The world of medicine is like a bubble. A lot of people THINK they know what goes on there, but unless you're down in the trenches it's unlikely you do. So here is my semi-anonymous blog, here to tell you what really goes on in the life of a medical resident.

Friday, September 15, 2006

Just Do It.

Although maybe not what you think.

Just vaccinate your damn kids already. I am so tired of having the same argument over and over with people who 'know someone whose friend had a niece who got autism from a vaccination'. Sure they did. But right now there is a young boy on the pediatrics floor with meningitis because his mother didn't believe in vaccinations. When questioned further about her beliefs, the mother admitted that she didn't have any concrete evidence or research to back up her decision, but a friend of hers suggested that vaccines were like 'putting poison into her child'. So she put it off. And refused it when her family doctor offered it. Repeatedly. She had been meaning to do the research herself, she said, but she just didn't have the time.

Hope you have the time to deal with a brain-injured child.

I have yet to come across anyone who can provide me with actual fact-based evidence to support a decision not to vaccinate. Particularly with the tried and true vaccinations-- MMR and DTaP-IPV. I am more likely to understand the hesitation to incorporate the 'new' vaccines with the (albeit misguided) reasoning that new vaccines have less safety data backing them up. But childhood vaccinations have changed the face of disease in the past 50 years. Smallpox has been eradicated. Polio has been eradicated in the western hemisphere, with the exception of some confined outbreaks in religious communities that are anti-vaccination. Diseases such as mumps, measles and whooping cough are so rare that when a child is admitted with one of them, medical trainees parade through the room at a constant pace to see how it presents.

And with the newer vaccines (Hib, Menjugate) even during my short medical career we've seen the impact. Meningitis used to be a much more common childhood killer. Since the advent of the Hib vaccine (hemophilus influenza B being one of the most common causes of meningitis in infants and young children) the incidence of meningitis has gone down dramatically (I think it's by about 90 percent, but don't quote me). Epiglottitis, an airway emergency that we're taught to be suspicious of in any child coming into the emergency room with stridor and drooling, is actually now more common in adults.

This topic infuriates me. If anyone out there in cyber-land can give me evidence (and by that I mean peer-reviewed trials, not the word of your next-door neighbour) that backs up the decision to avoid childhood vaccinations, I'd love to hear it. Because every time I see another kid come in suffering from a vaccine-preventable disease, I have to bite my tongue not to point out to the parents that their inaction was directly responsible for their child's suffering.

Judgemental? Sure. But YOU try treating a kid with meningitis who, up until admission, was a totally normal kid and is now deaf and brain-injured. And then find out that mom had opted out of vaccinating because she decided to take the word of her cousin's friend over her family doctor or pediatrician. And let's see how judgemental YOU become.

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Sunday, September 03, 2006

My First Day of Pediatrics.

I learn a lot at my job. Here are the gems that came out of my first day of peds.

1. Don't ever, ever assume that just because you are a doctor, you are allowed to touch your patients. First, make sure to ask permission from the nurse, the peds staff, the senior resident, the child's parents, the baby herself, the cafeteria lady and the housekeeping staff.

2. If your patient is a newborn, you are not allowed to touch it while it is sleeping or after it has eaten. So if you need to do a physical exam, that leaves about 8 minutes in the early morning and another 4 minutes sometime in the afternoon. Nurses will enforce this rule with the ferocity of a rabid pit bull.

3. If there is a parent in the room, it is best to assume that they believe that you are there to do their child irreperable harm. Regardless of whether or not you actually intend to touch the child. In fact, the fastest way to befriend your patient's parents is to agree that everyone working at the children's hospital is horribly incompetent. Yourself included.

4. Many people in pediatrics have devoted their lives to children because they aren't that great at relating to adults.*

5. Every crib on the pediatrics floor will work slightly differently. Which means that you will look like an idiot trying to release the side of the damned thing for 10 minutes while the parents of your patient stand by, amused. It's hard to garner any respect after that.

6. Children are very different from adults. Don't ever think that anything you've learned in your previous 14 months of residency will prepare you for dealing with children.

7. Pediatricians and pediatric residents spend an inordinate amount of time discussing how no other physician in the medical universe knows the first thing about treating children.

8. Parents will describe every episode of vomiting as 'projectile' if it is coming out of their child. Even if it just dribbles down the front of their sleeper.

9. At some point in parenting school, parents learn that if they smoke outside their cigarette smoke cannot possibly have any effect on their child's asthma. This is a belief that they will defend and argue to the death.

10. Trying to get back into a regular schedule after two months of shift work requires copious quantities of caffiene.

* Vitamin K is, of course, the glaring exception to this rule. Cause she's just wonderful to everyone. Even when she's sleep deprived.

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