Sunday, October 22, 2006


Flea's recent post about the things a general pediatrician can do without referring kids to a subspecialist put me in mind of the time I spent as a general pediatrician. I practiced it for about a year before I saw the light (realized it wasn't for me) and went into neonatology.

There are good and bad things about being a general pediatrician. The best thing is that you get to work with kids all day. They could really be pretty funny and just make your day. Some would be outgoing and glad to see you, while others would cry when you came near the door to their room. I also liked the variety of general pediatrics. You not only took care of all ages, you took care of all kinds of diseases, from infectious diseases like strep throat to the much more nebulous diseases like ADHD.

Eventually, though, the large amount of time spent on minor things, coupled with the huge amount of worry by parents about these minor things, got to me. You have to enjoy being a counselor, I think, to enjoy general pediatrics. Parents need lots of reassurance and instructions. And I don't mean this as a criticism of parents, because that's expected. When it's your own kid, even minor things seem major. Taking care of runny noses and ear infections, along with the seemingly endless stream of well child checks, just wasn't my thing.

One particular scenario bugged me the most. Mothers would often bring their, say, 8 to 15 month old child in to have the ears checked because the baby wouldn't sleep at night, and they were worried it might be an ear infection. More often than not, there was no ear infection and the baby was staying up at night because, well, that's what babies do sometimes. In such cases the parents would often be disappointed that their baby didn't have an ear infection, because then they would have had something to treat or at least to blame it on. Parents being disappointed because their kid wasn't sick: I understand it, but still, it bothered me.

I'm happy doing neonatology and at the same time am happy that there are docs who enjoy practicing general pediatrics. I have a great deal of respect for them. They work very hard, have to know a wide variety of things, and somehow have to pick out the one kid who has a serious disease like meningitis among the 100 or so kids with fevers and colds they see. My hat is off to them, but I'm glad I'm out of it.


Blogger Flea said...

Good for you, bad for us fleas. We need more general pedies who realize how crazy is the world we've helped create, AND who are willing to help me stuff that toothpaste back into the tube.



5:54 PM  
Blogger Dream Mom said...

I have great respect for Dear Son's pediatrician however at the same time, I expect to be referred to a specialist. We see his pediatrician mostly for wellness checks, shots and referrals. I consider him an important part of Dear Son's healthcare however. After twelve years (we had another ped for the first three) he has become a good friend and is always excited to see Dear Son. Because Dear Son is frequently hospitalized at the Big Academic Medical Center, our ped is rarely part of that equation. I will keep him though because he is a great resource for me and it's a good checks and balances as I call it, when I think something doesn't seem quite right. He's a great pediatrician though-very proactive plus understands the issues of special needs children AND is willing to make time for them in his practice. I am lucky because he specializes in Peds and Internal Medicine so I can keep him as Dear Son grows up.

At this point and time, our primary specialist (ped neuro doc) does most of the caretaking. He takes care of neuro issues and is a great ped at that. He is always right on the money when something isn't quite right. Due to the nature of Dear Son's issues, it makes sense that he actually does more referrals for us, plus does all of the letters of medical necessity etc. that we need. Undoubtedly, he spoils us and from what I hear, does the same thing for all of his patients.

I guess my pet peeve with Peds was early on when the first ped we had didn't have time to spend with me on issues like how to feed Dear Son when he couldn't sit up, had oral/motor issues, etc. etc. Peds in general (both docs and nurses) is boring to me. Maybe it's the babies/kids crying that drive me crazy, I don't know. I actually love babies though. My favorite specialties/docs are usually neurologists, neurosurgeons and ICU and my favorite nurses are those is the PICU. I love the complexity there and the fast pace. The place I like the least is the ER-very monotonous to me, plus I hate giving the medical history.

I think the most important thing is finding a specialty that you love and something that you are good at-that comes through at every level.

7:46 PM  
Blogger Ex Utero said...

I did some rotations in residency that were pretty cool.

General Ped.s in Idaho is pretty different than say... Boston. In rural Ped.s you might set a bone one visit, treat scabies the next, diagnose a teen pregancy, and yes treat a god-zillion cases of rota-virus/dehydration through counseling and oral rehydration.

I liked that, but for me, at the end of the day it was about getting the most bang for my buck. In neonatology, what we do in the first few minutes of life may impact the next hundred years. It's an awesome responsibility. Also I like development and we get to watch fetal development, ex utero, in a plexiglass box.

It's hard not to marvel at that. As I say on my blog,there are days when it's not pretty. But there are days when a 500 grammer goes home intact, more and more often lately.

I've been at it for almost a decade now and I still can't imagine doing anything else; research, writing, educating and all. I get to do so many different things in academic neonatology. It's not just the day to day medicine. I also get to help shape the future of how we practice, albeit one fellow and one scientic manuscript at a time.

This is starting to sound like an army recruiting ad. But academic neonatology is hurting for good people right now. Although there are more neonatolgists than any other pediatric specialty, the population is aging and it is aging disproportionately in academics. In otherwords, most of the people we're training today are going out and doing private practice.

Part of this may be because student loans are just so expensive. It's too bad. I have a great job.

11:24 AM  
Anonymous Anonymous said...

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4:55 PM  
Blogger PaedsRN said...

So ND, when are you going to 'see the light' again and shift to PICU? ;)

6:14 PM  
Blogger Fat Doctor said...

Students often ask me for specialty advice, and I tell them if they don't mind occasionally not knowing an answer but knowing who does probably know the answer, choose a generalist field because it's very rewarding. If not knowing all the answers drives you nuts, choose a specialty. Sometimes, I admit, when I don't know the answer, I wish I'd specialized. But for the most part, my job is fun.

9:16 PM  
Blogger neonataldoc said...

Thanks, everyone. Not much to add!

2:33 PM  
Blogger Judy said...

One time in 25 years of motherhood I called the pediatrician because my child would not sleep at night.

One night.

The only night since his birth that he had slept less than 6 hours straight.

The only time in over a year that he'd slept less than 12 hours.

He wasn't crying. He wasn't complaining. He didn't have a fever. He wasn't tugging at his ear. He just woke up at 2am and wanted me to play with him.

Findings - bullae on both eardrums.

I'd have been relieved if I'd been wrong, but I was glad I'd asked them to check. Not too long after that episode, I decided I needed my own otoscope. Kid never complained about anything until he came to tell me yellow goo was dripping out of his ears.

I do understand about parents who appear to be disappointed that their kid isn't sick. I had a non-sleeper. It really wears you down.

My first child slept through the night at age 4.5 years. That was after we had his tonsils and adenoids removed. I never called the pediatrician to complain that he didn't sleep. It was normal for him. Too bad I didn't realize that he had obstructive sleep apnea.

BTW, the reason I'm a NICU nurse and not a well-baby nurse is that while I deal well with parents of 23 weekers who ask when their baby will be circumcised, I don't do nearly as well with moms who panic when their healthy newborn has hiccups.

11:54 PM  

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