Pediatrics in brief

Pediatrics is already halfway over, I can hardly believe it. I have mostly loved it so far, and even though my inpatient month is over, I can’t imagine that my outpatient month will be so miserable as to entirely deter me from this specialty.

It barely took a week into the rotation to see some noticeable differences that set pediatrics apart. A number of aspects in particular are in stark contrast to the last 2 months in Ob/Gyn (which were miserable on the whole). The first thing I notice here is that the residents and attendings smile. And they laugh. And they even joke around with each other and with the patients.

I know, it’s a shocker. In fact, I was in the presence of more happiness in the first 6 hours of Peds than in the entire 2 months of Ob/Gyn. The docs here are also legitimately nice people. During morning rounds, they say “pull up a chair, sit at the table with us” (during Ob/Gyn the students were permanently resigned to the “outskirt” seats away from the table, along the back wall of the room).

When make mistakes, nobody reams me, they just explain what was wrong or what I forgot without the snippy edge or eye-rolling I had grown accustomed to. In other words, like a normal person who has respect for the student as a learner. It’s not as if I haven’t encountered one of these before, but never in such large percentages. I haven’t yet met a single jerk doctor. I’m sure they exist, but I have also been told that Pediatrics is a specialty that does not tend to attract what are referred to as “competent jerks.”

Obviously, everybody has their moments; there was a particularly stressful day last week during which neurology consults weren’t finished until 7pm (which is obscenely late) and the residents had to stay until 10 to discharge patients that neuro had cleared. It wasn’t any individual residents’ fault, but two of them got into a near-shouting match about it and one of the interns was caught in the middle.

The stress gets to everyone, but the point here is this: it was a big change to not have to be constantly unsure of how the residents would react to your presence from hour to hour.

I’ve also found that while peds comes with its own set of common illnesses, like asthma, bronchiolitis, gastroenteritis, and abscesses, many of the adult illnesses that I truly abhorred are pleasantly absent (or nearly absent) from the pediatric population. Granted, there are still type 2 diabetics, but there are very few and between the willingness of the patient and the involvement of the parents, there is time for intervention before their feet fall off and their kidneys shut down. For the most part, though, when a kid comes in with a giant bag of medications, it’s much more likely to be because of something that happened to them, rather than something they did to themselves. I find it easier to have sympathy for sick, whiny children than sick, whiny adults.

Of course, in pediatrics, you are still dealing with plenty of whiny adults in the form of parents. One of the most frequently cited sources of annoyance among the residents is a parent, whether too overbearing, too demanding, too aloof, too short on common sense. And you have to go through the parents in order to do any sort of treatment on the child. You might guess that in adult medicine, the patients are much more likely to risk their own health in search of a cure for illness than a parent who is consenting on behalf of their child.

Many times, more so with the younger kids, taking a history feels a lot like what I imagine life would be like as a veterinarian. Because the kiddos can’t always say how illness affects them, an accurate picture of the illness depends on how observant the parents are. While parents can often hinder effective medical care of their children, they are also some of our most important allies. The vast majority have parents who care enough to at least try to get their kids well (or allow their doctors to do so), which means that if you can get the parents on your team, then there’s a much better chance of these kids being compliant—and seeing success—with whatever treatment plan you choose for them.

I suppose you could argue that the parents might go ahead and do whatever they want without following the treatment plan, but adults do this, too. And with any specialty, there are going to be people without basic health education, and there will be those without common sense, and then there are a few who are just morons regardless of how much benefit of the doubt you give them. Helping them to understand health is something that I’m learning to do at every possible level of education, and it’s something that applies whether a physician is in peds, internal medicine, surgery, even dermatology.

Now that I’ve moved to outpatient pediatrics, there’s more time to do every kind of teaching from bicycle safety to the importance of reading and even ideas for age-appropriate activities to do with their kids. But the post is sufficiently long for now, more on the details of outpatient pediatrics later.