Child’s play

Paediatricians need to be comfortable communicating with people of all ages

One of the key factors which differentiates paediatrics from other medical specialties is the fact that paediatricians don’t just manage an individual patient — they manage a whole family.

Dr Gervase Chaney, president of the paediatrics and child health division at the Royal Australasian College of Physicians, says he loves being able to work in partnership with families to manage a child’s condition.

“That still gives me great pleasure after 20 years as a paediatrician … From presentation to diagnosis to treatment, it’s not a one-on-one patient relationship. It’s far more complex than that, with at least one parent or guardian involved. It changes the dynamic significantly.”

Because many paediatric patients are pre-verbal or have limited speaking ability, paediatricians also rely heavily on secondary history from family members, says Dr Chaney, who is a general paediatrician at the Princess Margaret Hospital for Children in Perth.

A large part of his work involves providing reassurance for families who are worried about their child’s health.

“A great privilege of my job is being able to relieve anxiety and provide reassurance, starting from the moment of meeting the family”, he says.

On the other hand, working with families can also be one of the biggest challenges of paediatrics. Dr Chaney says it is particularly difficult when family members are suspected of neglecting or harming their child.

“Normally we partner with families, so if we have to question parents to see if they are the perpetrators it can be very difficult.”

Nonetheless, Dr Chaney says his hospital has a good system in place for managing child protection cases, and they can be satisfying when handled well to ensure the safety of the child

The fact paediatricians work so closely with families means doctors in this specialty need to be comfortable communicating not only with children, but with people from all age groups.

Junior doctors considering the specialty need an interest in physician-based medicine; however, some types of paediatrics do include procedural or interventionist work, such as paediatric intensive care.

Although most paediatricians work as general paediatricians, there are a range of subspecialty options, from neonatology to community and developmental paediatrics. Additionally, just about every subspecialty within adult medicine also exists within paediatrics.

Dr Daryl Efron, a general and developmental-behavioural paediatrician at the Royal Children’s Hospital in Melbourne, says this range of options means the specialty can suit doctors with a wide variety of interests.

“Paediatrics includes everything from hardcore pathophysiology to more psychosocial elements”, he says.

There is often a need to address the social determinants of disease as well as the disease itself.

“You’ve got the disease process but then you’ve also got all the stuff about child development and behavioural problems, all embedded within the social and family situation”, he says.

Dr Efron says he knew he wanted to become a paediatrician as soon as he did a term in the specialty as a 5th-year medical student.

“Although I’d previously never really noticed a child or picked one up, within days of working with kids it was a no brainer for me. It was just such fun hanging out with kids, getting on the floor with them ... Plus I realised that they get better quicker than adults, they are often more honest, and they don’t smell”, he says.

He says his favourite aspects of the job have evolved with time, and he now loves the fact that the specialty lends itself to creative practice.

“The more creative, flexible and curious you are about the family — the more effective you can be … it’s a specialty where you can practise not just the science, but also the art of medicine, because you need to apply the evidence and therapy specifically to that particular child and family”, he says.

Paediatricians generally see patients aged from 0 to 19 years. Dr Efron enjoys being able to follow patients from early childhood through to early adulthood, which can be particularly rewarding when he is able to help patients overcome developmental problems.

“It’s great to see them as healthy adults after negotiating troubled waters and coming out the other side … I also now have enough grey hairs that some of my patients bring their own children in. Those long-term relationships with kids and families are an absolute joy.”