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.
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.”