EM Mindset: Compton Broders – A Reflection

Author: A. Compton Broders, MD, MMM, FACEP (Professor, UT Southwestern) // Editors: Alex Koyfman, MD (@EMHighAK) and Manpreet Singh, MD (@MPrizzleER)

I have been in the emergency department for 40 years.  I first set foot in the fall of 1974.  Much has changed in the world, emergency medicine and myself in that time. This is a reflection article and consequently I am sure it has flaws in it.  However here goes.

When I started, I was insensitive to the plight of others and could work all hours.  I could do 18 shifts and be the medical director and not a completely clueless husband.  Also I am not sure I thought straight.  Disposition then as now has been the ultimate goal at least for this emergency physician.  It has taken me years to develop the EM mindset of “think bad first”.  This is an unnatural way of thinking and requires constant effort.  As humans we are always looking for the easy way out — i.e. the most likely diagnosis.  Also in the beginning, I did not think I listened very well.  Really listened.

As a human I am not good at listening.  I jump to conclusions.  Compound that with the fact that most humans are scared in the ED.  Consequently they do not communicate very well themselves.  What does this mean?  The history of present illness (HPI) is especially affected by distortion.  I want to know the decision making process behind their coming to the ED.  How often have we seen a patient who comes in with a seemingly chronic problem only to discover a catastrophe?  I rarely take the HPI at face value especially in a perplexing case. I try to look behind the words.

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.