title: Medical problem solving and uncertainty in the emergency department.
abstract: OBJECTIVE
  To compare the diagnostic processes of experienced emergency physicians with those of novices.
  
  
  METHODS
  Prospective, convenience sample of patients.
  
  
  METHODS
  Emergency department of a county university medical center in a large southwestern urban community.
  
  
  METHODS
  Experienced emergency physicians (attending and senior residents) and novice clinicians (junior residents and senior medical students).
  
  
  METHODS
  Participants developed initial diagnostic impressions after reviewing the chief complaint, nurse triage notes, and vital signs. Tests were then selected, and a final diagnostic impression was identified after results were known. Clinicians also marked a visual analog scale corresponding to their estimate that each diagnostic possibility was correct.
  
  
  RESULTS
  Experienced physicians increased their certainty more than novices (P = .014). They deviated from a standard history-physical-laboratory sequence more often than novices (P = .008).
  
  
  CONCLUSIONS
  Expertise in medical decision making is characterized by a moderate initial level of certainty concerning a diagnosis that significantly increases as the experienced clinician follows a flexible strategy of testing to arrive at a final diagnosis.
authors.affiliation: Division of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque 87131.
authors.forename: D P
authors.initials: DP
authors.lastname: Sklar
authors.forename: M
authors.initials: M
authors.lastname: Hauswald
authors.forename: D R
authors.initials: DR
authors.lastname: Johnson
mesh_terms: D000046:Academic Medical Centers; D002983:Clinical Competence; D002985:Clinical Protocols / Q000592:standards*; D003661:Decision Support Techniques; D004635:Emergency Medicine / Q000379:methods* / Q000592:standards; D004636:Emergency Service, Hospital; D006801:Humans; D008487:Medical History Taking / Q000592:standards; D010808:Physical Examination / Q000592:standards; D011340:Problem Solving; D011446:Prospective Studies