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| Originally Published in Nov/Dec 2014 Common Sense |
Naval Medical Center San Diego
As a new resident in the emergency department, I am starting to learn that serious and life-threatening conditions require rapid identification and intervention. Response time is often lengthened due to ancillary services, existing policies, overcrowding and cost of care. The most efficient emergency medicine (EM) physicians have a mental model or road map to guide them through the uncertainty of pathology. I call my EM diagnostic paradigm the Sculptor’s Compass. My mental model frames medicine as a sea of uncertainty where physicians are captains sailing through stormy conditions of disease and pain trying to avoid hitting the icebergs of death and suffering. In sailing, we reach for a compass to help aid in navigation. In this model, my schema for how to approach the undifferentiated patient is my compass. In my short time within this fast paced, quick thinking and amazingly fun field, I noticed that our paradigm in the ED is completely different than the rest of the hospital. For example, a friend who is a urology resident asked me to explain how ED personnel approach patient care. This resident couldn’t follow the thought process of consultations from the ED. I initially tried to use a metaphor of playing with a box of Legos. I said that the diagnostic process in the emergency department is a lot like assembling a structure using Lego pieces. You take data points and put them together to see which pieces fit correctly in order to build a stable structure. That logical structure will hopefully form some foundation for a reasonable diagnosis.
