Paediatrics (Part 2/5, RETROSPECTIVE POST)

Paediatrics Outpatients was where I became very enthusiastic for the first time in Clinical Medicine. The awesome thing about Outpatients was that we had the opportunity to see Patients on our own, and then present the information to the Paediatricians afterward for further input. The children always came with at least 1 Parent / Guardian. The majority were for Respiratory or GIT complaints (eg Abdo Pain, Constipation), with some presenting for follow-up following Inpatient management several weeks ago.

To be honest, whilst my Clerking wasn't particularly good at the time as I didn't use any shortcuts and was being too methodical in both History and Physical Exam, and writing all the details down (and thus taking too long), I really enjoyed the Consultations. For some reason I found it quite easy at the time to engage both the the child and the parent, something which a senior Paediatrician said was a challenging aspect of the Specialty. I was hypothesizing that it was because I am overly sensitive, and also get distracted easily, it enabled me to “bounce” back and forth between the 2 individuals with little effort. What also facilitated this was that if I had difficulty figuring out what to say next to a parent, I could reduce the “awkwardness” by focusing on the child, and vice versa. Switching to the child was sometimes useful when the parent was being too chatty (which happened frequently).

The best thing was the children (without trying to sound like a Paedophile), I felt I could relate to a lot of them better than the adults. It felt easy for me to talk to the ones who were verbal. The younger ones (especially Pre-Teens) had more concrete thinking which I could relate to (Frontal Lobe underdevelopment). I found it very endearing when one of them asked how they managed to put the Test Tubes (containing Blood) into the computer I was using (in the Outpatient room) in order to obtain the blood results. My basic explanation was that the Test Tubes were being analyzed by a big machine in a lab somewhere else in the hospital, and that the results are recorded by a computer program, which then sends the data electronically to other computers for view. It reminded me of when I was younger and didn't understand how a Fax Machine worked – I used to think that the same piece of paper that got put into a Fax Machine would physically be transported through the thin telephone wires and pop out, to be printed at the receiving end!!!

I could use simpler English (cognitively easier for me) and shorter sentences when speaking to the children without being seen as patronizing. I relished in the fact that I could ask simple questions without pretense like “What is your favourite colour?”, “How old are you?”, “What do you like to play?”, and get straight answers from the Children without being seen as a “loser”, “dickhead”, or “pervert”. The parents also seem pleased that I was engaging with the children and communicating at the same level. Neurologically, I knew that they were less developed than an Adult NT, so I found them much less threatening on the whole, as I perceived them to be cognitively less able of being manipulative and chronically dishonest. This probably increased my confidence which permeated into my behaviour, seemingly despite my poor medical knowledge. I liked how a lot of the NT Children seemed more inquisitive and disinhibited, before they become fully conditioned into their stereotypical, conformist Adult forms. In short, I felt I had more potential to make a positive difference to the Children.