so comes the end of my 6-week paediatrics block. i have to say, it has really opened my mind about paediatrics. i went into it thinking "there is no way i am going to go into this specialty". i'm finishing it thinking exactly the same, but for very different reasons than before.
i like paediatrics. i didn't think i would, but i do. it's not nice seeing ill children - i'd very much prefer them well and annoying, thank you - but it's so rewarding and exciting every single day as you deal with an entirely different spectrum of disorders than what you usually see in adult medicine (minus the usual chest infections and asthma).
however paediatrics really isn't just about medicine. there's a whole other part of it, and it is this which totally puts me off from being a paediatrician: the social aspect. i recently learned that in the UK, 1-2 children die PER WEEK from NAI (non-accidental injury). this is a really alarming statistic, coming from a country which takes children's welfare seriously as compared to many other countries with very laxed laws on child abuse. NAI should always be considered in a child with physical injuries or a suspicious lack of emotional/social skills. then there's sexual abuse which all paediatricians fear to come across as it puts them in very complicated and difficult situations.
on my on-call week there were 4 cases on the ward with suspected NAI, all with various presentations. i spoke to a paediatrics registrar about his thoughts on dealing with NAI. he told me that it is the one thing which paediatricians hate to have to deal with, because it is indeed ridiculously difficult. if you miss an NAI in a child and the child dies, you are in trouble. but if you wrongly suspect a case of NAI and the child is taken away from his/her parents, you will very well get sued. the thing is it's not like getting sued for malpractice, it's being punished for good intentions but with very poor judgment.
i know it might be silly to completely disregard paediatrics as one of my specialty choices because of this, but child abuse is something paediatricians must always have at the back of their heads, and i really, really don't want to have to deal with it. another thing that puts me off is having to answer to children's parents all the time. sure, most of them are nice and compliant, but there are some who are incredibly fussy and you can't really blame them because it's their children after all, but sometimes you can't help but think, shut up and let me treat your child! just the other day on the ward, a senior house officer was inserting a cannula into a toddler when quite a large amount of blood spilled on the floor. the worst part was, not only did he have to deal with the child's parents, the child's GRANDPARENTS were there as well, and they were all clearly upset. in the end the SHO had to sit them down to apologise and give his explanations, which took up quite a lot of his time (it was a very busy evening and he had many other patients to tend to).
oh and also, i don't like neonatology - which i'm aware that all budding paediatricians have to go through somehow.
it's been a very good 6 weeks indeed, but i am feeling very jaded coming to the end of it - though i feel like i've been in an alternative medical universe the whole time doing paeds and it has been somewhat refreshing. i've learned that i do actually like children and that children like me, but it has also enabled me to add another specialty to my list of what i don't want to do (a list which includes chest medicine, surgery of any form, psychiatry, oncology, geriatrics and radiology). i've gained a lot just from these 6 weeks and while a lot of people feel 6 weeks of paeds is not enough, which is quite true - it's SO wide a specialty after all - i am ready to move on to something i have a strong feeling i would very much enjoy: obs and gynae.
and i absolutely cannot wait.
