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...