I just changed specialty....No, really, I did!

tallaght01

So, Ive spent the last few years in paediatrics. I work long long hours, and there's a hell of a lot of stress. I'm not sure I get a lot of bang for my buck, for the effort I put in.

I've worked in ireland, the UK, Africa, New Zealand and Australia.

Wherever work, the illness depends on a lot of stuff. But mostly it depends on economic and social factors.

I've worked in hospitals where most of the population are poor. I've worked in hospitals where most people were middle class. There's a world of difference between their health, their outcomes, and their access to healthcare.

I've worked in paeds wards in Africa where 70% of the patients are HIV positive. This is not about just biology. It's about so much more.

Over the years, I've leaned further away from clinical sciences, towards the healthcare "bigger picture" and the wider determinants of health. I'm currently doing a masters degree in public health.

So, today I got accepted onto the Public Health registrar scheme. I start in January. Public health doctors work on a population level. They try and control outbreaks of disease, and they try to prevent disease in the community.

I'm going to carry on doing some paediatric A+E to keep my skills up. 'll maybe do some neonatal ICU too.

It's scary. Paeds is all i've known since I was an intern.

I'm scared, but excited.

Belfast

tallaght01 wrote: »

Wherever work, the illness depends on a lot of stuff. But mostly it depends on economic and social factors.

I've worked in hospitals where most of the population are poor. I've worked in hospitals where most people were middle class. There's a world of difference between their health, their outcomes, and their access to healthcare.

I've worked in paeds wards in Africa where 70% of the patients are HIV positive. This is not about just biology. It's about so much more.

Over the years, I've leaned further away from clinical sciences, towards the healthcare "bigger picture" and the wider determinants of health. I'm currently doing a masters degree in public health.

I agree. Health has more to do with economics and social factors than medicine.

sam34

wow tallaght, thats a big change! good luck, and i hope youre happy in new job.

tallaght01

Yea it's a big step, sam.

I've been pondering this for the last 2 years. I've done a lot of research about the life of a public health doc, and have spent time with a lot of them. The masters degree has also given me some of the basic skills/statistical tools.

It could still all go arse over tits, though. I don't start til january though. I can't wait. I guess I'm a bit worried about whether or not I'll like it. And also whether or not I'll be any good at it. I'm in a comfort zone in paeds, where I know I'm reasonably competent.

In january I'm the new guy again :eek:

sam34

yeah, it must be daunting. do you have a head for all that stats stuff? that would wreck my head, i couldnt do public health for that very reason.

the loss of clinical contact would bother me a bit, but if you do some a and e shifts that'll keep your hand in.

you have your paeds memberships, havent you? so at least if it doesnt work out, it'll be relatively easy get back into paeds again. but, hey, that kind of thinking is what we psychiatrists call catastrophising, and i wouldnt want to be encouraging that!

Nothingcompares

Good luck!

Traumadoc

Good luck!
Are you planning to contiue training in OZ or returning?
A Classmate of mine gave up NICU (finished training) as the stress was too much. Best thing she ever did.

Just remembered I changed career path also - worked out pretty well

Chunky Monkey

Was talking to a doc recently who went into public health. Told me she adored it. Good luck! Hope you adore it too

Larianne

Good Luck Mr. T! (that should really be Dr. T! shouldn't it.)

Vorsprung

Best of luck tallaght, I remember you saying a while back that you were thinking of making the jump. Where is the scheme? How long is it?

Amnesiac_ie

Best of luck Tallaght. I hope you find the switch rewarding. I would be interested to know how you find it. Public Health was one of the few subjects I had a real flair for in medical school and managed to do well in. Of course come internship, noone is really in touch with the guys from Public Health anymore and even now as a second year SHO I'm pretty ignorant of what public health doctors do on a day-to-day basis.

DrIndy

I'm planning a switch too - i trained for 2 years with the view of always being a physician - i liked it but never loved it.

I'm doing emergency medicine now and i truly think i've found my niche. I just wish I discovered this years ago.

tallaght01

Hi guys,

Thanks very much for the good wishes. I appreciate them a lot.

I'll actually be training in Australia. I've been enjoying it over here a lot more than in Ireland/UK, so I've decided to hang around a bit. There were only 2 jobs on the scheme this year, so I didnt think i'd get one. BUt, through some administrative error I got in :P. So, it was a bit of a surprise, and I was actually expecting to come home to Ireland in january. But I'm here now until I'm a consultant.

I can get back into paeds if I like at any stage, though I probably wouldn't. I think that even if public health isn't for me, paeds isn't either. I enjoy it. But I don't enjoy the life. I've just finished a 15 hour shift. It's midnight, and I'm back in at 0745.

When I did adult medicine, my registrars never did the ridiculous hours, though I suspect that may be changing. When I was a surgical intern, the surg registrar was always on call from home.

I guess that would be OK, as I'd only have a few more years before consultancy. But my consultants still have a hell of a life. They do crazy long hours too in paediatrics.
Also, the kids are much more stressful. If I make a big decision, especially if it's a bit controversial, then I don't sleep well. I spend my night tossing and turning. I'll even ring the ward to check how they are. If I make a mistake with a kid, it takes ages to forgive myself.
I missed a case of encephalitis a few years ago, with a poor outcome. I don't think it was really my fault, but I hardly slept for about a month afterwards. My obsessive compulsive nature also make a me a bad clinician. I never ever switch off. If I'm passing by the hospital on a weekend I'll drop in and see how my patients are going. If I'm being honest, I'll go in most weekends st some point to check on my sickies.

So, I think if I carry on I'll end up just giving my whole life to medicine. I do that now, and I have the type of personality that makes people become married to their job, I stay late every night etc and the wards have my mobile number in case one of my patients is ill over the weekend,

I also have no life, and I'm getting a bit sick of it. Every weekend I'm too tired to go out, if I'm not working. While all my friends are getting married, I'm nowhere close. I can't even commit to a cat :P

You get shouted at a lot by angry parents, which is demoralising. It happened to me again tonight. I want to tell them how I've given up all my twenties looking after kids like theirs, and how I have no life outside of this madness, but I don't. And they go home and tell their friends about how the lazy paediatrician took an hour to see their kid. Like I said, it happened tonight. The kid had an earache. Viral. After I saw the kid, I drank a pint of water in a bid to make my dehydrated body pee for the first time in 10 hours. It was 11pm. I hadn't had time to drink anything since 1pm. A few years ago I was in hospital with kidney stones from dehydration in work. I got out of hospital at 11am that day, and went into work at 1pm as I knew my absence would be putting pressure on the team.


Plus, like I've said before, I don't feel that I'm making a huge difference to people's health overall by doing what we're doing. I've treated a world of bronchiolitis and asthma and pneumonia and croup in the last few months. Next year there will be the same outbreaks.

So, we'll see how public health goes. I'll keep you posted. I'll still be doing afew hours of paeds A+E every week, so I'll still be able to put on the scrubs over my sandals and cardigan once a week and keep up my skills

Thanks again for the nice messages D

tech77

If I'm passing by the hospital on a weekend I'll drop in and see how my patients are going. If I'm being honest, I'll go in most weekends st some point to check on my sickies.

Wow, never knew any colleagues myself who would've done that tbh.
More like straight out the door at five kinda thing (not blaming them of course what with the long hours/sh1tty working conditions etc anyway).

tallaght01

Well, I think medicine attracts a lot of people with OCD :P

When I was leaving work at 19:30 tonight (we're supposed to finish at 16:30) virtually every reg and SHO were still in work.

But my obsessive compulsive ways are worse than most. I've just gottwen off the phone to the ward about one of the kiddies who has high output cardiac failure.

I have the weekend off, but I'm pretty sure I'll be in there tomorrow seeing him and another patient on my team.

tech77

Fair enough.
I just always got the impression from the jobs i worked in that my SHOs/reg's wouldn't be sticking around after 5 that frequently (if not on call).
I never heard of anyone going in when not working though- you're the first.
-maybe they did and i just didn't see it.

Easier jobs than Paeds obviously.

charlieroot

tallaght01 wrote: »

But my obsessive compulsive ways are worse than most. I've just gottwen off the phone to the ward about one of the kiddies who has high output cardiac failure.

High output cardiac failure - what would cause that in child if you don't mind me asking? Is it a common paed's problem? Some kind of anaemia?

tallaght01

Yea his bone marrow is failing, unfortunately, along with renal failure, and multiple other problems.

charlieroot

tallaght01 wrote: »

Yea his bone marrow is failing, unfortunately, along with renal failure, and multiple other problems.

Yikes! Poor kid, whats the underlying cause?

tallaght01

Not sure yet. Just waiting on the bone marrow results. I suspect it's a very nasty fanconi's anaemia though

Victor

tallaght01 wrote: »

I'm scared, but excited.

Anticipation and anxiety. Same coin, different side.

Stop! Give me my coin back!

PoleStar

tech77 wrote: »

Fair enough.
I just always got the impression from the jobs i worked in that my SHOs/reg's wouldn't be sticking around after 5 that frequently (if not on call).
I never heard of anyone going in when not working though- you're the first.
-maybe they did and i just didn't see it.

Easier jobs than Paeds obviously.

That must be your experience from medical specialties.

In my own specialty (surgery), we never leave before 7pm (along with rest of team) and I or one of the other registrars (there are 2 others) will see all of the patients every day at the weekend, which means one in 3 weekends. Thats on top of on call weekends.

It sounds like to me that you guys are living in holiday land!

Hey lets start a medics vs surgeons fight ha ha!

tallaght01

Surgens were worst when I did adult medicine, but the paeds surgeons work crazy hours. The medical specialties work ridiculous hours here, too. Especially the oncologists. I've just popped in to see my patients now (saturday evening 7pm) and the haematology consultant was doing the same. He was just nearby so he came into check the sicker kids. The infectious diseases prof was also kicking around seeing kids in ICU.

I think most medics work pretty hard.

Except public health physicians, hopefully

Carsinian Thau

Good luck Dr. Tallaght.

Hope it all goes well for you.

missmatty

Best of luck Tallaght, public health is really interesting. I'm not a med (lab person) but have done a lot of parasitology and stuff and i was mad into it. You sound so dedicated though, I'm sure most of the parents of your kids would be reassured to know you're on their case

Chunky Monkey

tallaght01 wrote: »

I think most medics work pretty hard.

Except public health physicians, hopefully

Except the ones in India! I was reading Better recently and your man was saying that they immunised I think it was 4.2 million kids in three days for polio :eek: If that's not hard work then I don't know what is.