EM Mindset: Christopher Doty – Approaching the World

Author: Christopher I. Doty, MD  FAAEM  FACEP (@PoppasPearls – Program Director & Vice Chair, Associate Professor of Emergency Medicine, Department of Emergency Medicine, University of Kentucky-Chandler Medical Center) // Edited by: Manpreet Singh, MD (@MPrizzleER – Clinical Instructor & Ultrasound/Med-Ed Fellow / Harbor-UCLA Medical Center) and Alex Koyfman, MD (@EMHighAK – EM Attending Physician, UT Southwestern Medical Center / Parkland Memorial Hospital)

The Emergency Medicine mindset to me is a multi-factorial way of approaching the world. Often, I think this way of approaching the world goes beyond just our ED shifts. An emergency physician has many of the same characteristics outside of the clinical area, as they do inside.  Confidence, excellent people skills, good judgment, and resilience.

People Skills

One of the fundamental skills in the emergency medicine mindset is to develop a quick rapport with our patients. Successful emergency physicians have to be extraordinarily efficient and need to have the skills to develop a quick rapport with their patients. The ability to get a patient to see you as being on their side quickly is the first step informing a good therapeutic alliance. This alliance is necessary to move them forward through the process of diagnosis and therapeutics.

If you are interested in reading the rest of this and other EM Mindset pieces, please see “An Emergency Medicine Mindset,” a collection evaluating the thought process of emergency physicians. This book is available as ebook and print on Amazon.

14 thoughts on “EM Mindset: Christopher Doty – Approaching the World”

  1. There has been some debate on Twitter regarding if EM doctors want to be more sensitive or specific. I think it depends on the patient presentation and what disease we are talking about. I was trying to make the point many specialists trying to rule-in the correct diagnosis while emergency physicians often try to rule-out the dangerous diagnoses.

    This is a subtle but relatively important difference and highlights a strategy that Emergency Medicine does not share with many other specialties. I am interested to hear other peoples’ thoughts. C. Doty @poppaspearls

    1. Hi. Thank you for your excellent post. I too would lean towards having good rule-out tests. I just wanted to discuss the point on specificity vs sensitivity: I was wondering if you had the terms the wrong way round. The rule out test would be a high sensitivity test (http://www.bmj.com/content/329/7459/209) which we as EM physicians would want, whereas other specialties would want a rule in highly specific test. With Thanks

  2. There has been some debate on Twitter regarding if EM doctors want to be more sensitive or specific. I think it depends on the patient presentation and what disease we are talking about. I was trying to make the point many specialists trying to rule-in the correct diagnosis while emergency physicians often try to rule-out the dangerous diagnoses.

    This is a subtle but relatively important difference and highlights a strategy that Emergency Medicine does not share with many other specialties. I am interested to hear other peoples’ thoughts. C. Doty @poppaspearls

  3. I found this article interesting (I love the jazz analogy) and well thought out. It touched on many points worthy of more lengthy discussion, especially in training programs. I have a comment about judgement in the paragraph titled Clinical Decision Making. Add to that essential paradox, the reality that many EDs are often single doc covered. That means, for a newly trained physician, they are out on their own unsupported, to gain all the experience they need, sometimes, unfortunately, by making bad judgement calls. The perceived panacea for this is to err on the side of over testing, which is often justified by the need to r/o worst case scenario. Among other things, this actually may preclude developing judgement, unless some serious longitudinal work is done to correlate pre-test judgement with outcomes. It also puts patients through an often expensive, time and resource consuming process that can seriously impair the function a small ED. From my experience, residency programs (including my own) do not address this issue–the need to practice solo in a busy ED–sufficiently. The ability to function in that situation is not going to be the same as in residency. The resources are simply not there, whether it be for calling in consultants early or to have an extra experienced hand for a difficult pediatric resuscitation or procedure. A rotation or two in a community ED does not do the trick unfortunately, unless the resident is mentored by a seasoned, and academically oriented doc. Mostly, I find the resident is perceived as a bonus worker. Food for thought I hope, for those in a position to make the changes needed to address this.

    1. Very good points. I would add that the same issues of “more is better” apply (often more so) to PAs. I find that when I’m working with PAs (and especially signing charts after the fact) – that they usually order more tests than I would, prescribe more antibiotics for dubious respiratory complaints, make more calls to consultants, etc.
      (Hi, Doty!)

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