you can find good, credible evidence for something then you can change a doctor’s mind. You can, you absolutely can. Doctors are not gods. We don’t know everything and information changes all the time. And by nature, of any profession, I think doctors learn the most consistently over their career in terms of having to continually learn and read and everything like that. So you hear it all the time where patients go to the practitioner and maybe even the practitioner kind of blows off whatever they did, like “Oh yeah, that would never work.” And then three months later they come back and they did the thing or they went to some other practitioner and the kid is totally better, and they’re like, “What did you do!” And then, that is a lot of times what spurs a doctor to — they’re like, “Wait a minute. I don’t know of any of this stuff and I was blowing this off as crazy, and then the kid got better. What am I missing? Maybe there is something to this!” And then you start to look into it and then maybe very slowly you start learning a few of these things.

That is how many, many, many doctors that I have spoken to started to get into integrative medicine at all, because it gives you more options. It gives you more tools, and doctors do want that, they just want to make sure that it’s safe for their patients. So you have to believe that you have some power to make changes, and doctors will do what patients want, just like grocery stores do what people want. There was no organic food however many years ago, but people want organic food, so now every grocery store for the most part has it. And if every patient is only going to go to a doctor that does a blend of care, then doctors are going to have to learn that. They’re going to learn both and I think that kind of care will get better and better because there will be more and more research because it was forced upon them because that’s what people want. 

Dr. Nicole Beurkens: 

Such a great point and I would just say in my own experience because I have many dear friends who are integrative physicians or other types of providers, and you’re so right. As I am just thinking through them in my mind, virtually every single one, myself included, has a story of either a patient experience or a personal experience that led them then down the path of going, “Huh, what is that about. Let me learn more!” And then going on to do that. So I think that’s such an important point, and parents who are listening, I hope that feels empowering to you that you can really play a role, not only in educating and advocating and collaborating on what’s best for your child, but potentially even changing the trajectory of care for other children who go to the practice that your child goes to, who are served by practitioners. That’s a pretty cool thing. 

Dr. Joel “Gator” Warsh:

It is. I think people forget: We’re all on the same team. Doctors are on your team and really, everybody should be working together. And at the end of the day, my hope in the long run is that natural medicine, naturopathic doctors, whatever, whomever the practitioner should be part of the team. Doctors know where to send for an ear, nose and throat doctor, they know how to send for a cardiologist, they know where to send for x, y and z. But if we can just get the natural medicine part of it into the armory of what we can do, you don’t need to even have very much knowledge on it. You just have a person that you can refer to and say, “Hey, this person has a chronic issue. I’ve done everything that I could and nothing is working. Maybe you have some natural options available, why don’t you go there and I’ll follow you from the medical perspective?”

And that’s where we need to go. It’s a team. We’re all working together, we’re all here to help kids get healthy and by and large, kids are not healthy. So we’re not doing the right thing, we haven’t — we’re moving in a bad direction. We need to sound the alarm and wave the flag. Something is wrong and we need to make that change. We’re not going to make that change by closing our ears. We have to bring everything together, everything that we’ve ever had. Take the best of what we know from before, combine it with the best of what we have now and that’s how we move forward in a better direction instead of just forgetting about what we learn, forgetting about diet, exercise — and I call it the seed of how the foundations, the stress, the environmental toxins, exercise, diet, sleep — these are the things that are so foundational that Hippocrates used to talk about it. All of the forefathers of medicine, this is what they used to do. But now we’re so focused on “Well, you have this symptom. For pain, here’s your Tylenol, here’s your medication. Oh you have a cough, here’s your antibiotic.” But we’re missing the bigger picture of how we prevent these things and how we keep the body in balance, and we’re just not doing that by and large right now. 

Dr. Nicole Beurkens:

I would agree, and I think those of us who work with children, especially, they are the canaries in the coal mine. Children are becoming less and less healthy earlier and earlier in their life and that really should be an alarm bell. Because if we think we have a problem with chronically ill adults, adults on disability for whatever reasons, this next generation coming up is going to show that in a whole new, more severe way because they’re already having this many issues as kids. That does not bode well. So we do need to turn this around and be doing something different. 

Dr. Joel “Gator” Warsh:

Yeah. Life expectancy is going down from what I’ve seen. We haven’t had that be the case in a very long time. But now we’re seeing it go down. So we’re obviously doing something wrong as a race, as a society, as human beings. We’re not moving in the best direction. We’re making some incorrect choice or we’re just surrounded by too many chemicals and toxins. All of these things that our bodies just are overloaded at this point, and we need to work on, okay, what are the few things that we can do to make small improvements that can change our health for the better, moving forward? Because what do we want? We want a better world for our kids. We want a healthier world for our kids. We don’t want our kids to grow up needing the medication, but the way things are going, if you have two kids, one of them is going to need a medication every single day. One of them is going to have a chronic disease. That’s terrifying!

Dr. Nicole Beurkens:

Absolutely. I’m glad that you said, a couple of minutes ago, when you were talking about the importance of collaborating, and most physicians being open, and you said, but if you are talking to your child’s healthcare provider and they are closed-off and they are being dismissive and you’re not feeling heard, it’s okay to go and seek out another provider who you do feel heard by. Let’s talk about that for a minute because there are families, there are parents listening right now, there are families out there who — there isn’t the possibility of having a real collaborative relationship with their provider. What do you recommend to those parents? How should they go about communicating their concerns to the current provider, if at all, how do they go about seeking somebody who might be a better fit? 

Dr. Joel “Gator” Warsh:

If you have concerns, I think it’s always better to speak to somebody directly, speak to them face-to-face. Address the issues that you have and see if you can resolve it, especially if you like the provider. But if you have, like some people, just been going to someday for 5 or 10 years just because that’s who your friends went to or that was the closest person to you in your area, then you definitely can think about switching and going to somebody else. And I can tell you this from the other side, it’s not personal. It’s totally fine, I tell people all the time: If you’re not happy coming to me as a physician, there are so many children out there, this is not a competition, we’re not trying to have every single kid in our practice. We want families that are happy, we want people that trust that, that have a good level of communication and that have a trust and a bond. We’re part of your family as a doctor, especially in the first couple of years, there are so many visits. If we’re not the right fit for you, for whatever reason, whether I’m naturo-minded and you’re not naturo-minded, or you want a big office and we have a small office, whether you don’t feel like you’re being listened — whatever the reason is, if you don’t feel like it’s a good fit, it is absolutely totally fine to say, “Hey, thank you so much. We’ve had such a great time, you were a great physician. We decided to go elsewhere.” It’s really easy. We just fax over the records to the other doctor, and people go. That happens all the time. People move all the time. We’re very used to having an in and out from our practice. We don’t take it personally. 

We want you to be happy and if we’re not the right fit, you need to go to someone that is the right fit, especially when it comes to things like mental health and discussions. You need to be with the right provider. You have to jive well with the child and you have to jibe up with the parent. Both people have to have a good level of communication. And if there isn’t that level of communication, you’re not going to get better. It’s not going to work if you don’t trust what your physician is saying and can’t get on the same team, and I see this all the time with let’s say teens. They’re going to a psychologist or a therapist and they don’t like the therapist. Well, it’s never going to go well. If they don’t like the person that they’re talking to. You have to love them, and then if you can have that open dialogue and conversation, the majority of healing from most of these things is in your head and it’s in the discussion that you have and the belief that you’re going to get better and trust in the process. And if you don’t trust what your physician is saying or your naturopathic doctor or whatever it is, it’s not a good relationship. 

And please, please, don’t feel bad. It’s totally fine. The switching happens both ways. You get people from other doctors and we give people to other doctors and we want you to be happy, and we want your kid to be healthy. If you don’t feel like you’re getting there then make that change. It’s not that hard to do. 

Dr. Nicole Beurkens:

Beautifully said, and I really appreciate you really giving people permission to change. Some people feel like, “Is that okay?” You said yes, it’s okay. Not only that, but it’s expected and it’s not a personal thing. I think so many people, moms especially feel like they don’t want to hurt anybody’s feelings, and what you’re saying is, look, this is how it works, right? And this is about finding the right fit. And I could not agree with you more: In the realm of psychiatry and psychology, we’ve had studies showing for a long time that 80% of the therapeutic benefit comes from the relationship between the provider and the patient, and I’m sure that it’s similar in the fields of medicine and whatever else, so I’m so glad that you raised that because I think that’s key, especially if you are parenting a child with more complex health needs, you as the parent need to feel like you’re on the same team, like there is alignment there, like you are being cared for, heard in the way that’s supportive to you, because if you’re not, then that’s going to get in the way, not only of the therapeutic relationship with the provider, but that’s also going to create more stress in the dynamic in the home between you and your child. So I really am thrilled that you brought that up. 

Dr. Joel “Gator” Warsh:

Yeah. Every office is different. And this is what — just going back to even the initial parent interviews that we have, and I think this is important for this conversation because people are trying to make choices for what they — But you have to, I think write down or at least know what it is that you want in the practice, in the physician that’s going to be the most important things to you. For example, our office, we’re a small office, we have two doctors, we spend a lot more time with patients, we have concierge type services where you have 24 hour access and people can text me after hours and things like that. For some people, that’s super-important.

Some people want to have constant communication with a doctor. They want to know that at 9 o’clock at night, if their kid has a cough that they can just text me and they don’t go to an answering service or whatever it is, but some people don’t need that. They don’t want that extra service, and that’s not a good fit for them, and they wouldn’t be a good fit for our practice. Maybe they want to go to a bigger office. They want to have somewhere where there are 20 doctors. There are all sorts of different practices and offices, and it’s not offensive for me if somebody can not choose my office because they want a different style of office. I choose the office that I like the best and it works for our patients, and people are happy. And that’s why people by and large here are extremely happy and don’t usually leave, because it’s the right fit. When we do an interview and we talk about what we do, and I think you have to find that kind of practitioner in your area and if it’s not the one that you’re with, there are other kinds of doctors around, unless you unluckily live maybe very, very remotely, and then maybe you only have one option — well then, that’s where you have to work on that communication, but for most people that live in a city, there are multiple options all over the place for pediatricians. 

Even if you’re not an integrative doctor, there are lots of integrative-minded doctors who are more open to things and you can generally find that by asking friends, going on Facebook groups and saying. “Hey, I live in Rhode Island…” or wherever, “…anybody know a pediatrician that is more open to x, y and z?” And people always find out. In our Facebook group, people ask that kind of stuff all the time. And that’s how you find someone that maybe even more in line with what you’re thinking. 

Dr. Nicole Beurkens:

Yeah. That’s great. What I hear you saying is that it is important to, whether you call it an interview or whatever it is, to have some conversation initially up front, to schedule an appointment before any care is provided, before you’re even part of the practice, to talk about that. To make sure that it is a good fit. I think especially if you’re — a lot of people are in a situation where maybe the integrative practitioners in their community don’t provide primary care. So they have to utilize a pediatrician or a family practice physician for primary care, and then they are utilizing an integrative person or specialist for other kinds of things. I think it’s important in those situations too to have that initial conversation an to specifically ask about openness for cross-communication and collaboration because what I see is some families are working with lots of different people in the medical realm, and if they are not communicating well or they are not open to collaborating with one another, especially if it’s a child with more significant concerns, that can become a problem. 

Dr. Joel “Gator” Warsh:

I think it’s super-important to interview a doctor if you can. Not every doctor is open to doing interviews, but most do. But even if you can’t do an interview, kind of your visit is an interview, so you can always have that be your interview and ask them all your questions and then make your decisions after that. But it always baffles me when people just don’t — they call after they’ve already had their kid and they just want to come in and see me. And I always find that very funny, and it’s fine. It’s great, I mean you’ve read good reviews or whatever it is and that’s what makes you want to come. But for my kid, I would never want to send my kid to a doctor without ever knowing anything about them, never meeting them, never talking to them. 

That person is so important in your life. If your kid is sick, you’re going to be calling them. They’re going to be the ones saving your child’s life or noticing something is off at some point, if need be. And that should be someone that you trust and you like and you respect and goes along with your — is in line with your value, I should say. So to me, interviewing is so important, or at least doing your research and thinking about it over the first visit and if it’s not in line, if you can’t do an interview but you go over there or something, you can always look for somewhere else after that. But don’t feel like you can only go to that one doctor that you’re assigned to. That’s not the case. You can almost always find a different practitioner. Even if it’s a big group. I used to work at a children’s hospital in Los Angeles. There are hundreds of doctors in there, so you could be assigned or want to go to a place, but you can always switch to a different doctor in the group until you find one that you love. 

Dr. Nicole Beurkens:

Yeah, and I think something that’s coming to mind right now, for those of you who are listening who are thinking, “Well, I did interview our pediatrician back when I first had kids, but now it’s not a fit.” Look, for most parents, when you first are choosing a pediatrician and you’re first having children, you don’t anticipate that you’re going to end up with a child with special needs or with these issues. So as your needs or your child’s needs change over time, that may require a reassessment of what that fit is going to be. The person that you chose initially may have been wonderful for general pediatrics, but you may now have a kid with more severe autism or more significant physical health conditions or ADHD or learning disabilities or whatever it may be, and that person may not be the best fit for that. So to feel like, “Okay, that’s not my fault as a parent that I didn’t pick the right person. It’s just that needs have changed, circumstances have changed”, and to be open to looking at what is going to be the best fit based on your current circumstances. 

Dr. Joel “Gator” Warsh:

Yeah. And you’re not going to go to your family doctor to deliver your baby, right? You’re going to go to an OB to deliver your baby. Everyone has different needs. Sometimes the doctors do deliver babies, but that’s beside the point, but I think that if your child has autism there are people that specialize in that. There are pediatricians that specialize in that, there are practitioners outside of pediatrics that specialize in that and it’s really fine. For me, if somebody has something like PANDAS or PANS or something more complicated, most doctors can handle it in the basics of it. I can handle a lot of those things when it comes to the basics, but there are people that do it every single day, all the time. They know all the minutiae, they’ve done more of the research, they’ve read these things. Just like if you have an gastrointestinal issue and you go to a gastroenterologist, I know a lot about the stomach, but I don’t know as much as a gastroenterologist, so sometimes you just need to make that change, which is the better fit for your family. That’s fine, that’s good, that’s what you should do. 

Dr. Nicole Beurkens:

Yeah. Awesome. This has been so helpful. I know that there are so many parents listening who are sort of breathing a sigh of relief of “Okay, maybe I felt like I needed to make a change but I didn’t know how to do it/I was feeling unsettled.” And I think you’ve really reassured people that not only is it okay, it’s an important thing to do, and given some really practical tips for how to do that. I want to make sure that people know where they can find out more about you, not only your practice, if they happen to live in the Beverly Hills area and are looking for an integrative pediatrician, but I know that you’ve got a lot of resources available online too. So where’s the best place for people to find out more?

Dr. Joel “Gator” Warsh:

You can find me at integrativepediatrics.com or @drjoelgator on Instagram. Those are probably the two easiest ways. 

Dr. Nicole Beurkens:

And I follow your stuff on social media — lots of great information and resources and humor and all kinds of great things there, so I encourage people to check all of that out. Thank you so much for spending the time with us today. This has been a really important and really helpful conversation and I know that we all are appreciative of your time, so thank you!

Dr. Joel “Gator” Warsh:

Thanks for having me!

Dr. Nicole Beurkens:

And thanks to all of you for listening, we will catch you back here next time for our next episode of The Better Behavior Show.