Can first impressions predict patient outcomes?

In time-pressured environments or triaging situations, the clinician's first impression is important for efficient resource utilization, prompt initiation of treatment, and prediction of patient outcomes. A doctors’ first impression is their immediate, intuitive, and often subconscious “gut feeling” during their first encounter with a patient; it often cannot be explained. In the emergency department (ED) it is essential to quickly distinguish the “sick” from the “not sick” patient, a decision based on both intuition and reasoning. This is especially relevant for patients who cannot give a succinct history or have vague or multiple chief complaints. Emergency physicians work in time-pressured and resource-limited environments. As a result, emergency medicine is shifting toward having more trained emergency physicians involved in the triage process. These triage situations demand accurate first impressions to drive decision making regarding disposition and ultimately better resource utilization. Despite many clinicians reporting that they are able to “intuitively” recognize a sick patient, there is limited empirical evidence validating this. The role of heuristics and clinical intuition have been studied in the nursing environment, but little research is available from emergency medicine providers. This systematic review therefore aimed to synthesize the current literature on physicians’ accuracy of predicting patient outcomes based on their initial first impression. Furthermore, it aimed to amalgamate the paucity of literature in this area, to create a reference point which future studies can use when designing interventions and tools to assess first impression and its impact on patient outcomes.