I shadowed the pediatrician on Wednesday. It was a little more exciting than usual because the water was not working. No sinks. No working toilets. Nothing in the entire building! The hospital next door also did not have water, but they could run off the reserve tanks. Nobody talks about urine as often as they do when emptying your bladder is no longer an option! The nurses joked about cathing each other and a few little patients needed urine specimen cups because they simply could not wait. It was the first time I ever left campus for lunch while shadowing because venture out into the world in search of working restrooms. I had to ration my beverage at lunch so that I wouldn't have a full bladder later in the day, which worked like a charm. Nice to know I can hold it when I have to, I've heard enough horror stories about med school and residency to know it is a skill I need to have.
Clinic itself was interesting, as always. A few new things I saw: a 5 year old who broke 100 pounds (I thought the nurse had written the temperature in the wrong spot on the chart!), molluscum contagiousum, and fingernail shedding from HFMD. I also got to use the otoscope to visualize an infected ear (KayTar was so jealous when I told her I used the otoscope). We saw a few kids with pneumonia, one poor guy with both flu A and strep, and a lot of cute 9 month old babies. It was 9 month old day, evidently. I learned that sometimes, no matter how many different ways you say it, parents/patient just don't understand that something cannot be cured with a prescription...be it eczema or a virus. These are the patients/parents who leave very unsatisfied when they don't leave with a magical cure-all prescription and feel like they've wasted their time in clinic. I also learned that sometimes you can spend 10 minutes explaining something to patients/parents in great detail as they nod in what you perceive to be understanding, and as soon as your hand touches the door knob to leave the room, they ask you the EXACT SAME question you just spent 10 minutes answering. It makes you wonder about people.
We ran behind and didn't finish up until nearly 6pm. I got home between 6:30 and 6:45pm. Josh and BubTar had been working on his science fair project. The house was messy, the kids hadn't had dinner, and they go down for reading time at 7:30pm and bed at 8. My feet were quite tired (I'm not used to standing and walking all day yet!), so I took a 5 minute break when I walked in the door (well, if holding a chatty 5 year old in your lap counts as a break), but then we had to get down to business. We cleaned up a bit, made BubTar a quick dinner, and then KayTar begged me to play a game with her, so I did. We played anarchist Cootie (Cootie without rules) and she decided to make a KayTar-Cootie and an Uncle Z-Cootie and marry them. I told her, "KayTar, you can't marry your uncle!" And she said, "This is NO RULES Cootie, we are going NUTS!" I couldn't argue with that logic, so I officiated the Cootie marriage. In the blink of an eye, it was reading time. Once the kids were in bed, I took my shower, ate a pudding cup for dinner, and fell into bed. I think I watched a little TV, too, before zonking out around 10pm...which is early for me. This was the first mid-weeknight I have shadowed and it was quite a different experience at home. On a Friday night, things are much less structured around here so it doesn't make much of an impact, but during the week it does...it felt more accurate. Makes me wonder what evenings are like for most doctors with young kids! By the time I'm an actual doctor, my kids will be considerably older...but I'm sure we will have plenty of wild evenings during training!
It seems as though I brought home a little souvenir from clinic, as my throat has been inflamed for a day or two now and sleeping last night was next to impossible between little apneic episodes and the general discomfort in my throat. It isn't painful, it just feels swollen. I feel fine otherwise, but my throat sure is irritating me. I really enjoy being in clinic, though, so a little viral pharyngitis is a small price to pay, right?
The reasons parents feel unsatisfied is because their agenda hasn't been met. They come in with the agenda that My Child Has A Problem That Needs Fixing. Your agenda is usually I'm going to diagnose and treat appropriately. The key is getting those agendas to meet.
After I review a plan with parents I ask them both if they understand and if they're ok with this. It gives them the opportunity to be an active part of the decision making process, rather than a passive one.
If I think they don't understand, I ask them to repeat the plan back to me how they understand it.
If they're not ok, I ask why and what's the thing that worries them the most about this.
If I can get a parent to tell me what they're thinking about their child's illness, that's my best treatment.
I think the pediatrician did a great job with that, right down to asking if the information was understood, which was met with an affirmative answer. However, once we started to leave, the parent asked the same question that had been answered, in detail. The pediatrician did go over it again, patiently and a little differently to try and clear up confusion. I don't feel like it was a failure of communication, but maybe one where the parent had expectations that couldn't be met medically, like a cure for a condition that requires maintenance treatment. Although it was explained that the condition needed to be treated regularly to be kept under control and would become problematic if treatment was discontinued, it was unsatisfying for the parent because she wanted the condition to be gone and not have to continue treating it.
In another case, the parent was dissatisfied that she had brought the child in for a viral URI and she wasted her co-pay with nothing tangible (ie:antibiotics) to show for it, although it was explained that for a viral infection, antibiotics will not be effective and what she was doing at home was the best treatment for the symptoms. These were the exceptions and not the rule for sure, though!
It's really interesting to read these shadowing stories. Thanks for sharing.
And, what is Cootie, much less Anarchist Cootie?
I'm a pediatrician and mom to 3 kids (8, 5, and 9 months) and yes, it's exhausting coming home after a full day at the clinic then getting them to bed, then having to catch up on the charting. Just wait until you have to document everything you do!
Yup, peds clinic is exhausting. That's why I decided on pathology:), after sitting down all day at the scope I'm ready to do projects, cook dinner, and play tag - often all at the same time! But a life at the scope is only appealing to a few people.
Sounds like you are having a blast. My kids have the pharyngitis crud, too - I lined them up the past two nights for some nighttime Triaminic cold and cough. Works like a charm.
i bet you'll keep seeing interesting things. even outside of no rules cooties. ;)
I'm also completely fascinated by these stories. I've always been interested in medicine and I enjoy living vicariously through you on your journey. :)
And yay for a day filled with 9 month olds. Teedle is just about that age and I swear his cuddles just get sweeter and sweeter.
The NP out our old Ped (he passed away just recently) said that no matter how much hand washing she did at work, she would change clothes and shower before touching her own kids. So many germs, all day long.
Wow, your life is busy. It's a good thing you're young and have enough energy for all of it!
Peds is so rewarding though huh?? Exhausting which is why I now have my dream job of working only T/W/TH. With great EMR you can access your charts from home and catch up on your day off. I try not to do this but I will check my inbox and return some calls. I often tell people to call me if the fever isn't gone in two days and we can talk. It lessens their fear of winding up in the Urgent care with a 3 hr wait and makes me feel better that they are relieved.
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