1. Typical diseases never present typically & atypical diseases will only present when you don't suspect them.
2. You'll never be sued for good communication with the staff or your patients.
3. a. Lacerations always cut through tendons, nerves and arteries until proven otherwise.
   b. Chest pains are cardiac until proven otherwise.
   c. Headaches are subarchnoid hemorrages until proven otherwise.
   d. Serious illness is present until proven otherwise - that's why we call it Emergency Medicine.
4. Specialists are always awake at 3 am. Remember to call them for consultations.
5. Patients who return to the ER after visiting earlier in the day usually have something seriously wrong. A "bounce back" is a red flag.
6. Always talk to everyone - nurses, paramedics, family. They're great information sources in the search for the truth about what occurred or why the patient's there.
7. Patients are usually quite smart about their own diseases. Give them the benefit of the doubt - and believe what they say.
8. When in doubt, admit the patient.
9. Senior citizens are always sicker than they appear or state.
10. Teenagers are always pregnant and usually will deny it until asked three times.
11. If you think of doing a particular test - Do It. You'll regret not having done it later that night when you go home - and the worry just isn't worth it.

* The above work by John Levin, M.D., Emergency Medicine & Family Practice, was provided by the Technical Assistance Bureau, Inc.

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