We are in paediatrics rotation now and just yesterday I witnessed something unreal. Three of us were standing in the feared-by-all-students doctor’s cabin, meekly in a corner. He was asking us questions and we were trying very hard to put our combined knowledge together and impress him while giving each other the side eye for moral support.
Just then a mother holding her one year old baby walks in and sits next to the postgraduate who was to examine the child. The mother started telling her what complaints the kid had. I picked up words like cough and breathlessness.
Sir found at us looking at the baby and asked us what we could find on simply looking at the child. Immediately, we started whispering to each other “intercostal retraction” “flaring of nose” “tachypnea”. “Stop talking to each other, talk to me”, he said sternly (I swear my heart skipped a beat then, and not in a good way). We told him what we saw, and he added to the list, the things we had missed. The postgraduate auscultated the baby’s chest and told him everything seemed fine.
He looked at her and smiled. “Squeeze the back gently and hear again, I am a 200% sure the baby has a wheeze.” And behold! As though mocking us, was a high pitched sound heard over the baby’s chest. We took turns and heard the sound too.
Sir explained to us that with the things we saw, there are certain findings which were expected. He told the PG what to prescribe and sent the mother on her way. What blew me away was the certainty with which he knew what to find, without even having heard the complaints or touching the baby!
Ever since we started our hospital postings three years ago, there’s one thing that every doctor repeats like a mantra, no matter which department : “A good history will lead you to a diagnosis.”
“Doctors are like detectives”, they tell us. The patient will give you all the clues. All we have to do is connect the dots. While history taking is an art, our skill lies in arriving at a diagnosis from all the information. We’ve seen experienced doctors talk to patients and get their story from them and believe me when I say this, its magical.
But how do you talk to a baby that can’t even tell you what’s wrong. Or a child that can talk but is too fussy to deal with you?
So here in paeds they tell us a new thing. Let the baby sit in the mother’s lap, let it be comfortable. Observe and you’ll learn so much about what is wrong with the kid. Kids don’t cooperate. If you touch, prod, poke children, unlike adults they will start to cry. And that is the end of examination.
I am fascinated by the workings of the human body and intelligent minds in general. So when you put the two together, a tricky disease and an expert doctor, to me that’s visual poetry.
But dealing with sick children from my humble experience, is a different ball game. I have tremendous respect for doctors. But paediatricians deserve a tad bit more.