EM Thinker: Pearls From The Frontlines

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

Welcome back to The EM Thinker series. This series will provide important considerations for the practice of emergency medicine. Today’s post provides pearls on a variety of topics including biases and cognition.


1) Know your biases and how your decision making capacity changes over the course of a shift or across different shift slots. Be extra careful in these patient care scenarios, and use a mental checklist/framework.

2) In stressful situations, fall back on the basics. Most of the time there’s time to think prior to acting.

3) One of the hardest things for us to do: just stand there and do no harm.

4) Be mindful of the patients cynically labeled by other clinicians / staff. These are going to be some of your most memorable cases.

5) Review medications. Check levels. Consider drug-drug interactions, side effects, and polypharmacy.

6) Beware the diaphoretic patient. “If the patient is sweating, you should be sweating.”

7) Build a targeted differential diagnosis with level of concern each time. This comes more naturally with clinical experience.

8) When the ship is sinking, ask for help.

9) Many patient complaints fit with Occam’s razor; some will surprise us with Hickam’s dictum.

 10) Child abuse, elder abuse, intimate partner violence, and human trafficking will humble us all at some point. If you think/ask about it when something doesn’t fit, you’ll impact a life.


References / Further Reading:

Emergency Medicine Cases – Diagnostic Decision Making in EM

Emergency Medicine Cases – Decision Making

emDocs – Organizing the Room

EMCrit – The Fog of War

An EM Mindset

Life in the FastLane

One thought on “EM Thinker: Pearls From The Frontlines”

  1. Spot on; powerful words to live by…thank you. A corollary to #4 is that the less time you want to spend with a patient, e.g. frequent flyer, out of control psych, malignant personality, the more time you should spend with the patient.

Leave a Reply

Your email address will not be published.