Thursday, January 27, 2011

The month I almost switched specialties

I am finishing up a really great month on outpatient pediatrics. I thought I wouldn't love it. I was scared in the beginning how much I really love it. I had a moment in the first week or two that made me waver, ever so briefly, from wanting to do obstetrics.

I love the babies, even when they are screaming. I especially love the girl ones, since I don't have one of those at home. I love the variety. Sure, there is an awful lot cough, runny nose and fever X 2 days on top of the chart. But, I have been pleasantly surprised by the variety.

I have done everything from a one month well baby visit to STD counseling on a young man. I have seen children living with autism, a child with Fragile X syndrome, one with mosaic Klinefelter syndrome, and a few with insulin pumps. I have seen congenital and developmental variations.

My main fear was becoming too upset by seeing a serious ill child. I cried more than once during my preclinical years during films and lectures about terminal developmental disorders and abuse. I still have to do a month in Peds ER, but my rotation site doesn't do pediatric trauma. I hope I don't end up too emotionally overwhelmed by anything I see. I don't have to do PICU or NICU. I think I would have been fine if I wasn't a mother. Now, I identify with every parent and associate all the kids with my kids.

I think one way we end up picking a specialty is by what we can't handle. Some people can't handle the idea of treating someone who is pregnant. I have an internal attending that always jokes that treating someone under eighteen makes him diaphoretic. I know another who can't face pus. There's a student who dreads the ER.

I still haven't done my ob/gyn rotation yet. I am pretty sure I'll love it, since I trained as a midwife. If not, I suppose I can switch everything over to pediatrics. I really doubt I'll be doing it, though.


  1. I've been told that if you're on your ob rotation, and your attention keeps drifting away from the mom over to the new baby, then you're probably a pediatrician. You'll figure it out. I'm so glad you're enjoying Peds!

  2. Yes, Old MD Girl, that's how it was for me! The mom would deliver and then I lost interest in mom and wanted to see the baby.

    I don't know if it's because I started residency before having kids, but it's not been too hard to deal with very sick children. Being a mom has made me a better pediatrician for sure. Either way, you will figure it out. Good luck!

  3. Thanks! I have heard that before about wanting to go with the baby after the birth. I have been at about 60 births so far, and I think the mom is winning out.

  4. Sounds like a fascinating month, with plenty of variety.

    My friend's son has Fragile X and I have a child with multiple developmental disabilities. We have been fortunate to have a great ped. that has always pointed us in the right direction when he doesn't have all of the answers.

  5. Good luck with your decision. OB is a great field..if you don't mind practicing standard of care in this country which includes continuous EFM, high induction rates, and high C/S rates (up past 40% in some hospitals.) I just finished 4 weeks of OB night float (I'm a resident at a large academic med ctr.) and was ..again ...disheartened by the level of intervention that we perform on otherwise healthy laboring women..scalp clips, AROMing practically everyone, IUPCs, etc. I knew this was the culture before starting but it still bothers me.
    If you love surgery and intervention, Ob is great.. but you may be surprised coming from a midwifery background.

  6. Anonymous, I am a med student in the U.K thinking of OB. I am also considering doing my specialist training ( residency) in the U.S. It might be a naive question, but I come from a very different formn of health care provision and am wondering why so many interventions that arent needed preformed in States?

  7. I know the trend is toward specialization (because that's where our lovely faculty at academic med centers - and to be honest, $$$$ the almighty dollar in most cases - push us) but if you were interested in certain geographic areas of the country, family medicine with OB might be a great option. I am a family physician in WI - where in most towns babies are still delivered by family physicians and midwives - but you can live in every city in WI as an FP and deliver babies. I did a fellowship and got C-section training too - I love being able to take care of both mothers and babies. My OB volume is great, and my partners (midwife and FPs) all deliver our OWN patients - we chose this life because we love it (but can take a break if we need to). And you won't believe the crazy and interesting things we see - but the fun part is a non-interventional approach in a hospital setting.

    And for the record, I have student loan debt and am doing just fine paying it off. And I don't live totally out in the middle of bumblef*** either. Just wanted to note that there are more options!

    And enjoy the med school rotations that are fun - because man, some of them are so miserable. :-)

  8. Thank you for bringing such nice posts. Your blog is always fascinating to read.

  9. Ah, but why "almost" and why "doubt it"? Your supposition is right, MomTFH, you could just change everything over, that is, you could waver... and apply to a pediatrics residency and have an incredibly fulfilling career caring for the future. But whatever you choose, or whatever chooses you, you will no doubt be a caring and thoughtful physician. In time (soon?) it'll be more clear to you, but I'm glad you had a glimpse of the joy and diversity of outpatient pediatrics.

    Please do keep us "posted"!!

  10. All the best with Peds ER. Reading your post makes me realize just how much being a parent determines your view of medicine. Right now I'm not very charmed by the idea of a ward full of babies, but I suppose a mothers heart allows for greater patience.


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