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We are having a similar discussion in our hospital. We have a "pediatric"
emergency section that is incorporated (not separate from at this time) the
adult emergency department. The section that sees all the children also sees
less acutely ill adults. This area is staffed by adult EM physicians and PEM
trained physicians (mostly adult EM with fellowship training) working side by
side. We have a very respectful relationship and little of the acrimony in
the previous discussionss

But the perceived difference is creating significant tension OUTSIDE the
emergency department. There is a lot of pressure right now from the
pediatricians to have only pediatric physicians see the kids. Where it is
real or not there is a perception of differing care from the community. The
adult EM physicians are feeling threatened by this attitude and maintain that
if you actually look at quality of care indicators, no difference will be
noted. I think that Lou Hampers in Denver did a fabulous job of placing this
entire discussion in perspective.

I believe I have a unique (albiet not exceptional) perspective. After
completing a peds residency I completed an adult ED residency and from actual
experience, Lou hit the nail on the head. The number of very sick adults that
the adult ED resident encounters in 3-4 years greatly exceeds the number that
come through most pediatric EDs. On the other hand, as a pediatrician I
"know" kids in a way that no general ED physician can. I believe my adult
collegues are very skilled in caring for critically ill children and would
trust them with my own children. On the other hand, I would bet less obvious
problems like intussusception more frequently are missed on the first go
around. Both groups have strengths and they are a little different; so in
some ways it is like comparing oranges and tangerines.

Rick Place
INOVA Fairfax Hospital
Falls Church, Northern VA

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The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html