Maturing physicians can maintain confidence in skills

It sometimes can be difficult for "maturing" pediatricians to maintain the level of confidence in their talents that they had when they left residency. I'll be the first to admit that there have been times in my career, especially after referring uncomplicated pediatric admissions to young hospitalists, that I felt my "edge" was getting a bit dull and rusty. For those of you who can relate to this experience, I'd like to provide some suggestions on how maturing pediatricians can regain confidence in their diagnostic and therapeutic abilities-what many call their "medical mojo."

Do more, not less!

Ever since pediatric hospitalists became abundant, many of us have begun routinely relegating our inpatient duties to hospitalists at community hospitals. The rationale is that this frees up our day so that we can spend more time in the office, which is the most cost-effective way for pediatricians to practice.

At its core, pediatric medicine involves expertise in newborn medicine and inpatient management of ill children. We became experts in inpatient pediatrics long before we learned our outpatient management skills. In my opinion, we need to take care of our patients both in the hospital and in the outpatient environment, lest we paint ourselves into a corner from which we can never emerge. Taking care of our inpatients sharpens our clinical skills and is honestly better for our patients, as this assures continuity of care from a pediatrician with whom the patients have had a long-standing relationship. It is also a good idea to do an occasional procedure, such as a spinal tap or bladder catheterization. These procedures are easy to do and are great confidence builders.

There will still be plenty of work for pediatric hospitalists who can admit patients presenting from the emergency room, perform procedures when necessary, and provide consultation for children admitted by our surgeon colleagues.

Be a teacher

Although we are experts at communicating with parents in our offices, these conversations do little to help us retain or regain mojo. To stay on the cutting edge, we need to find someone-a new medical assistant, a physician assistant, a medical student, or a resident-to teach. This helps us articulate anatomy and physiology facts that have a tendency to disappear from our memories unless they are revisited from time to time.

Give talks to parents or nursing groups whenever possible. Having to prepare a short, organized discussion on a medical topic forces you to review the basics and to investigate what you may have missed if you aren't as up on the current clinical literature as you would like.

Stay up-to-date

Over the past few years, there have been substantial changes in pediatric medicine. New vaccines, new medications, and many new policies have emerged recently. Many Internet-savvy parents will challenge you at every turn and may intimate that they are more knowledgeable about their child's medical problem than you are. It is essentially a "job requirement" for pediatricians to keep current reading journals such as Contemporary Pediatrics to stay informed about the latest and greatest news. The American Academy of Pediatrics (AAP) has excellent review journals online (Pediatrics in Review, AAP Grand Rounds, and NeoReviews) and provides ready access to policies, guidelines, and clinical reports through the AAP Web site.

Set aside a few minutes each day (or night) to catch up with your required reading, and take notes if necessary. All pediatricians should consider enrolling in the UpToDate online service, which provides invaluable information about current pediatric disease management. Lastly, don't neglect your CME. Identify and acknowledge your weaknesses and take relevant CME courses to eliminate them.

Talk to your specialists (and read their notes)

For my patients who are complicated cases, I often feel like a medical "travel agent," coordinating visits with all of their specialists. There is a lot to be learned from conversations with these practitioners, as well as from reading their notes. By doing this, I learn about new medications and diagnostic and therapeutic strategies that I can assimilate into my own practice after further research.

Use technology

Fortunately, very few pediatricians these days are technologically challenged. If you are one of the rare holdouts, it's time to seize the opportunity to buy that iPhone, netbook, or PC and start to explore the universe of online or software-based medical resources. No doubt you use the Red Book and the Harriet Lane Handbook on a daily basis; these resources and a plethora of others are now available via the Internet! These tools will not only educate you, but can also be used to educate parents.

Don't delay!

By following just a few of the suggestions detailed above, you will awaken your inner pediatrician and get your medical mojo back again.