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Having worked in busy EDs over more than three decades, I see another major factor that affects both morale and workload increasingly - it is risk aversion and fear. More and more is done to rule out less and less likely diagnoses in well-looking people, based on a single presentation to ED. ED clinicians can be crucified for "missing something" (a significant diagnosis - even if it is not time-critical) - but we are rarely held to account for the costs or harms of over-investigation or over-admission to hospital.
A huge culture change is required to return to good history taking and realistic risk-assessment, understanding that diagnosis in ED settings can never be perfect, and that trying to drive down error rates to vanishingly low levels leads to the reciprocal harms of over-diagnosis. We need to explain pathophysiology to our patients, validate their concerns, and come to a joint understanding of risk, and help patients understand that not testing does not mean not caring. Then, we need to stop the intra-professional blame that leads to clinicians taking the most risk-averse approach.