Academic physicians live in a protected bubble inside their institutions. They have residents, interns, and a whole plethora of support staff who do most of the work for them. Additionally, they rarely have to worry about insurance when planning for patients, since academic centers usually absorb a large percentage of non-insured patients. In short, they don't live in the real medical world. When many of them try to go into private practice, they find out exactly how ill-equipped they are, which is why they usually end up back in academia. My issue with them doesn't exactly involve that, but instead has to do with the grilling I usually get when I talk to them over the phone.
Me: "I need to speak to a neurosurgeon about possible transfer to your facility."
Neuro: "Yes, what is the problem with the patient."
Me: "The patient has a large bleed in his brain and we do not have the capability to adequately monitor him."
Neuro: "What is his GCS?"
Me: "Eight. He currently withdraws to pain appropriately, no posturing and is stable on the vent."
Neuro: "Does he have Bieber's sign?"
Neuro: "How about Kardashian tremor?"
Neuro: "Does he have Peter Griffin pupillary response?"
Me: "His left pupil is blown, if that's what you mean."
Neuro: "Hmm, that's a negative Peter Griffin, then."
Me: "Oh, ok."
Neuro: "Have you tried performing a reverse Matthew McConaghey maneuver on him?"
Me: "Dude, WTF are you talking about?"
Neuro: "You need to know these things, I can't believe they let you pass medical school without..."
Me: "I am not one of your residents or a med student. Let me put this in perspective for you: I have a currently stable patient in my CCU who is intubated with a large brain bleed. We do not have neurosurgery here so the next words out of your mouth better be, 'We will take the patient' or I am reporting you."
Neuro: "Oh, we'll take the patient. I just need you to tell the complete story to our Neuro ICU fellow who will ask you to tell it to the intern for the general medicine team who will then send you back to me for a recap."
Me: "F*** you!"
The converse of this is when I tell the story to the private hospital here:
Me: "Yes, I have a patient with a brain blee..."
Neurosurgeon: "We'll take him."