Author: Seth Trueger (Assistant Professor of Emergency Medicine, University of Chicago, @MDaware) // Editors: Alex Koyfman, MD (@EMHighAK) and Manpreet Singh, MD (@MPrizzleER)
The classic model of history, physical, testing, diagnosis & treatment does not apply to us. I think we do 3 things in emergency medicine:
- Resuscitation
- Risk stratification
- Care coordination
Resus is the fun sexy stuff that we stay up late at night having twitter arguments about. As much as I love ketamine, I can go a number of shifts without using it, and very little of what we do is resus. Most of what we do is risk stratification and care coordination. Syncope or ACS are good examples: what are the odds that this patient’s symptoms were caused by something dangerous? Is it high enough that they need to be admitted for more workup and monitoring, or can they go home and follow up with their cardiologist? Do I need to call their cardiologist and make them an appointment, or is the patient reliable and the risk low enough that the patient can call themselves tomorrow?
I never use low-acuity diagnoses like costochondritis or gastroenteritis or gastritis. My job is to tell the patient what they don’t have – “I don’t think your chest pain is from a heart attack or a blood clot or anything else dangerous; it’s safe for you to go home and follow up with your doctor in a few days.” The diagnosis is still “chest pain, but safe to go home now” – calling it costochondritis can only get me in trouble.
I work in 3 speeds:
- Patients with simple problems (sore throats, URIs)
- Patients with potentially dangerous problems (chest pain, belly pain)
- Get out of my chair now and stay within 10 feet of the patient (altered mental status, acute resuscitation, etc).
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.
8 thoughts on “EM Mindset: Seth Trueger – Resuscitation, Risk Stratification, Care Coordination”
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Great article and words to live by at any stage of one’s career. “Dispo, dispo, dispo” was the mantra repeated in my residency and it continues to ring true to this day. Keep up the great work.
I certainly agree Dr. Hipskind… I rotated with you 2 years ago as a med student… I still stand on the right side of the bed when I take my H&Ps… Hope all is well.
Love it. To add to your thought that anything that isn’t important will take the MD and RN time from something else, it bugs me when with people with dischargeable back pain or other benign condition that can leave right away, I get the “lets give them some Motrin and see” from the resident or PA. They can take their Motrin at home!!!!!!! Stop wasting the RN time!
This article is spot on. Thank you, Dr. Trueger for writing it!
Love this! So true especially about paying attention to the RN assessment
Great tips, thanks for sharing.
Great article ! Thanks!