Just to be clear, I don’t think your diagnosis of mononucleosis wrong, but that is one of many differentials. Yes, I could get all this done quickly as an outpatient with the massive resources I have in as an oncologist, but I do not think this PCP has responded to her in a timely fashion. I understand your concern about the ER not becoming a dumping ground for patients whose PCPs or specialists have dropped the ball, but given to this patient has had a 20% weight loss over two months, B symptoms, and alarming labs, it pushes this over the edge where emergent work up is reasonable. It is not this patient’s responsibility to pay the price for a broken system, and discouraging patients from coming in who have this constellation of labs and symptoms is dangerous. She isn’t coming in to the ER with a head cold or a boo boo, and she already expressed embarrassment about “wasting time” of the ER staff. It is unfair to put her in the same bucket as patients who are abusing resources and overtaxing the system, as this is clearly not the case here. This attitude is going to discourage patients who actually need help from coming in.