Sunday, 17 May 2015

Paediatrics is not a specialty

Paediatrics is an art not a specialty

Paediatrics is difficult to define as a specialty.  The RCPCH says that paediatricians are “doctors who look at specific health issues, diseases and disorders related to stages of growth and development.”  Note that this definition does not specify that it applies only to clinicians who have completed their years of training in paediatric medicine.  In fact paediatrics may not be a specialty at all.  How can it be if we use the RCPCH definition?  It could instead be defined as the art of treating children differently from adults by knowing what diseases affect them, how they respond to illness and how to use that knowledge to help them during their illness or prevent them from becoming ill.

Anyone who works with children in a healthcare setting should make studying of the art of paediatrics their business.  Doctors, nurses and other practitioners stand to gain much from dedicating their time and energy to learning how to assess and treat ill children as well as being experts in all the other aspects of child health including safeguarding, growth and development.  Children and young people are different in so many ways and it takes a bit of effort to get good at being a clinician who has specialist paediatric skills and knowledge but it is completely worth it.

The fact that children have very different physiology to adults is the least of what makes paediatrics in primary care both challenging and fun.  They respond differently to pain and stress in ways that can be impossible to detect but they are amazing in their ability to cope with illness.  They rarely have complicated medical histories or long lists of medication.  They tend to come with one problem at a time.  In fact, the more I think about it the more I realise that my job is a lot easier now than when I was a GP.

When I facilitate teaching sessions for Primary care there is often a sense that there is a lot more to paediatrics than meets the eye.  I don't think that this is true.  My experience is that I spend more than half my time confirming to GP and Nurse practitioners that what they think is correct.  It's just that they didn't know it.  Often, GPs will intuitively be working in a certain way but worrying that they are doing so in an out of date or idiosyncratic way.  This is rarely the case.

I hope that with these posts, I will manage to pick out a few of those topics that are common enough to be relevant and add a bit of my experience of what is a bit confusing or cover areas where practice is changing.  If I cover the basics, don't feel patronised.  I need to do that for my own benefit.  If you have questions, please ask and I will try to answer them.

Am I a specialist?  Sort of, but if you are a GP then so are you.  What I might have that you don't is a lot of colleagues to talk to and a working environment which brings me new lessons every day about the various clinical scenarios that children present with.

So, next time you consider referring a child for assessment I would suggest that you think of us in secondary care simply as colleagues with a different set of tools at our disposal.  After all, it is difficult to call yourself a specialist when you don't have a specialty.

Edward Snelson
Former GP
@sailordoctor #GPpaedsTips

(All the views expressed here are solely those of the author.  Any references to Royal Colleges are entirely fictional and should not be used as a reason to revoke the author's invitation to the annual RCPCH cheese night.)

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