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Write Lighthouse Pearls
One insight in clinical reasoning, drawn from the book. A new pearl every Friday.

The chair is a diagnostic instrument.
The most underused instrument in medicine isn't in the supply room. It's the chair. Pull one to the bedside, sit at eye level, ask an open question, and wait through the silence. Patients hand a seated clinician the detail they never volunteered standing up — the medication they quietly stopped, the symptom they were embarrassed to mention, the thing that reframes the whole case. Most diagnostic error isn't a knowledge gap. It's attention, cut short. Sitting down is the cheapest countermeasure we have.

What would make this not what I think it is?
The first diagnosis arrives early, feels right, and quietly begins to defend itself. That sense of a finished story is the most dangerous moment in a workup. So ask the one question the story doesn't need in order to make sense: what would make this not what I think it is? A blood pressure in the other arm. Whether this pain resembles anything the patient has felt before — something that costs almost nothing and changes everything when the answer is the one you weren't expecting. Ask it especially when the case feels settled. Especially then.your text here...