What do you think about this bread and butter list: reddit. com/r/medicalschool/comments/cp13t3/comment/ewmp9fn
Hi anon!
That is a pretty comprehensive list! Iâm impressed someone put all that time and effort into writing this all inâŚ
In my humble opinion, Iâd add in a few more subspecs that were not covered:
Peds emergency medicine: fever, minor head injuries and headaches, abdo pain, foreign bodies in various orifices, seizures, (usually minor) lacerations/punctures, and some random orthopedic stuff (usually soft tissue strains/sprains and fractures); the really, really acute patients are actually less common but are the main reason most of us want to do PEM (i.e. trauma, resuscitation of critically ill neonates and children)The ugly: the stuff that either didnât need to come to ER at all or comes to ER WAY LATER AND WAY WORSE THAN IT SHOULD HAVE BEEN because parental anxiety is HUGELY out of proportion with the patientâs presenting symptoms (e.g. the otherwise healthy toddler with fever x1 hour versus the known type 1 diabetic thatâs been in DKA for days that parents brought in ânot knowing why he wonât wake upâ), any and all forms of child maltreatment, the inorganic symptoms (e.g. conversion disorder), the mental health crises for whom there just arenât enough resources (so they stay teetering in crisis mode until they are suicidal enough or just successful enough in self-harming that they finally get admitted), the chronic non-urgent complaints that for some reason just have to be assessed in the ER TODAY at 4AM, and the things that really should have gone to the primary care docs but the family couldnât get an appointment/couldnât wait a few hours until morning/donât have a primary care provider/werenât satisfied with the wait time for their specialist appointment and for some reason think that presenting to the ER will expedite things for them even though nothing has changed
Peds rheumatology: arthritis +/- arthralgia, the weird inflammatory processes that no one knows how to deal with (that sometimes end up being autoimmune disorders and sometimes⌠arenâtâŚ; closely related to the strange constellations of wtf symptoms that also happen to be accompanied by elevated CRPs and/or ESRs), the âquery periodic fever syndromeâ, and lupusThe ugly: hypermobility syndromes which you unfortunately canât actually do anything for, the âundifferentiated inflammatory conditionâ that is really hard to treat since you donât actually know what to treat, the referrals for âjoint painâ that are clearly non-inflammatory and MSK in origin but the referring provider didnât actually take a history or do a physical examâŚ
Allergy/Immunology: asthma that no one else has gotten under control, allergies (of course) + desensitization + exposure trials, anaphylaxis, and immunodeficienciesThe ugly: debunking the âpenicillin allergyâ which was really just a rash that a kiddo had a gazillion years ago but may or may not have been right after a dose of amox
Adolescent medicine: eating disorders, substance use disorder, mood disorders, anxiety disorders, poor adherence to management of chronic diseases, conversion disorderThe ugly: âŚsome of these kids are going through more awful stuff than anyone should ever go through and it breaks your heart; also some of them are belligerent and they just DGAF and it makes you want to tear your hair out because please just take your meds?!
Developmental peds: the really complex/low-functioning global developmental delay/intellectual disability/autism spectrum disorders, behavioural disorders, and sometimes not-so-low-functioning developmental delaysThe ugly: the fact that most of these kiddos need a lot more than the system can provide, fetal alcohol spectrum disorder (because that diagnosis doesnât actually help kids access more services/resources and it is kind of just a mother-blaming, socioeconomically-segregating label that neither guides management nor aids in patient care) and the GIANT DISCONNECT between the educational system and the healthcare system that leads to many of these kids lacking services that actually are available but they âdonât qualify forâ because their family canât afford the ridiculous expenses associated with psychoeducational testing
Neonatology: premature babies, really premature babies, and REALLY, REALLY premature babies; also perinatal trauma, congenital anomalies, and a bunch of syndromesThe ugly: ethical decision-making around neonatal resuscitation, the fragility of this population with the incredibly high emotional stakes, and the terrifying weight of responsibility knowing that every action you take in managing one of these patients has implications on the rest of their life
