Adrian Gutierrez
As an older brother of 7 siblings of a variety of ages, I enjoy seeing my siblings grow up and always tried being the model brother, although I was not good-looking. I kid! However, in all seriousness, this responsibility did lead me to enjoy being around children.
As a medical student, I feared becoming a pediatrician, because what if I made a baby cry or a child does not let me perform a physical exam? Or what if I make a parent upset because they do not feel I’m taking adequate care of their child?
Luckily, I had met some awesome residents during my medical school career. As a currently aspiring pediatrician, I would like to share with you their advice on what you can do to be a great pediatrician!
Even if you do make a couple of babies cry…
Principle #1: Addressing the children
Principle #2: Be creative
Principle #3: Include the family
Principle #4: The dreaded physical exam
Principle #5: Ask for help, stay curious, and learn from your patient
Principle #1: Addressing the children
On your pediatric rotation, you will definitely encounter all sorts of children. Some children may be so shy that they may not even dare look you in the eye, while other children may be so fast and active that you may think they are a reincarnation of Barry Allen.
In either scenario, you have two options. You can either A) give up and focus your interview solely with the child’s parent or B) attempt to communicate with the child as your patient. I hope you chose option B!
As a possible future pediatrician, it is good practice to be able to adapt to any patient as there are many personalities encountered in pediatrics! Practicing introducing yourself to the patient and trying to communicate with them shows that you are interested. It not only makes the patient feel more comfortable with you, but also makes their parents feel more comfortable with you.
Even if your attempt to make the patient feel comfortable fails, whether your shy patient remains silent or your Flash patient runs off to the horizon never to be seen again, this practice of addressing your patients allows you to have the potential to grow your social intelligence as well as learn how to address different personalities in the future.
Principle #2: Be creative
Sometimes in order to reach a child and gain their trust you must go above and beyond to show that you are someone that they can trust! Being creative may not be easy for some and for this principle, it may be a good idea to hit the “Phone a friend” button in your head and contact some of your right-brain friends for help.
I’ve found personally that script-reading could be very helpful for your shier patients. For example, I personally had one patient who would never speak to the pediatric team in the hospital. So after rounds, I would print scripts from the Lion King or Coraline, which was her favorite movie, and we would act the scene with her mom! It was then I would hear her voice and laugh. Nothing in the hospital sounds sweeter than a child’s laughter.
Now, you do not have to be the most creative person to be a great pediatrician, however, minimally it is essential to be able to adapt to your patient and show enthusiasm. This is the time to carry stickers or little toys in your white coat. Maybe remember a few corny jokes to tell, as many children enjoy jokes! If you dare, maybe you can prepare little magic tricks such as a magical vase that makes a red ball disappear or a coloring book that does not have any images inside unless supplied with magic? Weird…
No matter what you do, just be creative as this skill will not only allow your patient to open up to you but also allow them to trust you.
What is a good name for a hotdog? …Frank!
Not my best joke, but you get the point.
Principle #3: Include the family
Now that we know that we should address our patients and how to do it, let’s also try to remember to keep the parents involved in the care. I know this may seem hypocritical as principles #1 and #2 are based on focusing on the patient, but I will explain.
One of the most exciting parts about pediatrics is that not only do you have the opportunity to educate children about their health, but you will also have the opportunity to educate parents.
You will find that most parents are eager to understand why their child may not be feeling the best, and the importance of involving them cannot be stressed enough. This principle is crucial when your patient’s parents are first-time or younger parents.
So now it is time to become a teacher. It is important to find ways to make important topics simple and easy to understand. It is always rewarding knowing that you relieve a parent of the stress of having a sick child.
“We are not just teachers, we are manager’s of the world’s greatest resource: Children!”
- Robert John Meehan
Principle #4: The dreaded physical exam
Now that you know how to skillfully address your patient AND to also address the patient’s parents like a teacher, you can move on to the physical exam. This may seem procedural as you are a seasoned medical student, but wait…now the patient can evade your physical exam!
One of the most uncomfortable parts of the routine physical exam that many children do not like is the HEENT exam, especially when you examine their ears. Having an otoscope inserted into their ears or nose will make any patient cranky.
Some tips that I was advised are to save this particular exam towards the end of routine physical examination as a whole. For example, perform a heart, lung, and gastrointestinal exam first, then proceed to the HEENT exam. Once you get to the HEENT exam, that’s when you can perform your expert tactics to make the exam as easy as possible.
First, if your patient is small enough, you can suggest that their parents can hold them while you are performing the exam. This allows your patient to feel as comfortable as possible and if the exam makes them uncomfortable then their parents can assist you by holding your patient steady while you perform your exam. This tactic also reduces the risk of any kind of injury that may happen if the patient is not steady.
Secondly, remember principle #2. Be creative! Some students like to improvise during their physical exam by “finding” comical things inside children’s ears or nose. Examples can include finding mickey/minnie mouse, Elsa from the movie Frozen, or even tacos, which is the personal key to my heart, but I digress. In addition, you can also allow your patients to become familiar with your physical exam equipment such as letting them touch the lighted tip of your otoscope. The familiarity can help your patients relax during the physical exam.
Finally, remember that no matter what, your physical exam is crucial to the patient’s care. It sometimes can be tricky, as children are resilient and may not be able to voice their concern or are unaware what is abnormal. So be meticulous! Assume every child is guilty of illness until proven healthy!
Principle #5: Ask for help, stay curious, and learn from your patient
Principles 1- 4 will guide you through any clinical encounter in your pediatrics clerkship. This principle is useful with the aftermath. Did you ask the right questions during your interview? Did your physical exam help you determine your diagnosis? This is where most of your learning as a future pediatrician comes in.
With everything, never be afraid to ask questions. If after an encounter you are unsure, ask! Believe it or not, even at the residency level you will constantly question yourself and think about things that you may have missed. This is a common feeling that I have found out and it is a feeling that I personally feel makes you a better pediatrician.
I was advised to ask and to be curious, because this is how every clinician learns throughout their careers. This is how you can maximize your learning from each and every patient that you may encounter.
If you are an aspiring pediatrician like myself and you remember these five principles during your pediatric clerkship then I believe you are on the road to being the best pediatrician you can be. So when you hold that baby and he or she starts to cry, just remember that every great pediatrician probably held a crying baby in their arms as well.
“Good, better, best. Never let it rest. Until your good is better and your better is best. “
- Tim Duncan