For a senior elective at Washington University I got to spend a month in a group pediatrics practice. It was a fabulous experience. My previous experience with pediatrics as a third year student did not give me a good idea of what pediatricians do. I spent the first 3 weeks in a Level 2 nursery taking care of small or sick newborns and occasionally running off to resuscitate newborns at delivery. It was fun but highly specialized. I spent my next 3 weeks on the cancer floor of Children's Hospital taking care of kids getting chemotherapy. Educational, but again highly specialized. At that time we got zero clinic experience. One problem at Washington University is that even with Children's Hospital right next door, the school has a hard time supplying all of us with enough pediatrics experience. This was especially true when we signed up for our electives this year. There weren't enough to go around all of the students planning on going into pediatrics, let alone those of us who wanted pediatric experience before a Family Medicine residency. I got lucky and got one of the 12 spots in the Health Key pediatric group.
I spent the first few days following the pediatricians into the exam rooms and observing. After that I was able to go in first, talk to the family and the children, examine them and go back and report to the pediatrician. We would then go in together and sometimes the doctor would repeat part of the history and exam, then prescribe treatment and dispense advice. I found out that about 30% of what peditricians do is give advice and reassurance. If the kids needed shots, the doctor would leave and the nurse would give them. I think this is a much better system than when my pediatrician would give me my shots himself. I hated my pediatrician. :)
I worked with three different doctors and they all had different teaching styles. One of them would have me see his checkups but we would see his acute visits (colds, earaches) together. Another doctor would have me see the acute visits but would do the checkups herself. One doctor treated me like a resident and only rexamined the crucial exam points. This put extra pressure on me not to miss anything because I knew that if I didn't find it, he wouldn't either because he trusted me to look for it. This helped to reinforce my confidence in my own history taking and exam skills. I even made some accurate guesses at diagnoses and treatments. The second doctor I mentioned felt there were three stages to managing a clinic patient. Good histories and exams are the goal of the medical student, accurate diagnoses are the goal of the intern, and proper managment of the illness is the goal of the senior resident. She felt I had the first stage down pretty well, I was right more often than wrong at the second stage and that I needed a lot of work with the third stage. Being in this clinic was a great opportunity for me and I highly recommend it to anyone who is considering primary care.
Until next time,
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