One of my favorite sections in the article is when he writes “Defining The Specialty.” He states that the responsibilities of the emergency physician (EP) entails differentiating the sick from the non-sick patient, handling multiple patients at the same time, and instituting life/limb saving interventions. He uses the analogy of a climber who for whatever reason has fallen from a precipice and the job of the EP is to get the climber to a much safer place as possible, assuming 100% safety is not attainable.
In the essay, he states that stabilization takes priority over diagnosis. This contrasts medical school teachings where the emphasis of education is on primary care. Consequently, the priority is to take a history, do a physical exam, and then treat the patient-- in that order.
The hardest thing to teach residents, according to Dr. Rosen, is to “assume the worst even if statistically improbable”. I believe that Dr. Amal Mattu ( @amalmattu ) refers to this as a “healthy paranoia”. This means that we still need to rule out life threatening diagnoses for seemingly non-emergent patients. We must also have enough knowledge of NON-life threatening diagnoses in order to address these in the ED, if possible. If we feel confident that the patient has no life threatening diagnoses and can be discharged the patient home, then we should ensure appropriate follow up.
In tomorrow's post (part 2), we will look at how Dr. Rosen categorized ED patient visits and his views on EM administration and research.