A patient presents to the ED with wrist pain and expresses guilt over a missed dinner. What should be your first action?

The best initial action in this scenario is to obtain an X-ray of the wrist. This choice prioritizes the assessment of the patient’s physical condition and helps identify any possible fractures or injuries that may require immediate medical attention. It is crucial to perform an initial physical examination and appropriate imaging to understand the nature of the wrist pain and to rule out serious musculoskeletal injuries, especially since the patient is in the emergency department (ED) seeking help for acute pain.

Addressing the patient’s guilt or emotional concerns can follow after ensuring their physical safety and addressing any urgent medical needs. Engaging in psychological support, such as calling the police or consulting with a psychiatric professional, is appropriate only after a thorough assessment of the patient's medical condition and the immediate physical needs have been satisfied. Thus, proceeding with the X-ray provides essential information for further management of the patient’s care.