Points well taken Mike,

in our institution surgery call is taken by a senior pediatric fellow who is
a physician that has already completed a surgical residency, and as a result
is someone that I can rely on more than  mere resident in surgery.

When I am evaluating a patient with abdominal pain I try to make a decision
as to whether I think there is something surgical going on based on history
and exam( including pelvic exam for any female past menarche).I then would
generally obtain CBC, diff, UA.and KUB.

I call surgery for consultation immediately on the "hot " ones, or after
labs & XR return on the low index of suspicion cases.
Advanced imaging is left up to the judgement of the consultant surgeon.

Now when I practice at a community hospital , where there is no surgical
consultation readily available and definitive care requires a transfer, I
would get a CT in those cases that are equivocal for findings, but if the
patients exam and history are very strongly supportive , I arrange transfer
and let the receiving doc decide.

Just a few more thoughts...


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