Thursday, March 1, 2007
I began my Pediatrics rotation recently at the Schoolhouse outpatient clinic and can already sense a refreshingly playful change from the scrub-soaked gush of blood and amnion of OBGYN. Fortunately, most of the kids we see routinely are healthy babies, even if they are prone to developing the occasional stuffy nose, sore throat, and fever. But if you think that the cutest, most adorable and healthy two year-old girl is just all fun and games, try looking into her ears with an otoscope while she is squirming around resisting the exam. Its not such an easy task if you wish to avoid destroying her tympanic membranes and leaving her permanently deaf while still in infancy. Attempting to listen to a three year old boy's heart and lungs while he is tugging away at the tubing of your sthethescope is equally challenging. I once had a boy stuff the entire head of my stethescope into his mouth. I got him back by examining him with the same slober-covered instrument. I've learned that to succeed in pediatrics as a medical student, one must learn to strike the right balance between playfulness and professionalism. You gotta throw the kids a bone every now and then, using Sponge Bob and Dora stickers as your ambassadors. I've even resorted to the most childish of tactics at times by placing a Scooby doo sticker on my otoscope and convincing the kids to "let Scooby take a peek in your ears." I think the key is to make the kids comfortable so that the parents feel comfortable with letting you care for their kids. Sounds straightforward, but in reality you need to act like you know what the hell you're doing, or else these parents are gonna give you that threatening look, letting you know its time to lay your grubby paws off their precious child. Demonstrating confidence when examining a newborn can be especially difficult. It takes just the right touch of gentleness and finesse, but enough confidence and forcefulness to perform an adequate physical exam. Even if the newborns wished to comply with your physical exam, they wouldnt have the slightest body control yet to move their floppy limbs out of the way. Learning how to understand and anticipate their behavior is often impossible even for the most practiced of all pediatricians. I find it curious how capriciously children can often behave; docile and calm one minute but screaming and inconsolable the next. As I like to say, from two to terrible, in just one damn blink of the eye. Regardless of your approach, you cant take away the full blown stranger anxiety that exists in 15 month olds. By that age, they're smart enough to know that shots will be coming, and it is only natural for them to be suspicious and fearful of you. And thus, I am resigned to saying ridiculous things like "no ouchies here" all day long.