Shadowing Experience: Pediatric Infectious Disease

As soon as I entered the office, I was warmly welcomed, then immediately transferred to a team of fellows. Unlike previously planned, the attending physician had to be at a conference at another hospital; the fellows would take me to Women & Infants’ Hospital, where a team member would be presenting on S. aureus to pediatricians from the NICU. When you shadow, you’re really following whoever is doing the most exciting thing, I was told. It was true. The team of the attending physician, fellows, and residents moved busily back-and-forth through conferences, the outpatient clinic, inpatient rounds, and in-between paper-work. Because of swine flu, the outpatient clinic was physically delegated to another building, making the delegation of tasks more formidable. The coordination of the team-members, and their ability to physically re-convene at various points of the day to discuss patient cases (and also to catch up on personal life) seemed almost a refined art. Though I had always envisioned working in a hospital setting, I had never quite realized the intensive amount of teamwork required, nor the central role that interactions with colleagues played on an hour-to-hour basis.

At the outpatient clinic, I was filled in on the routine paperwork. Before the patient enters is ushered into the examination room, the fellow reviews the medical history of the patient and the plans made at the last meeting. During the actual conversation with the family, the fellow writes throughout much of the meeting. Though I saw this as inevitable, and would have done the exact same thing, I wondered if there could possibly be more continued eye contact and undisrupted conversation. Would it help if the more straightforward facts, like recent patterns of symptoms and drug use, were pre-recorded and sent to the doctor? No, this could actually lead to more mistakes and reduce opportunity for more spontaneous conversation. The fellow then informed the attending physician on how the patient is doing, and her recommendations and plans. The attending physician-fellow duo then talked to the patient’s family. After the patient left, loads of paperwork ensued. The attending physician filled out forms for re-imbursements, whereas the fellow filed papers on the patient’s chart and for a fellowship-program database. Because of the paperwork surrounding each visit, the doctor-patient relationship seemed to become a more 2-D one, at least before and after the actual interaction. This was disappointing to see, because this seems to be the reality of medicine in actual practice. In theory, the doctor-patient relationship seems much more noble and idealistic.

Since so many of the patients were very young, the parent (often, the mom) was the main individual communicating with the doctors. In fact, the phrase “According to mom…” seemed to be the most central part of the team’s lexicon. In classes like our GISP, we often talk about enhancing the doctor-patient relationship. For those in pediatrics, though, a new type of communication and relationship seems necessary—a form that integrates the patient-child, the parent(s), and the other family members (like grandmas!) involved in the care of the patient.

I was surprised at the great diversity of patient needs. Since pediatric infectious disease requires both a residency and fellowship as training, I considered it to be a highly specialized sub-specialty, and expected less variety especially during this swine flu season. However, though swine flu/pneumonia was the common factor among all the patients I saw that day, there was such a wide variety of patients and circumstances. For example, there was an older male patient with developmental disorders. Unlike most of the other patients, he was eligible for the swine flu vaccine as a high-risk individual. Since he had to use equipment to clear his respiratory tract throughout the day, his recent medical history was very much based on his usage of the equipment. Much of the appointment was also spent talking about the interactions the patient has with the other students in his special education-classes. I was surprised even more by how familiar the fellow and attending patient was with the details of this patient’s case. Until I observed this specific case, I remained set aback at the realization of the paperwork-dominated nature of the doctors’ work. However, this close, intimate interaction restored for me the hopeful expectation of solid future relationships with my patients.