This ability to separate the wheat from the chaff is an essential skill for emergency physicians, and it improves with time.

Residents will occasionally ask me why I did a thorough work-up on one patient and discharged what seemed to be a similar patient with a lesser evaluation. Sometimes the explanation is clear and other times I can’t completely put my finger on the reason.

I wonder how many well patients one needs to see in training to become adept at discerning who is sick and who is not. If you boil it down, this is essentially our purpose in life. I’d like to think that it is 3 years, but it’s probably longer than that. A lot of learning goes on during those first few years out of residency.

The art of it is being able to tell a mother that her teenager does not have meningitis without spending $3,000 in the process. After all, anyone can order a bunch of tests on every patient who comes in. There is no skill in that. The art and skill is seen in reaching a conclusion with the minimum of testing and poking.

There was a time when a seasoned emergency physician could lay his hand on the abdomen of a 25-year-old man at 4:00 in the afternoon and then call a seasoned surgeon to tell him that the patient will be hydrated and ready for an appendectomy by the time he is done with his office hours.

This is the quiet competence of emergency physicians that often goes unnoticed by patients, nurses, and other doctors. It is the ability to tell a patient with confidence that she has renal colic and that she does not need another CT scan to prove it. It is the expertise to tell a young man that his cough is due to a virus and that a chest radiograph and a blood count will alter your treatment plan little.

This underappreciated talent will probably always be thus. What you don’t do will rarely get noticed. This is not on the Press Ganey radar, nor will it ever be. Just keeping going with your quiet competence, leave them with a smile and good discharge instructions, and be happy that you did your job well.

Dr. Baehren lives in Ottawa Hills, Ohio. He practices emergency medicine and is an assistant professor at the University of Toledo (Ohio) Medical Center. Your feedback is welcome at David.Baehren@utoledo.edu.