How do Emergency Physicians Reason? A Synthesis of the Main Results from a Multicentric and Multidisciplinary Qualitative Research on Decision-Making in Emergency Medicine
Résumé
Objectives: Little is known about how emergency physicians reason in order to make diagnostic and therapeutic decisions. Yet, reasoning errors are the main cause of diagnostic errors in the context of the clinical practice. This article brings to the attention of emergency physicians and emergency medicine teachers the main results of a vast study carried out from 2010 to 2015 within a multidisciplinary team that brought together researchers from several countries. The project aimed at modeling expertise in emergency medicine. Methods: We carried out a multicenter prospective observational study based on a qualitative approach. We conducted interviews with expert emergency physicians until data saturation. The interviews focused on the recent management of an emergency situation. They were underpinned by the video recording of the situation according to the physicians' own point of view perspective. Results: The interviewed emergency physicians mainly used their intuition, forged very early on the basis of two to four clinical and contextual data. They often generate the correct diagnostic even before meeting the patient, but systematically wait for the results of the complementary examinations to be certain. They are far from being ``objective'' when they deal with data from their environment and always worry about the worst. Conclusion: The modeling of expertise in emergency medicine is likely to help practitioners and teachers to better understand the causes of decision-making errors in the field of emergency medicine.