Before breaking the news to his parents, I was able to speak to one of the leading experts in the country and arrange an appointment at his unit the following week to offer to the family. Although this was devastating news, it was rewarding to be able to make sure that the best possible arrangements were in place for a specialist opinion and testing of his baby sister, and then be able to provide ongoing multidisciplinary support for the child and family at our one-stop shop child development centre.
What advice would you give to a student who is considering this specialty?
There is a huge range of opportunities within the specialty, with something which would interest almost everyone. As a registrar, I undertook placements in gastroenterology, oncology, neonatal intensive care, infectious diseases, neurology, renal medicine and community paediatrics.
How did you first get into medicine?
When I was seven my grandmother became unwell with a brain tumour and was looked after at our home and treated in hospital before she died. From that time I wanted to be a doctor, but I had no idea what specialty.
What inspired you to pursue paediatrics as your specialty?
As a medical student I was first inspired by general practice. I had two excellent GP attachments and enjoyed the breadth of the work and the holistic nature. At that stage, I didn’t enjoy paediatrics so much; medical students in a busy teaching hospital were last in the queue to see patients after the SHO and registrar. We didn't get to follow patients' progress, so we didn't see them get better; we just got a snapshot of their illness at the time of admission.
After house jobs I undertook a GP training scheme with six-month placements in psychiatry, obstetrics and gynaecology, medicine and paediatrics. This time around, I loved working in paediatrics. It was so different from the experience I'd had as a student; it was fast-moving and exciting, and as an SHO I saw progress and provided continuity for my patients, which was very rewarding.
At the end of the GP scheme I was still heading for general practice but decided to develop a special interest and took a one-year post with a mix of neonates, general paediatrics and community paediatrics. From the tiniest preterm infant in intensive care through to adolescents with a learning disability, I was completely hooked.
From the tiniest preterm infant to adolescents with a learning disability, I was completely hooked.
How does paediatrics differ from other medical settings?
Paediatrics is so wide-ranging with all its subspecialties. It requires a holistic approach, rather like general practice, as family circumstances affect the child's health and development, the child's illness impacts on the rest of the family and the family's input is vital for the child. You also need to consider how the illness might affect the child's development and schooling.
Children get very sick quickly, then often get better quickly. With chronic conditions, you develop a long-term relationship with them and their families, which is very rewarding.
What additional skills have you learned as a result?
One of the most challenging parts of the job as a consultant is breaking bad news. Luckily, I had some excellent teachers, and learnt how important it was to be able to do this well.
I remember a three-year-old child whose mother had a long list of soft concerns. He had met all the milestones checked by the health visitor, but he was just not behaving quite like his peers. Finally he was referred to the child development centre. He was an attractive little boy with prominent features. When I examined his abdomen I found he had an enormous liver and spleen. I ran tests for storage disorders, which confirmed that he had a mucopolysaccharidosis. This is a group of neurodegenerative disorders with progressive disability and a much-reduced life expectancy.
The child's illness impacts on the rest of the family, and the family's input is vital for the child.
Dr Christine Walker
Medico-legal adviser
Dr Christine Walker
Medico-legal adviser
Christine Walker undertook GP training before choosing a career in paediatrics. Her particular interests were neonatology, paediatric neurology and child development. She became a consultant in community paediatrics, leading a multi-disciplinary child development centre team and she was made a fellow of the Royal College of Paediatrics and Child Health. She has been a medico-legal adviser at the MDU since 2009.
See more by Dr Christine Walker