The Emergency Mindset: What Med School Got Wrong

01/27/25 • 28 min

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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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Scripts for your least favorite conversations. The quick and dirty guide to calling consults. A 10-minute "Driveway Debrief" to switch off from work. My favorite documentation templates. Step-by-step guide for delivering the news of death.

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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

Mentioned in this episode:

5 Free Tools To Make Medical Practice Easier

Free Resources Link

The UnBurnable Course

Career Longevity. Self Mastery. Anti-Burnout. Next cohort begins Sept 2025.

The UnBurnable Course

Doctoring Done Well | Bite-Sized Wins

Every other week, a few minutes of career-elevating insight delivered straight to your inbox. The Doctoring Done Well Newsletter is never lame, never spammy, and always fresh.

Previous Episode

Nonverbal Communication | From facial expressions to tonal authority

Mastering nonverbal communication can be an elusive task, but the fact remains: what’s unsaid leaves a significant footprint in any interaction. Nowhere is this more palpable than in the medical exam room, where trust and connection between physicians and patients often hinge on subtle, nonverbal cues.

So, how can one build trust through facial expressions and tone of voice alone?

In this episode, we break down how to silently establish rapport, effective use of pauses, the curious role of your eyebrows, impact of end-of-sentence inflection, how to convey uncertainty with confidence, and why learning a patient’s eye color can pay dividends.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

Guest bio: Bradley Block, MD, is a private practice otolaryngologist on Long Island, New York, where he lives with his wife and three young sons. He is a partner at ENT and Allergy Associates and creator of the Physician’s Guide to Doctoring Podcast. He realized that rapport was the key to gaining trust, seeing patients efficiently, enjoying his practice, and building his reputation. He tried to find a podcast that would help him improve at doctor-patient communication, but there was none, so he created Physician’s Guide to Doctoring! The topics quickly expanded to “everything we should have been learning while we were memorizing Kreb’s Cycle.”

We Discuss:

The "Interest and Authority" Framework for Nonverbal Communication
Facial Expressions: Conveying Interest
Humor and Likability in Patient Interaction
Making Eye Contact and Noticing Eye Color
Attitude and Authority in Patient Care
Effective Communication Techniques
Addressing Patient Concerns and Fears

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Next Episode

The Upset Patient Protocol

Dealing with an angry, upset patient can feel like walking into an emotional storm. The frustration in the room is palpable, and even the most experienced clinicians can feel thrown off balance. While medical training equips us to handle complex diagnoses and emergencies, it often falls short when it comes to managing interpersonal conflict. That’s where the Universal Upset Patient Protocol comes in—a straightforward, highly effective framework designed to de-escalate tense situations, restore trust, and protect your own emotional bandwidth. In this episode, we explore Dr. Dike Drummond’s original protocol, breaking down each step with specific language to use in the heat of the moment. Finally, we’ll add a few practical tweaks to help make these conversations even more natural and effective in real-world practice.

💡 Check out our Free Resources specifically designed to address pain points in medical practice💡

Guest Bio: Dike Drummond, MD, is a physician coach, burnout prevention expert, and creator of the Universal Upset Patient Protocol—a step-by-step framework for managing challenging interactions with upset patients. A former family physician, he transitioned to coaching to address the emotional toll of healthcare on providers. As founder of TheHappyMD.com, he’s helped thousands of physicians improve communication, manage stress, and build healthier professional relationships.

We Discuss:

The Universal Upset Patient Protocol: A Framework for Diffusing Conflict
Key Principle: Acknowledgment Over Fixing
Step 1: Acknowledge the Vibe and Name the Emotion
Step 2: Open the Door for Them to Speak
Step 3: Apologize and Show Compassion
Step 4: Identify Their Need
Step 5: Clarifying Reflection (Rob O Addition)
Step 6: Set Boundaries and Expectations
Step 7: Express Gratitude
Beyond the Protocol: The Magic of Conflict Framework

Mentioned in this episode:

5 Free Tools To Make Medical Practice Easier

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Every other week, a few minutes of career-elevating insight delivered straight to your inbox. The Doctoring Done Well Newsletter is never lame, never spammy, and always fresh.