What defines the unique mindset of an emergency clinician? It’s not just the fast pace or the chaotic environment—it’s the deliberate, top-down thinking that prioritizes patient safety over diagnostic certainty. This approach, though deceptively simple, often flies in the face of traditional medical training, which emphasizes comprehensive differentials and exhaustive workups. In emergency medicine, knowing what the patient needs often matters more than knowing exactly what they have. In this episode, we explore the emergency medicine mindset, the pitfalls of the bottom-up approach, and why experienced clinicians focus on acute interventions and dangerous conditions. Finally, we discuss how humility and strategic communication with patients can make all the difference in mitigating risk and building trust.

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Guest bio:  Reuben Strayer is an emergency physician based in Brooklyn, at Maimonides Medical Center. He tweets @emupdates and blogs at EMupdates.com on a variety of emergency medicine topics. His clinical areas of interest include airway management, analgesia, opioid misuse, procedural sedation, agitation, decision-making, and error. His extra-clinical areas of interest include sweeping generalizations and jalapeño peppers. 

We Discuss:

• A Critique of Medical School Training and the Bottom-Up Approach
• Top-Down Approach and Ophthalmology Insights
• The 8 Responsibilities of Emergency Physicians
• The Wheel of Dangerous Conditions
• Top-Down Thinking in Practice
• Humility and Communication in Emergency Medicine

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