My pediatric rotation was my second rotation. Since I have always been interested in pediatrics and it is currently my top choice of field that I want to go into, I was particularly excited for this rotation. 

For this rotation, I rotated at a Pediatric outpatient office in Queens. Although this was outpatient just like my last rotation in an urgent care, there was a stark difference between the two not only because of the age group I looked at, but because of the patient-provider relationships. While in urgent cares, there are different providers and new patients every day, so there is a very limited patient-provider relationship, this office was quite the opposite. It is an outpatient office run by a single doctor who has been working there for many years, and not only has he been treating all of the patients for their whole lives, but many parents of patients were also previously patients of his. Thus, the patient-provider relationship is extremely strong, and I was able to see how that positively impacted the patient experience. Firstly, he really knew a lot about the lives of his patients, which helped him make conversation with patients, making them more comfortable and putting them at ease, as well as distracting them. Secondly, his relationship with the parents instilled a deep sense of trust in them. Additionally, he always makes himself available to the patients, emphasizing the fact that this is more than just a job and he genuinely cares about the well-being of his patients. This type of relationship building and genuine patient care is something I am very passionate about, and hope to find in my future job as a PA. Because, as a PA, it is not just about treating patients- it is really about caring for the needs of a whole person, and knowing your patients and having a relationship with them can really enable that high level of care. 

There were several challenges I faced in the pediatric setting that I did not realize would be such challenges before I began. First of all, most patients are unable to give you any history, and you must rely completely on parents to obtain it. This is difficult because often parents do not provide a thorough history, do not provide enough details, or provide incorrect history. Furthermore, patients are unable to describe what is bothering them or where they are feeling pain. What makes it even more difficult is that sometimes patients will answer incorrectly. For example, a little girl came in complaining that her throat was hurting, but upon further questioning, I discovered that she was just answering yes to everything I asked (She told me her stomach, ear, and toe were hurting her, so I started to get a little suspicious.) This definitely makes it increasingly difficult to generate a differential diagnosis. 

Moreover, it is extremely difficult to perform even a simple physical exam in the pediatric setting, since many children, at least in the office where I was rotating, have negative associations with doctors and begin crying the second they enter the office. Even something as simple as auscultating lung and heart sounds is infinitely more difficult when children are kicking, screaming, and squirming. Any simple procedure, such as an injection, throat culture, or nasal culture, is also significantly more difficult when children are crying and refuse to allow it. Finally, very young children are unable to follow instructions, such as “say ahh,” making simple parts of the exam much more complicated. This was something I took for granted in my previous experience performing physical exams, as even with language barriers, patients eventually were able to understand and do what they needed to do in order for me to perform a thorough and accurate exam. 

The knowledge I gained through these challenges in obtaining a thorough history and physical will help me immensely going forward in my future rotations as well as in my future as a PA. Although in the adult population, it is generally more simple to perform history, physical, and procedures, sometimes it may be more difficult, and I have gained skills in this rotation that will help me navigate these difficulties. For example, I learned distraction techniques for various ages that are helpful in calming patients down when they are undergoing an uncomfortable procedure or when they are overall anxious and overwhelmed. I know that going forward, I will encounter anxious patients of all ages, and I hope to use these distraction techniques to help calm their nerves as well and give them more positive experiences. Furthermore, I learned unique ways to ask certain questions to get proper history, as well as to enable people to do what they are told to allow a proper physical exam. I know that in the future, I will encounter patients who may have difficulty understanding what I am asking of them in terms of history and physical exam, and with these new skills I will be able to explain it in different ways so that they can better understand. 

During this rotation, I was also exposed to various parents of patients who were stubborn in their ways and were hesitant to listen to medical advice that was for the best of their child. When these cases arose, I would discuss with the physician the ways of dealing with these patients in order to ensure they receive the best care possible to ensure the health of their child, while also respecting their wishes. For example, many parents would come in with infants who were not gaining weight since they were determined to exclusively nurse, but were not producing enough milk. We would validate these patients wishes while gently explaining the best options available to make sure their child gains weight properly and remains in full health. I hope to use these interpersonal skills learned to help give the best care for my patients in the future. 

The challenges I faced at first overwhelmed me and made me reconsider whether I really wanted to go into pediatrics. But after a few days, I got more comfortable with it and realized that I still really enjoy the experience. Also, I discovered that I have a talent in communicating with children, calming them down, and using distraction techniques when necessary, in order to make their experience overall more positive. This is something that gives me a sense of fulfillment and joy, because our goal as healthcare professionals is to give patients the best care possible, both physically and emotionally, which includes helping them with their physical issues as well as making their overall experience a positive one.