How Not to Succeed in Pediatrics

July has arrived and new interns flood medical residency programs across the country. Having been in the field of pediatrics for a few years myself, I thought that I would pass along some unsolicited advice to aspiring pediatric interns. There is no shortage of advice on how to succeed in various specialties. But, I thought to myself…what were some things that you could do to guarantee your failure in a specialty such as pediatrics? So, here are a few pieces of advice on how NOT to succeed in pediatrics.

Be Impatient

During the medical visit, you gather information about the history of the present illness and examine the child. The history of the present illness is a detailed description of the course of the illness or problem that is relayed by the parent or the child. It details symptoms, exposures, timing, and feelings about the problem at hand. There are often a lot of bits of information that are communicated and it is difficult to filter what is important and what is not. But, it does take time and focus to put together a full picture of what is going on with the child. The history is probably the most important part of the visit because it is mainly responsible for making the correct diagnosis. The physical examination is important to confirm the diagnosis that you were thinking of while taking the history.

If you want to fail in pediatrics, rush the history and take shortcuts. Not listening to what is being expressed by the parent or the child will help you miss vital bits of information that could help you make the correct diagnosis. It will also help you to not establish a trusting rapport with the family. So, if you actually make a diagnosis with incomplete information and the family does not feel like you were listening, they will not likely trust your judgment and are not likely to follow through with your care plan. Also, being impatient during an exam of a toddler or young child will not only facilitate missing subtle findings such as heart murmurs, ear infections, and pharyngitis but also cause a lot of crying and stress for the child and the parents. It is a guaranteed way to incite anger from the parents and fear from the child if you are impatient during the physical exam and do not treat the child with care and kindness.

Don’t Listen to Parents

Not listening to parents goes a little deeper than just being impatient with the history that is being communicated. It is not believing or trusting the information that is being communicated by the parents. You disregard what the parents are telling you and chalk it up to their anxiety, not understanding what is going on, or just being over-reactive.

The truth is that parents know their children better than we will ever know their children. If a parent is concerned about their child, then it is on us to listen and allay their concerns through our expertise. We have to try and understand what is concerning them and how their child appears or is acting differently than their baseline. We can garner a lot of information from parents. One surefire way to fail in pediatrics is to not listen to parents.

Avoid Teamwork

Avoiding teamwork is another definite way to fail in pediatrics. There is so much information and details to note in medicine that no one single person can know everything that there is to know or see everything there is to see. A good example of this is in the pediatric intensive care unit.

In the pediatric intensive care unit, there are pharmacists, physical therapists, occupational therapists, nutritionists, nurses, respiratory therapists, physicians, and others who care for the children during the most critical time in their illness. Because there are so many aspects of the care that is required to be delivered for sometimes extremely complicated illnesses, we depend upon the team. The collective team knows more and can see more than one person alone.

Nurses are caring for the kids for prolonged periods at the bedside and monitor them for any physical changes. Pharmacists are checking medication compatibilities and doses to make sure that there are no severe side effects or problems with the medications being delivered. Nutritionists make sure that the children are receiving enough calories and nutrients to optimally survive and heal. Respiratory therapists are monitoring the respiratory status and adjunctive machines that assist with breathing for children who are having breathing difficulties. Many others are involved in the care of these children, but are not mentioned for the sake of brevity.

The pediatric intensive care unit is just one example of the kind of teamwork that is required to care for children with critical illnesses. However, this teamwork is universal across other areas of pediatrics. If you are not working with the team and just doing your own thing, you are depriving kids of the best care that they deserve. No man or woman is an island. Teamwork and collaboration are always the recipes for success in medicine. Rejecting teamwork in pediatrics is a sure way to fail.

Ignore the Importance of Toys, Cartoons, Treats, and Stickers

Being a child means placing utmost importance on toys, cartoons, treats, and stickers. These things bring children joy. So, one way to connect with kids is to ask them about toys, cartoons, treats, and stickers. It is one way to establish rapport with children. If you can relate to them through these simple things, it makes it easier to get crucial information from them about their illness and eases the examination period.

While some may feel that these objects are trivial to the medical encounter, it is actually the opposite. Kids’ faces light up when you ask them about their favorite cartoon, comment on the toy that they brought with them to the doctor’s office, or offer them treats or stickers for being so brave at their doctor’s visit. It is a way to engage with them on their level and show that you care about them and make them feel special. Obviously, older children may not be into things like stickers, so you will have to find something that is more age-appropriate. However, these objects represent an opportunity to connect at any age and show human interest instead of just mechanically doing your job. So, if you want to fail in pediatrics, ignore a child trying to tell you about their favorite toy or cartoon, don’t offer them treats after the visit, and definitely don’t give them stickers.

The Obvious

While all of these things would seem obvious as things NOT to do during the pediatric encounter or whatever field of pediatrics in which you are working, you would be surprised at how often these things are actually done. From general or specialty outpatient pediatric practice to pediatric urgent care or from pediatric emergency care to pediatric intensive care, these principles are universally applicable. They are ways to engage with people to make them feel heard and appreciate their humanity. The lessons of patience, listening, teamwork, and appreciating the interests of your patients or families are ways to bring compassion and caring into the pediatric encounter. Anything less would cause one to fail not only in pediatrics but also in every other area of medicine as well.

Do you have any other advice for pediatric interns on what NOT to do in pediatrics?