In this episode of Med Student Over Easy, Patricia, is joined by EM Over Easy hosts Tanner and Drew, as well as long time guest of the show, Geoff Comp to tackle one of the most fundamental—and sometimes daunting—skills for students in the emergency department: determining if a patient is sick or not sick. While it sounds simple, this decision-making process is crucial, as it sets the tone for triage, management, and escalation of care. Check out this conversation where our team discusses key strategies for building this skill as a medical student and how to start trusting your clinical instincts.
First Impressions Matter
The very first moment you see a patient gives you important clues. Take a second before asking questions to simply look, listen, and feel. Is their skin diaphoretic? Are they gasping for air or moving little air at all? Are they altered or unresponsive? Subtle findings like tachycardia, hypotension, or tachypnea can also signal hidden instability. The key question is: Can I stop and ask questions, or do I need to act right away? It’s usually obvious when a patient rolls in by EMS in extremis, but the nuanced cases—like an obtunded patient who might have a critical exacerbation of a chronic disease—are where careful observation matters most. Trust your gut when something feels off and alert your team quickly when needed. With practice, your instincts will sharpen, and you’ll feel more confident in doing so.
Speak Up, Even If You’re Unsure
If you ever think a patient looks sick or something doesn’t add up, you must speak up—whether you are a student, a resident, or even an experienced physician. It doesn’t matter if you’re wrong; what matters is that you advocate for the patient. Don’t worry about looking “dumb”—emergency medicine is about acting quickly when needed. If you think a patient is critically ill, let your attending or senior resident know immediately, even if you haven’t gathered a full history. Also, remember that nurses are often the first to pick up on subtle changes—if they seem concerned, pay close attention.
Practice Makes Permanent
Learning “sick or not sick” comes through repetition and experience. Each patient encounter gives you new data points to build your clinical intuition. Over time, you’ll get faster at picking up on subtle cues and making judgment calls about who needs urgent attention. A good habit to develop early is asking yourself: Do I think this patient will be admitted? If you can explain why, you’re starting to think the right way. Remember, it’s not about whether a patient has multiple visits for chronic conditions—it’s about recognizing if this visit represents a critical turning point. Seek feedback often: if you’re wrong, use it as a learning moment; if you’re right, you gain valuable confirmation. The goal is not perfection—it’s building sharp instincts through consistent practice.
Take Home Points
- First impressions during your initial patient encounter are powerful and worth trusting.
- Never downplay a patient’s condition, especially if you are unsure!
- The skill of recognizing sick versus not sick develops over time—stay curious, ask questions, and practice consistently.
Post by Mikaela Brown
About Our Guest:
Assistant Program Director, Creighton University School of Medicine/Maricopa Medical Center (Phoenix) Emergency Medicine Residency
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