|Year : 2021 | Volume
| Issue : 2 | Page : 160
Skills that pediatricians cannot learn from books or databases
Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
|Date of Submission||08-Apr-2021|
|Date of Decision||15-Apr-2021|
|Date of Acceptance||30-Apr-2021|
|Date of Web Publication||31-May-2021|
Dr. Varuna Vyas
Department of Pediatrics, Academic Block, All India Institute of Medical Sciences, Jodhpur - 342 005, Rajasthan
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Vyas V. Skills that pediatricians cannot learn from books or databases. Indian Pediatr Case Rep 2021;1:160
I recount this incident from the early years of my pediatric residency. I had recently started attending the Genetics Clinic in my institute and found dysmorphology fascinating.
One day I was allotted a 5-year-old boy with developmental delay and dysmorphism. After taking a detailed history and performing a thorough clinical examination, I presented the patient to my senior. After an in-depth discussion, we entered the salient clinical features into a dysmorphology database and got a list of differentials, the topmost being Coffin–Lowry syndrome. The clinical description and images of this disorder matched the clinical phenotype of our patient. I felt very proud of myself for contributing to the establishment of diagnosis and felt sure that I would be able to make many more diagnoses, now that I had learned how to operate the database. My senior chalked out the management plan. The family would be counseled about the disorder, prognosis, and other details by my senior as soon as he got time. In the meantime, I was to facilitate the referrals to multiple departments that were required in the workup of such a case.
Diligently, I wrote down all the places that the mother was expected to take her child and started explaining where they were located. After a first few minutes, she interrupted me and asked “Why do I need to go to so many places?” I replied, “Your child needs some important investigations.” Her next question was, “When will you give my son some medicine to cure him?” When I said, that I could not prescribe any medicine, she asked me whether we were waiting for the investigation reports to start the treatment. After telling her that the condition in question had no cure, I started to explain that the investigations were important for assessing the child holistically and providing supportive care. Suddenly she burst out, “What kind of a doctor only gets investigations done, but does not prescribe any medication? What do you have to gain from getting these done?” Luckily, my senior intervened and started to calm the mother by asking her to sit down and offering her a glass of water. The father was called and the next hour was spent counseling the family about the condition and how we would all be working together to support and optimize her child's physical and mental well-being. I was completely taken aback and then started to feel angry. Here, I was with her child's best interests at heart, and I was being accused of malintent!
Later my senior told me in detail how counseling was supposed to be done, and how to recognize the steps of grief in a parent and pace the content accordingly, among others. But I was still miffed. It was only much later that I realized how insensitive I had been. That day, the only thing I had been keen on learning was how to operate the dysmorphology database to enable myself to deduce a rare diagnosis. I did not treat the child as a person but as a medical condition. I did not pay any attention to the mother's body language or care about how she must be feeling when I broke the news so insensitively. I did not wait for the parents to be properly counseled. I was just bothered in getting the tasks assigned to me, completed.
In those days, and till date, the top priority of most residents is gaining clinical knowledge and experience, learning examination skills, and performing exotic procedures. Learning how to empathize, and communicate with the patient and family is never a priority for residents, or taught or demonstrated proactively by the departments. These skills are somehow expected to develop magically just by themselves. Such close encounters can be quite dangerous during the early years of training. The art of communicating sensitive information and dealing with anxious parents is an essential competency for all pediatricians. It has to be a shared two-way process, not a didactic monolog. Competency-based medical education has been introduced in the undergraduate curriculum. However, postgraduate residents do not receive any formal instruction. This should be included as a part of their curriculum, and sensitization activities should be carried out right from the start of residency. Empathy and communication cannot be learned from any database or textbook.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.