Tuesday, January 25, 2011

Another 10cm of snow!

More snow....more winter.

Some people have asked me to describe a typical day.  The first thing to know is that there's a very wide variety to my days.  I'm going to describe today which was a typical clinic day.

8:30 am
I arrive at the clinic at One Kid's Place where all of the North Bay pediatricians have their offices. I start by reviewing charts for new patients who are coming today.

My first patient arrives.  Generally a new consult is booked for first thing in the morning.  This means that the patient's family doctor has requested a consult with a pediatrician because there is a specific clinical question or problem which the GP would like the pediatrician's opinion on.

In Canada, typical clinical questions include:
6 year old boy with difficulty paying attention and behavioural problems at school, could this be ADHD?
2 year old girl who is not gaining weight.
11 year old girl with a first seizure.
12 year old boy with obesity and snoring at night.

Today my first patient was having behaviour problems.  I spend over an hour talking to the family and then examining the child.  My assessment includes finding out about the mother's pregnancy, the family history, any past medical problems, hospitalizations or surgeries and the details of the current problem.

I exit my office and cross the hall to Dr. Madden's office to discuss the case with him.  We agree about the diagnosis and return to my room to talk with the family.  Together we discuss the diagnosis and any tests or further evaluations which are needed.  Often with children who have school problems, psychoeducational testing is recommended to look at the child's IQ and for any learning disabilities.

The patient leaves and I go to get my next patient from the waiting room.  Another new consult.  This time for what looks like absence seizures.  I diagnose the patient's condition after seeing a few brief seizures while examining the child.  After a quick chat with Dr. Madden, we make a plan for further testing and treatment.

Another new consult, for behavioural issues again.

I stop for a quick lunch.

I see a newborn baby who I had seen last week at the hospital for a quick check up.  I order some blood work and reassure the mother.

Another new consult.  After spending an hour with the patient, I talk to Dr. Madden.  We end up spending another 30 minutes talking with the family.  Behaviour problems can be very complex and the family has a lot of questions and issues.

Finally a follow-up patient.  It's a quick check-up and the patient's symptoms have resolved.  I discharge them from the clinic with instructions to call and book an appointment should the problem recur.

I see a few more patients for follow up.  Several are on medications and I make sure that they're not having too many side effects and the meds are doing their job. I renew medications and examine the patients.

I sit down at my desk and finish all of my notes from the day.  I dictate reports on any new consults and fill out a few requisitions for tests and consults with other doctors.

I spend a while chatting with Dr. Madden about some of the cases which we saw today.  I ask a few questions about similar cases which he's seen in the past.  He's been practicing in North Bay for 24 years.  He tells me about when he started out, he was one of only a few physicians attending school meetings.  He shares some of his wisdom with me, telling me it takes 5-10 years to really become proficient after you start practicing.

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