‘How I Chose My Specialty’

Of all the specialties I could have chosen, pediatrics seemed an unlikely choice. Working with children was the last thing I had in mind when I entered medical school. Yet from the time I started my pediatrics residency in 1983, I knew I had picked the right specialty, even though I came to my decision in a rather circuitous way.

When I entered medical school, I had a vague idea that I would probably work with older people someday, most likely in the field of internal medicine. As a child, I had always loved old people. My first encounters with the elderly involved my grandparents. I would spend days at a time visiting the farm where my "country" grandparents lived. Grandma always saved jokes from farmer magazines or Reader’s Digest for us grandchildren, she baked cookies with me, and she helped me spot birds with her cheap plastic binoculars. Grandpa showed me how to milk the cows, played sneaky tricks on us kids, and hitched up the horses to pull his grandchildren on a horse-drawn sleigh. My "city" grandparents offered homemade Spritz cookies or ice cream for me, fed chopped liver to their massively obese cat, and they let me play with the old-fashioned wind-up phonograph. Spending time with my grandparents, I felt like I was the center of the universe. And during the time I spent with them, they were the center of mine.

What really convinced me of the superiority of old people was my life as a magician. By the age of 10, I had started to dabble in magic, and before long I became Mr. Mysterious, Master in the Art of Illusion, at least according to my business card. I performed at kids’ birthday parties, nursing homes, and church groups.

The older adults were always terrific audiences. They listened attentively, often laughed at my jokes, marveled at the magic, and their applause was deafening, at least to my young ears. If I paid any attention to older people, they totally loved it, and were always incredibly grateful for the time and attention I spent with them.

My experience with other kids was something else altogether. I always thought babies were noisy, annoying, and unpredictable. Any kids younger than four who came to my magic shows seemed totally disruptive, crying as they somehow ignored my brilliant show! Teenagers were even worse. They tended to offer unhelpful comments such as, "I know how you did that," "Give me that box, so I can figure that one out," or "The magician at the last party did that trick, and he did a lot better job!"

I did enjoy showing magic to some groups of kids, mainly the 5- to 10-year-olds. For them, magic was really magic, and not just a trick. They listened attentively, they were amused and amazed, and they were a total blast to perform for. If I could be a pediatrician who only saw 5- to 10-year-olds, that would be great. But somehow that didn't seem like much of a business model.

My experience as a medical student mostly reinforced my bias in favor of adults as great people to work with. Older men and women loved to tell stories, which I in turn loved to listen to. So I took lots of electives in internal medicine, did a sub-internship in cardiology on the medicine ward, and was headed in the direction of a residency and career in internal medicine.

Then something happened that made me question my chosen career path. After I did my pediatrics rotation, I found I actually kind of liked kids, and I really liked pediatricians. Apparently there's a difference between performing magic shows and practicing medicine. Dealing with kids one at a time seemed a lot less overwhelming than handling a roomful of screaming banshees.

So when it came time to interview for residencies, I was in a bit of a quandary. I was pretty sure I would pick medicine, but pediatrics also seemed like it might be a possibility for me. Family practice - which included medicine, pediatrics, as well as OB/GYN and surgery - seemed too broad for me to ever master completely. After agonizing for a few weeks in my fourth year of medical school, I arrived at a solution: I would apply for medicine and pediatric residencies.

During my interviews, I didn't tell anyone about my confusion in career choice, so no one would think I was wishy-washy. I drove across the country in the fall of 1982, giving me the chance to compare the internal medicine and pediatric programs at various institutions. What I found was that physicians in internal medicine and pediatrics were all good, decent people, trying their best to provide excellent care for their patients. Yet the thing that separated these worlds was not the patients, but the doctors. I learned that internists and pediatricians are completely different people.

The residents in internal medicine I encountered all seemed very serious and slightly cynical. They complained about their nights on call, referred to their patients in sometimes disparaging terms like GOMERs (Get out of My Emergency Room), and seemed slightly bitter and annoyed that they had to work so many hours on call. They were decent people, but not an especially happy bunch.

The pediatric residents I met were completely different. They worked the same miserable hours, with frequent 36 hour shifts, yet they were the nicest, happiest people I ever met. Not only did they seem to love their work and the kids they worked with, they liked each other and were incredibly supportive of one another. I watched in amazement as they told of getting no sleep on call, yet they were laughing, cheerful, and grateful for the help and support their colleagues provided that helped them get through the ordeal. They worked as hard as the medicine residents, but somehow, they were having a blast. And it seemed to me they would be really fun to hang out with.

After interviewing at about eight medicine programs and eight pediatric programs, I came to a conclusion: I would only rank pediatric programs. My decision to leave internal medicine behind had nothing to do with the patients I would work with. I just knew that in my residency I'd be working 80- to 100-hour weeks, and if I had to spend that much time for three years, I wanted to hang out with the fun people. And the people at my bottom-ranked pediatric program were 10 times nicer than the nicest people in what would have been my top-ranked medicine program.

It was the best decision I could have made. For the past 28 years, I have worked with the nicest, kindest, and funniest doctors in the world, and I also get to work with pediatric nurses, who share these same qualities. If you have to work a lot of hours (and I do), it's nice to be working with people you like. And the biggest magic trick of all was that eventually, I even got to like babies and teenagers.

David G. Thoele, MD, is a pediatric cardiologist at Advocate Lutheran General Children’s Hospital in Park Ridge, Ill. He lives near Wrigley Field with his wife and daughter, and commutes to his day job on his bicycle - mainly to strengthen his heart and help the environment, although he also dislikes paying for gas.

This article originally appeared in the September 2011 issue of Physicians Practice.