Emergency medicine is difficult.

We are presented with incomplete information filled with variables. We are asked to balance risk verses benefits in every encounter, where, if wrong, a patient can die. It’s a tremendous responsibility.

I love it!

To succeed in emergency medicine requires a specific mindset. Specifically, one that thinks of the diagnosis first. A patient presents with a headache – that is the triage information – the initial impression is sub-arachnoid hemorrhage until proven otherwise. We then start our evaluation from the perspective of a potentially lethal diagnosis.

“Heartburn” is not indigestion in emergency medicine; it’s a subtle presentation of an acute coronary disease until proven otherwise. With every patient presentation, you must ask, “What is the worst case scenario here,” or “What is going to burn me about this patient?” What is the worse case scenario in a patient that presents with a simple finger laceration? They die from tetanus!

This is the EM mindset, and you will get yourself in trouble unless that paradigm is adopted early in your training.