Search for tag: "pediatricians"

"Should I call the on-call pediatrician?" It's a question you've probably asked yourself when you have a question for your child's doctor and the clinic is closed. I'll help you figure out when it's appropriate to call and when a question can wait until the next office day.

As a pediatrician, we all take call, meaning that we rotate with our colleagues when we answer after-hours phone calls from concerned parents.

Usually, the questions parents have are very appropriate. Sometimes parents are just looking for reassurance that they're doing the right supportive care for their little one. Sometimes they're wanting reassurance that taking their child to urgent care or the emergency room is the right decision and that they're not overreacting. And sometimes they just want to know how much fever reducer to give.

One thing I don't think most parents realize is that the job of the on-call pediatrician is to help determine if their child needs to be seen urgently or not.

We cannot diagnose anything over the phone. Parents will often tell me that they know their child has an ear infection, or strep throat, or a urinary tract infection. I can't tell if your child has any of those over the phone, so they need to be seen.

We absolutely cannot call in medications like controlled substances. We cannot call in medications in general, because if your child needs an urgent medication, they should be seen.

If they need a refill of a long-time medication, that's better to be addressed by your child's pediatrician specifically during office hours. Questions that are not urgent should wait until the clinic is open.

I have one colleague who answers her calls, "Hello, this is the on-call doctor. What is your emergency?" One reason for this is we've gotten questions like, "I'm in the baby food aisle at the store. What food should I get my 6-month-old?" or, "My toddler won't take a nap. What can I do to force them to take one?" or, "How old does my daughter need to be to get her ears pierced?" These are all questions I've gotten.

One thing I've noticed in my years of taking call are that parents often think I'm sitting in the clinic just waiting for their calls. More than once, I've been asked if they can just come in and see me or if I can meet them at the emergency room.

When you call the on-call pediatrician, we are at home with our families. We are not in the office. I've answered phone calls from soccer games, while doing landscaping, when I'm doing hospital rounds in the newborn nursery, when out to eat, and of course, from my bed in the middle of the night.

As pediatricians, we want to be there for you when you have concerns. Kids don't come with instruction manuals, and often things happen when the office is closed. If you have an urgent concern, you are always welcome to call and we will give you the best advice we can. If your concern is not urgent, it will be better handled by your pediatrician during office hours.

Your pediatrician knows your child and your family. They can address non-urgent concerns better than one of us who has never met your child before.

Learning disabilities are a common concern that parents bring to pediatricians. I'll be discussing those on today's Scope.

I have a lot of parents coming to me to see if their child has a learning disability. Usually it's dyslexia, which is a reading disability. But sometimes is dyscalculia, which is a math disability, or dyspraxia, which is a developmental disorder that affects motor skills like writing. Parents normally notice that their child is struggling in only one subject and does fine in others, or they notice that their child is writing letters, words, or numbers backwards. The teachers may be the first to recognize if there is a problem and tell the parents to have their child see their pediatrician for an evaluation.

Now, here's where it gets tricky. Yes, most of us can identify if there is a learning disability. However, we as general pediatricians are not the ones who can do a full evaluation and diagnosis. Even behavioral and developmental pediatricians are not usually qualified. Why? Because there is a lot that goes into determining if this is truly a learning disability or if there are other reasons for the difficulty in a particular area. We as pediatricians are the right place to start the process though. Schools also. School psychologists can actually do a lot of the testing to start the process, and that is what most of us recommend. While schools start doing the initial learning evaluations, pediatricians do full physical exams to rule out other medical reasons, such as ruling in or out movement disorders, ADHD, anxiety, depression, or speech issues.

The final evaluation and where the actual diagnosis is made is with a neuropsychologist. These are specialists who will do a huge evaluation with a lot of specialized tests, including IQ tests, standardized tests in reading, math, language skills, things like that, to get a good idea of how the brain itself is working, or not working, and be able to come up with the exact diagnosis specific for the child. This can be a long process, but it is necessary to get the correct diagnosis.

Once a child has been diagnosed with a learning disability, the next step is to notify the school and have them come up with an IEP or individualized education plan. This is a written contract stating what the child's disability is and what the school is able to do to help the child learn successfully. It's drafted with the parents, teachers, and school psychologists all involved and goes off of the results from the neuropsychology report. This IEP should follow the child all the way through graduation. It should be reevaluated every six months to make sure that the child's needs are being met and that there are not new issues coming up.

There are no medications to help with learning disabilities. As pediatricians, we can help direct you to resources that can help your child. Our relationship with your child will not change. And we too, like the schools can adapt if your child has problems with learning.

What your child needs most is encouragement and a lot of positive reinforcement when they get something right. Let them know that this is something that they can totally be successful with. Let them know some of the famous people that have had dyslexia, such as Keanu Reeves, Albert Einstein, Steven Spielberg, even Ozzy Osborne. They've all been successful. Henry Winkler had both dyslexia and math problems. Even Ben Franklin was thought to have a math learning disability.

Having a learning disability will make things harder, but not impossible. And often those who have a learning disability in one area often have exceptional abilities in other areas. Encourage your child to focus on what they are good at while they work hard things out that don't come easy. Remind them that they are not defined by their learning disability only by their abilities.

Dr. Chan: Why does someone decide to go into triple board residency program? How do you promote wellness and balance during a five-year residency program? What's the difference between West Coast swing dancing and the jerk and pull swing dancing found in Utah? Today on "Talking Missions and Med Student Life," I interview Dr. Powell, a second year psychiatry resident and triple boarder here at the University of Utah School of Medicine.

Announcer: Helping you prepare for one of the most rewarding careers in the world. This is "Talking Admissions and Med Student Life" with your host, the Dean of Admissions at the University of Utah School of Medicine, Dr. Benjamin Chan.

Dr. Chan: Well, welcome to another edition of "Talking Missions and Med Student Life." I have a repeat guest back here, Dr. Powell.

Dr. Powell: Hi.

Dr. Chan: How are you doing?

Dr. Powell: I'm doing really well.

Dr. Chan: And you are in your second year of residency?

Dr. Powell: Yes.

Dr. Chan: All right. And you were on the podcast about two years ago, give or take.

Dr. Powell: Yeah, third or fourth year. Anyway, med school.

Dr. Chan: All right. So when you graduated, what did you go into?

Dr. Powell: I went into a combined residency program at the University of Utah. The three programs that it combines is pediatric medicine, adult psychiatry, and child psychiatry. And just to give you some perspective, in the country there are nine of those programs versus the 900 pediatric programs I could have chosen from if I had just gone into pediatrics.

Dr. Chan: Lot of pediatricians.

Dr. Powell: Yes.

Dr. Chan: A lot of pediatricians. Okay. And why did you want to do the triple board program? What attracted it to you originally?

Dr. Powell: So when I was on the wards during my third year of medical school, when I started medical school, I actually had written off psychiatry and pediatrics. I thought I was going to go into family medicine, maybe some geriatric medicine. And then as I'm getting on the wards, I just got more and more excited about kiddos and I'm on the pediatric wards. I'm enjoying talking to kids. I'm enjoying talking to teenagers and kind of keyword talking there. I liked the medicine but something felt like it was missing. And then when I did my rotation on child psychiatry, I realized I really like this but I don't want to leave out this medicine piece. I like these medically complicated kids. I like these kiddos who have a lot going on and they need somebody who can really dig in there with them and work on their medical and psychiatric problems. And so that's why I decided on a combined program.

Dr. Chan: Was it daunting to think that you needed to be like do three programs in one? Was that kind of exciting or . . .

Dr. Powell: It was. I think kind of like the decision to go to med school and then residency, you don't want to think about it too hard otherwise you can get into your head and kind of talk yourself out of it. I do get a lot of from attendings and other residents and other programs, "Wow, you're going to do three at one?" But for me, it just makes so much sense that they just naturally fit together. Right now I'm on child psychiatry rotations but I'm at the children's hospital and so thinking back to when I was walking around as a pediatric intern at the children's hospital and the things I was thinking and what I was concerned about and how I was getting things done, I can see the growth in a year. And it's so fun to now on the psychiatry side be supporting the medical teams. And I know what the medical teams need and the way they need it because I was there just last year.

Dr. Chan: So I want to talk about the jump. Like I have a theory and you can agree or disagree that the jump from undergrad to med school is pretty big. But I feel personally that the jump from med school to intern year is huge.

Dr. Powell: I would agree.

Dr. Chan: So I'm curious, what was your experience for your intern year? What did that look like? How hard was it? How stressful was it?

Dr. Powell: So I remember, wrapping up fourth year I did everything that I at least thought would be important to kind of wrap up and make my intern year easiest as possible. I ended up staying here at University of Utah. I was a medical student here so I was lucky enough I could stay in my apartment. That was nice. I took a nice, big vacation at the end of fourth year. I went out of the country.

Dr. Chan: Where did you go?

Dr. Powell: I went to Oaxaca, Mexico, and probably butchering that name still.

Dr. Chan: I just want to say the word Oaxaca.

Dr. Powell: Even when I was there for a month, I was still saying it wrong. But I went there and I did something totally and medicine related and loved my time. I'd never been to Mexico for an extended trip like that. It was fantastic. And so just a lot of the time, kind of like, "Okay, here we go." Once intern year did start, I think going in just knowing it's going to be hard, just expecting the hours to be long, just setting your expectations in a place that you're not going to be disappointed because I can't change the weeks. I worked 80 hours. What I can do is take care of myself on my days off and not get too down on myself and just be okay with the learning curve that I'm in. I actually I felt like I was putting more pressure on myself in retrospect than everyone around me was because I was an intern. I was a new intern.

It was July and everyone in the hospital in the teaching hospital knows that's when the new interns come in. So in retrospect, I actually could have asked for help a couple more times, even for things that I thought was really simple. But, yeah, it was hard but you kind of just get down and you do it. That was the biggest thing. When I asked for help, and then people would respond, it was lovely because then you felt supported and you knew where you could go for help.

Dr. Chan: Did you feel your tactic of trying to take a lot of intense fourth year electives, did that help you or it was just tough to say?

Dr. Powell: So I actually stacked all my intense fourth year electives in the beginning of my fourth year, all the required and electives that I had chosen and then I had a few earlier in the spring and fourth year and initially starting fourth year like my plan was to kind of work right up really hard, right up until intern year. And then I changed my tactic personally because I just realized I was going to be very burnt out on med school and if I just rolled straight in from hard things from fourth year to intern year I wasn't going to have the energy reserve I needed to get through that year.

Dr. Chan: That's why we needed the fish tacos in Oaxaca.

Dr. Powell: Yeah. That's why I was there. It was lovely. It was absolutely lovely.

Dr. Chan: All right. So intern year, what were your first . . . the entire year is pediatric, right?

Dr. Powell: Yeah.

Dr. Chan: So you're essentially a pediatric intern.

Dr. Powell: Yes.

Dr. Chan: What does that look like exactly? Like what kind of teams rotations did you start and what time were you going to the hospital? And how is this different than being a med student?

Dr. Powell: My first two weeks as an intern were actually on night flow. So I was arriving at 5:00 p.m. and leaving at 6:00 or 7:00 a.m. the next morning. So for the first two weeks that was quite a jump because already you're transitioning your sleep schedule and now you're trying to learn this hospital system as an intern, and you're doing it on nights where . . .

Dr. Chan: Things are closed.

Dr. Powell: . . . things are closed.

Dr. Chan: So what is the night flow? What does the night flow look like?

Dr. Powell: Yeah, so I was on what's called the hospitalist team. So the general medical teams in the hospital. So kiddos who don't necessarily need to be admitted to a sub-specialty team like gastroenterology or cardiology, instead are admitted to hospitalist teams. So kids are coming in with pneumonia or maybe babies with some weight loss that's unexplained. Just very general kind of bread and butter pediatric things that would be admitted to the hospital and it just happens to be that these kids showed up at night. So I'm the one admitting them with the help of my senior resident.

Dr. Chan: Okay, let's just say you weren't alone. Did you have a buddy to kind of . . .

Dr. Powell: Yeah. So there is a couple of interns. And then at the kind of the top of the pyramid, there was a senior resident that's overseeing these different interns. And then I don't believe that first two weeks we had medical students around. But then like the weeks next that I switched over to them, that's when the medical students started coming because when they were coming for the beginning of their third year for their clerkships. And then we also had our sub-I's for their fourth year showing up later in July as well.

Dr. Chan: And were you supervising the med students?

Dr. Powell: Not initially but by the end the second half of intern year, I was taking more leadership, at least with the sub-interns. The third year medical students were still supervised by the senior residents, but as an intern, I was given responsibility with some of the sub-I's because that's what they are. They're sub-interns. They're kind of be expected to be functioning at my level. So it's best to pair them up with a more experienced intern.

Dr. Chan: And would you say as an intern, you just had a lot more responsibility and a lot more duties compared to a med student?

Dr. Powell: Yeah. Occasionally as a med student, I remember looking at my interns or even my seniors, and I'm like, "Oh, I feel like they're ignoring me." And then once I was on the intern side, I realized, like, if we're ignoring you, it's not on purpose. We have one million things to do but only one of the one million is something that you can actually help with because the rest of them need that like MD signature or whatever it is pass off to make it happen. So yeah, I would that was also part of a learning curve is not only learning how to be an intern, but learning how to now supervise medical students when I was just one a year before. But I think by the end of intern year, you have your feet under you enough and you're able to start, especially if you have a medical student that shows up and is enthusiastic and wants to learn and help even if it's not something that they're interested in, but they're still like, "Nope, I'm here to work and learn." Those are the best students to rope into the team flow.

Dr. Chan: That's awesome. And did you get to pick what you did during the intern year or did they just kind of tell you?

Dr. Powell: Somewhat. The categorical pediatric resident, so those who are just doing a regular three-year pediatric program and not the combined program I'm in, they have a little bit more flexibility during their intern year than I do. But what I did get to choose, I did get to choose a couple of different four-week electives. I chose endocrinology, especially with kiddos with diabetes, that's a chronic lifelong illness. There's an overlap there with behavioral health and psychiatric care. So I wanted to see the medicine side of what those kiddos are experiencing. I also chose gastroenterology outpatient for four weeks. So a lot of what we would call functional abdominal pain, kiddos who are really anxious and maybe have other psychiatric issues and they end up not in a psychiatrist office but a gastroenterologist office because their presenting symptom has to do with their stomach.

Dr. Chan: The mind-gut link. Yeah.

Dr. Powell: Yeah, it's really powerful. So I wanted to see what is the workup, what does it look like when these kids do get sent to these specialists? And also those who do have, again, lifelong chronic illnesses that they will see a gastroenterologist for the rest of your life and whether they have premorbid or comorbid psychiatric disease, just kind of seeing what does it look like and how is it taken care of in these sub-specialty offices? So those were a couple of my choices that I had in addition to the work on the hospitalist teams.

Dr. Chan: And then did you have a clinic, an outpatient clinic?

Dr. Powell: Yes. Yeah, I have . . . it's called pediatric continuity clinic. It's a half day once a week and this is something that I'll do for my entire residency. And it's general pediatrics, so ages, you know, newborn to 18 and it's sick visits, you know, "I have a cold, is it pneumonia? And my belly hurts, is it something with my belly or is it something anxiety-wise?" I see teenagers for mood checkups. I see newborns that I met when I was in the Well-Baby Nursery as an intern.

Dr. Chan: The [WBN 00:12:01].

Dr. Powell: The WBN. And we hit it off myself and the parents and since they were planning on coming to the clinic I was already working at they chose me as their primary care provider, their PCP. And some now I've actually have a couple of kids that I've followed for every one of their well child checks from since they were born. Until now, they all just turned a year old a couple months ago.

Dr. Chan: So even if you're on a child's psych rotation, you still have your pediatric continuity clinic one day a week, an afternoon a week. That's pretty cool.

Dr. Powell: Yeah. It's a fun break, especially some days are hard on psychiatry. So it's a brain break to like, "Okay, I'm going to go do some well child checks. I'm going to see some of my healthy kiddos or even just do some quick sick visits and remind myself what a cough and a cold looks like and what looks sick and not sick in a child." And then vice versa. And a few years, I'll actually start my kind of a continuity clinic for psychiatry as well, then I'll be doing that in addition to my peds continuity clinic. And so then I'll be doing both of those no matter if I'm on the psych side of rotations or the pediatric side.

Dr. Chan: And going back to this combined program, so, like it's five years, how do you split up to three different specialties within the five years?

Dr. Powell: So there's an official document from the accrediting board nationally for these programs and that it's this percentage and this percentage of my time in pediatrics, this percentage of my time child psychiatry, and this particular percentage of my time in adult psychiatry. I forget the exact percentages. But what each program has done is crafted what they feel is the ideal schedule for getting exposure in a good order of now you're able to build your skill. So even though I'm switching from pediatrics to child psychiatry, I'm using my skills as a pediatrician but now applying it in my child psychiatry rotations and then progressively, just like with any residency program, you kind of do harder and harder things as you go on. And they've also they've kind of woven that through all three programs.

Dr. Chan: Okay. So it's very integrated.

Dr. Powell: Yes. Yeah. So you mentioned my intern year, that was entirely pediatrics. And that's for a couple of reasons. The way the U has chosen to do that is they want us to be able to get to know our pediatric cohort that is going to be here for three years and we'll graduate after three years, and then I'll be staying on for another two years. So they want us to have that kind of home base in pediatrics and feel like we belong there. Especially since they'll be turnover when by the time we're seniors. And also, I think, and I'm happy for this is that pediatric intern year is intense. There's a lot of hours, there's a lot of kids, and then at the program here, it's high volume. So you are seeing a lot of kids very rapidly . . .

Dr. Chan: Lots of kids in Utah, I've heard.

Dr. Powell: There's a lot of kids in Utah.

Dr. Chan: Lots of kids in Utah. Yeah.

Dr. Powell: So I think it teaches you not only good medicine as a pediatric intern, but just how to be a resident like it's very like here's this time intensive thing of like how to be a resident. So then when I make that switch, the first switch I made was to adult psychiatry my second year. So July of my second year I'm on adult psychiatry for the first time and I'm the equivalent of a psychiatry intern. But in that I'm new to adult psychiatry, but as far as my workflow and my and knowing the logistics and being able to get things done, I'm a second year resident. And so it's kind of fun because attendings, you show up and they're like, "Oh, I have one of the newbies," and they're like, "Oh, I have the second year newbie."

Dr. Chan: Yes, yes. I have a triple boarder.

Dr. Powell: Yeah. So it's kind of it's one of the . . . there's a couple of different switches that we make. And then when we show up and everybody is happy to see us because we're there and we're going to work hard and we already kind of know how the hospital works.

Dr. Chan: Yeah. How do you find balance? How do you find your wellness during intern year? How do you do that? Because I get the sense 60 to 80 hours a week . . .

Dr. Powell: Yeah, yeah, is a lot.

Dr. Chan: So maybe one day.

Dr. Powell: One day off.

Dr. Chan: It's usually not the weekend. It's usually like a . . . or it is the weekend? I don't know. Is it a random Friday?

Dr. Powell: It's usually like a random weekday. So the blocks that I was working six days a week, it was usually not a weekend that I got off. It was a weekday and then occasionally when I was on outpatient rotations I'd get one day or both days of the weekend off. And so you got two days off on a weekend, it was like, "Wow, this is what a normal weekend it is."

Dr. Chan: Yeah, what is this feeling I have? Yes, yeah.

Dr. Powell: So I looked at my schedule at the beginning of my intern year and I realized that a lot of my inpatient rotations were over winter break or like the winter season, I should say, and I realized I'm like, "You know what? I do like being in the mountains. I know how to snowboard, but I want to learn how to ski. I've been here for four years and this is now my fifth winter here. I want to learn how to ski."

And it was I would say a little bit of an ambitious goal for an intern to be like, "I'm going to learn how to ski during intern year." But once I realized some of my days off were during the week, I knew there'd be less crowds, less traffic, and the mountains are already so accessible. So I say that relatively like there's actually not that much of a time to get to the mountains here to go skiing. But I bought a pass and I was skiing on, I would say, most of my days off even if it's only for an hour or two because the rest of the time I wanted to sleep in or get some groceries, or anything like that, but just to get outside and experience something new. And so I prioritize that.

I really liked dancing. I'm West Coast Swing dancer and during med school I was doing it competitively. And I realized, "You know what? I want to try something new." And so I kind of put that on the back burner for a year. And it was a conscious choice because I knew I wasn't we have time for both. And since West Coast Swing dancing, most of the dances happened late at night and I was going to be on a regular schedule of getting up really early. That's kind of why I chose to like "Okay, now I'm going to like maximize my daytime hours and I'm going to maximize them outside since I'm going to be in the hospital most the time." So I switched. That's how I found the balance back here.

Dr. Chan: That's beautiful. What is West Coast swing dancing?

Dr. Powell: Yeah, it's a type of swing. Actually most people when people think of swing at least in this area, they like think of kind of what I call as like Utah jerk and pull because it's actually just like this like really . . .

Dr. Chan: Is that like where in front of businesses with those big inflatable people then like blows the air and goes like that?

Dr. Powell: No, it's lead and a follow, holding hands and it's like a partner dance.

Dr. Chan: Jerk and pull.

Dr. Powell: I call it the jerk and pole. It's this colloquial. It's actually like most people just call it country swing, but West Coast swing is actually the nickname. It's like the ballroom of swing because it's a smooth swing.

Dr. Chan: Is there an East Coast Swing?

Dr. Powell: There is an East Coast Swing. That's the one that most people know of. It's like kind of like more like Lindy Hop like you're like really upbeat or like the jitterbug. Those are all closely related. It's a lot more . . . there is swinging involved. But it's a lot more like up on your toes and fast whereas West Coast swing is you're actually flat footed and going really smoothly through the music.

Dr. Chan: And you do competitions?

Dr. Powell: I haven't recently, and again like I did a lot during medical school because I would get weekends off regularly and that's when the competitions are held. But as added intern year I was like, "You know what? Switching gears I'm not going to be able to compete this year. So let me like focus on a different hobby, something that I can do during daylight hours and not have to stay up late for." And then, during second year, I have gone to a competition or two not with the hopes of winning anything and I didn't. I fell horribly on my face because I was out of practice, but it was fun being there with my friends and reconnecting with my friends who I hadn't seen for a while.

Dr. Chan: That's wonderful. I had no idea you did that. That's really cool. And your second year in, any wavering, any doubts, like, "Oh, I really like pediatrics. Maybe I'll just switch and be a categorical pediatrician"?

Dr. Powell: It's usually . . .

Dr. Chan: So you know what I'm talking about?

Dr. Powell: Yeah.

Dr. Chan: Because it's a long program. It's five years.

Dr. Powell: It's a long program.

Dr. Chan: You straight [inaudible 00:20:07] grade on your pediatrics.

Dr. Powell: I might have more feelings like that, especially at the end of my third year is I see my pediatric cohort graduating, either moving on to being an attending in a general pediatric office or moving on to fellowship. I think it on my good days, which I would count today as a good day, I feel perfectly happy and content and I don't feel rushed that I have to make my next career decision. I'm happy just being in a space where my job is to just learn. And also I get to choose some rotations and things of things that I know that I might never see again. So I see it as a privilege to like learn and understand these different patient populations.

And so it's just cool to be in that space. Because once you're out of residency and fellowship, that changes. You're here, this is your specialty, this is what you're doing a little. I definitely on days where it's been long hours, I've had a really frustrating day. I definitely I'm not immune to the thought of, well, I could actually quit a year early and I'd still be done with pediatrics and adult psych. And then I could just like do one of those. Not necessarily combine them. I wouldn't have the child psych finished. But yeah, I have thoughts like that. And then I have another good day and I'm okay with it.

Dr. Chan: Okay. So it's like as long as a good days outnumber the bad you're on the right track.

Dr. Powell: Yeah. Yeah. And I mean, sometimes, and I have known there's people been in my program who made the decision like, "No, actually, this isn't for me. I have to make a switch." And it's hard. And med school, I thought it was impossible in med school. And so I didn't think that wasn't even a thing. But I've realized, you know what? If that does need to happen, you can make it happen. It's difficult. You might be behind, you might be starting over. There's a couple of people that I've known for my program that they finished their program and then they restarted as an intern in another program just because they like, you know what I got to do what's going to be best for me and what I want and what my goals are. And I realized the first choice I made wasn't the best one. That it's not common but it's not uncommon if that makes sense.

Dr. Chan: Yeah. People don't realize that from the outside that there is some switching that can happen within residency programs. It takes a lot of work.

Dr. Powell: It does.

Dr. Chan: Bridges might be burned a little. But, yeah, I mean, I think for a lot of students, they think that the residency is going to be like X and then they start doing the residency and it turns out to be more like Y. Like, "Oh, well, this is not what I envisioned for myself." So people sometimes can switch residency programs. People graduate residency programs, go and practice and then they get disillusioned or they want to do something else and they can . . . you can do two residency programs. A lot of people like my age who are thinking about going back and do another residency program. So to each his or her own.

Dr. Powell: Yeah, occasionally, also on bad days, in addition to just thinking like, "Okay, I can be done at this point in my residency and I'll have enough qualifications to work." I also have the thought of, "Oh, maybe I'll just go back to undergrad and do something totally . . ."

Dr. Chan: Yes. You might have to eat a lot of money.

Dr. Powell: They're going, "Yes, that's silly."

Dr. Chan: Yeah, it's debt thing. Yeah.

Dr. Powell: Let's pay off my debt first. That's when I start calculating how many years I have to work as a doctor and pay off my debt and then . . .

Dr. Chan: How many years would I have to yes, as not a doctor. Yes. All right, so Rebecca, like where do you see yourself practicing? Because I know you're from Southern Utah. So do you see yourself ending up down there or like what are your current thoughts?

Dr. Powell: There's a chance. As an undergrad, I did a lot of volunteer work in the Four Corners area of Utah, Arizona, Colorado, New Mexico. And I'm from St. George, the opposite end of Southern Utah. So I just liked that area and I like that space. I like that desert landscape and that's where a lot of my family is. And then as a medical student I spent more time down there in the Four Corners area for six weeks through my family medicine rotation and loved it again and actually just this week I am working with the schedulers on the adult psychiatry side to see how many weeks I can get down to the Four Corners area again for psychiatry rotation, so I keep being drawn to that area and making connections and networking down there. So I think that is a possibility I could end up there for at least.

Dr. Chan: What is it about Southern Utah that like excites you? Like what attracts you to it?

Dr. Powell: Initially, it's like I do have family there and so like that like special piece of like spending time there with my grandparents in the summers is always fond memories. It's just a beautiful area and I like kind of . . . I think I'm more of a small town girl. Like I like the pace down there. I think I already said this, I'm going to say it again, it's a beautiful country and I can just see myself working really hard during the week and then every weekend just enjoying going camping and being outside. Cost of living would be fantastic.

Dr. Chan: And there's a huge need because I remember when I'm on service, we get a lot of children, teenagers from Southern Utah. And we can treat them up here in Salt Lake but like for aftercare follow, there's not a lot of providers in Southern Utah.

Dr. Powell: And generally and at least for on the psychiatry side and the child psychiatry side, in the state of Utah, there's only two counties that have the enough child psychiatrists per capita. One is Salt Lake. We have an academic center here. There's a lot of residents and attendings that are child psychiatrist and the other one is Washington County, which is St. George, Utah where I'm from and the only reason they have enough down there is because they have one child psychiatrist in that entire area. So it would also be interesting for me because there is a small part of me that I'm like, "You know what? It would be cool to take care of some adults in psychiatric in a psychiatric capacity, have like some percentage of my practice doing that." And in Four Corners, so they're in Southeastern Utah since it's very limited, I would kind of be able to like write my own ticket as far as this is how many kids I want to see, this how many adults I want to see because I would be not it but I would be one of the few who could provide the kind of services that they need in that area. That's really needed.

Dr. Chan: Like what I've seen is you probably have like a really busy like inpatient outpatient consult, you'll probably do a lot of different things.

Dr. Powell: Yeah. I think there were a lot of different hats, which is kind of what's fun about residency so far and I haven't . . . all the switches I've made between the three programs, inpatient and outpatient pediatrics, adult and child psychiatry, nothing's really stood out is like, "This is the one that I absolutely love." I just kind of like it all. And I think that's part of the reason why I'm drawn to that area is I could see myself wearing a lot of different hats down there and enjoying it and maybe eventually I'll kind of narrow it down to one. But early on in my career, I see myself being very happy kind of blazing the trail. And then getting other people down there, whether it's doctors or PAs or NPs and just kind of building what they already have down there. And like just making it grow.

Dr. Chan: Yeah, sounds like building a really good infrastructure.

Dr. Powell: Yeah.

Dr. Chan: This is wonderful. It's beautiful. All right, I guess last question, Rebecca, any advice? I love this question. Like anyone who's listening who might think they can't do it or is thinking about . . . they love this idea about triple board and they're not sure if they can do it, if they're not sure they can go on to med school or residency, what would you tell them? What advice would you give them?

Dr. Powell: I would tell them that at least explore it. And that means different things for different levels. For me as a premed, I was actually a finance major. And when I decided, "You know what? Maybe I want to go into medicine." I was a junior in my business program. So I went and found the office at my undergrad that was known for helping kids get into medical school. I said, "What should I start doing?" And they said, "Take this seminar, meet these doctors, come look at these guest speakers, start volunteering here, see if you even like it, expose yourself to it."

So I started volunteering in different hospitals just to get exposure to be like, "Okay, I like the idea, but do I actually like being there in the space?" And I did. And then the same with medical school, like I said, at first I didn't think I was going to do kids or psychiatry, but once I was exposed on the clerkships, I realized I really did like. And also there was a lot of pressure I feel like during first and second year of med school to be like to already know what you want to do because then you can go join student interest group. You don't know what you want to do. If you have a slight interest in something, go join that student interest group. Go listen to that guest speaker, go get that free meal, which is the best part of that . . .

Dr. Chan: Free meal, that is the best part of med school. Yeah, all the free food.

Dr. Powell: Just to hear and listen and like ask questions. And then just really take advantage of anytime that you have assigned clinical duties anywhere, whether it's a clerkship or a different class or something like that. Just really understand like, "Okay, this is a specialty I'm going to go see. This is what I'm seeing. Is this inpatient or outpatient? Is it community based? Is it hospital based?" Just really pay attention because something might grab your attention that surprises you.

So allowing yourself to be exposed and being open to something that does grab you and then when it does just start asking around like, "Hey, who do I talk to about this?" Because that's what the reason that the doctors and residents and people that work here were curious because they like part of that teaching and that mentoring environment. That's just part of it. And so being able to after you find kind of an interest even if it's just a slight interest, you can just ask. Start asking.

Dr. Chan: Rebecca, I'm so glad you're here. I'm going to have you come back . . . I want you to come back every year to give a little updates.

Dr. Powell: That's be great.

Dr. Chan: Even though, yeah, Southern Utah totally need you, like I hope you like stay in practice here and join us.

Dr. Powell: I might. I might. Even though I said I'm small town, Salt Lake's really grown on me. So there also is a part of me that might stay here. I'm in my second year so I have exactly three and a half years, not that I'm counting, left before I have to graduate.

Dr. Chan: Make that decision about where you're going to practice. Cool. Well, thanks, Rebecca.

Dr. Powell: Thanks, Dr. Chan.

Announcer: Thanks for listening to "Talking Admissions and Med Student Life" with Dr. Benjamin Chan, the ultimate resource to help you on your journey to and through medical school. A production of The Scope Health Sciences Radio online at thescoperadio.com.

Dr. Gellner: You are in need of finding a new pediatrician whether it's because you're expecting your first child, you moved to a different city, your insurance has changed, or your previous provider has left their practice. It can be a pretty stressful situation. But I'll let you know some tips to help make this a little easier.

Announcer: Keep your kids healthy and happy. You are now entering "The Healthy Kids Zone" with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Finding the person you like and trust to help you raise your child, take care of them in sickness and in health, it can be tricky. The first thing I would say to do is to ask people around you who have children. Who did they see? Do they like their pediatrician? Do they like the staff at their pediatrician's office? Is the location close to you? Are their hours convenient?

I can't tell you how many new patients I get that come in saying, "You see my neighbor's kids or my family member's kids." It's actually quite humbling and an honor as a pediatrician to know that so many parents speak highly of me.

Next, call your insurance company. Do the pediatricians whose names keep coming up amongst your friends take your insurance? Doctor bills can be expensive, so make sure you pick a pediatrician in your network.

I then look them up online. Most practices not only have a short biography about their provider outlining what their education is. They'll also say if they're board certified. Do they have a particular area in medicine that they really like to practice? For example, my biography points out that my areas of expertise are preventive care, childhood obesity, and allergy and asthma management.

The biography also should give you a little insight into their personal life, like what do they like to do when they're not working. You might find that someone has a particular hobby that you do as well, which makes for a great icebreaker when you go in for your first appointment. Many of my new patients lately have been from Texas. And when they see I did a lot of my education in Texas, it's an instant connection. When you look them up online, also look at their reviews. What do other parents say about that provider?

Finally, when you've done all your homework and you've found someone who you think would be a good fit for your family, schedule a visit to establish care when your child is ready for a well visit or if they're sick or if they have a chronic condition that needs long-term care. Use that visit to see how this provider interacts with your child. Do they talk to your child as well as you? Is your child comfortable? Does your child leave with a smile on their face even if shots are involved in the visit? If you have a positive experience and you feel like you and your child connect well with the new pediatrician, then you know you found your match.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Dr. Gellner: With this being my fifth year of recording, my producers have asked me to do a best of episode with the top five topics I think parents need to know about before bringing their child to their pediatrician. These are concerns that I hear often or ones that really need to be in the spotlight. I'm Dr. Cindy Gellner, and you're listening to my "Five Best Topics" on The Scope.

Announcer: Keep your kids healthy and happy. You are now entering the "Healthy Kids Zone" with Dr. Cindy Gellner on The Scope.

Dr. Gellner: It was pretty easy to come up with my top choice -- the poop on poop, everything parents want to know about their kid's poop. It's pretty amazing how obsessed parents are with their kid's poop. Parents have even brought me poopy diapers and sent me pictures of their child's poop wondering what's going on. Babies and kids have developing digestive systems, so their pooping cycles are different from those of us as adults.

For newborns, dyschezia or apparently painful pooping is the norm until they learn how to coordinate all the muscles needed to poop. For breastfed babies, pooping with every feeding or only once a week are both normal. While formula-fed babies can go several times a day to once every three to four days.

Kids who are potty training often get scared of pooping and start holding it in leading to constipation issues. Some kids develop constipation shortly after they turn one, especially if there's a family history of others with constipation.

I see so many kids with constipation, I've actually been given the nickname of the poop whisperer at my office. Not one I choose for myself, but apparently I'm good at fixing constipated kids. The bottom line literally is everyone poops a little differently. If it hurts, if there's blood, if it's rock hard and causing stomach pain, then it's time for your child to be seen.

For number two, I would choose anything mental health related. Most pediatricians will tell you that we are the ones managing anxiety, depression, ADHD, behavior issues, most of the psychiatric issues in kids lately. There are days I see so many patients with behavior or mental health issues that I feel like a child psychiatrist.

Sadly, there's been a notable increase in mental health issues in people of all ages, and there's not been an increase in the number of mental health providers to help manage these issues. While all of us pediatricians are able to address many mental health diagnoses, there are some that are just out of our scope. We aren't counselors or therapists. Many of us cannot manage complex mental health issues, and medication prescriptions can be tricky as there aren't as many options for patients under age 18.

Your pediatrician will be the one that you bring your child to for the initial evaluation. But please understand that we can only help so much and often we need to refer you to a specialist. I always explain it as you wouldn't want your child's psychiatrist to manage your child's asthma. The pediatrician is better at that. In the same way, a child psychiatrist is better for addressing your child's mental health needs if they are beyond what we as pediatricians are trained to do and are comfortable treating.

Number three would be kids and colds. It seems that's my daily special lately. Everyone is coming in coughing, sneezing, not wearing a mask, so I wear mine and look like a duck all day. It's hard when you see little ones coming in and they look miserable and parents are exhausted. And for most of these viruses, all you can do is nasal saline, humidifier, honey if they're over one and lots and lots of TLC.

Parents often bring their kids in wanting something to help make their kids feel better faster, but unfortunately there isn't much out there other than supportive care. Antibiotics won't help unless they have a bacterial infection, like an ear infection or pneumonia. Breathing treatments won't help unless they have asthma. Green boogers don't always mean a sinus infection and pulling at ears doesn't automatically mean an ear infection.

Cold meds aren't safe in kids under age six, and many adult cold medications contain aspirin which aren't safe for anyone under 18. As a parent, I know how frustrating it is and how one would do anything to make their child feel better, but with cold viruses, it's symptom relief only.

Number four would probably need to be any of my Debunking Old Wives' Tales pieces. I spend a good deal of time on these in the office. No, your child can't get a cold because the weather changed or they went outside without a coat. Yes, your child can get their vaccines if they just have a mild virus. No, teething doesn't cause a fever or diarrhea. And yes, a little bleeding when your newborn's umbilical cord is coming off is actually normal and expected. And unfortunately, no, telling your child to eat their carrots won't really improve their eyesight.

Number five would have to be picky eating in toddlers. I get this concern at least once a day. I've had it twice today. Usually at a well-child visit when I asked how a child's eating is and parents tell me they were doing so good and now I can't get him to eat anything, I'll look at the growth curve and show the parents that their child has gained two pounds since I last saw them, and the parents are like, "How can that be? They're not eating?"

Well, kids' metabolisms put the brakes on between one and five. They only gain a few pounds a year during that before they hit their kindergarten growth spurt, so their eating patterns change. Some days they'll eat great. Other days they'll have five Cheerios and call it a day. Some days they will only eat mac and cheese for a whole week, and the next week mac and cheese is the most disgusting food on the planet and they won't go near it. Yep. All normal.

Our kids wouldn't eat well at home, but they did great at daycare or at a restaurant and we decided they just needed an audience to eat. As pediatricians, we're good at tracking your child's growth and if there are any red flags, we'll let you know. Until then the best advice is don't force your child to eat. Limit milk to 24 ounces per day, so they don't fill up on liquids, and make meals a positive experience. And trust that when your kid is hungry, they'll eat.

So those are my top five topics that I think parents need to listen to before rushing to their pediatricians' office. Hopefully, they've been helpful.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.