Physicians who practice emergency medicine think differently than physicians in many other specialties. We have different (1) goals, (2) clinical reasoning, and (3) expertise. These differences do not make us better or worse than other physicians; rather, they are distinctive and revealing features of our specialty that define us. In this chapter, I will explain why and how emergency physicians think differently and how those differences make our specialty unique. Decision-making in emergency medicine ultimately reflects the primary goal of the specialty: to identify and address emergent conditions in acutely ill or injured adults and children.1 Our job is to recognize emergencies and intervene accordingly. Sometimes emergencies are quite evident (e.g., gunshot wounds, cardiac arrest, hemorrhage), and our decision-making is centered on treatment options; we must consider whether to follow common algorithms, deviate from them based on unique patient characteristics, or act at all.