Monday, December 20, 2010

Pediatrics as a Med Student

My first third year rotation was in pediatrics at my province's major pediatric hospital. Pediatrics is a great first rotation because the attendings, residents, and nurses are used to dealing with children, so they are patient. At the start of third year, patient co-workers are probably the most essential part of our learning because we have very little practical medical experience.

Learning how to function in a hospital as a medical student isn't easy. We are learning how to manage our patients both medically and personally; understanding the medicine isn't useful if we can't build enough rapport to elicit a history. We also have to bridge the gap between the attending physician/residents and the rest of the hospital staff.

Throughout the first two years of med school, we are constantly warned about third year because being at the bottom of the medical team totem pole is a terrible place to be. Why? Because crap really does slide downhill... If the medical team is upset with the nursing team, they yell at us. If the nursing team is upset with the medical team, they yell at us too. At the same time, we are never supposed to demonstrate any outward signs of distcontent at the anyone. The mentality is: "you know how many people tried to get into medical school but didn't, you're lucky to be where you you should thank me for telling you that you're incompetent because you didn't do the thing I forgot to tell you to do".

However, my experience in pediatrics was fantastic because all of the staff were interested in teaching us and most realized that we were in the infant stages of our training.

Another challenge in pediatrics is dealing with patients. We have all worked with patients in first and second year, but now we actually have to manage acutely sick patients for the duration of their hospital stay. Particularly difficult in pediatrics because kids are not rational, dislike waiting, and often fail to communicate important issues. We are told to rely on parents to liaise with their kids...this is often a good idea, but sometimes it's actually a terrible idea. Having a child who is sick enough to come to hospital is a stressful situation and some people deal with stress better than others. Some parents are calm enough to provide excellent histories that thoroughly describe their child's problems. Other parents are too overwhelmed by their child's illness to be able to remember anything relevant about their child's health. Histories are usually more important than any physical exam or laboratory investigation we can undertake. Thus, if we don't get a good history, we are much slower at starting the correct management for our patients. Delays in management mean extended hospital if you don't want your kid to be in hospital any longer than they need to be, make sure you can provide a good history!

So my take on pediatrics as a med student:

1. The staff are usually very friendly and easy to work with.
2. Patients are usually a lot of fun to interact with.
3. Kids rarely want to stay in the hospital any longer than they absolutely need to.
4. Kids usually get better.
5. Kids are hospitalized for reasons that are not there fault (i.e. Not too many kids come into hospital with a COPD exacerbation from smoking).

1. Patients with only one issue to manage...kinda boring.
2. Often can't rationalize with a kid.
3. The bread and butter pediatric patient is either ADHD or failure to thrive.
4. Pediatrics requires very very detailed paper work.
5. Limited job opportunities if you want to sub specialize.

I had a lot of fun in pediatrics, but it is definitely not the specialty for me. In the end, I think I would get bored in the long run.

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