This video by Dr Reuben Strayer of Mt Sinai Department of Emergency Medicine provides a good perspective on how the approach to a patient in the emergency department varies from that in many other settings in medicine. He contrasts the traditional ‘bottom up’ approach that has been taught in medical schools for decades with a ‘top down’ approach that focuses on the presenting complaint and addressing what the patients needs including initial resuscitation and evaluating for potentially dangerous conditions.
Our practice in the emergency department has to be different from the approach to patients in the outpatient setting by necessity. As he points out our job is not always to make a final diagnosis but instead to recognize and quickly, (ideally) cost-effectively address potentially life-threatening conditions. The challenge is often carrying out this process while also being cognisent and successful in managing patient expectations, customer satisfaction as well as patient safety.