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Our specialty guest interview features Dr Keir Shiels this week, who is something of a household name after starring on the BBC 3 series Junior Doctors: Your Life in Their Hands. After studying on Cambridge’s Graduate Medicine course he moved to Newcastle to complete an Academic Foundation Programme. Towards the end of his FY2 he decided to specialise in paediatrics, a decision which was documented by the BBC 3 series. We chatted to him about the challenges of working with children, his experience of paediatric training and the benefits of a working knowledge of Peppa Pig.
Thank you for your time today Kier, can you start by telling us how you decided to become a paediatrician?
It was very late before I knew what I wanted to be when I grew up. I was doing an F2 job in Plastic Surgery, which involved a lot of paediatric burns work. Working with children was so much more fun than adult medicine. Luckily my next rotation was paediatrics, so I was able to gain good experience in the run-up to interviews. Though that was luck rather than judgement. Up until that point, I didn’t even know whether to pursue a medical or a surgical career. I’m so glad I picked the paediatric medical route. Much of this was documented in the third episode of season one of BBC Three’s Junior Doctors.
So what has made you glad you chose paediatrics, what are your favourate parts of the specialty?
The working atmosphere in paediatrics is by far the best you will find in medicine. It is a colourful, vibrant and fun environment for patients and professionals alike. Christmas is particularly magical.
There is a wonderful variety of presenting problems. No other specialty deals with a population as varied as a premature baby and a teenager. You touch on a bit of everything – renal, intensive care, respiratory, psychology. Nothing you learnt at medical school goes to waste. I’d hate to specialize in one thing and feel that learning the kidney or the brachial plexus had been a waste of effort.
I think lots of doctors feel difficult about choosing one part of the body to specialise in, so it’s good to know that choosing paediatrics is a good option for getting lots of variety. On the flip side, what’s the worst thing about paediatrics?
Picking one is hard, because it is so easy to be pithy and say “Child Abuse” or “Sick kids.” But actually, I think the hardest thing can be managing the expectations of a sick child’s family. Telling parents in A&E that their child is fine and can go home is sometimes harder than telling them that they need admission. Parents can feel like you’re not taking them seriously – especially when their child has clearly been miserable at home, but is now running around playfully. Parents need to be pushy advocates for their children – and we must never judge them for it. But managing the expectations of parents who want a diagnosis of autism/ADHD or who are demanding a cure for the common cold is tough. Tough, but understandable.
What was the single most challenging moment during your training?
Disagreeing with the diagnosis and management plan made by a senior consultant. This is not a paediatrics-specific problem; but it is a good question for an interview. Knowing what route to take to escalate concern about a patient’s management is difficult. I don’t think it’s important to go into the details of the case – but ultimately, because of the escalation of my concerns, things worked out well for the baby.
What do you think are the most critical personality traits that a doctor should possess for a career in Paediatrics?
You aren’t going to be able to get anywhere in paediatrics if you can’t get patients and parents alike to trust you. This means occasionally having to become a four year old: explaining management plans is a difficult enough skill, but it’s tougher to explain diabetes to a four-year-old. Communication skills are by the far the most important qualities in a paediatrician – picking up the nuances of the way parents are speaking, identifying their concerns, putting them, and their children at ease. It’s by far the most important bit of my work.
What are your top tips for dealing with ill children as a doctor?
Dealing with ill children is just like dealing with well children. Engage them – talk to them. By talking to a child, you are talking to their parent albeit vicariously. Parents will take comfort from a sensitive explanation to their child. Measure language according to age. If it looks like you understand children, you will gain their confidence.
Never underestimate a mother’s instinct. It’s intangible and scientifically unverifiable. But it can often be right.
Many junior doctors consider a career in paediatrics but worry that the role is very demanding emotionally. What’s your advice to junior doctors in coping with this when treating children?
It is a job of emotional extremes. But the lows are very very rare. The joys are far more frequent. Having a child name their teddy bear after you is a great privilege, and it more than makes up for the bad days.
Generally the most emotionally difficult situations are not the end-point of a child’s management. Diagnosing child abuse is tough. Diagnosing cancer is tough. But it is the start, not the end of a process. It is actually a great achievement to improve the life of a child by offering the family social support, or by getting them to an oncologist. It is easy to focus on the bad news, but generally things are going to get better.
There is no advice on how to deal with the horrors in any branch of medicine: paediatrics is not unique. But witnessing the anguish of parents is hard. There is no magic bullet. Talk to colleagues about it. Don’t bottle it up. Standard advice.
Paediatrics has a long and difficult training programme with demanding rotas and on-call schedules. What is your advice to junior doctors in maintaining a work life balance?
Maintaining a work-life balance has been by far the hardest aspect of my job. The shift patterns – particularly in Neonatal Intensive Care – can be difficult to work hobbies around. I have had to sacrifice acting as a hobby, as well as dancing – it is difficult to maintain group hobbies that rely on not missing rehearsals. I decided to prioritise other hobbies, such as writing and travelling. I still have time for a couple of holidays a year and seeing all my friends. A life is not impossible.
You’ve blogged previously about the difficulties of deciding what to specialize in. What’s your advice to other junior doctors about making this crucial decision?
Don’t do anything you haven’t experienced. Try to get a taster week in something if you haven’t directly worked in it. I toyed with neurosurgery and radiology as subjects which I thought I might find interesting. It was only direct experience which helped me decide on paediatric medicine.
It’s also not a decision that you have to get right first time. Plenty of people swap specialities down the line. You are not signing your life away in blood. You’re just applying for a training programme. You are allowed to make a mistake. It won’t cost you anything.
Finally, what’s your number one piece of advice to junior doctors who are considering applying for training in Paediatrics?
There are very few F1 jobs in Paediatrics. The application system is therefore based around the ethos that people who haven’t done a full rotation in paediatrics will not be discriminated against. Don’t worry about having a child health related audit in your portfolio. Have a good audit. Don’t worry about having a child health reflection in your portfolio. Have a good reflection. Skills are interdisciplinary: if you’re asked for evidence that you will be a good paediatrician, it is completely appropriate to talk about experiences involving carers, adults with learning difficulties, sporting injuries, needle-phobic patients etc. The skills you need to demonstrate are the same as you need for any other medical specialty. Just with a subtle working knowledge of Peppa Pig thrown in for good measure.
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