Notes from a Medical Student:

A Day at Childrens Medical Center

As the first member of my family to pursue a career in medicine, I hear opinions from everyone about which specialty I should choose. My grandmother and my sister, who has three young children, seem to think pediatrics is the natural choice. They say I've “always been good with children.” They are right: I was the preferred babysitter on my block. I was great at coming up with games and activities to keep whole groups of children occupied for hours. When it came time for my first pediatric encounter, I should have been excited. This was an area where I could really shine. Babysitting and pediatrics, however, are in completely different hemispheres in the world of children.

The truth is, the idea of having infants and children as my patients has always made me a little apprehensive. Medicine is not an exact science, and all of my instructors have stressed the importance of a good and detailed patient history to help me make an accurate diagnosis. Herein lies the first stumbling block; how does one take a patient history from a child? Depending on their age, kids either can't tell you what is wrong, are too afraid of you to try, or simply lack the vocabulary to describe it. And half of what they do happen to say will be muffled by their mother's sweater, into which they have buried their face. The young patient can be quite a challenge when it comes to the physical exam as well. Children have a special talent for making students, who may already be nervous, look like they have no idea what they are doing. Getting them to cooperate often becomes a bit of a game... usually with you as the loser.

Last Friday, I spent the better part of my day at the Children's Medical Center of Dayton working with some residents. I can't say the experience altered my opinion of the difficulty involved in pediatrics. One little boy we examined was more interested in the TV than in sticking out his tongue and saying "ah." He squirmed, pulled away, and pretended not to hear when asked how he was feeling. Usually, I walk away from a patient encounter and feel that for my level of training, I have been thorough. Not this time. With children, there is always that unsettling feeling that perhaps there is an icky sound at the bottom of a deep breath they are unwilling to take. The whole process is enough to make you want to throw up your hands and say, “Forget it.”

To do so, however, would be to ignore one of health care's most vulnerable populations. The residents I saw seemed relaxed and at ease with their patients. As if sensing my discomfort, one doctor turned to me, shrugged a little, smiled, and said, "Well, you just do the best you can." I thought about that as we saw other patients. After examining the little boy, we checked on a little girl, less than a year old, sleeping peacefully with a swollen abdomen while waiting for a liver transplant. Looking at her, I realized that pediatrics may be a challenge, but it is an important one.

Getting down to a child's level, trying to think creatively to get the information and cooperation you need, may be difficult, but patients who are hurting need you to “just do the best you can” to help. Pediatrics is such a challenge because pediatricians are more than physicians. They are a voice and an advocate for their patients. A little girl may not be able to stand up and say, “I hurt. I need help.” But her pediatrician can.

To be honest, I'm relatively certain pediatrics, as a specialty, is not in my future, though I have been proven wrong before. But I am grateful for days like this that really illustrate how great medicine can be. Pediatrics may not be my new career goal, but I certainly developed a heightened level of respect for physicians willing to take on such a challenge. I hate to think what health care would be like without them.