Adult critical care vs. Pediatrics

Two not-so-exaggerated interactions.

Peds clinic (after 4 minutes with the patient):

Me:

"Patient Baby is a healthy one year old who presents with a birthmark on his head that has been previously diagnosed as a sebaceous nevus by two pediatric dermatologists who recommend removal between age 8-11.

My assessment is that this child has a sebaceous nevus that should be removed sometime before adolescence."

Staff pediatrician:

"Great job! Exactly right! I agree! Excellent presentation and clinical instincts! Woo-hoo! You've been working so hard, that's your second patient, right? Go take a coffee break."

Adult Critical Care: (after literally 12 overnight, sleepless hours of being in the patient's room every 10-15 minutes while juggling pages about literally, yes literally, 43 other critically ill patients)

Me:

"Good morning Dr. S! Patient W has significant history of every cardiac pathology imaginable (which I then listed in chronologic order including details such as systolic function, dates of hospital admissions, and cardiologists consulted) as well as end stage renal disease (presented in similar detail). He presented in vtach cardiac arrest and was found to be febrile.

I literally saved his life by performing three rounds of CPR including epinephrine, shocks, intubation, central line placement, aggressive fluid and electrolyte management, antibiotics, and blood transfusion. He proceeded to code two more times, requiring initiation of an antiarrhythmic drip, and subsequently developed pulmonary edema while remaining hypotensive, requiring a dialysis consult and initiation of pressors. I've arranged for dialysis this morning, cardiology consult, ordered all necessary labs and diagnostic testing for this morning and patient is currently clinically stable."

Staff:

"Well, doctor, (somehow impregnating a Colbert Report season's volume of sarcasm into that one word) I notice that his [random irrelevent electrolyte like manganese] was checked at oustide hospital and is slightly low. Did you miss that? Were you planning on fixing it anytime soon? And what supremely esoteric fungal infection observed only in a 1 mile subtropical region of latin America might you have considered and covered for? And what is his exact troponin level to the third decimal point. . . .? "

Me: [reflexes are slow at hour 29 awake] ::long pause::

Staff: I highly suggest, doctor, that you know your patients before presenting them. Now why don't you get to work at fixing this? ::walk away::


I'm currently on the peds side, by the way, and going through pretty significant negative reinforcement withdrawal. I keep waiting to get yelled at and it keeps not happening. Makes me nervous.