how comfortable are you with adult problems?

[noolie]

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To all the Pediatricians/Pediatricians-in-training out there: How comfortable are you in dealing with adult problems when friends or family members ask you random questions about their health, or when discussing adult cases with other Physicians who are not Pediatricians? I know that most people who get done with medical school are generally more comfortable in dealing with adult diseases than Pediatric ones since most Med-schools stress adult pathology. So, overall it seems like most pediatricians would be more comfortable with adult problems than IM docs would be with Pedi problems. Just wondering!

 

[pmpkn219]

I feel fairly comfortable thinking through adult questions myself, given that I Just finished (even though a huge chunk of 4th year was spent on Peds). Ask me in 3 years?... who knows.

As a rule, when family/friends try asking me stuff, I don't like that slippery slope, so I say something along the lines of "old person problem, not my thing! ask your doctor" in a joking way. But I mean it 😛

 

[Stitch]

Occasionally we'll get an adult with chest pain strolling into the peds ER. I don't like it at all. Obviously you get an EKG and send off enzymes, but I transfer them as fast as possible to the adult facility where they see that stuff regularly. It's just better care (the same reason they send bad astmatics to me).

In general the adult and pediatric differential diagnoses are totally different, and assuming that you can guess from your own experience is an easy way to get into trouble. There are things we think of in kids (say for example intussceception or congenital heart disease) that adults don't think of and there are lots of adult things that I don't think of. I rarely see much CHF and chest pain is almost never the heart. Even the disease processes that overlap are often treated differently.

So in general I know 'of' adult illnesses, but don't know a lot about the details (and I'm not that interested). Honestly these are reasons I find it hard to believe people can really learn everything you need to know about peds, adults and OB in a 3 year family practice residency, and attests to how hard those good FPs have to work to stay on top of things.

When people ask, either family members or sometimes even parents of patients, I tell them "I'm sorry, but I'm not that kind of doctor, and that's a great question for an adult doc."

 

[albe]

I would be interested to hear from pediatricians how comfortable they would be in handling an adult emergency. For example, if you were the only physician on a plane or other remote setting, how comfortable would you be in handling an adult with an MI or other adult emergency?

The reason I ask is because I am considering pediatrics after having gone through internal medicine (I feel like I enjoy working with the peds population more than the adult population). However, I would feel pretty bad if I were in a situation like the above but be unable to provide care to an adult patient. I've thought about med-peds but I don't think I would enjoy the IM portion. I just want to be able to initially manage the acute problems in adults.

 

[J-Rad]

I would be interested to hear from pediatricians how comfortable they would be in handling an adult emergency. For example, if you were the only physician on a plane or other remote setting, how comfortable would you be in handling an adult with an MI or other adult emergency?

The reason I ask is because I am considering pediatrics after having gone through internal medicine (I feel like I enjoy working with the peds population more than the adult population). However, I would feel pretty bad if I were in a situation like the above but be unable to provide care to an adult patient. I've thought about med-peds but I don't think I would enjoy the IM portion. I just want to be able to initially manage the acute problems in adults.

Most initial emergency care, be it pediatric or adult, is pretty algorithmic. I wouldn't feel comfortable and I would wait until no-one else answered the "is there a doctor on board" call but if absolutely necessary I can probably remember MONA and I can do chest compressions if need be.
As for the bolded portions: you might want to think that though a bit (or you meant something entirely different). You think you want to do six years of [two separate] residencies (and your second residency will get lower compensation since it's your second-i.e. they'll have less incentive to take you) just so you can handle an adult emergency? You wouldn't like the IM portion of a Med Peds residency so you want to do an independent IM residency before Med Peds 😕? You've got to like both to do Med Peds. But if you want to be a pediatrician who can handle an adult emergency on some rare occasion why not just do peds and stay certified in ACLS? Take ATLS if you want, too.

 

[ahd929]

Most initial emergency care, be it pediatric or adult, is pretty algorithmic. I wouldn't feel comfortable and I would wait until no-one else answered the "is there a doctor on board" call but if absolutely necessary I can probably remember MONA and I can do chest compressions if need be.
As for the bolded portions: you might want to think that though a bit (or you meant something entirely different). You think you want to do six years of [two separate] residencies (and your second residency will get lower compensation since it's your second-i.e. they'll have less incentive to take you) just so you can handle an adult emergency? You wouldn't like the IM portion of a Med Peds residency so you want to do an independent IM residency before Med Peds 😕? You've got to like both to do Med Peds. But if you want to be a pediatrician who can handle an adult emergency on some rare occasion why not just do peds and stay certified in ACLS? Take ATLS if you want, too.

i think they were saying they are thinking about doing peds after having just finished their M3 IM clerkship.

 

[albe]

i think they were saying they are thinking about doing peds after having just finished their M3 IM clerkship.

Yup, that's what I meant. I am currently an M3 who has already finished my IM clerkship, currently in my pediatrics clerkship.

Thanks for the replies. The comment about keeping up with ACLS/ATLS sounds like a great idea for what I want out of my career. Are there any pediatricians who have found themselves needing to apply their ACLS skills in an outside setting?

 

[Stitch]

The comment about keeping up with ACLS/ATLS sounds like a great idea for what I want out of my career. Are there any pediatricians who have found themselves needing to apply their ACLS skills in an outside setting?

I agree with J-Rad's comment. Most true emergencies are managed along the line of ABCs and if you know the protocols/algorithms then that's enough with CPR. Also keep in mind, that occasionally it's a kid in trouble, and you'd be more qualified than an adult doc stepping up to the plate if necessary.