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Tue, 07 Jan 2003 08:40:05 -0500

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Rick,

Your "rebuttal" was-I am sorry to say-very poor.......

First of all, you bring up the scenario of what if ALL pediatric
problems were initially handled by Gen Sx's etc.....
Totally faulty analogy, although most pediatric acute issues
cannot/should not be handled by gen Sx's, BLUNT ABDOMINAL TRAUMA is a
rather common occurrence in the ED and thus it is in the scope of an ED
doc to manage this entity...what that thought provoking article also
showed with impressive stats was that the large majority of ped. blunt
traumas never end up in the OR so......Rick, say I would consult you
every time a kid came in with a presenting  complaint that we both knew
only less then 1-2% of the time would end up in the OR you would say
what a waste of resources/time, you would also tell me to use my EBM
knowledge base and call back ......

Your or perhaps your contemporary's second point of ED docs being
glorified triage nurses is a rather archaic philosophy and as such I
will not even attempt to refute it......

13-15 years of study and training!!!... over here ED training is 5 years
of duration post med school, same number as Gen Sx +/- fellowship years

Gastroenteritis...my favorite diagnosis.....I agree that many
pediatricians and  SURGEONS (at least where I come from) hold to the
archaic notion of needing a WBC and an ABDO series and maybe an U/S and
maybe a CT for w/u of ?appendicitis by which time perforation has
occurred.....

...and my last point (I promise) about not being dogmatic...Rick you and
I both know that what is true today is folly tomorrow (too many e.g.. to
mention) so what i always tell my residents is not to be dogmatic, just
think of how many dogma's in the past 10 years have remained
unchallenged just in the filed of traumatology alone...very few

With that I will close, let's turn a new page and start over

JN

Don;/t fall into the oh so easy trap to fall into on this list, and
start
seeing things in the posts that just are not there.  Read my post
again--in
no way was I calling YOU arrogant--I was referring to the basic message
of
the editorial, and--yes--to its authors.  That MINDSET is arrogant
ignorance.
 I agree with you that it was provocative, and even that it is a valid
issue
to bring to light--don't also misread into my post any indication that
such
ideas should not be espoused.
Think a minute--what do you think a pediatrician would say if a general
surgeon, with no pediatric training, said that evaluation of pediatric
problems does not require a pediatrician--just consult one if a problem
becomes evident after surgeons do the screening evaluation and care.
What would you say to those who assert that it does not take an
emergency
medicine resident to care for ER patients--they are just glorified
triagers,
such training is unnecessary, let each specialist see these patients
themselves and eliminate the middle man--it doesn't require a trained ER
doc
to evaluate ER problems.
I don;t think for a minute you would at all disagree with the obvious
flaw in
the above--no ER physician or pediatrician would for one second sit
still for
such rot.  I've worked in ER's, and know how much training and
commitment it
takes, and also that I am not capable of doing what you do.  What would
go
thru your mind???  I'll tell you--how could someone with no training in
that
specialty even presume to know what it takes to care for these patients?
How
in the world could anyone have the gall to agree with the flaws of the
above,
then turn around and say "Oh, but trauma and surgery is different--it
doesn;t
take 13 - 15 years of education and training, and several more in
practice
(more BTW than ER and pediatrics put together!) to know SURGERY--ANYONE
can
do that!" (And if for one minute you think SURGERY means
OPERATIONS--well,
you still just do not get it!  Operating is only one small part of
SURGERY)
I.e. what other specialists would never tolerate for themselves is OK if
it's
only SURGERY you're talking about.  Who could ever think that a
pediatric
intensivist knows a THING about the early subtle signs of hemorrhage,
peritonitis or the need to go to surgery, before the patient is near
dead and
an armadillo could recognize it?!  I.e all those times I've lost count
of
when cases of appendicitis in young kids were "watched" until the edge
of
septic shock, being called gastroenteritis--then dumped on us to take
care of
the perforation and abscess and week on the ventilator in the PICU,
while
they then go back the next day and do the same thing (why not--no
accountability there, no skin off their backs--when they're wrong, they
just
call the surgeons to clean up, so why need to learn how to be right?)--I

guess we just forget about that, huh?  There is an extensive literature
of
studies clearly showing the increased morbidity AND mortality, LOS,
LOSICU,
costs, etc, etc of patients with surgical problems admitted to
non-surgical
services--and this should be no surprise (some in the Internal Medicine
literature!)!
I don't have a problem with people not knowing an area of medicine--that
is
true of all of us--that's normal.  I have a problem with people not
knowing a
whit about a field, but thinking they do--because that makes them
DANGEROUS!
The most important quality in anyone, certainly physicians, is to at
least
know and acknowledge your limitations--that is the difference between
being
HUMAN and being a walking talking MENACE.
Again--May, 2003 Annals of Surgery--read it, as just a small start.
ERF

HMMMMM--it's OK for anyone else to have opinions, but for me, well--....

Now another double standard?  What, pray tell, is wrong with being (Oh
my
God!) OPINIONATED?? I see an opinionated person in what you
posted--nothing
wrong with that, though?  Or is it only too much (i.e. so as to "lose
credibility") when the opinion just does not gibe with yours???  Or is
it
only when I have  opinions on "so many issues"?  (Please tell us what
you
think is an appropriate number of issues for it to be alright to be
opinionated?)  Please clarify for the rest of us what limits YOU think
there
should be to opinions?
Think a minute about what you said above.....

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<html>
Rick,
Your "rebuttal" was-I am sorry to say-very poor.......
First of all, you bring up the scenario of what if ALL pediatric problems
were initially handled by Gen Sx's etc.....
 Totally faulty analogy, although most pediatric acute issues cannot/should
not be handled by gen Sx's, BLUNT ABDOMINAL TRAUMA is a rather common occurrence
in the ED and thus it is in the scope of an ED doc to manage this entity...what
that thought provoking article also showed with impressive stats was that
the large majority of ped. blunt traumas never end up in the OR so......Rick,
say I would consult you every time a
kid came in with a presenting&nbsp; complaint that we both knew only less
then 1-2% of the time would end up in the OR you would say what a waste
of resources/time, you would also tell me to use my EBM knowledge base
and call back ......
Your or perhaps your contemporary's second point of ED docs being glorified
triage nurses is a rather archaic philosophy and as such I will not even
attempt to refute it......
13-15 years of study and training!!!... over here ED training is 5 years
of duration post med school, same number as Gen Sx +/- fellowship years
Gastroenteritis...my favorite diagnosis.....I agree that many pediatricians
and&nbsp; SURGEONS (at least where I come from) hold to the archaic notion
of needing a WBC and an ABDO series and maybe an U/S and maybe a CT for
w/u of ?appendicitis by which time perforation has occurred.....
...and my last point (I promise) about not being dogmatic...Rick you
and I both know that what is true today is folly tomorrow (too many e.g..
to mention) so what i always tell my residents is not to be dogmatic, just
think of how many dogma's in the past 10 years have remained unchallenged
just in the filed of traumatology alone...very few
With that I will close, let's turn a new page and start over
JN
 &nbsp;
Don;/t fall into the oh so easy trap to fall into on this list, and
start
 seeing things in the posts that just are not there.&nbsp; Read my post
again--in
 no way was I calling YOU arrogant--I was referring to the basic message
of
 the editorial, and--yes--to its authors.&nbsp; That MINDSET is arrogant
ignorance.
 &nbsp;I agree with you that it was provocative, and even that it is
a valid issue
 to bring to light--don't also misread into my post any indication that
such
 ideas should not be espoused.
 Think a minute--what do you think a pediatrician would say if a general
 surgeon, with no pediatric training, said that evaluation of pediatric
 problems does not require a pediatrician--just consult one if a problem
 becomes evident after surgeons do the screening evaluation and care.
 What would you say to those who assert that it does not take an emergency
 medicine resident to care for ER patients--they are just glorified
triagers,
 such training is unnecessary, let each specialist see these patients
 themselves and eliminate the middle man--it doesn't require a trained
ER doc
 to evaluate ER problems.
 I don;t think for a minute you would at all disagree with the obvious
flaw in
 the above--no ER physician or pediatrician would for one second sit
still for
 such rot.&nbsp; I've worked in ER's, and know how much training and
commitment it
 takes, and also that I am not capable of doing what you do.&nbsp; What
would go
 thru your mind???&nbsp; I'll tell you--how could someone with no training
in that
 specialty even presume to know what it takes to care for these patients?
How
 in the world could anyone have the gall to agree with the flaws of
the above,
 then turn around and say "Oh, but trauma and surgery is different--it
doesn;t
 take 13 - 15 years of education and training, and several more in practice
 (more BTW than ER and pediatrics put together!) to know SURGERY--ANYONE
can
 do that!" (And if for one minute you think SURGERY means OPERATIONS--well,
 you still just do not get it!&nbsp; Operating is only one small part
of SURGERY)
 I.e. what other specialists would never tolerate for themselves is
OK if it's
 only SURGERY you're talking about.&nbsp; Who could ever think that
a pediatric
 intensivist knows a THING about the early subtle signs of hemorrhage,
 peritonitis or the need to go to surgery, before the patient is near
dead and
 an armadillo could recognize it?!&nbsp; I.e all those times I've lost
count of
 when cases of appendicitis in young kids were "watched" until the edge
of
 septic shock, being called gastroenteritis--then dumped on us to take
care of
 the perforation and abscess and week on the ventilator in the PICU,
while
 they then go back the next day and do the same thing (why not--no
 accountability there, no skin off their backs--when they're wrong,
they just
 call the surgeons to clean up, so why need to learn how to be right?)--I
 guess we just forget about that, huh?&nbsp; There is an extensive literature
of
 studies clearly showing the increased morbidity AND mortality, LOS,
LOSICU,
 costs, etc, etc of patients with surgical problems admitted to non-surgical
 services--and this should be no surprise (some in the Internal Medicine
 literature!)!
 I don't have a problem with people not knowing an area of medicine--that
is
 true of all of us--that's normal.&nbsp; I have a problem with people
not knowing a
 whit about a field, but thinking they do--because that makes them DANGEROUS!
 The most important quality in anyone, certainly physicians, is to at
least
 know and acknowledge your limitations--that is the difference between
being
 HUMAN and being a walking talking MENACE.
 Again--May, 2003 Annals of Surgery--read it, as just a small start.
 ERF
 &nbsp;
HMMMMM--it's OK for anyone else to have opinions, but for me, well--....
 Now another double standard?&nbsp; What, pray tell, is wrong with being
(Oh my
 God!) OPINIONATED?? I see an opinionated person in what you posted--nothing
 wrong with that, though?&nbsp; Or is it only too much (i.e. so as to
"lose
 credibility") when the opinion just does not gibe with yours???&nbsp;
Or is it
 only when I have&nbsp; opinions on "so many issues"?&nbsp; (Please
tell us what you
 think is an appropriate number of issues for it to be alright to be
 opinionated?)&nbsp; Please clarify for the rest of us what limits YOU
think there
 should be to opinions?
 Think a minute about what you said above.....</html>

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