EM Mindset: Deborah Diercks – The EM Environment

Author: Deborah B. Diercks MD, MSc (Professor and Department Chair, UT Southwestern – @debdiercks) // Editors: Alex Koyfman, MD (@EMHighAK) and Manpreet Singh, MD (@MPrizzleER)

To understand the EM mindset, we must first understand the environment of the emergency department. It is this environment that is the foundation of our approach, processing, and response to our patients. The emergency department is unpredictable. At any moment chaos may occur and uncertainty may rule. It is where people present in their most vulnerable states: seeking nothing more than help to relieve pain, treatment for an illness, or management of an injury. It is where the wealthiest person can be placed next to a person with nothing. It is where no patient ever stays, as there is always a disposition to a location such as home, a room upstairs, or less commonly the morgue. It is where the worst and best of society present: the reality of unprovoked violence is seen and stories of heroism exist.  It is the clinic to the emergency physician. Only in our clinic other specialties visit often and provide recommendations and no physician enters without expecting to be told they need to do more work.

Considering all of the factors above, the EM Mindset must include:

• The ability to establish trust and demonstrate empathy to those in need
• A chief complaint and exam driven systematic approach to life threats and illnesses
• The ability to multitask
• The ability to focus in a loud and chaotic environment and perform procedures
• The ability to compartmentalize emotions
• The ability to communicate not only to patients but other physicians
• The ability to focus on details
• The ability to think beyond someone’s physical complaints to identify social issues that may impact illness
• The ability to be a salesman: to convince patients that their diagnosis and treatment plan is correct and physicians that they need to admit or manage the patient you are seeing.

How do you develop this mindset?

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.