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.

10 comments:

  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!

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  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!

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  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.

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  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.

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  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.

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  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?

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  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. :-)

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

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  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"!!

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  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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