EM Thinker #2

Authors: Alex Koyfman, MD (@EMHighAK) and Brit Long, MD

Following in the footsteps of EM Mindset and EM Collective Wisdom, emDocs is proud to introduce the EM Thinker series. This series will provide important considerations for the practice of emergency medicine.

1) Prior to calling the consultant, consider how can he/she truly help your patient. This is an important cognitive stop point, as creating unnecessary diagnostic momentum isn’t benign. Pulling them away from another patient should be a consideration as well.

2) Three things ED nurses expect from us: address their concerns, keep the department moving, and organize teams in resuscitation scenarios.

3) Rural/critical access hospitals have some brave doctors; don’t judge, but rather advise and accept transfers. These men and women are heroes working in sometimes difficult scenarios with limited resources. Reflect on these experiences and re-evaluate the care you deliver on a regular basis.

4) Understand the pluses/minuses of the hospital system you work in; it impacts the care of your patients.

5) When you bump into an inpatient physician or consultant, ask for lessons learned and what we could be doing better.

6) Don’t let a consultant (over the phone) walk you off of the cliff. You’re the one at the bedside. Take input with humility. Ultimately, the final decision is up to you.

7) There are many more grey areas in EM decision making than black or white.  Evidence-based medicine isn’t always the right answer for the patient in front of you. You must consider the patient’s background and understanding.

8) Be kind to your colleagues in all fields of medicine. Learn from them. Highlight their awesome work.

9) Know what consultants are regularly available. Think outside of the box when needed. For example, if you are caring for a crashing ectopic pregnancy and do not have OB on call, then contact the General Surgeon.

10) Know the limitations of the labs and imaging you’re acquiring, and don’t order a test if it will not change your management or disposition. Diagnostic tools aren’t foolproof. Master explaining the results of commonly obtained labs. Don’t settle for a suboptimal radiologic study and/or read during a particular time of day. Bottom line: trust the patient in front of you.


References / Further Reading:

REBEL EM – How to call a consult

EM Mindset – Book

Emergency Medicine Cases – Decision Making in EM

Emergency Medicine Cases – Diagnostic Decision Making in EM



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