outpatient pediatrics

After three weeks of caring for some seriously sick kiddos, this past week of mostly well visits has been a welcome reprieve.  While I think I’m more of an inpatient kind of girl, a month of clinic every now and then, or an afternoon or two a week of outpatient is a sweet deal.

First of all, the schedule is simply lovely: arrive at the office at 8:30; take 30 minutes for lunch; leave by 5:30 at the latest…and that’s a busy day.  (This is definitely not to say that all outpatient pediatric experiences are like this…to the contrary, most attendings in private practice are feverishly swamped.  But, as a student, things are a lot cushier.)  As I enter my 35th week of pregnancy, I’m overwhelmingly appreciative of the extra time allotted for sleep and study–oh God, I’m horribly behind on studying.

Two: at a tertiary care center, it’s easy to forget that rare diseases are rare, that not every child has a catastrophic  illness or injury.  Not all children who have asthma have to be admitted to the pediatric intensive care unit for days in order to make sure they oxygenate their blood.  Not all children who have a fever have bacterial meningitis.  For me personally (and somewhat selfishly), it’s nice to be reminded that there are so many healthy, happy children out there.

Finally, outpatient peds is a fairly unique environment for providing true preventative care.  Parents love their children and, for the most part, they’re pretty amenable to changing behaviors, considering suggestions, and making some hard parenting decisions if it means their kids will be better off.  Sure, we’ve all seen parents who refuse to get their kids vaccinated, who could care less what and how much food their kids consume but, although they’re a loud minority, they still are very much the minority.  The challenge is much more a battle of resources.  It’s hard to argue with the fact that cheap foods are often not the healthy ones.  And it sucks when you and mom are in agreement that her child needs to get outside more for stimulation and exercise, but the neighborhood is far too dangerous to allow for it.  So, in the mean time, we have things like WIC to provide healthy supplemental foods, and Brighter Futures to provide (among other things) a book to take home for every child who comes in for a well child visit.  It’s something.

Oh, and this is funny: I think I’m starting to develop age preferences.  Right now, I’m totally digging 4-month-olds and teenagers.  4-month-olds will smile responsively and make all sort of fun vowel sounds.  Teenagers will, sometimes, talk shockingly openly about their sex lives and their completely untempered, borderline lofty life/career goals.  Love it.