Decision Making; Roadside to Resus

The Resus Room

Simon Laing

Medicine, Science, Health & Fitness

4.9 • 708 Ratings

🗓️ 16 March 2026

⏱️ 45 minutes

🔗️ Recording | iTunes | RSS

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Summary

Decision making sounds like a slightly academic, niche topic… but in reality, it sits underneath every single thing we do in emergency and pre-hospital care. Every patient contact, every test we order, every treatment we start and every one we choose not to – is a decision made in an environment that is time critical, information-light and full of uncertainty.

In this episode we take a step back and look at how we actually make decisions at the front door and on the roadside. We talk about why the importance of the decision really matters, not just whether a diagnosis is possible, but how severe it is, how common it is, and whether finding it will genuinely change what we do for the patient. We explore pre-test probability and prevalence, and why knowing how often a condition really occurs in the group of patients in front of you is one of the most powerful tools in emergency medicine.

We then move into testing. What actually counts as a test? It's not just bloods, scans and ECGs. It's how someone looks, how they move, what hurts when you examine them and how the story fits together. From there, we build into likelihood ratios and Bayesian thinking; how a piece of information should genuinely shift your estimate of risk, rather than just making you feel more or less comfortable.

We also tackle test and treatment thresholds; the idea that there are times when we should stop chasing a diagnosis, and times when the probability is high enough that we should treat without waiting for more tests. Finally, we bring all of this back to real life, with human factors, competing priorities and the reality that sometimes the technically "correct" decision isn't the best decision in that moment.

This one is all about becoming more comfortable with uncertainty and making better decisions because of it.

Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon, Rob & James

Transcript

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0:00.0	Welcome to the Recess Room podcast.
0:03.5	Five, four, three, two, one, fire.
0:12.2	So hi, and welcome back to the Reeser Room podcast.
0:15.6	I'm Simon Lang.
0:17.0	I'm Rob Fenwick.
0:18.2	And I'm James Hayes.
0:19.5	And we're back with another roadside to resus and this time on a topic which I am really excited about and that is decision making.
0:30.2	I'm pretty pleased with covering this to be honest Simon because you have gone on about this topic for quite a long time but I'm a bit bit nervous, to be honest, because if we're having
0:37.6	to think about thinking, that means that I've got to have a look inside the mind of you and Rob, and that's making me nervous. That's a deep, dark place, mate. It's a nice place to visit, but you don't want to spend any long time, maybe. Let's face it. I think this is a great topic. I mean, I know you've been focused on it for ages, Simon.
0:52.3	It's one of your absolute love topics, isn't it?
0:55.2	It's brilliant.
0:55.8	But this is absolutely critical because, I know you've been focused on it for ages, Simon. It's one of your absolute love topics, isn't it? It's brilliant. But this is absolutely critical because, you know,
0:58.0	decision making is literally every minute of every shift that we're in contact with patients. It is
1:03.1	absolutely critical to everything that we do out there in practice. And not only that, it is
1:08.8	also one of my favourite things. I love to quiz my trainees about understanding why they're making the decisions that are making because it has such a knock on effect. So this is going to be a great episode. I've really enjoyed the preparation for this one and I'm really looking forward to the record. So I just, come on, man. Let's get cracking on this bad boy. Yeah, I mean, anything that involves a graph and a Fagin's
1:27.6	nomograms. Oh, don't. Absolutely peak podcasting. It's too early to break out the Fagin's
1:32.7	nomogram. Leave the easers in gently. All right, okay. Well, before we get into it, once again,
1:39.4	a huge thanks to Zol Medical Corporation for collaborating with us on the podcast and making this all free
1:46.0	open access and available to you in their pursuit of excellent patient care. And once again,
1:52.3	once you've listened to the podcast, go over to the website at the recessroom.com.uk and fill in
1:57.6	the MCQ that's there to get your CPD certificate for listening.
2:02.4	And just to clarify, because a few people ask,
	...

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