Ep 201 How EM Experts Think Part 2: Data Gathering, Diagnostic and Treatment Decision Making, Test Ordering and Interpretation, Documentation, Emotional Resilience
In this Part 2 of our 2-part podcast series on How EM Experts Think with Dr. Reuben Strayer, Dr. Mike Betzner and Dr. Scott Weingart we dive deep into the nuances of practicing smarter, faster, and better in the ED. We answer questions like: How should we employ hypothetico-deductive reasoning in our daily practice of Emergency Medicine? How can we best streamline thorough data gathering for each case so that we don't miss key data points? How do the master EM clinicians perform an efficient and targeted history and physical exam? How can the concept of heuristic cycling help you avoid outdated or faulty thinking? How can we document our clinical encounter in a way that considers a differential diagnosis that prioritizes dangerous conditions and improve our thinking around cases? How can we use the 2-10% rule for pre-test probabilities and the concept of preferred error to guide our decision making for tests and treatments in the ED? What strategies can we use to avoid anchoring bias and keep your mind open to all possibilities? What’s the role of shared decision-making when navigating diagnostic uncertainty? How does understanding the vigilance pendulum help us assess our risk tolerance better? How can post-shift decision journaling, conducting pre-mortems and meditation improve our decision making and boost our emotional resilience on shift? and many more... Podcast production, sound design & editing by Anton Helman Written Summary and blog post by Rowan Helman and Anton Helman January, 2025 Cite this podcast as: Helman, A. Weingart, S. Betzner, M. Strayer, R. How EM Experts Think Part 2: Data Gathering, Diagnostic and Treatment Decision Making, Test Ordering and Interpretation, Documentation, Emotional Resilience. Emergency Medicine Cases. January, 2025. https://emergencymedicinecases.com/how-em-experts-think-part-2. Accessed February 28, 2025 Résumés EM CasesEpisode 200 How EM Experts Think Part 1: Strategies for Pre-Shift, Arrival Ritual, Staying Focused, Managing Interruptions, Cognitive Load & Negative Emotions, Resuscitation Mindset, Post-Resuscitation Recovery History taking: How EM Experts Think "We're not as concerned only about what the patient has. We're concerned about what the patient needs". -Reuben Strayer Traditional approaches to history-taking taught in medical school usually by internal medicine, often fall short in the dynamic and unpredictable environment of the ED, and fail to address the patients immediate needs. Emergency Medicine works on a hypothetico-deductive methodology, using simultaneous inductive and deductive reasoning. It involves formulating a hypothesis to make predictions, comparing predictions to observations and determining if they are consistent and finally, confirming or falsifying the hypothesis. The cardinal skill in differential diagnosis generation for EM is being able to link symptoms and signs to a list of dangerous conditions that apply to the patient in front of you. Generating a list of dangerous conditions for all common presentations to the ED at home, and them having them easily accessible via documentation templates can help hone your diagnostic skills. Data gathering Preparation before entering the patient’s room is critical. Effective pre-history strategies include: * Chart Review: Review triage vital signs, nursing notes, EMS run sheets,