Jan 12, 2010

Children and zebras...

Okay, for those of you who watch House (hopefully all of you), you've heard the medical cliché "If you hear hoofbeats, think horses, not zebras" which pretty much summarizes the syndrome medical students have where we want to diagnose people who have diabetes as being infected with a silver-bellied Peruvian brainworm. And the only reason we have this syndrome is because we've been infected with a silver-bellied Peruvian brainworm.

Thing about kids is they have zebras. Obviously I can't go into strategic detail because HIPAA doesn't have a clause to make exceptions in privacy settings for crap I think is cool... though they totally should, but since starting peds a week ago, I've probably seen 4 kids that have syndromes that were filed in medical school under "Why do I have to learn about stuff that only affects 1 in 40,000 people?" Oh, because those 40,000 people are more likely to go to the hospital than others, and when they're kids, they're still ironing out the details of how to manage the condition, so bam, hospital.

And then there's the kid who has, at present, stumped everyone on the floor, required consult by a specialist whose contribution included not having seen a case like this in umpteen years of practice and that if we had any thoughts, we should feel free to input them because f- if they know. So they're running more tests.

What I'm liking about peds is that in peds so far, they seem way more interested in puzzling out what they're dealing with. I don't know if it's because they like kids, like medicine, or just watch as much House as I do, but it's refreshing. And the stuff they're dealing with is frequently really interesting, which helps.

Then there's the seventeen thousand babies with bronchiolitis. But then those kids don't tend to present with the spectrum of baggage adults have so their cases are fairly straightforward. They're also far less inclined to yell at me for taking too long during an examination before demanding drugs.

And so far exams on kids hasn't been too bad. The sort of expectation of crying helps, but then they don't really hold grudges, and they're easy to placate afterward. And what's wrong usually shows up as what's wrong rather than oh, these skin lesions are from an untreated fungal infection, and there's existing diabetic peripheral neuropathy and blah blah blah.

Of course, the fact that kids are being less difficult than I expected means it sucks when they get really sick, so that can be a stone cold bummer.

And I'll talk briefly about the staff... while I can't count myself as being someone described by anyone as "someone that loves kids", the people that choose to go into pediatrics seem to, which seems to instill a refreshing position in them of being patient advocates, so I think we all get slightly less cynical as a result of it.

Though no worries; surgery will beat it straight back into us.

And lest anyone think I've gone soft on path for peds, recall that one of the reasons I'm liking the crap out of peds (minus the hours) is because I get to see weird stuff, which is not really the motivation most parents want their pediatrician to have.


Anonymous said...

What kind of weird stuff? I'm not in medicine, so I have no idea.

Ishie said...

Almost anything... a ton of those genetic conditions people hear about or rare disorders. Kids come in for more varied stuff. Instead of saying what I *have* seen (possible legal violation), I'll give some examples of stuff I haven't seen in person, but the types of conditions we'd see.

Fragile X Syndrome... Turner's Syndrome, retinoblastoma, congenital rubella.

Haven't seen any of those, but they're examples of weird stuff we learned about in the first two years of medical school that I forgot actually existed in people I might see, not that I have any desire to see children suffer.

Anonymous said...

Wow, so it is not just in textbooks. I vaguely remember those names from my undergrad genetics classes.

Thanks for the reply, as I know you're very busy.

All the best.

Grace said...

Aww... Ish, I think I see babies in your future... LOL

Ishie said...

Bite your tongue, my love! How the heck are you? Has England deported you for jumping on the statues yet?