Monday, August 01, 2005

Sometimes being a doctor means... doing nothing?

As a fourth year student I get to spend my time doing electives. A nice change from being pushed from one required rotation to the next. I've spent the past month in Developmental and Behavioral Pediatrics or, as one of my attendings put it, "seeing the kids that no one else wants to see." I spent my days seeing kids with behavior problems like Oppositional Defiant Disorder, ADHD, anxiety as well as the kids with developmental delays. I've seen more crazy syndromes than I knew existed -- the more common ones like autism, Asperger, and Downs, and then some like velo-cardio-facial syndrome, fatty acids metabolism disorders, and Retts. I even saw 2 cases of selective mutism -- that's right, 2 kids who only speak to their immediate family and no one else. Can you imagine being a teacher and having that kid in your class?

I decided to do this rotation because I've worked as an Applied Behavior Analysis (ABA) therapist for autistic children and loved it. The kids were amazing and it was so rewarding to see them progress from nonverbal and withdrawn to having words and playing with toys and other people. I was so impressed and thought it would be amazing to work with these kids every day and champion their cause. But actually being in the office was so different. Often there is nothing to do for these children and little to offer their parents. Prescribing meds to improve attention and aggression doesn't solve their problems. The doc I was shadowing put it best -- "We don't cure, we treat." So true and so sad.

On my last day of the rotation I met a 5 year old boy who has never spoken. He has muscle weakness, exaggerated reflexes, an abnormal MRI of his brain, and severe developmental delay. When speaking to his mom she said she considered cancelling the appointment because there was nothing new for her to do. He's in all the therapies that are available but is making little progress. He doesn't even have a diagnosis. What words of advice and encouragement was she given -- we'll keep looking and try to find out what is causing his delays. How does that give her strength? How does that help her little boy's functioning? How does that provide for his future? I just wish we could have given her more. But sometimes we are left with nothing more than sympathy and kind gestures.


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