Clinical Reflection: Outpatient Examinations

The second week of my elective was more or less the same as the first week the only difference was the verity of the cases that ranged from as simple as bacteremia, meningitis, urinary tract infection to as complex as genetic and neurological disorders.

The last two weeks of the elective course were in the outpatient clinics where I had a completely different experience. In the outpatient clinic I got the chance to have hands-on experience in taking histories from patients and their caregivers and preforming different types of physical examinations. The first clinic I attended was General Pediatrics, in this clinic I learned about the common conditions that a child might face while growing up such as, common cold, Influenza, Gastroenteritis

During my time in this clinic I learned about the vaccination process from birth till childhood. I also learned about the developmental milestones and the examinations that are done to detect any delay in these milestones. The most enjoyable part of this clinic was getting to play with adorable newborn babies and listening to the parents while they share their challenges and the experiences of raising a child.

At the end of the fourth week I realized that I had gained an experience beyond my expectations and the goals that I had set for my self. Not only did I exceed the number of histories and physical examinations that I had set in my goals but also gained the skill of communicating with children and their caregivers. To summarize my experience in this elective course, I will mention the stories of two patients that have changed my perspective on practicing the specialty of Pediatrics. The first patient was a girl with a condition called Sanjad-Sakati syndrome, a rare autosomal recessive condition seen in the offspring of Middle Eastern origin. Its clinical manifestations at birth are Hypothyroidism, congenital retardation, low birth weight, short stature and Hypocalcaemic seizures. What really caught my

In this condition the patient experiences weakness and muscle atrophy of the extremities, which leads to flaccid paralysis. This condition can also affect the muscles of the chest wall and the diaphragm causing difficulty breathing and may result in respiratory failure and death.1 The first question the consultant asked me one I was taking the patients history from the mother was “ what does it mean by autosomal recessive disorder Sondus?” I replied in my own words, “ autosomal recessive disorders occur when the child inherits two copies of the diseased gene one from each parent”. The consultant replied, “Knowing that fact, what do you think is the most important questions to ask the mother in the history?” I immediately answered, “ I would ask the mother if any of the family members have had this disorder as well” then, the consultant turned to the mother and told her to answer my questions. The mother replied with a low voice “ I had two children before this child who have died because of this disorder”. I came out of the room disheartened, and asked the consultant “is this child going to die too?” then the consultant explained to me that this child is a “NO CODE” patient also known as “DNR” which stands for do not