3 - Pediatric Emergency Medicine Approach: Be Vigilant but Be Reasonable

Summary

When compared to other medical specialties, it is clear that Emergency Medicine clinicians approach medical decision-making differently. As a medical student, I was taught to organize my differential diagnosis list with the most likely conditions first. The uncommon and unusual would be reconsidered later if additional time and information required it. In contradistinction, in the Emergency Department, without the luxury of time or well-established clinician–patient relationships and facing imminent threats to life, we must focus on “the worst first.” My prior program director and mentor, Dr. Amal Mattu, described our perspective this way: whereas medical “horses” and “zebras” do exist, our attention in the Emergency Department must be on the “lions, tigers, and bears” that may be lurking. Fortunately, for patients, the ferocious beasts are relatively rare. The common will outnumber the catastrophic. Our task, however, is to protect our patients from the morbidity and mortality associated with the medical “lions, tigers, and bears.”