What I Hate About Pediatrics: The Specialties

[J-Rad]

I love pediatrics and I don't think I would have been happy in any other field (well except for maybe ENT). But most people don't love everything about their chosen profession, so to allow a little venting, especially for the interns who are still slogging away at their first few (most painful) months of residency I thought I'd start a few threads about the things we individually hate about pediatrics.
First thread: what specialty or specialties do you hate (it's fair to make general outpatient/inpatient/both a "specialty" for the sake of this thread)? Have a little fun with this thread and for those who get offended too easily, lighten up.

I'll start: #1 Developmental pediatrics. Fundamental, crucial, key to the training of any good pediatrician. But dear lord, could there be anything more painful than three 2 hour autism evals in a day. CP, MR, developmental delay...thank the gods that there are people who want to do this (and bless 'em, I brought my son to them for some concerns) but I can only see the field as everything that is the most boring in general pediatrics all wrapped up in one field. And why don't you just put some of the loonier parents into the mix to make it even more fun why don'tchya? Add a fair smattering of off kilter docs and there you have it: developmental hell.

And coming in a close #2: You guessed it, the supplier of many (the most?) future visitors to number one...ratology (neonatology for the unitiated). Now do I hate EVERYTHING about rat farming? No, no, no (that's why it's number two, silly). I actually kind of enjoy the acute resuscitations and stabilizations. There's nothing like the three am fat cane toad of a full termer who comes out stinking like sewer, gray, and with a fun case of PPHN to get your juices flowing. And hell, I liked torturing the 23-24 weeker with tubes and lines and all sorts of sharp stuff as much the next guy...because I figured they were gonna make my life miserable the next time I was on call, what with there stupid residuals and NEC watches, and midnight fevers (and is it me or do the evil little turds just know when evening checkout is? Because it always seems like no matter how well they were taking their feeds during the day, about 15 minutes after checkout and the day resident and attending leaving about three of them have to have a "significant residual"). Now mind you, I derive great deal of satisfaction knowing that there are a good few young tykes out there who are alive and breathing (and hopefully developmentally normal!) because of me and the teams that I was working with at the time. But isn't it weird how when some of those kids hang around for a while a fair number of their parents forget the multiple times that their child's life was saved by the NICU staff and are just pissed that they can't go home yet (how about we get your kid off of CPAP first, shall we?)? Oh and the daily slog, that's what I really hate: I don't want to formulate their TPN, I don't care whether they're stage 1, zone two, I don't want to remember if it's billie jo bob or deja'vushauwan who has the G3 IVH on the right. Just give me the ETT, I promise that unless there an airway trainwreck I'm likely to get it in (cause I don't like their mewly little 28 weeker whining either). I love fellowship now. I get to go up to our (very nice) unit, chit chat, do my duck check (quack, quack, yup they have a duck) and never again a TPN order will I make. (PS on a serious note, I consider some of the neos I worked for very much mentors and am grateful for what I learned under their tutelage. So many thanks to the OBP types out there. Now back to having fun venting...)

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[J-Rad]

You know, I forgot. Neo has to drop to number three. Filling the number 2 spot (really, almost tied with number one): Peds Pulm. To obnoxiously quote my self in a long ago thread: "the only field in Peds more boring than its adult counterpart: asthma, asthma, asthma, asthma, asthma, asthma, asthma, asthma, asthma, asthma, asthma, asthma, asthma, a little CF, asthma, asthma, asthma, asthma, asthma, asthma, asthma, a little CF, asthma, asthma, asthma, asthma, asthma, asthma, asthma, asthma...You'll learn a lot of asthma and a little CF, and you'll "

 

[CrazyPeds527]

As a lowly 'tern, I have yet to experience the "wonders"

of specialties like Developmental (not 'till next year), Adolescent - "I swear i haven't been having sex" "You're pregnant", or Telephone Triage....I have experienced the ridiculosity of Ratology (I like that J-rad!).

Yes, I would love to intubate this 23 1/2 weeker and stick lines and tubes in them. This way they will be here for a lovely 3 1/2 months. Sure, need surgery for NEC? No problem, that will just leave you with a wonderous 15cm of bowel so I can continue to take care of you on the GI service for most of your natural life. Eye surgery? Sure...that way your ROP can be healed so you can maybe see, that is, if your cortex even works, which we don't know.

OK, that's enough venting; I don't have to be there again until next year...whoo-hoo!!!!!

 

[meconiumdelee]

I hate most of general outpatient pediatrics.
Well child. Well child. Well child.

 

[kristing]

endocrinology

diabetes diabetes diabetes diabetes diabetes diabetes diabetes, looking at little children's private parts, diabetes diabetes diabetes diabetes diabetes diabetes looking at little children's private parts diabetes diabetes diabetes diabetesdiabetes

And pulm for us was the opposite
CF CF CF CF CF CF CF CF CF asthma CF CF CF CF CF CF CF CF CF asthma CF CF CF psychogenic cough asthma CF CF CF

I liked outpatient pulm. I hated all of the inpatient pulm. If I didn't have to do so much CF, I would totally do pulm. Why? It's NOT HARD. It's actually kind of fun, because controlling someone's asthma can make their lives lot better! But inpatient. - barfffff

 

[Homunculus]

And coming in a close #2: You guessed it, the supplier of many (the most?) future visitors to number one...ratology (neonatology for the unitiated). Now do I hate EVERYTHING about rat farming? No, no, no (that's why it's number two, silly). I actually kind of enjoy the acute resuscitations and stabilizations. There's nothing like the three am fat cane toad of a full termer who comes out stinking like sewer, gray, and with a fun case of PPHN to get your juices flowing. And hell, I liked torturing the 23-24 weeker with tubes and lines and all sorts of sharp stuff as much the next guy...because I figured they were gonna make my life miserable the next time I was on call, what with there stupid residuals and NEC watches, and midnight fevers (and is it me or do the evil little turds just know when evening checkout is? Because it always seems like no matter how well they were taking their feeds during the day, about 15 minutes after checkout and the day resident and attending leaving about three of them have to have a "significant residual"). Now mind you, I derive great deal of satisfaction knowing that there are a good few young tykes out there who are alive and breathing (and hopefully developmentally normal!) because of me and the teams that I was working with at the time. But isn't it weird how when some of those kids hang around for a while a fair number of their parents forget the multiple times that their child's life was saved by the NICU staff and are just pissed that they can't go home yet (how about we get your kid off of CPAP first, shall we?)? Oh and the daily slog, that's what I really hate: I don't want to formulate their TPN, I don't care whether they're stage 1, zone two, I don't want to remember if it's billie jo bob or deja'vushauwan who has the G3 IVH on the right. Just give me the ETT, I promise that unless there an airway trainwreck I'm likely to get it in (cause I don't like their mewly little 28 weeker whining either). I love fellowship now. I get to go up to our (very nice) unit, chit chat, do my duck check (quack, quack, yup they have a duck) and never again a TPN order will I make. (PS on a serious note, I consider some of the neos I worked for very much mentors and am grateful for what I learned under their tutelage. So many thanks to the OBP types out there. Now back to having fun venting...)

omg. i've never seen the NICU summed up so eloquently

i also enjoyed the first 2-3 days (acute management) of the gerbil farm admissions. it's the following 3 months of tending to the rockgarden and watering the plants that killed me. i also discovered the more apostrophes in your name, more likely your outcome will be worse. same goes for "heaven" spelled backwards or "angel". i never figured the "angel" one out-- i mean, it's kinda setting them up for failure if you give them a name normally reserved for them after the die . .

--your friendly neighborhood former miracle grow (or TPN, whatever) concocting caveman

 

[J-Rad]

For all the Neveah's I've met, most of them were pretty normal (not their parents though). Now "Destiny" and "Miracle", those are the most cursed names. Apostophes and males with a name beginning with "Da-", not quite as bad, but not usually on the fast track to wellsville either.

 

[kristing]

neveahs don't do so badly. You are right, the Destinies do terribly. And any set of twins with the SAME name except for a little bit of difference, like the first letter, often followed by an apostrophe? Also terrible.

For ****s and grins when we weren't busy on the wards we would look at the names on the NICU census to amuse ourselves.

 

[motorola]

I hate the Pay !

 

[m1234d]

now, I don't like to be uptight or anything, and I have a hearty laugh watching "it's always sunny in philadelphia" and other amazingly inappropriate things... and you can call me biased cause I'm interested in neo--I totally appreciate that it's not for everyone, and I currently have a pt who I can't believe we are continuing care on...
but I would generally stay away from calling the babies rats, gerbils, squirrels, aliens.. etc. I don't know, it just seems mean. sure, the parents can be totally crazy and can't understand why jr isn't going home while still in an isolette on CPAP... but it's still their baby.

(where's the icon for ducking while stuff is thrown at me?)

p.s. if i wasn't posting here already, i would have posted in the esoteric section that my biggest complaint about pediatrics is that NO ONE EVER COMPLAINS. it's all smiles and sunshine, all the time- ugh. So, thanks J-Rad for making these posts.

 

[J-Rad]

Your welcome and no stuff will be thrown thy way.

But we all vent somehow, and the poikilotherms seem quite deserving

(But bless all the future neos, it's a good thing some peeps want to do it)

 

[Bernardo_11]

Developmental pediatrics. Fundamental, crucial, key to the training of any good pediatrician. But dear lord, could there be anything more painful than three 2 hour autism evals in a day. CP, MR, developmental delay...thank the gods that there are people who want to do this (and bless 'em, I brought my son to them for some concerns) but I can only see the field as everything that is the most boring in general pediatrics all wrapped up in one field. And why don't you just put some of the loonier parents into the mix to make it even more fun why don'tchya? Add a fair smattering of off kilter docs and there you have it: developmental hell.

I won't take this personally, as I am quite sympathetic to your concerns. The field has taken a direction in being developmental disability specialists. Yet when you speak with some of the old guard, they'd tell you the fellowships were designed to produce academic teachers to better educate general peds docs in training. Frankly, I see residents having to be involved in tasks (like caseworker type duties for developmentally disabled adults) which even makes ME wonder its relavancy for future general pediatricians. If it means anything, when I was a fellow and had to do resident teaching sessions, I did my darndest to make them interactive, thought provoking, and most of all RELEVANT to their future practice as possible general pediatricians-- a role I myself had for a year prior to entering fellowship.

Most DB Peds docs though are open to suggestions. My advice for residents out there would be to think up certain questions you have regarding the field that could be relavant to your future practice (e.g. primary care management of ADHD; subtle signs which suggest autism; good screening tool for autism; giving sleep advice to parents; applied behavioral management, etc.). More likely than not your attending would be very open to answering them or maybe even fashioning the rotation to better suit your needs. Also, use the time in the rotation to go through DB Peds questions on PREP (they're easy to pull up now with the CD's) and use your DB Peds attendings/fellows as a resource. You may not ever face these psycho-educational/developmental types of problems/situations throughout the rest of residency, and this could bite you in the butt come time for board studying.

Nardo

 

[kickazzz2000]

You know, I forgot. Neo has to drop to number three. Filling the number 2 spot (really, almost tied with number one): Peds Pulm. To obnoxiously quote my self in a long ago thread: "the only field in Peds more boring than its adult counterpart: asthma, asthma, asthma, asthma, asthma, asthma, asthma, asthma, asthma, asthma, asthma, asthma, asthma, a little CF, asthma, asthma, asthma, asthma, asthma, asthma, asthma, a little CF, asthma, asthma, asthma, asthma, asthma, asthma, asthma, asthma...You'll learn a lot of asthma and a little CF, and you'll "

reflux prevacid reflux reflux reflux nissen prevacid prevacid reflux prevacid CF CF reflux prevacid

 

[mellow22]

The passive-aggressive back-stabbing bioches who run the show. They'll kill you with a smile on their face.