“My baby has a cough. Does he have ebola?”
No.
“My son got this lump on his neck right with his cold, do you think it’s cancer?”
No.
“Lovely presentation. Do you want to do any work-up?”
No.
“What about a CBC, CRP, LDH, LFTs, Monospot, and CXR?”
No.
“Okay, we’re going to get them.”
Okay.
“Do you think this kid needs to be admitted?”
No.
“We’re going to admit him.”
Ok.
“It’s a soft call, but it’s a Friday, and I have 32 years of experience. This is where experience tells you if a child will get worse before he gets better.”
Ok.
“Uh, thanks for calling me – most interns don’t remember to call the floor senior before a new admit – but I’m confused… Why are you admitting a totally stable kid?”
Because it’s a Friday. And my preceptor is citing his experience. So, you know.
“Okay. Does your preceptor have any idea of what we’re admitting him for?”
Well, either the lump in his neck will turn out to be a deep neck infection that will cause him acute respiratory distress and send him to the PICU, or it will not. So watch out for that.
“Thank you.”
Anytime.
“My baby is here for his well-child check.”
Your baby is blue.
“He is here for his well-child check. How many shots will he be receiving today?”
He will be receiving resuscitation. Incidentally, why is your baby blue?
“I will need a note for work. Saying that I was here for his well-child check.”
We are calling a code.
“May I have a note now?”
You may not.
Action Potential 
This is so true, thank you AP
I LOVE your posts…
Wow, that’s a lot of useless tests for one little lump in the neck.
Never once in a half decade of practice (except in the case of an unexpected ortho consult) have I said “Thank goodness I ordered that CRP!” Has anyone?
Perhaps you could enlist Urology to help your preceptor locate their balls?
Not CRP directly, but ESR(which I have yet to really understand the difference between those two clinically) has helped me several times in my 11 years of practice. Admittedly, I am not a pediatrician but neither am I a rheumatologist nor ID doc.
I left out ESR because it has a few (very few) valid indications, such as temporal arteritis. CRP, though, has only ever been useful to me to buff the chart prior to an ortho consult.
i goona know very important things from here.
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