Saturday, October 25, 2014

M3 - Pediatrics and Med-Peds

loved love Pediatrics.

After 8 weeks in Pediatrics (4 inpatient at the children's hospital, 4 in specialty/outpatient settings), I can safely say that I love pediatrics. Kids are awesome to take care of; they are (for the most part) really resilient, and are tons of fun to interact with when you can distract them from the reason they're at the visit / in the hospital. I love teaching, and (as I've said a million times when explaining to people the myriad reasons why I like Peds) nobody wants to know more details about a medical condition than the patient's parents. So far, I've found that (with very few exceptions) as long as you communicate well and efficiently, most parents are awesome to interact with. Sure, most parents have done everything they can to educate themselves, and sometimes this results in preconceptions that aren't entirely on base, for the most part the parents are incredibly appreciative of the fact that you are there to help their child.

I liked both inpatient (ie admitted to the hospital) and outpatient (pediatric clinic) settings. It seems really cool to be able to establish relationships with kids right from the time they're 2 days old and 8lbs heavy all the way to their 18th birthday. It's also awesome to see a kid come in to the hospital as sick as he's ever been, then see him walk home with his parents four days later because of the care he received from your team. Plus, I get to help a team of people solve problems! Sometimes they're more complex than other times, and thus sometimes easy, sometimes hard. Regardless, it's interesting; no two patients are the same, regardless how easy or hard their management is. You need to use different communication styles, different familial considerations, etc.

I wasn't expecting Peds to wow me like it did. I was expecting to enjoy it, but that's simply because I hadn't had any experience in Peds before. I wasn't expecting to love it because I didn't really know what Peds was. After 8 weeks, I don't really know how I could pursue a career that doesn't involve taking care of kids. Not to mention the fact that it would be cool to always know what's going on with my own, future kids... That would be cool too.

The thing is, I can tell that a lot of what I've enjoyed about Peds (longitudinal relationships, seeing a sick patient go home healthy, educating people about medical conditions, changing my communication and interaction to fit the needs of each patient situation) will translate to Internal Medicine (IM), which is my next rotation. Over the next 8 weeks, I will be assessing whether or not I enjoy IM as much as I've enjoyed Peds. I will need to decide whether or not I will need to take care of adults as well as kids in my future career. If I can't part with either...

Enter Med-Peds. According to the joking comments of a few Peds and IM residents I've talked to, it's the specialty for "people who couldn't make their mind up, so decided to do everything." Normally, IM and Peds residencies are a total of 3 years. With Med-Peds (a relatively new specialty), you have a 4-year residency in which you have two years each of Pediatrics and Internal Medicine. You rotate through alternating 3-month segments of Internal Medicine and Pediatrics so that at the end of 4 years, half your time was in Peds and half was in IM. This means that you essentially have 1 less year in each specialty to learn what you'll need to know to practice. You also get double-board certified at the end, sitting for the licensing exams for both Internal Medicine and Pediatrics. Despite the decreased time, you learn both IM and Peds in-depth. As one resident put it, they're the people you go to "if you want to know anything." The thing is, I love learning the details; it helps things stick in my head if I know the "why" behind the "what." I was always the person in second year as we began truly learning about pathophysiology who was constantly wondering, "Yeah, but what's the mechanism?" then going home, looking it up, and learning it to help me remember the particular condition or association at hand. That type of mentality is fostered in Med-Peds.

And so, that's the update for my current thoughts on a future career. There's still a lot of figuring out to do, but it's much more defined than back when I thought I wanted to do Emergency Medicine. Third year is definitely serving its purpose for me. I think I could be happy doing many different jobs in healthcare, but I've been learning that happiness is not all there is to the equation. It's also about what I and my individual skills can bring to the team - how I can best serve my patients - as well as how well the specialty fits you and you fit the specialty. Personal satisfaction plays a huge role in this decision-making process (how can I best help my patient if I'm not engaged enough to be sufficiently  up on their care?), but personal "fit" plays a huge part as well.

All right, it's currently my Saturday off (took the Peds shelf exam yesterday), and half-time is now over for the Michigan State University vs. University of Michigan football game. So, time to go.

Wish me luck over the next several weeks in Internal Med!

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