An Ode to the Differential Diagnosis

The differential diagnosis is a cornerstone of the profession of medicine which epitomizes physicians’ critical thinking skills. It is not an antiquated tradition of by-gone eras. The practice of medicine has been positively impacted in the past century by revolutionary scientific advancements, standardization of medical education, and transformative societal changes. Its overlap has provoked some unfavorable changes in the practice of medicine with the business of health care. The differential diagnosis must not be relegated to the trash pile of history.

Learning how to develop differential diagnoses is a critical and unique feature of medical education. Medical students start as generalists and are thought to initially think through broad possibilities, which is why they often list rare conditions on their differentials. Although rare diagnoses are unlikely to be present based purely on epidemiology, the “zebras” must not be discounted. We cannot diagnose what we do not consider. We cannot consider what we do not remember or even know exists. This is one of the many reasons why precepting medical students is mutually beneficial to teacher and student. Ideally, the evolving physician feels renewed by working with medical trainees, occasionally humbled by patients, and is able to learn from both.