One interesting aspect of this field is it's location. Out of all of the physicians that I had shadowed, this was the only one that I had to drive outside of the central St. Vincent Hospital area in order to meet. The clinic was actually located in the more affluent part of Indianapolis in Carmel. I should know since a 99 cent bagel cost $2.25 because I asked for spread on the slices. I have to admit that spread ( Honey Almond in case you are wondering) was really good, but not $2.25 cent good. But anyway I digress.
The setting of the clinic was interesting to me because I'm interested in both the sociologic as well as biochemical aspects of autism, and autism in the 1960s was given the stereotype of being the "rich white people" disorder so seeing this clinic that helps children with autism as well as other learning disabilities in this setting reminded me not only the advancements (actually having a developmental behavior pediatrician) but also some of the developments (more and easier access to physicians for patients) still necessary for the future of medicine. Anyway, Dr. Smith runs a small clinic and specializes in diagnosis and offering education plans and medications for autistic patients so shadowing him was very cool.
His first patient's parents came lived so far Indianapolis (near Kentucky I think) that they had to stay in a hotel the night before. They wanted to test their son for autism since he was very bright, however had obsession with strange shapes and was struggling with concentration and was unable to speak (although learned and communicated through sign language). While talking with the child, Dr. Smith observed the child and the family dynamic was very interesting. The mother was an hospital receptionist and very convinced that her son had hospital. She was also very vocal about her lack of support from her husband with training their son and not spoiling him. The mother also had all, and I mean ALL of the school records and doctor notes from the boy's pediatrician. After the mom and husband left, Dr. Smith talked about the patient and we both agreed that the patient seemed to have ADHD and not autism just because he was more social than most children with autism would have.
The next patient was a great demonstration of how a family environment can affect the a child. This patient had a verbally abusive father who was unsupportive of getting help for the child so the mother was struggling by herself in getting help for her children particularly the son that had ADHD. However, now the mother had officially fired for divorce and came to Dr. Smith complaining that her son was acting up and that the medication was not working for him anymore. After talking to the son and the mother separately, he concluded with me privately that it wasn't the medication that wasn't working but the family environment that was affecting the child and only when that became more stable that the child would be able to truly benefit from the medication. It was actually a sad case since with both the learning disorder and family environment, the child had no control over both.
The last patient was a great success story, the one that you like to see on TV. This teen was starting high school and his father came with him for a check up for his Asperger's Syndrome ( a "light" form of autism). The teen was doing very well and trying hard to do well in school ( his least favorite subject was Math). The father came to get a refill on his prescription as well as ask for advice on which private high school he should send his son to that would have the best program for him to give him the best attention and help. The teen was more interested in his IPOD than his appointment with Dr. Smith which was funny.
I really learned a lot about Developmental Behavioral Pediatrics from Dr. Ernie Smith. It was my first time shadowing a pediatrician in this setting and it was very insightful. I was interested in first just being a pediatrician then changed to pediatric neurologist now, developmental behavioral pediatrician doesn't seem that bad of a profession. Hey we'll see, the field of medicine is a wide and free as the horizon all I have to do is figure out what my horizon is for me. Who knows maybe in 10 years time, I'll decide on one of these three fields or decide to specialize in a completely different field.
