You have chosen to work in modern medicine's crucible; the land dubbed by Sir Edwin Leap as"Emergistan". Here your (and your patients) survival depends on quick, organized, thinking with concrete, clear, goals while paying attention to the "third order consequences" of your decisions. Master this rather than "protocolitis" to speed decision making, improve ED throughput, and promote patient safety. Guidelines, true evidence-based guidelines will always be useful as they represent the cumulative experience of thousands of doctors, patients, and research. Unfortunately there is no guideline will save you in unique situations or from the patient who hasn't read your guideline when they present.