Field Notes from the Difficult Diagnosis Clinic: When to Stop, When to Push, and When You’re Already Done

Overview

Through two contrasting cases from Northwestern’s Socrate Project for Difficult Diagnosis, this 30-minute session explores how to navigate diagnostic uncertainty in Primary Care: when to stop testing, when to push for the right test, and which elusive cases truly warrant referral.

Learning Objectives

• Recognize when a diagnostic workup is appropriately complete and articulate how additional testing in certain conditions can lead to harm rather than reassurance
• Apply an understanding of test characteristics to determine when a negative result is conclusive versus when to push for better or more invasive testing
• Reframe the management of medically unexplained and persistent symptoms with patients, shifting the goal from continued diagnostic pursuit toward validation and treatment
• Identify the features of an elusive case that warrant specialty or difficult-diagnosis consultation, distinguishing them from cases where the primary care workup is already sufficient