Thursdays

Thursdays are just such wonderful days here in Asheville. The weekly four-hours-plus of lecture are over; the weekend's in sight. I also get to wake up to the fresh, bright, smiling, young-minds of America (or if they aren't smiling, they're certainly crying/screaming/biting). Thursdays are a double day of Pediatrics in the morning and Neurology in the afternoon, and I swear my Peds preceptor only schedules the cutest kids on these mornings. On several occasions I've left a clinic room hearing: "If you don't want to go into Peds after seeing a kid like that, something's wrong with you!" If I ever drop out of Surgery, this is where my heart lies...

Besides how awesome the kids are, one thing I love about outpatient pediatrics is always being on the look out for something crazy (and I don't mean the parents). Behind the cool, calm, and collected exterior, you're a detective. The vast majority of kids are developing just fine, but it's your job to pick out the subtle anomalies. Amongst the health maintenance exams, flus, and the runny noses are the chronic granulomatous diseases, the Wiskott-Aldrich syndromes, and the one in a million genetic disorders. On the exterior, it looks routine. Ever wonder what the pediatrician is looking for when he or she checks your little one from head to toe? You don't wanna. Using the light to look in the eyes? Retinoblastoma. Squeeze the belly? Wilm's tumor. Moving the legs around? Developmental dysplasia of the hip. Trouble can be found anywhere. My preceptor told me about one mom who really wanted to know what he was looking for with each test. Despite trying to parry the question, she persisted. About halfway through the exam and explanations, she decided not to hear any more!

Probably one of the most important lessons I've learn in Pediatrics, however, has nothing to do with kids. The practice I work in (ABC Pediatrics) has six pediatricians, and they all love each other. They get along so well, and this has such a positive impact on quality of life. In picking a specialty, there are many things to consider. One thing I think it's interesting to ask is, "Who do I want my colleagues to be? Who do I want to wake up and see every day?" Based on my experience this year, both in and out of the hospital, I would want to work with Pediatricians. Laid back, fun, and they know their ish. I'm sure there are uber-intense Pediatricians out there, but they certainly aren't a dime a dozen. In general, finding a great group to work with makes such a difference, and I hope to be as lucky as this practice.

I also think it makes a big difference in patient care. All the parents I've talked to love the practice, and they are willing to see any of the physicians, even if they aren't their primary. All the docs are on the same page, they get along, and they have similar philosophies about approaching care. Because of that, I think there is more consistency for the patients amongst different styles. I have yet to hear from someone who doesn't like the practice, and I can see why.

As for the afternoon, it's off to Neurology. I have written about this clerkship before (see "Death Rate in America"), and will continue to write about it in the future. The patients I've seen in the outpatient clinic (and now on the inpatient service as well), tear me up. More to come on this front.

But now I must get ready for another week of Inpatient Medicine. See you on the other side...