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Admitting Peds patients
- Thread starter ComicBookHero20
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I admitted 2 peds patients last week. I don't have a peds floor, I'm doing rural medicine. I am currently at a 10 bed hospital as a locum provider.
I never did inpatient peds in residency. Just have to deal and wing it and look up doses for the little ones.
I never did inpatient peds in residency. Just have to deal and wing it and look up doses for the little ones.
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I know I am just a 2nd year and you are an attending but I thought all programs required at least 2 months of inpatient peds? After doing a VERY intense inpatient month and a more laid back inpatient month in my first year; I could not see myself admitting without this training. I guess I may be a little ignorant of just how rural family medicine can be?- are there other people in residency training that do not require 2 months of inpatient peds, if so I really think this is an issue that needs to be addressed.
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I think it depends on how complicated the patient is. I think the majority of peds admissions are straight-forward enough for someone who has had a good amount of hospital experience to handle without necessarily having a month or two dedicated to pediatric admissions. You have to know your limits though.
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I disagree. Kids crash fast. Without proper training one should not be assuming primary role. In my training at a tertiary children's hospital I would get the "worst nightmares" airlifted from rural care. I am not knocking rural care in the least but it would seem for the most part understanding of acute pediatric problems was quite inadequate. I wonder if this was from a lack of training? I am not trying to step on anyone's toes. Patient care is all i seek. Pediatrics is such a core aspect of Family Medicine. Many mothers look at me as their pediatrician for their children. Snake oil do you have inpatient peds? I really can not believe inpatient peds is not a part of all programs... please let me know if this is not the case.
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My residency training did NOT do inpatient peds due to the fact the city I trained in had a pedicatric hospital with its own residency program. The hospital I trained in did not do inpatient peds.
Rural medicine is a whole new ball game. I have admitted patients with severe croup and other upper respiratory problems. Rural means you fly by the seat of your pants and deal with whatever comes through the door. I just can't say, "I'm sorry but I can't admit your child because I never did inpatient peds in residency". You really think that will fly when I'm on an island??? If there is EVER a question that I think the child would be at risk of being intubated or dying then I would medvac then to the nearest pediatric facility. Rural medicine is a lot of doing what you can but also realizing what you don't know and shipping a patient before they become critical when you know you don't have the resources available.
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We do a month of inpatient peds at a peds program as part of the rounding team - two peds interns and a peds 3rd year.....and it's mainly to give us the basics - croup, constipation, rotavirus, asthma exac...and then genetic disorders....and to recognize when the kids really sick and immediate action drills....
But most of what we're learning is what you've stated -- separate the sick from the not sick....and knowing your limitations...
Like Harry says," Man's got to know his limitations".
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This is just wrong. It might be reality, but it`s wrong.
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I wholeheartedly agree with you....A word to the wise -- completely investigate your future residency program BEFORE you make out your match list...at least do a rotation there and PAY ATTENTION....do not trust anyone, if it's not happening now and is promised,"In the near future" don't count on it to happen.....
Won't say how I learned this...
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Our program does have required inpatient peds months. And I agree that kids can crash fast, but honestly for your typical croup/asthma peds patient, there really isn't a whole lot more a tertiary care center can offer to a kid that's crashing that someone with PALS certification and some decent hospital experience under their belt can't. I'm not saying FM residents should be handling everything that comes through the door, just saying that the majority of peds admits are straight forward enough for most FM docs to manage. Again, know your limits. There are plenty of pediatric presentations I wouldn't feel comfortable handling and for those I would defer to someone with the appropriate level of expertise.
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I agree everyone should know their limits. Cabin builder- my program does not have an inpatient in house pediatric program. We are sent to an in house peds program and work with the residents there for 2 months. I am not trying to repeat this to make anyone feel badly, but I really think inpatient training is a core aspect of residency, so when you are on your own you can better understand your own limits. I really agree you should research the programs you apply to. If you don't have inpatient peds I think this is a mistake, I think a huge mistake and this should be required of every family medicine program. Again no offense to anyone just my observations (I'm only a pgy-2 resident)
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Ok, just because you feel inpatient training peds is a core aspect, doesn't mean that every residency program out there has the same training. We all know that every program has strengths and weaknesses and we deal with it. I trained in a small city that had a pediatric hospital with its own residents. Our program did not rotate at their hospital. Whether is politics, etc. I'm not sure. I did do 4 months of outpatient peds since our residency clinic didn't see kids either. Why? because our attending at the residency clinic didn't see peds so we were outsourced. Just the way it was. My program was very internal medicine/ER/hospitalist heavy.
As far as researching a program, since I scrambled into a program and never expected to go into FM in the first place, well that's just a moot point with regards to my personal path. Not sure what you are trying to gain by your comments because I am sure not planning on going back to residency just to gain more experience in inpatient pediatrics.
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I had a residency with inpatient peds. The thing is it wasn't like a pediatric hospital where you have kids on echmo and it was a fairly small percent of hospitalized patients. Also we could consult a pediatrician if needed but the peds guys we could consult were a long way from residency and it's not like they been exposed to alot of high acuity peds within the last 30 yrs. Seeing a bunch of runny noses every day doesnt exactly keep your hospital skills sharp as far as a largely outpatient pediatrician. I also did alot of my electives in medical school in peds including pediatric surgery and pediatric cardiology. It's not the generalist capabilities that are the limiting factor in non-pediatric hospitals it's pediatric specialists. Not every kid with RSV, asthma, nonsevere pneumonia needs to be in a hospital dedicated strictly to pediatrics. We had no incidences of death or significant mortality at our hospital for pediatric patients while I was there. That's probably because we didn't accept significantly ill peds patients with significantly ill peds sent directly to dedicated pediatric hospitals after stabilization in the ER. Peds hospitals aren't equipped to handle every single low acuity peds patient and it's not necessary to have them accept every peds patient.
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