Emergency medicine requires a unique approach to decision-making with a constant struggle between efficiency and thoroughness. I have heard it said in emergency medicine that “we must get the disposition right, not necessarily the diagnosis.” Disposition is an important part of our decision-making; however, we must also strive to understand the diagnosis – or potential diagnoses – and the next steps in care beyond the emergency department disposition. To achieve this, emergency physicians must strive for clinical excellence for every patient who enters the door. This takes considerable effort in the broad specialty of emergency medicine. My decision-making is influenced by my training and practice in emergency medicine and inpatient critical care. In the emergency department, I’m considering how my care influences the next management steps and what I would do after admission or discharge. This approach to decision-making takes time and continued effort to develop and maintain, but the reward is the best possible care for our patients and the respect of our colleagues.