specialties with less focus on h&p's

[Goran]

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Hey everyone. Just starting third year and confirming the fact that I dislike h&p's, while I very much enjoy patients, especially kids. While peds cardiology is intellectually appealing, I wouldn't trust myself to correctly identify murmurs, etc. Are there any pediatric subspecialties that focus less on physical findings and more on lab data?

 

[J-Rad]

No, not really. To varying degrees all pediatric specialties will be reliant on the history and physical exam findings. Some may emphasize H>P and may emphasize certain portions of each piece (H and P). Examples would be devo: heavy on history, heavy on certain portions on the physical (neuro, mental status/psychosocial interactiveness, musculoskeletal [esp. for the CP kids])) less on others (just about everything else). Peds ER may employ a more focused H&P but is not absent. Neo will have less history at the beginning (basically pregnancy and perinatal period) but over time the medical history of the chronic boarders will become important. Also neos do use their physical exam findings (although neo does use lab/ancillary study data quite a bit). PICU won't get you away from Hs and Ps either, though, again, lab data may drive treatment a bit more than in other fields (for better or worse).
You might want to consider pediatric subspecialties of other fields, particularly radiology and anesthesia. In radiology patient history will be important but will have been gathered by others and generally no physicals. Anesthesia will have very focused H&Ps that may seem more manageable. The pediatric surgical subspecialties may have less intimidating H&Ps (general, OTO, Uro) though they, like radiology, can be particularly difficult to get a residency a/o fellowship in.
Two asides: totally lab driven medicine is not ususally good or even useful medicine. Appropriate labs and other studies are usually driven by good H&Ps, not the other way around. Remember willy-nilly labs often yield information that one never wanted but may confuse treatment. Second, H&Ps are very intimidating a/o time consuming to most 1-3rd (and probably 4th) year medical students. Over time people become more facile and faster at H&Ps and after a while have the accumen to narrow down the focus of H&Ps, so they become less cumbersome.

 

[generic]

I'd agree with what he said.

As a new intern, H&P's are still very important, and very much my responsibility. However, it's already gotten a lot better than when I was a student. For one thing, sometimes I can make the student do a full H&P...haha.

But seriously, I wouldn't discount cards because of fear of not hearing murmurs (unless you have bilateral sensorineural deafness). I have had similar fears, but have noticed improvement over the years.

And you could also think about staying in academics, where you might not have to do too much of the cumbersome H&P work--just listen to 2 peoples' presentations, walk in the room, shine the light in one spot, and declare a diagnosis! You'll look like a superstar.

 

[rotatores]

I'd agree with what he said.

As a new intern, H&P's are still very important, and very much my responsibility. However, it's already gotten a lot better than when I was a student. For one thing, sometimes I can make the student do a full H&P...haha.

But seriously, I wouldn't discount cards because of fear of not hearing murmurs (unless you have bilateral sensorineural deafness). I have had similar fears, but have noticed improvement over the years.

And you could also think about staying in academics, where you might not have to do too much of the cumbersome H&P work--just listen to 2 peoples' presentations, walk in the room, shine the light in one spot, and declare a diagnosis! You'll look like a superstar.

But even so...who cares....that's what ECHOs are for!

 

[BigRedBeta]

What bothers you about the H&P's? Is it just that they're time consuming? Do you feel lost, like you don't know what questions to ask? You say that you're unsure if you could correctly ID murmurs, so are you worried about your exam skills?

Or is there something else that bothers you?

If it's anything in the first paragraph, relax - you'll get better, faster, more insightful, and better with your exam.

Remember, that as a third year, particularly during the early part of the year, doing a thorough H&P and writing a good note are things that you can and should be doing. You may not be able to diagnose the problem, know what antibiotic to use for a certain pathogen, or know the steps for dealing with a critically high potassium level, but you can talk to your patient and find out the details of how they got to that point. And in terms of your physicals, the most important part of third year is getting to the point where you can say normal or abnormal. Just being able to say "this doesn't sound normal, it might be a murmur, can you listen to this" is a good starting point. Remember, pediatric cardiologists have 3 years of peds training, and then 3 more years of nothing but messed up hearts to get as good as they are at picking out murmurs!