5 - Emergency Medicine Medical Decision-Making

Summary

The basis for making any medical decision boils down to a careful evaluation of the case including chart review, patient interview, physical exam, and, when needed, test results and response to treatments. The cognitive work required to make medical decisions for a single patient can be time-consuming, difficult, and complex. Performing this exercise across multiple undifferentiated, potentially sick patients concurrently in a time-constrained environment makes Emergency Medicine (EM) medical decision-making truly unique across all medical specialties. Of all the challenges in EM, time is our greatest foe. To start, in every patient evaluation we are not only responsible for that patient, but every patient in the department including those in the waiting room. The sickest patient, according to an old EM adage, is the next patient yet to be evaluated. Unlike the progression of clinic patients with scheduled appointments or the sequential rounding on admitted patients, the ED is entirely unscheduled.