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Toddlers: 12 - 24 Months
I freaking hate our pedi office
I would love to switch to someone else, but we're military and the only place Tricare will cover is this particular Military Treatment Facility. UGH!
First of all, we never see the same pedi from appt to appt, which doesn't usually bother me because I often don't want to see a particular pedi again. DS has been seen by no fewer than 5 different pediatricians, mostly residents working without any apparent supervision.
Each and every one makes a stink about the size of his head. It's big, it's been big since he was a teeny little guy. It's a family trait, and earlier docs examined him and decided it's nothing to worry about. And yet, every.new.pedi that sees him makes a big deal out of it and wants to run tests or bring him in for more follow up. They don't even look at the old notes until I remind them to. 
And then the most recent pedi just told me he's not gaining weight quickly enough. She told me to feed him more fatty foods and looked at me like I have three heads when I told her he's already a great eater. I didn't argue with her, but I went home and plotted his growth on the chart I've been using all along. Dude, he gained 2 lb 4 oz since January! He's in the 68th percentile or so and has always been there. WTH!? Use the wrong chart much, doc?
And then there's the pamphlet they hand out at each visit. Some gems from the 12 month one include:
Now that your baby is 12 months old, you should wean her from formula or breast milk onto cow's milk... (Nothing against cow's milk, but there's no way in hell you're going to make me believe cows do a better job nourishing my kid than I do. Not to mention this goes against the AAP, the WHO, and just about every other medical organizations' recs.)
And my favorite: If your 12 month old is at least 20 lbs, you may turn her carseat forward facing now. Remember, she must continue to ride properly restrained in a carseat since it is [state] law... (NOTHING about carseats being safer and NOTHING about the option to keep toddlers rearfacing!)
I am so incredibly pissed off and fed up with these guys. 
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Re: I freaking hate our pedi office
This one gets a huge eyeroll from me. I'll never understand the rush to get babies off of mother's milk in order to drink milk from another animal. It makes no sense. Grrrr.
Sounds pretty standard to me, actually.
If pedi's offices started printing their literature to include every possible option and alternative regarding feeding, car safety, and other "up to the parent" stuff, each pamphlet would be the size of a dictionary.
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eh- i can see her point about the head size. nobody wants to hear alarm in their pedi's voice about anything. it's annoying to have to go through it every time.
For the most part, no, they're not horrible. But it's a bunch of little things adding up to one big PITA.
And I do think it's a bad idea to tell parents they need to wean from breastfeeding at one year. No, it's not going to hurt the kids, but it does go against the pediatricians' own medical organization's advice. Smooth. And it unnecessarily makes parents second guess themselves. Not everyone feels comfortable questioning the advice of their kid's doctors' office or is well educated on breastfeeding.
And I do think the carseat thing is a big deal. Carseats are safer (it's not just about "the law"). And rearfacing is safer. It's been proven. IMO, if a parent knows the facts and still decides to switch to forward facing, that's fine. The parent is within the law and is responsible for her own kids' safety. But I think the pedi office should at least present the option of keeping a toddler rearfacing--not enough parents even realize that's an option.
Not only that, but one resident started talking about doing a CT scan of his head. That's a whole lotta radiation to expose a baby to for no good reason! (Granted, the staff doc would hopefully have nixed the idea anyway--and DH and I certainly would've objected--but still.)
Hadn't really thought about switching to Standard. Might be an option to consider.
That is really sad if someone is uncomfortable questioning the advice of their kids doctors or any doctor for that matter. Everyone needs to be their own advocate and especially their childs.
Why not say to the pedi or even the office manager, hey you realize that the pamphlets you hand out are a bit misleading? You might want to change them or update them because it's not necessary to ff at 1 yrs old or even discontinue to BF at 12 months.
As for the head issue that is frustrating but it's to be expected when you are dealing w/ a ton of different doctors. DD has the same issue & I always just remind them that she has always had a big head.
Military Treatment Center's are clusterfucks. There is no other way to describe them based on my experience at three different ones in 15 months. The last doctor DD saw at one wanted DD to receive early intervention because she wasn't speaking in 2-3 word sentences at 15 months. The majority of the doctors aren't board certified in any discipline. They never communicate with each other, nor do they put notes in the computer. The "office managers" are usually completely overworked or simply don't care. The last clinic we were assigned to "cares" for 6,000 family members.
OP, I don't know where you are stationed, but it may be possible to stay on Prime and see a doctor out in town. Both DD and I went to the patient advocate and we were switched. For us, it was clearly a competence issue, but you could complain about the inconsistent care. Trust me, I know seeing many different doctors at a MTF is a lot different than seeing different pedi's within the same practice. I've ended up in the hospital commander's office because of such issues. Let me know if you have any questions.
My pedi is part of a very very large HMO network in CA. The largest in our state I'm sure. They have standard handouts for each well-child visit that include advice to CIO, institute time outs and that one year and 20 lbs is a perfectly reasonable time to turn a child forward facing. I ignore all of it.
Sadly, when my SIL was told by her pedi at her oldest's one year appointment to wean her from BM to WCM, she did it. She wasn't ready but she trusted her doctor. She never questions them on care for her kids even though the person isn't that great. She doesn't question authority in other areas either so it isn't a surprise and she doesn't spend any time on something like a parenting message board so she isn't exposed to the variety of ideas and parenting styles. She's an awesome mom anyway.
She's a teacher and is so amazing with kids.
Go to the Tricare office and file a grievance to switch from the MTF to a Prime provider of your choice. If that's denied, switch to Standard.
You can stay on Prime and just switch your LO to keep OOP costs down.
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I'm definitely going to look into my options for seeing a civilian pedi. I didn't know about some of these other options, so thanks for the heads up!
I possibly am overreacting a bit, but I don't care. I still think the peds clinic sucks. (Come the think of it, OB/Gyn wasn't much better...)
The lack of continuity of care is what really gets my goat. First of all, seeing the same provider as much as possible cuts down on mistakes and wasted time. If we could see the same provider most of the time, we could have a much more productive, efficient visit since we wouldn't have to spend 10 minutes going back and forth about Kiddo's big noggin. We also wouldn't have any more trigger happy docs wanting to expose my infant to a nice dose of ionizing radiation. And we would avoid things like that last doc telling me my kid isn't growing properly. (It's easy enough to make a mistake on the computer--I get that--but common sense should've cued her into her mistake. DS certainly doesn't look on the small side.) Given the option, I would hope I could choose a pedi who uses common sense in addition to the charts and computers, or who at least listens to me when I raise an objection.
As for the pamphlet, I think misinformation is worse than no information, and I expect my doctors to make evidence-based recommendations. Correct me if I'm mistaken, but there isn't any good research that suggests babies should be weaned from breast milk to cow's milk at 12 months. Weaning is an option. There's no medical reason a mom *should* do it. There's a big difference between an option and a recommendation, IMO. The carseat thing is even worse. Not only is the office not presenting more than one option, but they're making a generalization that is not always true. There are carseats on the market that must remain rearfacing until the child reaches some minimum height or weight that is over 20 lb. You can't automatically say that you can turn your kid at 12 months/20 lb no matter what. Oh, and the pamphlet says 12 month olds need 2 shots. When was the last time toddlers only needed 2 shots?! I'm thinking the problem is the pamphlet wasn't updated since around the time I was a kid! And, really, there's just no excuse for that.
The current research says that childhood exposure to ionizing radiation (such as from a CT scan) leads to an increased lifetime risk of dying from cancer. The techs/docs can take steps to limit the amount of radiation a patient is exposed to, but the risk is still there.
CT imagining is a fantastic diagnostic tool, and I would not hesitate to have DS CT'd if he truly needed it. But I--and most of the docs DS has seen--think it would be completely unnecessary in this case.
I don't have a problem with residents on the whole, but I think some of the residents in this particular clinic need better supervision and/or better instruction. I have no problem with DS seeing a competent resident who knows her limits, uses common sense, realizes that sometimes the parent has useful insight, and is comfortable asking for help when needed. We just don't seem to be getting those residents!