Many students find it difficult to decide what specialty they'd like to go into after graduating medical school. Unless you applied to school with a choice in mind, the first two years of lecture don't offer much help deciding how you'd like to spend your professional years. It isn't until your third and fourth years of medical school, when you're out on rotations and getting a feel for your different options that it becomes easier to pick a specialty. I've had the benefit of being about 99.9% sure I want to go into pediatrics since long before starting medical school. Early in my pediatrics clerkship, that decision was made all the more clear.

I was working with a pediatric neurologist who specializes in Attention Deficit Hyperactivity Disorder (ADHD). In the morning, a young boy of about 11 years (let's call him Johnny) came in with his mother. Her son was previously diagnosed with ADHD, and she wanted to discuss a number of behavioral issues he had been having both at home and in school. Johnny was a bully. He shoved his schoolmates, got into screaming matches with his mother, and was openly defiant toward authority figures at school. He threatened other students with physical violence and told his mother on repeated occasions that he wished she were dead. During this conversation with the doctor, Johnny appeared annoyed. He refused to verify any of his mother's claims and would not answer direct questions with anything other than a shrug or "It doesn't matter. I don't care."

Upon further questioning, Johnny's mother revealed that her true reason for bringing her son to see the neurologist that day was a recent sleepover at her home. She had noticed the boys being more quiet than usual, so she went down to her basement to check up on them. His mother had inadvertently stumbled upon a mock wedding ceremony between Johnny and his male friend (let's call him Matt). She promised not to tell the boy's mother if they stopped what they were doing and went to bed.

It should be noted that at this point in the conversation, Johnny's demeanor changed from annoyance to shame. He would not make eye contact with anyone in the room and remained silent when asked any questions. The neurologist pressed Johnny's mother for more information, but she was quick to deflect the conversation toward accusations of Matt's mother's promiscuity. She believed Johnny was tricked into the pretend wedding because, although she and her husband have a documented history of verbal abuse toward one another and repeated screaming matches in front of their children, she claims that they are rather "prudish" parents. Matt must have learned his behavior from his morally questionable mother.

It was clear that Johnny's mother was extremely uncomfortable discussing homosexuality. She had difficulty even saying the word aloud during our conversation. She seemed disappointed when the doctor told her that these behaviors would likely not go away and that there was no pill he could give Johnny to cure his other discipline issues. The neurologist recommended resuming regular therapy sessions with a psychologist to determine what was causing both his sexual and anti-authoritarian behaviors.

As a medical student on rotations, you often feel like your influence on patient care is limited. Depending on the location of your clerkship, the doctors you're working with, your personal comfort level, and any number of other factors, your role runs the spectrum from simple observer to (if you're lucky) integral member of the medical team. On pediatrics rotations, your job leans more toward the former due to the sensitive nature of the relationship between nervous, timid, or frightened children and the doctors they've grown accustomed to as they reach adolescence. This was the first time that, as a student, I felt as though there was nothing I could do to help my patient. Not only was it clear that Johnny's mother disapproved of her son's behavior, but it was also likely that she would not follow up with a counselor as the doctor recommended.

If anything positive came of the office visit, it was the certainty of my choice of specialty. With the continuity of care that comes from a primary care setting, the relationships I form with my LGBT patients will allow me to be a positive influence, guiding them toward important resources like the It Gets Better Project and the Trevor Project. There is nothing more rewarding in medicine than the potential for life-saving interventions, whether that intervention is a delicate surgery or a simple referral to the right resource.

Originally posted on Doctor Fishypants.