Pediatrics vs neonatology, how to distinguish?
Ou, deputy chief physician of pediatric internal medicine at Chang Gung Memorial Hospital in Linkou, said that taking Chang Gung Memorial Hospital system as an example, the neonatal department is mainly responsible for the outpatient service of healthy children. This clinic mainly provides "health examination" and "preventive injection", so no medicine is prescribed. All the babies who come to see a doctor and serve are healthy groups, and the key point is to help the baby develop healthily. Therefore, the items to see a doctor include: evaluation of children's growth curve, suggestions on non-staple food feeding, and so on.
However, Dr. Ou said that only a part of athletes' clinics are exceptions to abnormal health, that is, outpatient care and consultation for premature infants. Especially the follow-up of premature infants, before the baby 1 ~ 2 years old, also come to Jianer clinic; Especially very premature infants may have some serious diseases, such as chronic lung disease, retinopathy, tracheal intubation injury, necrotizing enteritis and so on. , need careful follow-up and nursing. In the outpatient department of healthy children, more special formula milk powder and feeding suggestions suitable for premature infants can be provided for parents to consider.
Generally speaking, the pediatrics department of big hospitals is separated from the outpatient department of athletes, because pediatrics mainly treats sick babies, not ordinary babies who come for health checks, so as to avoid infection during medical treatment. Pediatrics actually refers to children's internal medicine, and other children's sub-specialties can provide more in-depth screening and treatment services for baby's diseases. As for pediatrics in general clinics, it is not so detailed, and it also includes athletes' clinics, but its focus will be on vaccination.
How old can you see pediatrics?
According to the definition of the World Health Organization and the recommendation of the Pediatric Medical Association,/kloc-adolescents and children under the age of 0/8 are the main clients of pediatrics. Dr. Ou said that because the training of pediatric physicians also includes the development of adolescents' secondary sexual characteristics, these should still be seen in pediatrics. General adult internal medicine focuses on some common chronic diseases of the elderly, such as hypertension and diabetes. Diabetes in adolescents is also different from that in adults. Therefore, it is very appropriate for adults to see adult diseases, teenagers, children and pediatrics.
Find the right doctor, see the right doctor! How to choose junior college for children? What is the purpose of specialization?
Dr. Ou said that in terms of the trend of diseases in the world, the evolution and complexity of various diseases are higher, and the diagnosis and treatment technologies are becoming more and more advanced. Especially during the treatment, doctors and experts in specialized fields need careful treatment. Therefore, more sub-specialties have been born in pediatric internal medicine, providing patients with more in-depth and professional treatment services and quality.
Pediatric specialists can only become pediatric specialists after three years of general pediatric specialist training and two years of specialist clinical and nursing training. For example, there are children's gastroenterology and adult gastroenterology; There are children's endocrinology and adult endocrinology. However, doctors with specialties also have basic expertise in internal medicine and pediatrics, so they can also be doctors in athletes' clinics or even ordinary children's internal medicine.
On the one hand, the advantage of setting up sub-specialties lies in better medical security for seriously ill children. Because of these cases, more professional and experienced sub-specialists are needed to treat them. Because doctors in specialties are usually exposed to such diseases, they have more clinical treatment experience and more familiar inspection techniques for these diseases.
Therefore, Dr. Ou pointed out that if a disease or a symptom cannot be improved in general pediatric outpatient treatment, it can be referred to individual sub-specialties by pediatric internal medicine to give the baby more professional and in-depth treatment and solutions. If it can be initially treated in general pediatrics, there is no need to refer it to a specialist.
How to distinguish pediatric internal medicine from surgery?
The so-called pediatrics is actually pediatric internal medicine (excluding pediatric surgery). Therefore, all sub-specialties are actually classified according to a single disease under the general children's internal medicine project. Therefore, Dr. Ou said that basically these specialties also belong to internal medicine diseases. As for children's surgery, it is similar to general adult surgery training.
Pediatric surgeons, like other surgeons, receive basic surgical training in the first two to three years. After the training, they will further study their personal interests in sub-majors, such as heart surgery, thoracic surgery, plastic surgery and pediatric surgery, and choose to receive sub-professional training. Therefore, in addition to general surgery training, the specialty of pediatric surgery needs two years of professional training to become a specialist pediatrician of pediatric surgery. So the pediatrics we generally talk about refers to internal medicine; As for pediatric surgery, it is a branch of surgery and a common disease in pediatric surgery.
Dr. Ou also added that other parents may have heard of pediatric orthopedics, pediatric otorhinolaryngology, pediatric ophthalmology and pediatric dentistry, which are all visible in large medical centers and have a very fine classification. In fact, these doctors themselves are general orthopedics, otolaryngology, ophthalmology and dentistry, but only in the follow-up specialist training, they specially conducted necessary professional surgical training such as pediatric orthopedics, pediatric otolaryngology, pediatric ophthalmology and pediatric dentistry.
Classification of children's second major
Children (internal medicine) branch
Patients and diseases to view
Pediatric Allergy and Asthma Department
Arthritis (rheumatoid), joint pain, asthma, allergic rhinitis, conjunctivitis, dermatitis, allergic diseases such as homology of medicine and food, collagen vascular diseases such as lupus erythematosus, scleroderma, dermatomyositis and vasculitis, autoimmune diseases and immune deficiency.
Pediatric gastrointestinal hepatobiliary department
Find the right doctor, see the right doctor! How to choose junior college for children? Department of Pediatric Endocrinology and Genetics
Pediatric endocrinology: thyroid diseases, diabetes, obesity, hyperlipidemia, pituitary diseases, adrenal parathyroid diseases, osteoporosis, short stature, abnormal sexual organs, developmental abnormalities and various endocrine abnormalities.
Pediatric neurology
Headache, epilepsy, febrile spasm, abnormal convulsion, syncope, sleep disorder, encephalitis, meningitis, polyneuritis, cerebral palsy, developmental retardation, hyperactivity, attention deficit, mental retardation, Tourette's disease, chorea, myopathy, neuropathy, congenital abnormality, granular gland disease, brain tumor, encephalomyelitis, myelopathy, dermatomyositis, infantile torticollis.
Pediatric cardiology
Congenital heart disease, rheumatic heart disease, Kawasaki disease, heart failure, arrhythmia, chest pain and other heart and vascular diseases.
Children intensive care unit
Sepsis complicated with shock, severe respiratory failure, severe meningitis and various brain diseases, acute renal failure, emergency renal dialysis, patients with severe virus, patients with serious complications of hematological tumor, patients after major surgery or patients who need to monitor vital signs after major examination.
Pediatric infection department
Bacterial and viral infection of respiratory tract and gastrointestinal tract, septicemia, meningitis, osteomyelitis, arthritis, eruptive disease, unknown fever.
Pediatric respiratory and thoracic department
Cough, hemoptysis, chest tightness, dyspnea, asthma, respiratory infection, tracheitis, chronic obstructive pneumonia, pneumonia, chest and lung tumor, tuberculosis, bronchiectasis, foreign body in respiratory tract, sleep apnea, pleural lesions.
Pediatric nephrology
Nephritis, hematuria, proteinuria, edema, kidney calculi's disease, urinary tract infection, electrolyte imbalance, lumbago, hypertension, renal failure and uremia.
Pediatric hematology oncology department
High or low white blood cells, anemia, cyanosis, purple spots, abnormal bleeding and other blood diseases, cancers such as leukemia, lymphoma, hard tumors in various parts of the body and so on. Diagnosis, treatment plan and implementation of chemotherapy for childhood cancer. Diagnosis of hepatosplenomegaly with fever of unknown origin.
Neonatal Department (Jianer Clinic)
Infant growth and development assessment, infant nutrition consultation assessment, premature infant follow-up growth and development assessment, vaccination and vaccine consultation, child disease information and health consultation.
General internal medicine of children
General pediatric internal medicine and emergency department. Anyone who is unwell under 17 years old should be affiliated to the General Department of Pediatric Internal Medicine, which has other specialties and the symptoms are similar to those of ordinary adults.
Find the right doctor, see the right doctor! How to choose junior college for children? As mentioned above, to become a specialist in children's specialties, you must first receive the general training of children's internal medicine for the first three years, then go to a specialist hospital for about two years of qualified specialist training, and then obtain a specialist license, so as to obtain the qualification of a specialist. What percentage of medical college graduates choose to be pediatricians? Dr. Ou added that according to the national statistics for about ten years, if there are 100 graduates every year, about 10% of medical students may choose pediatrics as their future practice goal.
Therefore, after graduation, every medical student chooses internal medicine, surgery, obstetrics and gynecology, pediatrics, anesthesia, emergency and other in-depth studies according to his own interests, which becomes the internship goal. These subjects are freely chosen, so they were not well divided during medical school. Therefore, in the seven years before graduation, the course content of medical students is the same, but how to choose the department? This is usually because interns will take turns to train in various subjects before graduation. At this time, students can also start to choose a sub-major with depth in the future.
However, Dr. Ou added that in addition to seven years in internal medicine, since 2003, * * * has increased the rotation training system for doctors after graduation, that is, PGY (general practice training program after graduation). In the past, medical students would enter various specialties for training after graduation. But at present, in addition to seven years' training in medical college, one year's general practice training is needed, and its main contents are internal medicine, surgery, gynecology, pediatrics and community medicine.
Why is there such a system? Dr. Ou replied that this was a doctor's manpower reserve plan planned in response to the spread of SARS, so that every new resident could receive general practice training. Because ophthalmologists, dermatologists and other specialists have limited first aid and disposal ability for general diseases; Therefore, it was difficult to deal with the humanistic crisis of the epidemic at that time. * * * I hope that every medical student will apply for specialist training after PGY training, so that he can improve his general medical ability first and then become a specialist in various fields.
Once you have a specialist license, is there a valid period of practice? Or should I be evaluated regularly? Dr. O takes his own project as an example. For example, a sub-major of children's internal medicine needs to be re-certified once every six years. The way of certification is to attend enough education and training courses, and the medical association will continue to hold credits for re-education courses. These courses must accumulate enough class scores to be updated regularly, so as to maintain the consistency of the professional ability level of sub-specialties.
If the points are insufficient, can doctors still practice? European doctors replied that they can still practice in theory, but it is impossible to maintain the qualification of specialists; However, the practice signboard can only be hung with "clinic", but not with any disciplines, such as internal medicine, surgery, pediatrics, obstetrics and gynecology, dentistry, otolaryngology and so on. , cannot list aliases of all sub-majors! However, there are very few doctors who do not apply for new cards to accumulate professional points at present, so parents don't have to worry too much!
Find the right doctor, see the right doctor! How to choose junior college for children? Find the right doctor to see the acute symptoms of the disease, which subjects should I see?
When the baby is sick, if you don't know which subject to see, which subject will parents be advised to take their children to see first? Jiang Mingzhou, director of Chang Gung Neonatal Intensive Care Unit in Linkou, said that as mentioned above, all pediatricians have general pediatrics and sub-specialist training. If the child has no fever or symptoms of infection, if he is in a medical center or a regional hospital with different specialties, parents don't know which department to see first. Usually, they will advise parents to take their baby to Jianer clinic for a preliminary evaluation.
However, if the baby has signs such as fever and respiratory infection, you can also take the baby directly to the pediatric infection department. Although every pediatrician has a sub-professional field behind him, he has been trained in general pediatrics before. If you really don't know which subject to take your child to, you can initially choose a subject according to the symptoms. If you can't judge, you can hang up the athlete clinic and ask the doctor to judge. For example, if you have respiratory diseases, you can take your baby to see a pediatric infection department, a pediatric chest department or an allergic immune rheumatism department. If you have obvious gastrointestinal symptoms, you can hang up the children's hepatobiliary gastroenterology department. However, for the obvious fever problem, it is more appropriate to hang up the children's infection department first. If you really don't know, of course, you can still choose the neonatal clinic first and give it to a doctor for identification or referral!
Which subject should we look at for development problems?
If you obviously feel that your baby's gait is weird, I don't know which department to see, or which one? In this case, you can take your baby to the neonatal department. Or, if the baby is disgusted with milk, anorexia and short and fat, parents are not sure whether to take the baby to endocrinology or children's gastroenterology. In this case, parents can take their baby to the neonatal clinic! The following is to provide a general reference direction for the baby's medical department according to the common complaints of parents.
Chief complaint and symptoms
Sub-majors that can be referenced (no naming order)
* The baby has a cold, fever for almost a week, cough, runny nose and sore throat. What should I do?
(5) Pediatric Infectious Diseases Department
(v) General pediatric medicine
(v) Neonatal clinic
() family medicine
If the illness is mild and the baby's activity is not bad, you can also go to the nearby pediatrics to see the general children's internal medicine. If the condition is serious, the doctor will refer it to the medical center appropriately. If you go directly to the medical center, you can see a doctor in the pediatric infection department. If you don't know how to choose, go to the athlete clinic, and then the doctor will identify and refer you.
* Babies who eat fish, shrimp and milk eggs will get allergic rashes. What should I do?
() Pediatric Dermatology
(v) Allergy and Rheumatology Immunology Department
() family medicine
() Hepatobiliary Gastroenterology in Children
Regarding the allergic phenomenon caused by children's diet, it is recommended to seek medical treatment from the Pediatric Allergy and Rheumatology Immunology Department first.
*0-3-year-old babies are good at eating, but they are particularly short and heavy. What should I do?
(v) Outpatient services for healthy newborns.
(5) Department of Pediatric Endocrinology
(v) Pediatric hepatobiliary gastroenterology
() family medicine
This situation, because it is not acute infection, can also be examined in the neonatal clinic, and then according to the actual situation of the baby, see if the baby is in the endocrine system or digestive system, and then decide whether it is necessary to refer it to the children's endocrinology department or the children's hepatobiliary and gastrointestinal department.
Find the right doctor, see the right doctor! How to choose junior college for children? * What if the newborn baby often overflows, chokes and spits when drinking milk?
(v) Outpatient services for healthy newborns.
(v) Pediatric hepatobiliary gastroenterology
() Department of Pediatric Infectious Diseases
() family medicine
Generally speaking, parents can consider taking their baby to the children's hepatobiliary and gastrointestinal department. However, as far as the problem of neonatal milk overflow is concerned, parents can also go to the neonatal athlete clinic for medical treatment, and then ask the doctor to evaluate whether it is necessary to refer the baby to the children's hepatobiliary gastroenterology department according to the actual situation of the baby.
* Babies under the age of seven have severe constipation, thick and hard feces, and always cry when defecating. What should I do?
(v) Pediatric hepatobiliary gastroenterology
() Newborn Healthy Baby Clinic
() Allergy Rheumatology Immunology Department
() family medicine
If the baby's serious and long-term constipation is true, parents are advised to take the baby directly to the Children's Hepatobiliary Digestion Department. In addition, some clinical manifestations of chronic constipation may also be related to the structure of the baby's congenital stomach. You can find a child's hepatobiliary and gastrointestinal sub-specialist to do further related examinations and find out the cause.
* During the cold current, the six-month-old baby has purple spots and frostbite, and even has symptoms of cyanosis of limbs. What should I do?
(v) Pediatric cardiology
() Pediatric Hematology Oncology Department
() Pediatric Dermatology
() family medicine
Due to the low temperature outside, the baby's limbs may be prone to catch cold, poor blood circulation, frostbite and even purple spots. However, if the baby has cyanosis, it may be necessary to consider whether the baby has superficial heart disease. Therefore, parents can also consider taking their baby to a pediatric cardiologist for further examination.
* The baby had a fever for several days. After taking antipyretics, the fever was still fluctuating. Suddenly, the fever dropped and a rash appeared. Which subject should I read?
(5) Pediatric Infectious Diseases Department
() Pediatric Dermatology
() Newborn Healthy Baby Clinic
() family medicine
If the baby has a fever, it is usually caused by an infectious disease. Parents are advised to take the baby to see a pediatric infectious disease doctor. If it's just a rash and you don't have a fever, you can find a pediatric dermatology department or a neonatal department.
* What should I do if my baby has a lisp and can say very little?
(v) Children's Rehabilitation Department
(v) Department of Child Psychology
(v) Outpatient services for healthy newborns.
() family medicine
If the baby is sure that there is something wrong with pronunciation, it is recommended to go to the children's rehabilitation department to see a doctor. There will be a speech therapist in the children's rehabilitation department, which can provide clear help to the baby in this respect. In addition, some hospitals classify speech therapists as children's psychiatric clinics, so parents can ask clearly first. If parents don't know whether the baby is slurred speech or slow speech, of course, they can also make a preliminary evaluation of the outpatient service for healthy children in the neonatal department before deciding whether it is necessary to refer them to relevant sub-specialties.
* Three-year-old baby has a fever, persistent cough and earache. What should I do?
(5) Pediatric Infectious Diseases Department
(5) Department of Otolaryngology for Children
() Newborn Healthy Baby Clinic
() family medicine
If it is determined that the baby is suffering from otitis media, including middle ear effusion, further treatment may be needed, usually otolaryngology treatment. However, if the baby has fever, cough and other infectious symptoms at first, you can go to the pediatric infectious diseases department and ask the doctor to evaluate whether the baby has otitis media and whether to see the pediatric otolaryngology department for treatment.
* The baby is one year old and hasn't got the first deciduous tooth yet. Which subject should I read?
(v) Outpatient services for healthy newborns.
(v) Children's dentistry
() Children's Rehabilitation Department
() family medicine
In fact, the development of baby's deciduous teeth can be checked in the athlete's clinic first, because the eruption period of children's teeth usually does not exceed 1 year and 3 months at the latest; However, if parents feel it is necessary to know clearly when they see the athletes' clinic, they can also go directly to the children's dentistry to check the tooth germs carefully, which is also possible!
Find the right doctor, see the right doctor! How to choose junior college for children? Family medicine &; Pediatrics, what's the difference?
Dr. Jiang Mingzhou pointed out that the so-called family medicine also belongs to a sub-major. In the training stage of family medicine, doctors should go to internal medicine, surgery, obstetrics and gynecology and pediatrics for rotation training. Therefore, we should have a basic understanding of family medicine, preventive medicine, community medicine and internal and external medical theories of women and children. Therefore, family medicine is a subject that can be treated regardless of age and sex. If the family doctor judges that it is necessary to refer the baby to a more professional children's sub-specialty, he will open a referral form to provide a more suitable treatment direction for the baby. However, for babies under three months, it is usually recommended that parents directly see pediatrics!
To sum up, parents should give priority to taking their children to general pediatrics for all intractable diseases, whether they choose clinics or big hospitals. In addition, if the baby is initially treated in a pediatric clinic, but the cause cannot be diagnosed, the pediatrician has the right to decide whether to refer the baby to a large medical center for further detailed examination or treatment. In addition, if the baby has a fine branch hospital in the medical center and has not been infected before the age of seven, if you don't know which branch to see, parents are advised to go to the Jianer clinic first.
Pediatrics of traditional Chinese medicine, is it divided into specialties?
Dr. Jiang Mingzhou said that in addition to the allergy, rheumatism and immunology departments of western medicine, parents can also choose the pediatrics department of Chinese medicine, including the traditional diagnosis and treatment of ordinary three-volt stickers, which also belongs to the category of traditional medicine. However, parents are usually advised to see western medicine first in acute allergic symptoms. If the allergic symptoms can't be improved in the chronic attack period after the acute period, of course, according to the actual needs of parents, you can take your baby to choose a qualified Chinese medicine pediatric clinic for auxiliary treatment!
In addition, Dr. Jiang's expertise in neonatal cranial nerve intensive medicine also includes: taking a case of neonatal hypoxic-ischemic encephalopathy with perinatal asphyxia as an example; The doctor said that because most of these babies often have neurological sequelae, in addition to suggesting follow-up treatment in the rehabilitation department of western medicine, they sometimes cooperate with acupuncture technology of traditional medicine to give more professional medical care to small patients!
Who should I consult for premature delivery and neonatal diseases?
Dr. Jiang, who is a neonatal department, said that the neonatal department is usually responsible for taking care of all healthy babies, even newborns, about two months after discharge from the hospital nursery. Of course, it also includes medical care for premature babies. Therefore, as long as you are a doctor in the department of neonatology, you are like the baby's first doctor and good friend. Take Chang Gung Memorial Hospital as an example. Neonatal department is an outpatient service for healthy children, mainly focusing on the "growth and development" and "prevention and health care" of infants. Therefore, as long as parents have questions about the baby's vaccine, growth and development, they can always consult a doctor in the neonatal department's healthy children's clinic.
Find the right doctor, see the right doctor! How to choose junior college for children? Take medicine patiently, and don't "be afraid of illness and avoid medical treatment"
Based on many years of clinical experience in pediatric allergy and asthma department, Dr. Ou pointed out that many adult acquired asthma are difficult to cure or improve. But as long as children suffer from asthma, more than half of them can be completely cured or improved when they grow up. However, it is necessary to give the baby continuous and patient medication, including inhaled steroids.
However, when many parents hear steroids, they will worry that their babies will be afraid to give them food just like taking drugs. But in fact, after long-term use, the average dose absorbed by the human body is quite low, which will not cause terrible side effects such as buffalo shoulders and moon face, so parents should never misunderstand or avoid seeking medical treatment; Because if you stop taking drugs at will, it may also lead to pulmonary fibrosis in your baby. When you have a cold or lung disease again, it will be more dangerous for your baby to find folk therapy casually!
Trust+respect, build confidence in seeking medical treatment.
Although it is very hard for parents to take their baby to see a doctor, they still have to practice patience! Dr. Ou Liangxiu reminded that in the face of chronic diseases, don't lose patience, or change doctors immediately after seeing several consultations, because changing doctors often leads to repeated examinations and re-treatment, which is like a waste of medical resources; Moreover, it is better for the baby's condition. Secondly, under the medical insurance system, the state subsidies for medical care are actually limited; Therefore, it is a pity that in terms of medical quality, it is often impossible to increase more medical subsidies with the innovation of medical technology and new drugs. Therefore, under the limited medical resources, many doctors still strive to benefit patients in order to obtain the best and equivalent medical resources and care; Therefore, under these major premises, doctors will try their best to provide the best medical advice in any case. After all, doctors and patients are also a fate. Therefore, both doctors and patients need to trust and respect each other. Don't treat medical treatment as consumption, or question that doctors may intentionally hurt, which will destroy the goodwill of medical treatment itself to patients!
Ou liangxiu
Education: Bachelor of Medicine, Department of Medicine, Taipei Medical College; Master of Medical Education, Flinders University, Australia.
Experience: Researcher in Allergy, Asthma and Rheumatism Department of Linkou Chang Gung Children's Hospital, and researcher in National Jewish Medical and Research Center.
Currently, he is the deputy director of children's internal medicine department of Linkou Chang Gung Memorial Hospital, the associate professor of allergy, asthma and rheumatism department of Linkou Chang Gung Memorial Children's Hospital, the supervisor of Taiwan Province Children's Allergy, Asthma and Immunity Society, the director of Linkou Chang Gung Memorial Student Counseling Center, and the executive director of Medical Sound Chamber Orchestra.
Jiangmingzhou
Education: Bachelor of Medicine, Department of Medicine, China Medical University
Experience: Researcher of St. Chris Children's Hospital, researcher of drexel University Medical College, visiting scholar of Philadelphia Children's Hospital.
Current position: director of neonatal intensive care unit of Chang Gung Memorial Children's Medical Center in Linkou, and authorized assistant professor of the Ministry of Education of Chang Gung Memorial University.