Taking the stress out of morning report: an analytic approach to the differential diagnosis

Morning report is a traditional core teaching session in most departments of internal medicine where learners present cases to a facilitator who uses the material to teach clinical reasoning. It instills fear in both learners and teachers because they may embarrassingly miss diagnostic possibilities including even the actual diagnosis.

The two teaching tips described here enable the learner and the teacher to fall back on a routine approach to arriving at a differential diagnosis list.

The first tip describes how to elicit the ten "focal findings" in the case that best summarize the data used to derive a diagnosis list. The second tip describes a matrix of etiologies and systems that can be used to generate the diagnostic probabilities.

This approach is easy to teach and, where all else fails when coming up with a diagnosis, can be used to prompt the discussion of what is wrong with the patient.