Differences Between Pediatrics and Adults

I am making a comprehensive list of excuses perfectly good reasons for why I, a senior pediatric resident (fearless leader of interns! attending in the making! resident of the month x 3! winner of a multitude of teaching awards given by med students!) – make a terrible adult neurology intern.

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1: Adults with normal potasasium.. need more potassium. In peds, we are pretty much cool with anything over 3.2, and super scared of any number that starts with 5.

So in adult medicine this year, it wasn’t until the 3rd time I got a sign-out of “His K was 3.6, so we repleted IV” and reacted incredulously and indignantly before I finally accepted the truth of the new world order of adult medicine that I now must live by: K under 4.0 is unacceptable. Cardiac arrhythmias and whatnot. Asymptomatic PVCs.

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Be a man. Replete that shit.

2: Adults can sign-out AMA. My first AMA, I paged psychiatry to ask whether they thought the patient had capacity. I think the psych resident showed up more for moral support and genuine concern for me than anything else. Especially since I explained over the phone that I am from pediatrics and am scared to death to discharge a patient who needs more treatment.

They patiently explained that I am a doctor and can decide these things for myself. In turn, I patiently explained to them that I am basically dumb.

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3: Adult attendings are so hands-off you don’t even have to staff all in-house consults with them. You don’t even have to staff ADMISSIONS with them. In pediatrics, we don’t even page the resident first for consults – you page the attending, and they page the pediatric resident to say “Hey, go see this consult for me and then we’ll discuss it.” And at my program, even a 4am admision is paged to the attending first.

But in adult neurology subspecialties, it’s more like: Neurosurgery or the ED pages me out of concern for status epilepticus, I load the patient with whatever AED I want, I admit them if I want, and as long as the first thing I do works the attending doesn’t need to hear about it until rounds in the morning.

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Discovering this was… slow and painful. It involved an embarrassing number of incredulous conversations between me and an attending at 11pm.

4: Adults get lidocaine before you stab them in the back with a 22gauge needle. In pediatrics, we gave topical lidocaine, for all the good (NONE) that it did the patients. But if you turn 18 and get admitted to the adult unit – then you get SQ lidocaine and are not tortured.

… unless you happen to get a pediatric neurology resident as your LP-er. Then you get someone who has never given SQ lidocaine before and is not even aware that it is important.

5: Pediatric neurology residents are terrible people. As evidenced by the fact that there are 6 more of them in my program, and not a single one warned me of any of the above facts.

I distinctly remember the guy above me saying, and I quote: “Why are you so worried? Calm down. It’s gonna be fine.”

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Listen up, Mr. PGY-4:

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This post is for you.

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