11 - Decision-Making in Uncertainty

Summary

Emergency medicine (EM) is a prototypic example of a domain whereby decision-making is required without complete information. Although it is not unique, it certainly is a hallmark feature of the specialty. In fact, high-stakes decisions are frequently required under time-sensitive conditions with incomplete information. When a patient arrives in the ED with hemodynamic instability, initial decisions are made without a definitive diagnosis. The clinical team hedges toward management plans that effectively “buy” them time to improve hemodynamics while minimizing harm to the patient. Adding further challenges to the situation, there may be simultaneous and competing priorities elsewhere in the department. These high-stakes, time-sensitive conditions inherent in emergency medicine mandate a solid decision-making system. It is incumbent upon the clinician to develop pragmatic tactics and strategies that can be used in real time at the patient’s bedside. Clinicians are required to balance speed at the expense of certainty.