Lakhasly

During a morning report session, I presented a case of a patient with abdominal pain and was asked to justify my differential diagnoses.For example, when evaluating a patient with chest pain, I learned to quickly assess for "can't miss" diagnoses like MI, PE, or aortic dissection before considering GERD or musculoskeletal pain. This approach helped me present more focused differentials during rounds and during oral case presentations. However, I still sometimes struggle with anchoring bias--becoming overly attached to an initial diagnosis and overlooking contradictory findings. Once, I prematurely concluded a patient had gastroenteritis, only to later discover their symptoms were due to an atypical presentation of appendicitis. This was a humbling experience that reminded me to stay open-minded and reevaluate when the clinical picture doesn't fit. To improve, I've started reviewing missed or challenging cases from our department's M&M conferences and discussing them with peers to identify cognitive pitfalls. Moving forward, I plan to incorporate more deliberate reflection into my practice, asking myself, "What's the worst thing this could be?"

During a morning report session, I presented a case of a patient with abdominal pain and was asked to justify my differential diagnoses. The attending physician pointed out that while my list of possible conditions was broad, I needed to better prioritize the most likely pathologies based on the patient’s risk factors and presenting symptoms. They advised me to focus on high-yield clinical clues and use a structured framework (e.g., VINDICATE or surgical vs. medical causes) to narrow down possibilities efficiently. They also suggested reviewing Symptom to Diagnosis by Scott Stern and practicing with case-based quizzes to sharpen my diagnostic reasoning.

I took this feedback seriously and began systematically analyzing cases by first considering the most common and dangerous causes before exploring rarer conditions. For example, when evaluating a patient with chest pain, I learned to quickly assess for "can’t miss" diagnoses like MI, PE, or aortic dissection before considering GERD or musculoskeletal pain. This approach helped me present more focused differentials during rounds and during oral case presentations.

However, I still sometimes struggle with anchoring bias—becoming overly attached to an initial diagnosis and overlooking contradictory findings. Once, I prematurely concluded a patient had gastroenteritis, only to later discover their symptoms were due to an atypical presentation of appendicitis. This was a humbling experience that reminded me to stay open-minded and reevaluate when the clinical picture doesn’t fit.

To improve, I’ve started reviewing missed or challenging cases from our department’s M&M conferences and discussing them with peers to identify cognitive pitfalls. Moving forward, I plan to incorporate more deliberate reflection into my practice, asking myself, “What’s the worst thing this could be?” and “What evidence doesn’t fit?” to combat biases and strengthen my clinical judgment.

This feedback loop has been invaluable—while I’m progressing, I recognize that diagnostic excellence requires lifelong learning and humility. I’ll continue refining my approach through repetition, mentorship, and learning from both successes and mistakes.