Pediatrics: Treating Disease, Safeguarding Health

Love is... The best medicine by ~hjstory on deviantART

Compared to either medicine or surgery, peds is yet another world in and of itself. Again, at it's core only the patient population differs from internal medicine. However, children are not just miniature adults. There are many unique diseases specific to kids, and this is true also of adults. Medicine manages disease and surgery fixes disease. But pediatrics treats disease and safeguards health.

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Treating Disease

Most diseases that affect children aren't chronic in nature and aren't due to lifestyle choices. Often, kids get sick at no real fault of their own. When a child gets pneumonia or gastroenteritis, you treat it and it goes away. These diseases aren't "fixed" as kids may get them again later, but they're not something chronic to be managed long-term, just nasty infections (kind of like getting a cold, only much much worse). Thus these diseases are treated.

That said, there are some chronic conditions that kids do have to deal with, most notably being asthma and ADHD - neither of which are results of lifestyle choices. Both of these are heavily monitored and managed by the child's pediatrician, and tweaks are constantly being made with the hope that the child may eventually come off medications altogether (usually in the distant-ish future of young adulthood). More troublesome diseases include Crohn's disease and ulcerative colitis, and these tend to be inherited.

Safeguarding Health

Pediatrics - particularly in outpatient peds - the pediatrician addresses the whole patient. This includes development, diet, exercise, school environment, home environment, exposures, stressors, etc. A pediatric patient is more than a collection of symptoms to be managed or fixed. A pediatric patient is a person in the context of his/her sociocultural environment. Really, this is nothing new or different compared to internal medicine, however, there is a much greater emphasis on this in peds. Pediatricians are well aware that habits (good or bad) developed early on have long-lasting implications throughout life. Thus they endeavor to instill good habits into their patients and their patients' families. As such, pediatrics attempts to safeguard health.

This notion appeals to me on so many levels. When I was on medicine, I saw a patient who was so obese that she got stuck in a CT scanner. I saw another patient who was even more obese, so much so that she was unable to even roll over on the hospital bed, much less walk (it was a wonder how they even got her in the hospital doors). But I see the kids of these patients and they are normal - not obese, maybe slightly overweight, but by all other accounts normal. And I ask myself, "How do those kids in less than 2 decades' time become their parents? Or aunts? Or uncles?" Pediatrics has the unique position of being able to intervene when intervention has the greatest potential impact.

To achieve this requires two key things: education and an emphasis on health, not disease. I read an article (here) where a medicine resident goes through a cardiology rotation and encounters a patient who was "non-compliant" in taking her medications. Apparently no one had educated the patient on her cardiac disease and the importance of taking her meds, they just assumed someone in the past had done so. That moment of clarity revealed a gap in which educating the patient, rather than assuming, would've resulted in better compliance. I read another inspirational article (here) that elaborates on why "being a good doctor is more than writing prescriptions." One of the physician's roles in the community is to inspire better health, not just attend to the sick - important and critical though that is. In pediatrics I see this role in public health played out most prominently. One sees it in vaccines, in telling parents what are good food choices for kids, stressing the importance of exercise, etc.

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Pediatricians work just as hard as medicine doctors or surgeons. The difference, to me, is in how they care for their patients. There is much less managing of disease. There is usually little fixing of disease. But there's a lot of treating of disease and on top of that, there is the role of public health in safeguarding health. There's something more holistic about pediatrics that I had not seen in prior rotations, and it may have been the first time that I treated every one of my patients as a person first and a patient second.