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

INTRODUCTION: 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. AIM: 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. DESCRIPTION: 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. DISCUSSION: 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.