SALT LAKE CITY, UT – Confetti is raining down from the ceilings as emergency medicine physician Deion Gnosis is being congratulated for diagnosing and treating a patient with an oft-confusing medical condition completely on his own.
At 2:13 AM, 67-year-old Arthur Uremia began to have sharp pain in his right great toe and right wrist, so he promptly came to the ED. He explained, “I’ve had a bunch of flare-ups like this in the past, they come and go, and doctors call it ‘gout’ and give me medicine, but I’ve never been sure that it’s just due to that. Then why do I keep getting it? I take the medicine every time I have a flare-up. It should be cured by now. I thought it maybe it could be Ebola.”
Gnosis examined Uremia, ordered some lab tests and an X-ray, then determined that gout was the most likely diagnosis. Being a physician in a large urban hospital with plenty of resources, he considered the option of calling a rheumatologic consult just to confirm or perhaps an orthopedic consult to tap the joint just in case it was septic arthritis. But Dr. Gnosis, having been at this “20-odd years,” kept his cool and simply prescribed some NSAIDs.
Gnosis added, “I was really close to calling someone initially when I gave him some indomethacin and it didn’t get better in the first 30 seconds. I’ll admit I did actually page Rheumatology after 15 minutes of no improvement, since I really wanted to dispo him. But when they called back they asked whether he was feeling better after the indomethacin. I honestly didn’t know since I was seeing another patient, so I just told them, ‘No.'”
“Then they came down here and demanded that I cancel the consult since he was actually feeling better. So I cancelled it and I’m having him see them in clinic tomorrow for some close follow-up. He’s also going to Orthopedics and Internal Medicine later this week. Just to make sure.”
While he technically did call a consult, it was cancelled so it is as though it doesn’t count, explained his co-workers. “Curbsides are totally not consults,” explained another ER doc. “That’s just when we ask one of our very close friends what they would do in a completely hypothetical but exactly identical case.”