The Emergency Medicine Mindset

by John Bielinski Jr, MS, PA-C

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!

A mindset that is needed in emergency medicine is to think of the diagnosis first.  A patient presents with a headache, and 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 syndrome until proven otherwise.  With every patient presentation, one must ask, “what is the worst case scenario here,” or “what about this patient is going to burn me.”  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.

See John Bielinski Jr, MS, PA-C speak in 2018 at the Georgia Association of Physician Assistants Summer Conference July 15-19.

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