Sounds like a great opportunity to evaluate the pediatricians questions
or beliefs that there are differences.  What are the perceived
differences?  What are the "quality care indicators" that you mention?
This study could give us all insight and an objective view of this

Mick Connors

-----Original Message-----
From: Pediatric Emergency Medicine Discussion List
[mailto:[log in to unmask]] On Behalf Of Rick Place MD
Sent: Wednesday, September 04, 2002 7:09 PM
To: [log in to unmask]
Subject: ACEP and PEM

We are having a similar discussion in our hospital. We have a
emergency section that is incorporated (not separate from at this time)
adult emergency department. The section that sees all the children also
less acutely ill adults. This area is staffed by adult EM physicians and
trained physicians (mostly adult EM with fellowship training) working
side by
side. We have a very respectful relationship and little of the acrimony
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
real or not there is a perception of differing care from the community.
adult EM physicians are feeling threatened by this attitude and maintain
if you actually look at quality of care indicators, no difference will
noted. I think that Lou Hampers in Denver did a fabulous job of placing
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
experience, Lou hit the nail on the head. The number of very sick adults
the adult ED resident encounters in 3-4 years greatly exceeds the number
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
collegues are very skilled in caring for critically ill children and
trust them with my own children. On the other hand, I would bet less
problems like intussusception more frequently are missed on the first go
around. Both groups have strengths and they are a little different; so
some ways it is like comparing oranges and tangerines.

Rick Place
INOVA Fairfax Hospital
Falls Church, Northern VA

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