Locum Life: Intersectional Medicine

Just because I’m a Doctor does NOT mean I can solve your Adult Problems!

Although we differ in pre-Medical school and post-Medical school (residency) training, all doctors have gone through similar education in the United States in regards to our Medical School training. There was anatomy, there was basic science and there were generally at least 2 years of rotations comprising of inpatient and outpatient experiences and learning opportunities. All Pediatricians have spent some time in the Operating Room with Surgeons, all Dermatologists have once participated in some capacity in Labor & Delivery and all Psychiatrists and Internists at one point helped to take care of Children. Yet, as our training further specializes us and further diversifies us, we become entrenched in individual focuses and some even specialize themselves so far as to out specialize their own Residency training – aka Interventional Cardiologists are most likely not the ones to see for General Primary Care management, a Neonatologists should probably not conduct your Well Child Exams. There’s nothing wrong with it, but the vast growth and acceleration in medical knowledge, requires us to focus 100% of our brain space to individual sectors of Medicine. The old days of being a Jack of All Trades has been overshadowed by the energy and work it requires to be a King of One.

In other words, just because I’m technically a Doctor does not mean I’m the best one to help an 80yo man on an airplane – I’m a Pediatrician afterall. Likewise, just because your friend may be the director of an Emergency Room designed for adults, does not mean they are absolutely perfectly versed in the care of a Newborn Baby.

In Residency training, when we diverge from our well-rounded Medical School selfs, often times those of us in larger medical centers find a bigger divide between medical specialties. There still exists a great amount of overlap in smaller training programs and in certain specialties such as Family Medicine, but by in large, my Pediatrician self became more and more distanced from the operating room, adult medicine and the associated subspecialties and problems. There are some of us that are brilliant and complete dual residencies that specialize on multiple sectors of medicine (eg: Med/Peds, Med/Psych, EM/IM, etc.) or remember now ancient knowledge on taking care of problems we don’t see everyday (I know the BASICS of a Heart Attack in an adult, but just the basics), but for the most part as we grow in one way, we limit ourselves in other ways. I trained at a large Childrens’ Hospital – by nature of our physical location, we never saw adults (part of why I chose that program). Even for newborn babies, there was generally a clear distinction between antepartum or labor and delivery and the newborn nursery – I would walk over to the L&D department from time to time, but didn’t know what to make of some things.

And then I became an Attending and chose a life of working Locums. It has allowed me to re-open my mind to other sectors of medicine and other specialties I have long become distanced from by working specifically with children. By working in small hospitals, I have not had the physical separation across the hospital or across different floors of medicine to stay in my own bubble.

I have worked in several settings where labor and delivery as well as newborn care happened in the same room, or at the least the same area. It has allowed me to be present in listening to the OBGYN and the delivery nurses discuss their cases. I have learned what a ‘Category 2’ strip is, finally, after hearing it over and over from the OBGYN trainees across the way in Residency and not really knowing that that means. I have relearned the steps of delivering a baby, and EVEN CAUGHT ONE MYSELF!, as well as the things to be cared for and watched afterwards. I better understood my job as the Pediatrician in relation to the jobs of the OBGYNs before me and one of the even went from being the OBGYN to my OBWan and teaching me to do Circumcisions!

I have been in Critical Access hospitals where the Pediatric Care is in the SAME station and area as Adult Care – there are pros and cons, but I have interacted with Adult Internal Medicine comrades and remembered what COPD was (apparently it is NOT Chronic Old Person’s Disease, as my Pediatrician self has thought…) and the pitfalls and ethereal blissful moments of Dementia and a life well-lived. On the flip side, I have educated Med/Surg Adult nurses on the different care of Children and the various psychosocial aspects that play in Healing beyond the science.

The world that I chose to divulge myself in of Pediatrics exists not as an isolated area of Medicine but along the continuum as a small part of what makes Life important and WHY I chose to be a Doctor. Remembering my place in the wide scope of a life has been reawakened by my experiences as a Locum in such fields of Intersectional Medicine. Without the OBGYNs there are no babies and without the Internal Medicine doctors there is nowhere for the babies to go when they get older. The team work I have encountered and been privy to with active conversations with providers I would have hardly crossed paths with in Residency has solidified my perspective of well-rounded full-life encompassing medicine.

I’m a Pediatrician, don’t come to me with your adult problems… But, I have a Friend that can help.

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