Being a paediatrician

Dr Michele Afif, Medicolegal Adviser at Medical Protection, reflects on her experiences of working in paediatrics

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I don’t think I even hesitated. “I’ve always been interested in paediatrics,” I enthused breathily at what, until moments earlier, I had wrongly thought was an interview for an adult medical post. I recall holding eye contact with the panel; going for steely determination, rather than unnerving maniac, in my desperate bid to prevent them glancing at my application form and spotting the glaring absence of any evidence to support my assertion – because suddenly, and strangely, I absolutely meant it.

So began my unexpected career detour into paediatrics courtesy of an office temp’s effort to organise a slew of job applications in the computer illiterate world of the late 90s. Luckily it turned out to be a fit, so perhaps it’s worth trying to explain why.

In the beginning

The early days were exhilarating and terrifying. At the risk of sounding a little naïve, I was overwhelmed by the most obvious of facts – the patients were often very, very small and, well, sick. Many couldn’t even speak and almost all were accompanied by extremely protective parents.  

It is a lesson in human nature I have never stopped enjoying. It is less rare than you might think to find yourself suggesting an apparently innocent treatment choice – let’s say top-up formula feeds for a hungry newborn – to an apparently calm new parent only to witness an astonishingly rapid shift from anxious uncertainty to full-blown tiger-mother, imperiously sweeping you aside and demanding you keep your “devil’s juice” well away from her child. 

That’s right, the person you thought was your patient actually isn’t yours at all. At risk of stating the obvious, if you’re considering a career in paediatrics, I suggest you polish up your communication and collaborative decision-making skills. The parents will be with you all the way. 

Clinically, I learned the key was not just to have the knowledge, but to use it with skill; to be able to find that tiny wrong note in a history or examination that prompts a search for more. You are a detective; you discover the strenuously denied amitriptyline overdose in a teenager has occurred because her mother has been hiding her own antidepressants in a paracetamol bottle. You find that the child with behavioural issues is actually displaying signs of a virilising malignancy, and you deduce the dramatic alopecia in one child is, startlingly, better explained by the atypical presentation of her sister’s eating disorder.

Becoming a consultant

Seniority approaches until one day it happens; you are appointed into your first consultant post. You are simultaneously thrilled and daunted, conscious that you must now manage other people’s anxiety in a volatile NHS. By now you are also a medical miracle of multi-viral immunity, possessed of the ability to function effectively despite all forms of crying, gather detailed neurological information from even the briefest sighting of a child’s star jump and cannulate anything. Juniors marvel as you step elegantly to one side just before a child vomits, miraculously hear a gallop rhythm, remain straight-faced when discussing twins who have spent an afternoon meticulously inserting Lego into one another’s nostrils, and intubate an unexpected premature delivery without seeming to break a sweat. And that’s all before lunch.

Dealing with tragic cases

But it is not always easy, and every paediatrician must find a way to deal with those cases which seem to reveal nothing but horror, tragedy and despair.  

For me, it was always about establishing relationships. More than two decades after that first interview I find myself sitting quietly with the father of a child I have known since infancy. She is chronically, and now critically, ill. He is a big man – often intimidating, outspoken and quick to anger, but now his shoulders heave with silent anguish. We have had our moments over the years, he and I; he hasn’t always handled bad news well and perhaps I didn’t always know how to break it as needed. But the relationship is strong now. Perhaps stronger as I set out the remaining treatment choices and we talk them over in turn. His love for his daughter is humbling to watch. Eventually he recovers himself, a choice is made, a ‘thank you’ offered. But I know it is me who has been privileged – trusted to share this darkest of moments.  

Like I said, I’ve always been interested in paediatrics.

Find out more

• Read more articles for foundation doctors on topics such as ‘How to choose the career for you’ and ‘How to… make the most of core specialty training’
• Read specialty-specific case reports