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“We absolutely will not tolerate this kind of behavior,” the irate Department of Emergency Medicine chairman began. “This isn’t like the old days when we would do a complete history and physical before consulting the appropriate team. Times have changed and our residents should adapt.”

These comments were directed at Dr. Nooby, a PGY-1 Emergency Medicine resident, who has too often been accused of providing a thorough, detailed presentation to consulting providers. “Look, the algorithm is simple. 1. Is the patient alive? 2. What organ is affected? 3. Consult both the medicine and surgical services for that organ. I don’t understand why he can’t get it.”

When asked to comment on his firing, Dr. Nooby stated, “I don’t know, I guess I just thought that I could use what I learned in my four years of medical school and countless clinical hours to apply best practice medicine for some of the patients who come to us by taking an extensive history, completing a thorough physical exam, ordering appropriate tests, and then assessing which team to consult. I was just excited to have the privilege and responsibility to be one of the gatekeepers of this hospital.”

Several residents from other services came to his defense upon hearing the news of his firing. “He was phenomenal. The patients would have a CT, MRI, and complete neurological exam done before I was consulted,” said one neurosurgery resident.

“Instead of throwing my pager at the wall like I do for most consults in the ED, I would look forward to having a thought provoking and in depth conversation with Nooby about the differential diagnosis and his own personal assessment.”

A trauma surgery fellow also spoke highly of the intern. “Trauma patients would have all the appropriate lines in place and the correct medicines started. The families were also spoken to prior to my arrival. All I had to do was wheel the patient to the OR. No hecticness, no stress, just good patient

care.”

When asked to comment on Nooby’s supporters, the chairman remarked, “Obviously this type of effort is unsustainable. How can we expect him to efficiently manage his cap of 8 patients over the course of a 10 hour shift if he keeps practicing medicine like this? This is why we can’t match someone into the program just because they enjoy craft beer and like spending time outdoors.”

Attempts to reach out to Nooby for further interviewing have coincided with his rock climbing times.