Why I Chose Pediatrics

In medicine, we all choose our specialty or area of interest during our initial training and education in medical school. Some physicians choose orthopedic surgery, others choose internal medicine, and a few decide to pursue a career in psychiatry. There are an amazing variety of different areas in medicine to claim as your career. So, why did I choose pediatrics?

I chose pediatrics for several reasons which include engaging with children and families, the opportunity to be a detective, and the idea that children are not fully responsible for their illness. While there are other reasons that I will talk about in subsequent posts to discuss my reasons for pursuing pediatric critical care and urgent care medicine specifically, these are some remarkable rationales that attracted me to the area of pediatrics and not another specialty.

First, working in a medical career that allows you to engage with children and families was an obvious motivator to choose pediatrics. If you don’t like children, you don’t usually go into pediatrics. So, what is so special about kids in the medical field? Well, for starters, kids are very transparent. If they are happy, sad, scared, or feeling sick, they let you know. There are no surprises. Their behaviors are developmentally based and are predictable, yet unpredictable at the same time. A good example is the movie, Kindergarten Cop, with Arnold Schwarzenegger. If any of you have seen this movie, you will remember the scenes where he’s talking with the kids and getting some pretty innocent and funny answers. The behavior was predictable, but how they answered his questions was quite unpredictable. Kids can be very entertaining, but that usually changes when they are sick.

If a child is sick, you usually know it. Sure, there are times that kids don’t want to go to school and claim that they have a stomach ache or headache. But, if a child is truly not feeling well, it is reflected in how they play and interact. If a child is not playing or interacting normally, there is usually something wrong. For the most part, when it comes to illness, kids are not fakers and their activity reflects how they really feel.

Another important part of interacting with children and their families, in pediatrics, is that you get to be a little less serious. Kids, and their parents, don’t respond well to totally serious, sterile, “old-school” doctor interactions. You need to have a good bedside manner and engage with children and their parents from a place where they are, at that moment. This means that you get to wear a funny tie or none at all, ditch the white doctor’s coat, have toys hanging from your stethoscope, talk about favorite cartoons, or offer fun stickers. If you behaved this way in an adult medical office, you would get some pretty disapproving looks. In pediatrics, you have to channel your inner child to relate to the children and families that you are caring for. However, this does not mean that you are any less serious about the medicine of pediatrics and the care that you deliver. It means that how you deliver medical care is reflective of the population that you are caring for.

The next reason that I chose pediatrics is that one gets to act like a detective. In medicine, you always investigate what is wrong with a patient. But, in what area of medicine do you have to investigate what is wrong with a patient and they can’t actually tell you what is wrong? In pediatrics, most of the population can’t express what they are feeling. You have to use your power of observation, as well as knowledge of normal and abnormal developmental behavior and physiologic development that is appropriate for age. Furthermore, you need to extract information from the parents or caregivers of the children in a way that gives you hints at what is possibly wrong with their child. Parents or caregivers are an important part of the pediatric visit. They know their child better than you will ever know their child. So, the information and concern that is expressed by them is usually the key to figuring out what is wrong with their child. Taking a good history from the family contributes to 90% of your diagnosis. The physical exam contributes to about 9% of your diagnosis and labs and studies contribute to about 1% of your diagnosis and usually confirm what you already suspect from the history. The proportion changes a bit when a child is more critically ill and labs or studies give you more information. But, a vast majority of diagnoses, in pediatrics, can be made by getting a good history. All of these investigative skills are important in being a detective and a pediatrician as well.

Finally, children are not usually responsible for their illness. In adult medicine, adults may engage in behaviors that possibly contribute to their current medical condition. In pediatrics, a vast majority of kids are not responsible for their illness or the progression of their disease. Some kids are born with heart defects, others develop asthma, and a proportion suffers from various skin conditions. Sure, adults have similar conditions, but adults develop behaviors such as smoking, drinking alcohol, not exercising, medical non-compliance, and other activities that adversely affect their health that kids usually don’t adopt. Adolescents engage in some of these detrimental actions, but most of the pediatric population is not responsible for worsening their medical condition on their own. Also, you will have the not uncommon child refuse to take medications, but there is always a way to ensure that that ear infection, strep throat, or eye infection is treated. In the end, it is easier to empathize with children because their illness was not something that was brought on by them in some conscious way.

There are so many areas of medicine to choose from. Every physician has their reason for choosing their particular specialty or subspecialty. I am sure that many physicians would cringe at the thought of being a pediatrician in the same way that I would cringe at the thought of being an internist. But, that is what makes medicine exciting. There is something for everyone. Wrestling a toddler, as they perform their classic “alligator roll” maneuver, and hunting for a glimpse of the eardrum to evaluate an ear infection with an otoscope may not be everyone’s cup of tea. But, there are many more things in other areas of medicine that are not my cup of tea and this is why I chose pediatrics.

If you are a pediatrician reading this, why did you choose pediatrics?