In emergency medicine we use a top-down approach. What does the patient need? Not, what does the patient have?

4 Responsibilities of the Emergency Physician:

Resource stewardship - Not a lot of control over this variable

Customer service - Evidence based medicine doesn’t equal good customer service. You must be able to communicate well with your patients and manage expectations appropriately.

Symptom relief - Don’t forget to address the pain or symptom that the patient came in for while thinking through DDX and orders. 

Patient safety - Most of our time is spent here. 

Patient safety is resuscitation and identifying dangerous conditions

Dr. Strayers system:

Identify patients needing resuscitation and triage appropriately 

Identify dangerous conditions using HPI, physical exam, testing. This list is narrowed down by each step in the process. 

Have a plan for a negative workup as a positive work up will usually dictate a plan on its own.

Run the board frequently and after seeing new patients. 

Place orders before charting

Manage interruptions with a method that works for you. Multitasking isn’t possible.

Expand work up if the HPI and physical exam are limited. 

Huge thanks to Reuben Strayer! Check out his website EMUpdates.com