The Difference Between an Adult and Pediatric ER

The consults that come from the pediatric versus adult emergency rooms are amazingly different - and it's actually somewhat of an enigma to me.

When I get called from a physician in the adult emergency room, as a general rule, the problem is accurately stated. The severity of the situation is usually conveyed well. In fact, with some, I can expect  an accurate diagnosis from the initial phone call.

For some reason, things are very different from the pediatric emergency room. (The exception being when one of the adult emergency medicine residents happens to be rotating at the children's hospital). One of two situations is commonly the case. The first is when I get painted a picture of doom and gloom with a probable open globe and a bad marginal laceration; but on my arrival, there is little more than a small conjunctival laceration and a nick on the eyelid - neither of which will need anything done to them, although would require my visitation. The second is of course the exact opposite. I have been told about a "normal" eye exam (which doesn't even warrant a call to me) and come to find something much more - something very much not normal and needing ophthalmology care.

This is to be expected from residents - we are all learning and no one knows everything. I would never fault a resident early in their training for this kind of stuff. But this has not always been the case. I kind of feel an attending should be involved at least peripherally before the decision is made to consult someone. But no matter, because even the attendings at the pediatric emergency room do the same things. I don't know why this is. Is the training in eye probelms inadequate? Is there just a tendency to pawn stuff off onto consultants when the going gets rough? I know the latter is true since the consulting becomes more poorly done as the waiting room fills up.

I am always more than happy to help - when it's appropriate. But you don't call a cardiologist before you've listened to the heart, right? So why would you call me before you've actually taken a second to look at the eye and have some of your own thoughts as to what's going on? A well-informed consultant is always better than a blind one.