Consultation carnival
2023; Wiley; Volume: 59; Issue: 9 Linguagem: Inglês
10.1111/jpc.16479
ISSN1440-1754
Autores Tópico(s)Child and Adolescent Health
Resumo‘So, what do you do for work?’ My amiable medical colleague looked over his half-moon glasses and awaited my reply. In the course of looking after my own health, I was sitting in a gastroenterologist's consulting room. ‘Paediatrician’ I answered. He winced. ‘Oh, I couldn't do what you do’, he said through a grimace, as if recalling traumatic consultations past. ‘I hate it when kids come in here……roaming around, touching everything….’, he added as he looked around the room, gesturing at the exquisitely crafted furniture, delicate blinds and low-set shelf full of pristine textbooks. I briefly contemplated the prospect of long days attached to the end of a colonoscope….and quietly celebrated the broad church that is medicine, with a niche for each of us. Later I reflected on the encounter, and the kernel of truth within. How often my consultations must deviate from the popular notion of a doctor-patient chat between adults. I am immediately drawn to the more unpredictable elements. The sublime, the ridiculous. I do not have to reach too far back in the memory bank. I need only gaze across my desk at my last patient for the day, a charismatic seven-year-old, who chats while looking back at me through a pair of mirrored swimming goggles. ‘What's with the goggles, Zac?’ I ask, unable to curb my curiosity. ‘Swimming lesson next’ says he. Of course, makes total sense. Earlier that day, I had looked down mid-conversation to find star patient Siena scuttling across the room, underneath an upended toybox, having taken possession like a hermit crab trying out a new home. I can also picture Jayesh, rejecting convention by removing his shoes and positioning himself upside down on the clinic room chair. Going with the flow, I addressed my welcoming comments to the feet opposite. A conversation with a pair of sock puppets. ‘He does this’ said his mother, by way of explanation. I was sorely tempted to give it a go myself. Think of the appointments where a whole family turns up, replete with a brigade of youngsters. Instantly, the room is transformed into a mini day care centre, as you go to work extracting a history. Our ‘busiest’ children take us to another level of multi-tasking. Working through carefully targeted interview questions while simultaneously blocking access to the sink/printer/computer/cupboards/light switches, like a goalkeeper in a penalty shootout. I have conducted appointments in carparks, and the gardens near our community health centre, for the occasional patient for whom entering the clinical space was too much on the day. Feeling a bit anxious today, Oliver? No problem; let's just have a chat right here amongst the frangipani. For all the distractions, consider the perks. Our work environment permits conversations about Star Wars and Lego (and Star Wars Lego!), decades after this might be considered age appropriate. Opportunities abound to flash back to one's own childhood. In our first meeting, new referral Darcy volunteered his fascination with reptiles, and his simple dream of owning a pet lizard. This created an opening to regale him and his (somewhat bemused) parents with memories of expeditions into bushland near our farm with my brothers and dog, in search of the elusive shingleback, for potential exhibition at school show-and-tell mornings. There is also the unique requirement for some working knowledge on popular children's literature and entertainment, to add some street cred to your consults. This ought to be its own CPD category, with points awarded for Harry Potter factual knowledge, Bluey thematic analyses, and a demonstrated understanding of the strange allure of watching toy unboxing videos. Best of all is the ever-present possibility of comedic chaos. Consider my recent patient Chloe, aged 6, who entered the room sporting an impressive plush unicorn hat, complete with ‘limbs’ that draped down around her. At a critical point of an intense consultation, I directed a Very Serious Question at Chloe, seeking her views on an aspect of her care. She was unmoved. Not a sound, not a flicker. Chloe held my gaze for long enough to create just the right amount of tension. Then, with delicate, slow movements, imperceptible to my vision, she squeezed the dangling ‘feet’ of the unicorn. This caused a set of previously unnoticed ears on the hat to waggle furiously. I defy anyone to keep a straight face under that kind of pressure. How lucky we are. Our patients remind us every day that there is room for some silliness, some light-heartedness, amidst the intense business of paediatric medical care. The challenge of practising some serious medicine while simultaneously engaging with a child's inner life. Would we have it any other way? Of course not……challenge accepted! Now if you will excuse me……my next customer has arrived, and I need to set up the dollhouse and dinosaurs.
Referência(s)