The casualty of a tertiary government hospital in India at 11 p.m. on a Tuesday is its own ecosystem. There are usually 12–18 patients waiting, four on stretchers in the corridor, two on the floor, one being resuscitated in the trauma bay.

The on-call resident — usually a second-year PGT in medicine — is the only doctor available for everything that is not surgical or pediatric. He is making decisions on:

The man with chest pain who has been waiting two hours
The woman with breathlessness who arrived ten minutes ago
The young man with a knife wound that the surgical resident is reviewing
The elderly woman with altered sensorium whose family is loud
The motorbike accident patient whose CT just came back
The deliberate self-harm overdose patient whose poison is unclear

He has, by his own count, made forty significant clinical decisions in the last hour. Each one had a non-trivial differential. Each one involved a phone call to the appropriate specialty senior. Each one was made on six hours of sleep and three cups of canteen chai.

This is the environment in which AI workspace tools are sometimes pitched as productivity enhancers. The pitch is misguided. The PGT in casualty does not need more productivity. He needs fewer trivial decisions.

A productivity pitch says: "Use Medows to write your notes faster." A correct pitch says: "Use Medows so that the dose calculation for the paracetamol overdose is on the screen with the patient's weight already filled in, so you don't have to do mental arithmetic on hour-twelve of a 24-hour shift."

The difference between those two pitches is the difference between a tool that adds to the resident's day and one that removes from it. The published evidence on cognitive load and decision fatigue (Pignatiello et al., J Clin Psychiatry, 2020; Tierney et al. on EHR-related fatigue) is consistent on this point. Add more decisions and the resident makes worse ones.

Casualty at 11 p.m. is the place where the decision-removal benefit of a workspace is most visible. The right pitch to the casualty resident is not "this tool will make you faster." It is "this tool will make you not have to think about this particular thing right now."