Everything that can happen to adults happens to children: concussions and brain injuries, sprains and fractures, multiple sclerosis and spinal cord injuries and strokes and tumors and many more things happen every day.
Of course, pediatric medicine contains all the same physiological, cognitive, and emotional aspects as adult medicine. It is also in many ways more complex. First, while children are far stronger and more resilient than adults, their development impacts everything: physical growth worsens bony deformities and the scars of burns, and both mental and physical skills are far more difficult to learn than merely re-learn. Second, one must communicate with children at their own level, not just in terms of vocabulary but in the very way they see the world. Finally, children exist in the context of a family and the entire family must be cared for.
“I firmly believe in considering every aspect of a child's life and function. After my residencies in Physical Medicine & Rehabilitation and Pediatrics I did a fellowship in the evaluation of gait and movement disorders using 3D motion capture. Still, in every child who comes to me with difficulty walking, I also look for any opportunity to improve their fine motor skills, communication, academics, and emotional health.”
—A.J. Rush, MD
“I didn't intend to become a pain physician. Every doctor treats patients in pain every day, of course, but I didn't plan to care for patients whose pain had completely overtaken their lives. That changed almost fifteen years ago: Dr Birmingham referred a few patients with rheumatoid arthritis and chronic pain. My point of view was to rehabilitate them, get them stronger, and get them back to their lives and everyday functional activities. It worked.
The way that pain can take over people's lives is amazing and horrifying. The very systems in our bodies and minds which are designed to protect and heal us can turn against us. Often the greatest gift I can give to a patient is an understanding of what exactly has happened to them and that their pain is not "all in their head" and they're not "crazy". Well, to be honest, 70% of people with chronic pain are clinically depressed at some point, a great many have panic attacks, and other mental health problems are distressingly common. So, many of my patients are "crazy", but that's okay, we can work with that.
My approach is to first confirm that the patient's original diagnosis is correct. Usually it is, but I have to be sure. Then I look for any other minor or secondary problems which contribute to their overall pain and stress. Very seld have I met a patient whose original diagnosis was correct and who didn't have any additional problems.
Then I evaluate how their pain affects their life. Pain is far too complex an experience to be graded on a zero-to-ten scale. How have their relationships been damaged? How many days of work or school have they missed? When was the last time they went on a date or cooked for their kids? These are the objective measures of healing.
The solutions are different for everyone: medications, physical therapy, realistic stepwise goal-setting, et cetera. I vehemently do not believe that there is one solution for everyone. I frequently refer to specialists in sleep medicine, orthopaedics, neurology, psychology, rheumatology, allergy/immunology, and psychiatry.
We're all human. We're all the same in that we're all different. The solutions to our problems are frequently similar but never identical. ”
—A.J. Rush, MD
© A.J. Rush, MD, 2019. Based on an original design by Ming Kao, MD, PhD