Tuesday, December 1, 2009

Kevin might save babies like it's his job

The next installment of our career choice series.

3 reasons to do pediatrics
1. Congenital disease is fascinating
The magical journey from fish-like zygote to full blown baby is fraught with wrong turns and side streets to the bad part of town. Sometimes what comes out of the oven isn't what you expect. While most adult medicine follows some kind of logical pathology and things often dont stray too far from the norm, the presentation of congenital disease can be so bizarre it boggles the mind. Situs inversus (your insides are backwards), lissencephaly (your brain is flat), Transposition of the Great Vessels (your aorta and pulmonary artery are plugged into the wrong ends of the heart) are just a taste of some of the things you see as a pediatric specialist. A lot more interesting than COPD or diabeetus.

2. Plenty of subspecialties to suit your fancy
This is likely personal to me but during the first two years of medical school I always pictured pediatrics as a primary care residency with no subspecialty tracks. “Well where do pediatrics cardiologists come from?” you might ask. For some reason I thought you got there through internal medicine, cardiology then a fellowship in pediatric cardiology. Clearly I’m an idiot (but hopefully someone out there on the interweb is with me). In reality pediatrics is just like internal medicine, except you treat little people. This also means there’s a huge range of subspecialties to choose from, and as I mentioned in point #1, you get to focus on a lot of congenital malformations rather than the end result of a lifetime of self-neglect.

3. Saving lives (no seriously)
Adult medicine often revolves around management of chronic disease. Patients undergoing slow, methodical heart failure/COPD/diabetes/lupus(sometimes it is lupus), are never fully cured. The best you can do is manage their symptoms in order to extend/improve their quality of life. On the other hand, pediatrics is full of one-off illnesses that you can definitively treat and they can be on their merry way. Back when medical school was only 1-semester long and involved memorizing the 4-humors, congenital malformations was often a death sentence. Fortunately, we've come a long ways from then and there's a myriad of treatments for what ails children. You have a giant septal heart defect? No problem. Bowels outside the abdomen rather than inside? Just shove that right back in there. As a pediatrician you're really making a huge impact in the "total # of years saved" category. If there was a MD fantasy league, you'd want at least 1 pediatrician to pad those stats.

3 reasons to avoid pediatrics
1. Bad logistics
Unlike what your career counselor might have told you, you should never choose a career just because you like the subject matter. Every field has pros and cons in terms of call structure, location constraints, average salary etc etc that are all vital in making an informed career decision. For example, if you love cardiology but are on the fence on whether to treat big hearts or little hearts, here are some things to consider before you devote yourself to baby saving. Despite all my talk about congenital disease, kids are actually pretty healthy. And being healthy is bad for business. Because of the low demand, you will also make less money than your adult-caring counterparts. So do you really love congenital disease so much that you're willing to take a $100,000/yr pay cut? Furthermore, there are significantly less pediatric specialists than there are adult specialists. Because there simply isnt as many you, your group will be small, which is synonymous with lots and lots of call. What this also means is that there isnt a need for a pediatric neurologist in every town. If you want to subspecialize in pediatrics, you're almost guaranteed to be forced into a large-ish city in order to field the necessary amount of patients to stay afloat. Sorry, no country livin' for you.

2. Noncompliant patientsparents.
When I asked a lot of pediatricians why they decided to do pediatrics and not internal medicine, they often cited that they were frustrated by noncompliant patients such as COPD'ers that kept smoking or CAD'ers that kept eating McDonalds. For some reason, I have no problem with that. As long as the check clears, I dont care what you do. My job is to give you the knowledge, services and tools to allow you to live a healthy productive life. If you refuse, so be it. In pediatrics, the kids barely know what's going on so the work falls on the parents to follow through with the care plan. In this case, noncompliance by the parents means the kid is getting hurt. This I have a problem with. Even though CPS can step in during extreme cases, theres a huge gamut of noncompliance where you really can't do anything even though you really want to punch them in the head.

3. Child abuse
During my peds rotation I had the displeasure of seeing 3 child abuse patients. One of was severely overfed, one was severely underfed and the 3rd was an infant that had a broken femur and two broken clavicles. Obviously by ferreting out child abuse you're saving the child, but it's still a terrible thing to be a part of. Seeing that on a regular basis can be a real drain on the mental psyche.


Julia said...

Man, where'd this blog get all this gravitas from? Actually, this peds entry is perhaps the best of the series yet.

Jesse said...

I find your indiscriminate and inappropriate use of hyphens disturbing. I hope for everyone's sake this is a subtle callback of a long-lost meme...

K said...

hmm didnt even realize i did it. ill fix it

Cate said...

this post pretty much summarizes why i want to do peds- adults basically bring their problems on themselves, kids don't!

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