The Eyeball Test

These days, I walk around with pockets that are less bulging.

I traded the gauze, suture removal kits and medical tape for stickers and a doggie pen. I am proud to say that I walk around with stickers in my pockets, including Sponge Bob and an assortment of dog stickers. My favorite part of my job involves giving stickers to my younger patients.

I have moved from the world of surgery to pediatrics, two completely different worlds. I went from waking up before the sun had risen to waking up to the sun shining (I am currently working in the Urgent Care Clinic). I move away from focused abdominal exams to full head to toe exams, including looking into patient's ears and noses. It's a constant battle to get the otoscope into my younger kids, who cry and squirm. Even getting kids to open their mouth can sometimes feel like moving mountains. And yet, despite the challenges- it's such a pleasure to work with kids and families. When they smile, you feel a little less guilty about having to probe their ears.

In many ways, it's a stark contrast. I'm well-rested these days, catching up with friends and starting up my half-marathon training. The chief complaints have primarily been lots of upper respiratory symptoms and ruling out swine flu in kids having flu-like symptoms. In summary, lots of runny noses and coughing. Surprise surprise.

I do miss the intensity of surgery, the operating room and the complexity of the pre-operative and post-operative management. There is something remarkable about cutting someone open, visualizing the anatomy and defect, and fixing the problem with your hands (or instruments). I will miss the suturing for sure. There is no experience quite like it. A part of me will always be in love with surgery.

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I do look forward to working with younger patients and developing an understanding of how to best approach common and not so common pediatric problems in the outpatient, urgent care and inpatient settings.

Although pediatrics and surgery are so different, there is one thing very similar to both fields--the eyeball test.

In pediatrics, you are oftentimes working with patients, who can not speak for themselves or give accurate histories. So, you rely on the caregiver to convey the history.

One pediatrician jokingly compared pediatrics to "veterinary medicine," since the patient is a poor historian for obvious reasons and you have to consult the owners (or the parents) for information.

As a result, you rely on your ability to "eyeball" the patient, which involves observing the patient and taking note of how they look, how they interact with others, and if they look sick. In doing so, you can answer some really important questions- "is this patient sick or not sick? Does this patient need immediate medical intervention?"

In surgery, you apply the same approach when evaluating a patient. You "eyeball" a patient to get a general sense of their disposition and health, which enables you (as a surgeon) to quickly decide if the patient is sick and if they need immediate surgery.

The eyeball test can also replace lack of knowledge; it's almost an instict or gut feeling. It got me through my surgery rotation and has been useful for me in my first days of pediatrics.