"Am I missing anything?" Yes, yes you are. For starters, you missed the fact that medicine isn't a cookbook. If it was, artificial intelligence and robots would have replaced us doctors by now. You can't order the same damn things every time for the same chief complaint - and certainly not in an emergency setting! Apparently, the basic concept of knowing what to do and when to do it isn't something that's taught in the 100% online nurse practitioner / noctor curriculum. Unfortunately, diseases and pathology don't just disappear from the patient's body because the midlevel caring for the patient forgot to look for them. What happens when a patient presenting with shortness of breath / dyspnea as an anginal equivalent goes home and dies from a massive myocardial infarction because you forgot to check a troponin? Or how about a young female with abdominal pain who becomes permanently infertile or dies from sepsis due to a ruptured ectopic pregnancy because you were too pre-occupied checking amylase and lipase for pancreatitis?