Pediatrics: Part 2

This week I completed the subspecialty portion of my Pediatrics rotation. Though I still maintain that Pediatrics is just not for me, it gave me some insight into the world of subspecialties (something we don't get a lot of exposure to this year....naturally, we have to learn the basics first after all).

It was definitely a whirlwind tour. In 5 days I rotated through Endocrinology, Gastroenterology, Pulmonology, Cardiology, Adolescent medicine, and a clinical research clinic looking at childhood obesity. I spent half days in some of the clinics, but fortunately we had the opportunity to spend more time in a few areas of interest (I chose to focus on Endocrine and GI).

And I realized a couple of things:

1. Specialists see a lot of unusual cases. Pediatricians in particular have the cornerstone on congenital disorders (problems that are present at birth). This week I saw kids with syndromes I had never heard of, and one case that most would not have heard of because it is so rare. What I had not realized about pediatrics was that some of these kids may stay with their pediatrician for life since they are more experienced in this area(I am a total sucker for continuity of care!).

2. Specialists see a lot of redundancy too. This wasn't exactly a surprise, but I was somewhat amazed that in 2 days of Gastroenterology I saw little variation on the themes of abdominal pain and failure to thrive. And in my morning of Pulmonology we only saw Asthma cases.

My insights are not groundbreaking by any means, but personally this was a helpful experience since these concepts apply to adult subspecialities as well. First, I did enjoy seeing some of the more unusual cases. I could tell that my attendings' years of experience made them well equipped to handle both usual and unusual presentations. I like the idea of becoming an "expert" in a field and not having to defer to someone else to make clinical decisions as primary care docs often have to. Naturally that leads to some redundancy. These doctors are able to tease out difficult diagnoses because they see the same things over and over again. I found that I liked the variety of cases I saw in Family Medicine (though there is certainly plenty of redundancy there too), so specializing might come at a cost for me. And perhaps many specialists temper the redundancy in their differential diagnoses by partaking in other things like research and clinical trials?

Next week I am headed back to the hospital to work in the Newborn nursery! Stay tuned...

Pediatrics: Part 1

I just completed my 2-week community pediatrics rotation. Well, really it was a short 2 weeks because Thanksgiving break was right in the middle. I was placed in a small practice (2 doctors and one nurse practitioner) in a Richmond suburb, about 20 minutes outside the city.

The first week was kind of a wash since we had orientation on Monday and my preceptor works a half day on Tuesdays and I was a bad(!) medical student and asked for some time off on Wednesday to pick up my bestie from the airport....so I only worked one full day in total. Heh.

And Thanksgiving was marvelous! I hope yours was too! Not to mention, I turned another year older last week.

This week I had to get serious and make up for lost time. I am pretty sure my preceptor thought I was an idiot (and I probably was one), but in my defense I have pretty much never seen pediatric patients before (see my previous post on family medicine in which I almost never saw kiddos, or see way way early posts on my first 2 years' family medicine preceptorships in which I also basically never saw kids).

So I had to learn quickly how to examine babies, toddlers and adolescents. And trust me, they all require a different type of exam. It was also hysterical to me when I would listen to a 2 week old infant's heart and lungs with my adult sized stethoscope and it would basically cover their entire chest (hyperbole intended). In addition, kids have different types of medical problems than adults: ear infections, asthma/allergies/eczema, and tons of upper respiratory infections. Sure, adults have some of those problems too, but usually it's one of the above plus hypertension plus diabetes plus osteoarthritis, etc. Dare I say I got bored. I also might add, I got sick! All those kids are just running around incubating viral disease! Ew!

I will try not to run this conclusion into the ground over the next 2 months of my peds rotation (though it might happen), but I think pediatrics is just not for me. I sort of knew this going into the rotation, and I tried not to let my lack of experience and interest cloud my judgement (though it still may have). In the last 2 weeks, it seemed that the parent was the patient more than their kid (reassurance, reassurance, reassurance). The medical problems were not very complex nor the diagnoses/treatments. There were almost no procedures (though this is likely the choice of the practitioners and not a generalized truth). There is always someone screaming/crying -somewhere- in the office and it caused me a constant, mild amount of stress. It makes me really uncomfortable to cause distress in a small child (even if I know I am not hurting them and they are just scared). Ok, one positive: some of them are pretty gosh darn cute.

Next week I will rotate through a bunch of different pediatric specialty clinics (endocrinology, gastroenterology, cardiology, pulmonology, and adolescent clinic) and the following week I will be in the newborn nursery at the hospital! Until then...