The Medical Apprentice

Hot chocolate made with butter and heavy cream

A bowl of cereal with whole milk

Mayonnaise as a dip for raw vegetables

Extra eggs and powdered milk for pancake batter

Gravy for just about any dish

No, these aren’t tidbits from Paula Deen’s latest cookbook.  Nor were they used by the child-devouring witch to fatten up Hansel and Gretel.  They’re actually some of the suggestions given by nutritionists for children who need to increase their caloric intake.  While a high calorie diet is the last thing the average American might need, I’ve encountered many children on my GI rotation that are benefiting from this change in diet.  Our body digests food and absorbs nutrients through the GI tract.  Therefore any disorder disrupting the function of this system has the potential to cause malnutrition.  Adequate nutrition is crucial for child growth and development, so early intervention in this area is extremely important. 

During this month I’ve had the opportunity to rotate through a number of interdisciplinary clinics.  These bring together healthcare workers from a variety of fields that work together to care for patients with complex medical issues (such as the Intestinal Rehabilitation or Liver Transplant clinic).  Instead of making appointments and tromping around the hospital to see multiple people, patients and their families come to one clinic.  Families set up shop in a single exam room to be seen by multiple healthcare professionals.  In addition to the physician, a nurse might assess medication compliance or recent health issues.  A dietician will monitor weight gain and ensure the child is receiving adequate carbohydrates, fats, and protein.   A PharmD looks at medication dosages, efficacy and monitors for side effects.  A social worker helps families adjust to caring for a sick child and advocates for whatever help they might need (financial assistance, medical leave, or special accommodations at school).

As a student in these clinics I often get assigned to one family.  I then go in with each member of the team for their assessments.  It’s been interesting to witness each person’s role.  The teaching has been great too (i.e. calorie counts or updating TPN orders with a nutritionist).  It’s nice to see folks from many different fields taking an active role in clinical education.  After all, there are many people in the hospital that med students can learn from, other than physicians.  Interdisciplinary clinics have plenty to teach students (including the decadent new places to add butter on the menu!)