Charlotte, 40, is a primary care pediatrician at a busy urban clinic. She has been in her current position for 6 years. She is also a parent of a 6- and a 10 -year-old. Her spouse is a law firm partner, and Charlotte does the majority of household management with the help of an au pair. She has an interest in quality improvement in healthcare delivery, but she finds she does not have the bandwidth for additional projects. When she initially started at the clinic, she found the pace and complexity energizing. She became known as the go-to person for children with challenging behaviors. Lately, however, she has found her curiosity has been replaced by dread as she sits down in the evening to attend to her EMR in-basket, which never gets to zero. While she still gets joy from seeing patients and families, she finds herself being more and more impatient during visits, silently wishing people would bring up fewer problems so she can stay on schedule. She works through lunch and rushes to leave the office at the end of the day, so often she ends up finishing her work at night. Each time she has a vacation, she feels like herself again and returns to work with renewed energy, but this renewed energy seems to wane more and more quickly over the past couple of years. Charlotte wonders if she should leave her practice or find a nonclinical healthcare job that would allow her to be more relaxed in the evenings and on the weekends.

What is your diagnosis?

Have you figured out this issue's diagnosis? Submit it below. The first person with the correct answer will be recognized in the next issue of Children's Doctor.

My Diagnosis

The answer to last issue’s quiz is Horner syndrome, the topic of this issue’s lead story. Congratulations to Sanatkumar Dagli, MD, of Yonkers, New York, who submitted the first correct answer.