Dr Su Laurent is a consultant paediatrician at a District General Hospital in North London. She has been a consultant for more than 20 years and her patients range from the tiniest premature babies to teenagers up to the age of 16.
A day in the life of a paediatrician is never boring. Having been a consultant for 20 years, I could probably count on the fingers of one hand the days that I've thought 'this is a dull day'. (The only really boring days I've had are when I've been interviewing 200 people in one week and asking them all the same questions!)
A typical day?I never know what's going to happen. I've got a structure, so I know when I'm going to be the attending consultant on the ward, which means that I'm in charge of all the general paediatrics. As well as all the children on the wards, that includes all those coming into Accident & Emergency (A&E) and onto the children's assessment unit. As the consultant paediatrician, you're in charge.
When I'm on duty, any queries about child protection issues are my job. I take all the calls from GPs, when they phone asking for advice or to let me know I need to see a child, either urgently or in a week or so. There are a lot of those calls, so it can be pretty full on.
The morning handoverI start work at 8.30 when the night staff do a handover. This is when we find out what's happened the night before. We sit down with the junior doctors and hear from the team that is coming to the end of their shift about every single child who's been on the ward. They give us an update on what's wrong with each patient, how they're doing, what is expected in the next few hours, what results we need to find, what scans we need to organise and any other important information.
We also find out about any children who are waiting in A&E to be seen, any patients who have been sent home during the night, and any phone calls we need to make to check up on how a child is doing. A good handover has many different elements and sets us up to start our day.
Doing the ward roundAfter the handover, off we go to do our ward round. A children's ward round is very different from what you often see on the telly, when adult ward rounds are shown. This is because, with children, you have to be opportunistic. So we don't simply start with Child A and finish with Child Z – we go and see the children that are the sickest first. The nurses will often say, "I'm really worried about this one – come and have a look." So you go and see them at the start of the ward round.
If there's no one who's particularly unwell at that time, then I might go first to see the children who need to go home, as their parents are usually chomping at the bit! They're desperate to go home, their child is now well, and also we've usually got children waiting in A&E and need beds for them. If we chuck children out, we can move children in! So if anyone's ready to leave, if we can see them first, get their drugs and care plans sorted out, then they can go home as early as possible.
Children won't necessarily wait patiently in bed for you to come round and see them. So we might see a patient on their bed, in the classroom or in the playroom. I might sit on the floor next to them, or they sit on mum or dad's lap. Often one or both parents are there when I do the ward round and I'll examine the child and have a little chat with them. It doesn't matter how old a child is – you let them have a little chat to you and tell them (and their parents) how they're doing.
After this, we and the nurses decide what to do for each individual child, and hopefully by the end of the morning we have seen all the children that need to be seen. Then the team will sit down for a coffee together and catch up with what's gone on and what needs to be done.
Into the afternoon...Some days I'll have a clinic, where children come to see me. Or I might not have anything planned, which enables me to catch up on all my emails and other correspondence, and check up on test results I've arranged for children who I've seen in clinic.
I might also spend time with a junior doctor doing an assessment of them, hearing from them how they've dealt with a particular situation and giving them feedback about that. Alternatively, I might be planning or giving a lecture.
So my afternoons are never the same, and they are often unpredictable. Phone calls come in all the time – from GPs, from parents or other members of staff – and these all need to be dealt with.
If I'm on call, I'll be taking handover again in the afternoon at 4.30. As with the morning, we all sit together and catch up on how things have been.
...and on to the eveningNext, I'll go down to the A&E department and start seeing the new arrivals. Late afternoon onwards is a busy time of the day in paediatrics, as that's when all the children start flooding in. Parents get home from work and children always seem to get sicker in the evening, so it's really useful to have a consultant in A&E. I work out who just needs to be reassured and can go home; who needs treatment and can then go home; who needs observing for a few hours but can probably go home after that; and the rest who need to stay in hospital, so have to be admitted.
I will usually try to start winding things up at about 5.30 or 6ish and then, at about 7pm, if things are fairly calm, I might be able to go home. If they're not calm, I won't! And on an on-call night, I will be then be available if I'm needed. So I might have to come back in to the hospital again, or I might be able to sort out any problems on the phone. And then I start over again the following morning.
What I love about my jobThere are two things I love about being a paediatrician. First, the actual work. Seeing children, making a diagnosis, explaining everything, knowing how to make a child better, knowing how to reassure parents that it's all going to be okay – that this is normal. A lot of what we do is actually supporting and reassuring. Rather than giving a drug or doing a test, a big part of our work is saying: "This is what's happening, this is what's going to happen, and it's all going to be fine." So I love that bit of the clinical work.
The other aspect I love is the teamwork side of things – teaching and training and supporting junior doctors. Whenever I'm in A&E or on the ward I've usually got a junior doctor with me. They tell me what they've seen and I feed back to them or they ask me for advice and I make suggestions. I really enjoy getting and giving feedback.
I love working with the nurses and the therapists, because they're all experts in their own areas and although some people think doctors know all the things that therapists know, we don't at all! The therapists are specialists in their fields. Physiotherapists, speech therapists – they're all highly trained in their own area. It's very much a multi-disciplinary approach.
Teen troubles: an exampleSome cases can be really fascinating. Recently a concerned GP sent a teenager to see me about her tummy aches. Severe tummy aches. But when I saw her, I realised there were other things to consider. She'd lost an awful lot of weight and had a history of chronic fatigue, so she'd missed a lot of school.
As she opened up to me, I realised there was more to it than just simple tummy aches. In time, it transpired that not only had she lost a lot of weight, but that her weight loss was deliberate. It took her a while to explain, but eventually she said, "I'm worried about how I look and I wanted to lose weight."
It was very interesting because her weight wasn't what she initially wanted to talk to me about but, in fact, by the time we got to the root of the problem, she realised that the tummy aches were not really so much of an issue. And they were probably related to just not eating enough. She was hungry.
Doctors as detectivesIn my job I often have to be a bit of a detective and figure out what's behind a child's symptoms, and these situations are the most challenging. It's generally fairly easy to diagnose appendicitis, asthma, epilepsy or febrile convulsions. That sort of thing is bread-and-butter paediatrics: you make a diagnosis and you treat it. But when children have more subtle problems, which are more chronic and often more disabling, it can be quite difficult to work out what's really behind the symptoms.
We have to get a balance between doing enough tests, where necessary, to eliminate treatable, organic disease, while at the same time avoiding over-investigation. It's easy to do another scan and another this and another that, but one of the things you develop with experience is how to decide when to stop the tests and consider whether the symptom has an emotional rather than a physical origin.
Who are my patients?In paediatrics in the UK at the moment, we look after children from birth to 16 years of age. If a child has been referred by a GP to hospital or a clinic, they will not yet have reached their 16th birthday. However, interestingly, our ward is about to go up to the 19th birthday, which is a huge hike in the age range. This will be voluntary, so there'll be some 17-year-olds and 18-year-olds who would rather be on an adult ward and some who'd rather be on a children's ward. It'll be quite interesting to see who winds up on our ward – and also, which doctors land up treating them! It may be that it's best to have an adult respiratory person treating an 18-year-old, but they can be on my paediatric ward if they'd prefer.
The very earliest and the very smallest patient I would treat would be a baby weighing 500g, or 23 weeks gestation. That's the very start: the absolute limits of life. And I would go all the way up to a child coming in at 15 years old, who might have taken an overdose of tablets. That's the sort of contrast my job involves.
More about Su Laurent
Read about the day Su's child had a febrile convulsion.
Find out about Su’s amazing international charity cycle ride.
Tell your own story on the Storyboard.
Come and chat on Logarty talk.