Pediatrics

Your Real Responsibilities:
Nothing. You’re a medical student. You don’t count. I hear that in Arizona they’re going to replace medical students with migrant workers. Sure, they’ll have to pay them minimum wage but this is peanuts compared to the cost of educating a medical student. This way the hospital will save money, the employees will still have somebody to look down on, and the migrant workers can always mop the floors or do other useful work, something that you can never get out of a medical student.

Your Pretend Responsibilities:
Managing pediatric patients on an in-patient service. Attending pediatric outpatient clinics and learning to handle the breathtaking excitement.

Things You Should learn:
Presentations and treatments for common pediatric problems like rashes, diarrhea, colds, and vomiting. Developmental stages of childhood, normal milestones, and what to do or who to call if the child is not meeting them. Common congenital conditions. The major chromosomal abnormalities (like Trisomy 21), common congenital heart defects. Diagnosing and managing the more serious pediatric diseases. Identifying child abuse (a big one in my book). Learning how to examine sick and well kids without having them scream in fright during the whole exam.

Otitis Media. The big one. Deserves a whole blog of its own.

Things That Will Suck:
1. Well, it’s pediatrics. It all sucks if you don’t like kids. I have my own kids so I had a running start at disliking it. Other than that it’s not too bad. Inpatient pediatrics is as bad (or as good) as inpatient medicine. You will round, present, and take call. The primary philosophical difference between pediatrics and medicine is that most kids will get better and make a complete recovery, something you will not see that often on an adult medicine service where you sometimes feel like you are playing “Keep Away” with the grim reaper. But ward months are ward months and call is call. Rounding sucks no matter on what rotation you do it.

2. There is no clinic known to man more boring than outpatient pediatrics. Most kids are just not that sick but their parents bring them to the doctor with distressing frequency. The major culprit is the “Well Child Check.” The Well Child Check is a periodic screening exam to make sure that kids are growing appropriately and have all of their immunizations. If you can think of something more mindless than asking the same questions over and over about usually healthy children and plotting their height and weight on a growth chart then you have probably worked at more crappy minimum wage jobs than most of us.

Like two men and a ham, pediatric clinic can seem an eternity. The hours flow like thick syrup. Having to ask the questions in Spanish cuts the excitement in half.

Cool Things About the Rotation:
1. Well, they are kids after all. Who doesn’t like kids, especially if they are not yours and you don’t have to take them home? They are kind of cute and every now and then you will get a stupid smile on your face which you can’t get rid of.

2. Their are few things as gratifying as seeing a really sick kid get well through medical intervention. And, while you may not see this as a medical student, running a successful code on a child is probably the best feeling in the world (just like having to call the code is one of the worst).

3. The residents and attendings are fairly benign. Malignant people, as a rule, don’t go into pediatrics preferring as they do to keep their options open in Med/Peds. Additionally, if you want to know the one specialty that is a calling it’s pediatrics. The pay is bad, the hours are long, but people do it because they love it.

Call:
Fairly lame like most medical student call. You will soon grow tired of hiking down to the Emergency Department to help admit yet another asthma exacerbation. Or dehydration and fever from gastroenteritis. Still, kids are generally not as sick as adults even when they are admitted to the hospital so for the same size census, you will get fewer floor calls. I suppose that’s something. You know how I feel about losing sleep. As a resident it’s unavoidable as not only are you responsible for the patients but you are also getting paid, things that are not true for medical students. Have I said this before? I think it’s dumb for a medical student to answer floor calls as he is just going to have to page his resident for guidance. I say eliminate the middle-man.

Slacking Potential:
Not so good. Terrible in fact. It’s just medicine for kids with all of the rounding, morning reporting, conferencing, and other mandatory activities. When you’re doing your ward months you will pretty much be stuck with your team all day, every day so if pediatrics isn’t your bag you are out of luck. Clinics are, of course, mandatory, usually pretty busy, and dull.