Almost every specialty plays to win. To nail the diagnosis. Emergency medicine (EM) is different. Emergency medicine plays not to lose. This is one of the reasons why EM is so frustrating for the House of Medicine. The mindset is completely flipped. What does “playing not to lose” mean? It’s more than the adage of think worst first. Playing not to lose prevents immediate harm or deterioration, stabilizing when you have no idea what’s causing the patient’s condition (and may never know). Do other fields share this mindset? To a degree, yes, but it doesn’t undergird their every encounter. Playing not to lose is what allows you to act as a safety net so that someone doesn’t go home and die or have a preventable adverse outcome. Will you get it wrong? There are subacute, subtle, or atypical presentations of life-threatening diseases that you will miss. That’s just a fact of the job.