6 Responses to “The Death of Critical Thinking in Emergency Medicine”

1. 

   January 5, 2025

   Norman Borlaug Reply

   Is there a reference list for this article? The author makes what would be some excellent points, but without any citations it reads like an alarmist screed devoid of any supporting evidence about practice concerns that may only exist within the author’s system and/or may not be generalizable outside of Texas.

2. 

   January 19, 2025

   Paul Robinson MD, PhD Reply

   In my experience, this article is spot on. I have worked in emergency departments in Florida in which the physicians did not take histories or do physical exams. These critical endeavors were the bailiwick of the nursing staff. The physicians spent their time at desks following protocols and writing admitting orders on patients they did not understand. Their primary responsibility was to assure that data collection proceeded as the nursing and administrative staff dictated. Thus do physicians become glorified clerks.

3. 

   January 19, 2025

   Ian Staker Reply

   “Emergency departments will become conveyor belts of impersonal care, churning out treatments.”

   I wholeheartedly agree with the author, but sadly the ship has sailed on this one. My department (staffed by a medium sized democratic group) has a chest pain pathway. If I deviate from it and a patient has a bad outcome, I guarantee the first question raised in any peer review or lawsuit will be “does your department have a pathway for chest pain, and if so, did you follow it?”

   So 25 year olds with chest pain get blanket troponin testing and anyone over age 50 with chest pain gets a d-dimer. Patient suffer, and emergency medicine loses its soul.

4. 

   January 19, 2025

   Ricardo Martinez Reply

   I appreciate Dr Baker’s thoughts; we don’t want to be cogs in a machine and yes, critical thinking is very important. He may not remember why we rebuilt emergency medical care for time-sensitive conditions.

   EM docs used to be the highest-paid ward clerks in the hospital – calling the cardiologist on call, for example, to see how they wanted to handle an MI that we diagnosed. Our job was to call for and assemble the resources. Cardiology would come to the ED when they got around to it. It took hours.

   Each cardiologist also felt that clinical pathways/protocols were terrible, and each sought to make independent, autonomous decisions for EM to carry out. It was frustrating at best, with delays and constant variation. It was also not evidence-based.

   There aren’t 40 “best ways” to care for stroke, MI, asthma, etc. so we learned to put aside our desire for autonomy and instead act as a team focused on the patient. Putting that approach in place has improved the timeliness and effectiveness of care. Everyone knows the game plan, and resources come to the patient or are available in a timely manner. The EM physician is the Captain of the ship until handed off

   Similarly, it used to be that emergency physicians in the same ED each cared for patients differently, according to varied training and personal preferences. Patients with similar conditions had highly varied workups and treatments changed every shift depending upon who was working.

   I appreciate Dr Baker’s thoughts on ensuring that EM physicians retain and apply critical thinking and remind our colleagues that we developed evidence-based pathways and protocols with intention. If there are reasons to deviate, then that is a professional obligation and under the purview of the EM physician.

5. 

   January 19, 2025

   Matthew Lipton Reply

   Excellent article. I fully agree!! This lack of critical thinking is leading to the insane overuse of CT scans too.

6. 

   January 20, 2025

   Thomas H. Matese Jr Reply

   Dr. Baker, as an EM residency PD I could not agree with you more, anecdotal evidence as it may be….However, in our program we spend considerable time and effort teaching our learners the curriculum of critical thinking and clinical reasoning so as to prepare them for those times when the electricity goes out and they have to “sink to the level of their training”!