Learning Diagnostic Restraint

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Abstract
Recently, I had a disagreement with a house officer over diagnostic strategies in a hospitalized patient of mine. The patient, a 73-year-old woman whom I knew well, had hypertension, long-standing poorly controlled diabetes, and hypothyroidism for which she was taking replacement thyroxine. Five years earlier she had had a stroke and had been left with a moderate disability that limited her activity to independent living in housing for the elderly and occasional visits to a senior citizens' center and family members' homes. She now presented with abrupt onset of congestive heart failure without a clear cause, which responded promptly to . . .