Pedantic Pedagogy in Pediatrics

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There are separate male and female wards here. Just to emphasize that fact, the two gender-based wards are separated by 2 floors. These wards, as I've demonstrated in some of the photos posted earlier, are essentially colossal rooms crammed with beds from end-to-end. It makes sense that the two adult sexes should be separated, right? But what about the pediatrics population? Did you know that there are no children above the age of 12 in the Pediatric wards? The reasons are fairly straightward: the hospital does not want male and female children, who are "of age", to be placed together in the same area. Due to bedside procedures and general physical exams, it can be necessary that the adolescents disrobe, so the inevitable embarassing situation is mitigated by moving the adolescents to their respective gender's adult ward. And, perhaps more importantly, it prevents any sexual misconduct (don't forget consensual hanky-panky, too). One result of this is that Internal Medicine physicians are forced to manage a fairly large adolescent patient load, which traditionally gravitates in the realm of pediatrics. Therefore, these docs have trained themselves to manage both adults and children in the inpatient setting. MED-PEDS represent!

Rounding in the pediatrics ward has been so fulfilling. I have seen such a variety of cases, but the ones that intrinsically entice me are the kiddos with congenital cardiac conditions. I'd argue that their puny size and rapid breathing rate makes them the cutest kids in existence. There is something so rewarding about keenly auscultating (listening with the stethoscope) audible heart murmurs, describing the murmur's character, its intensity, its place in time, and its direction. I estimate the intensity of the "lub" and the "dub" (heart sounds) and do my best to organize my thoughts to formulate my own diagnosis. Most of the time, echocardiogram summaries are already available for me, so I can check to see how accurate my diagnosis is. I must admit I'm getting pretty good at this. And not just the cardiac exam. When you have this many malaria (spleen), alcoholic (liver), and tuberculosis (lungs, brain, peritoneum, etc.) patients, you start getting a great "feel" for various parts of the body.

After all, one of the main reasons I came here was to hone my physical exam skills in the presence of the very best in the business. No matter who your source is, KEM's physicians always earn hefty accolades for their exceptionally good and unparalleled physical exam skills. A thorough, well-calculated physical exam is an undeniably vital component to a physician's healing touch, and patients REALLY appreciate it. How many times have you heard friends and family say something to this effect: "My doctor barely layed a finger on me. He just asked me some questions, wrote a prescription, and I got a bill for $100 in the mail. What gives?" Talk about erosion of the physician-patient relationship! The physical exam connects you to your patients in ways that detached, esoteric lab values cannot. I think its a simple truth that is overlooked far too often.

And while I'm at it, let me make a plug for the Stanford 25: http://medicine.stanford.edu/education/stanford_25.html

We have all seen the studies, however, that demonstrate that the physical exam can oftentimes be unreliable. I get that. It is definitely subjective. Given the incredible advances medicine has seen as recently as the last 20 years, no one is saying that we should ditch laboratory tests and body imaging in favor of clinical findings. But you can't tell me that we haven't gone way too far in the other direction. And the result is dissatisfied patients, technology-dependent physicians, and increased health care costs. Big problems, huh? We definitely need to triangulate a more balanced approach. With my plan to enter academic medicine one day, you can bet that I am going to be a huge champion for the physical exam. It's fun, it's cerebral, and I think it makes you a more complete doctor.

Maybe the best thing about these kids is that they don't care that I don't speak Hindi or Marathi. A smile is all it takes to get their attention and start our interaction. A smile is all you need to reassure a concerned parent as you flip through their child's paper chart. Of course, some of these children are so profoundly ill that it pains me to even look at them. Thankfully, the average kid is far more resilient than your average adult. Fever of 103, an uncomfortable bed, a noisy environment that is sleep prohibitive, no matter. When I position my stethoscope over their heart and put the sound into their ears, they always get that initial inquisitive look, a gleam in their eye, and that wry smile of recognition. Man, I live for that.



Sunjay

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