Author: James G. Adams, MD (Professor and Chair, Department of Emergency Medicine, Northwestern University) // Editors: Alex Koyfman, MD (@EMHighAK) and Manpreet Singh, MD (@MPrizzleER)

Having had the opportunity to work alongside skilled emergency physicians and contribute to the training of students and residents, I have had the pleasure of observing the way that great emergency physicians think and behave. Described below are the frameworks and habits that appear to be common.

Pattern Recognition and Automaticity

The emergence of expertise in emergency medicine appears to be coincident with the development of strong, automatic recognition and response to identifiable patterns. When a 60 year-old patient complains of chest pain, or a young pregnant woman reports nausea/vomiting, or even when a person passes out, an almost instinctive framework of thought and action is called into action. Each chief complaint and triage note seems to call up a mental model that creates an initial presumption or set of likely diagnostic possibilities and treatment interventions. At the same time that the EP begins action, experienced EP also knows that pattern recognition alone is just a start. Pattern recognition is insufficient, even potentially dangerous since it could lead to a seemingly satisfactory but insufficient or frankly incorrect conclusion. So the EP continues to search for additional information, whether confirmatory or contradictory. Whether a patient presents with a fever and altered mental status, a tearing chest pain of sudden onset, or even major depression/suicidal thoughts, the EP has a core initial frame that may trigger actions but not a conclusion. The patient with fever and body aches might have a viral illness, but they might also have Lyme disease or, even more worrisome, the rare case of Ebola Viral Disease in the United States. The EP is vigilant for both typical diseases and also rare disorders. The experienced EP recognizes the common patterns but has extended fund of knowledge, training, and experience to not rely too heavily on them.

If you are interested in reading the rest of this and other EM Mindset pieces, please see “An Emergency Medicine Mindset,” a collection evaluating the thought process of emergency physicians. This book is available as ebook and print on Amazon.