We're clearly going to disagree and that's fine. But a few point and then I'll leave this alone - my statement about bad signout isn't about a doctor taking a bad history of physical, it's about hearing a story in signout with bad medical decision making, i.e. - this person is just waiting for x test, then they can go home - then the patient is obviously not appropriate to be discharged. I've gotten signout from a moonlighting surgeon on a young child "that can go home" when the child was clearly septic. Missed TTP. Pregnant bleeding patients rh negative not getting rhogam, etc.
Also, if you are proficient with airways, good for you, but I find that extremely surprising. No general surgeon I know is comfortable intubating. I'm doing a critical care fellowship with some very highly qualified, competent surgical fellows and airway management just isn't in their wheelhouse. Even at the end of their fellowship, they're not great. Obviously ENT is an exception.
Finally, you're kind of making my point about wellen's waves. History and physical exam is nearly useless in a chest pain workup. Only 4 historical features had any statistically significant prognostic value. Wellen's waves don't help you work them up. Theyre usually in the patient you don't think has coronary disease. Even still, the problem isn't that you might miss it and therefore miss the diagnosis (which goes without saying), it's that you have to understand the mandatory management of them. They are a critical, proximal left lesion that requires urgent cath - these patients will occlude and likely arrest if you simply put them in for a stress test.
Like I said, I'll leave this alone now, but I think non-EM folks staffing and ED is extremely dangerous and extremely arrogant at the expense of patients. Obviously, it happens, but people just don't know what they don't know. And sure you can call ortho with a question, but if you aren't aware of the fact that posterior fat pads are pathologic in kids, you won't know to call. You just don't know what you don't know.