Pediatrics: Home-Runs and Strike Outs

Tomorrow is the last day of my pediatric rotation. All and all I have had a great experience - it was wonderful way to ease into clinicals because it was busy (12-15 patients a day), but on an outpatient basis. In other words, I had the opportunity to see lots of things, but nothing so emergent that I didn't have 2 min to look it up on my iPhone or on UpToDate.

I saw a good variety of diagnoses. Some on a daily basis (otitis media, asthma, ADD/ADHD, developmental delay, jaundice, strep) and others just once (kidney stones, fifth dz, thyroid goiter, cystic fibrosis, mitochondrial disease). I also saw a good deal of orthopedic cases, which is my bread and butter, so it was nice to be able to contribute something back to the practice. I was very fortunate to 1) be in a setting that allowed me to use my expertise freely and 2) be surrounded by providers with 20+ years of medical experience that were open enough to accept my suggestions even though I was just "the student".

Before my PA days I spent almost 4 years as an Orthotist with a specialty in scoliosis and spinal trauma. I completed a residency in Kansas City at a practice that saw over 2,000 scoliosis patients per year and my mentor (Brian Kerl, CO) is one of the best in the country at managing scoliosis. Knowledge from my prior life turned out to be extremely valuable in more than one circumstance during my peds rotation and it felt amazing to hear the doctor tell a parent, "I know this may sounds strange, but although she's the student, she knows more than me about this so I'm going to go with her suggestion."

Now don't be fooled by the feel-good story- I had several occasions when I just plain missed a diagnosis:
1) a rash because the kid refused to take off his shirt... well... until the doctor asked... then he took it off and revealed a rash that covered his chest and back... geesh.
2) mild asthma attack because the pt's little brother was screamy bloody murder in my ear and I assumed normal breath sounds because I couldn't hear anything clearly... My first lesson on ASSumptions... never to be repeated.

Overall, I had some great personal victories and some crazy mishaps - but I made it through. Now I'm off to the opposite end of the age spectrum... internal medicine on the gerontology service.... I'll try to remember that breast-feeding jaundice is no longer appropriate to list as part of the differential for jaundice.

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