Sick Or Not Sick? An Essential EP Skill

A new series is here on the EMBER Project and a new educational tool. Check out the post below for both! And don’t forget to take the quiz when you’re done.


One of the toughest challenges in medical education is identifying and articulating the intangible skill set that is essential to every practicing physician.

A key skill required for working in a busy Emergency Department is the ability to rapidly assess whether or not the patient in front of you is sick. Is it the elderly patient with an acute change in mental status or the chest pain patient with diaphoresis? We are required countless times a day to hone in rapidly on the potentially sick patient based on a panoply of subtle and often intangible cues. Over time we become so good at it that a patient who simply has “that look” rolling by on a gurney is often all that is required to get us running to the bedside (that’s a figure of speech, no running please, it makes us EPs nervous).

We also ask residents to learn the “sick or not sick” skill. In the ACGME educational milestones it is a cornerstone of competency. But do we really teach this skill or is it another one of those intangibles that we imagine only trial and error and experience will provide? I often ask talented colleagues how they make the call of sick or not sick and find they have trouble articulating what goes into their almost instantaneous decision-making process.

The “Sick or Not Sick” series is a set of posts designed to elucidate what goes into honing this key skill. To help those learning it bypass some of the trial and error, and make tangible those things that experienced EPs do on a daily basis without articulating it.  I’ve decided to go in reverse order so the first one of three is really the last one “surviving discharge”


sick-or-not-sick-safe-discharge-education-presentation-odIeAdSMLx

Click to go to the educational content

Culled from a recent qualitative analysis of patients who died within seven days of discharge from the ED, the moment of discharge is often a final opportunity to “get it right”. Many of the identified risk factors will be familiar to experienced physicians; some may be new and warrant integration into your practice. Either way, in a world of hospital overcrowding, inpatient service pushback on admissions, and pressures to make patients happy in the face of long delays its nice to have some evidence supporting what you already know is right.


The EMBER

Qualitative Factors in Patients Who Die Shortly After Emergency Department Discharge

New Educational Tools

Haiku Deck.  Make your knowledge more accessible, more visual, and more learner focused.  I’m a fan, and this platform will be highlighted at our upcoming Innovation in Education Theme Day  at NYPEM

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