Scenario Analysis: This scenario is professionally challenging because it involves a critical decision under pressure with potentially life-or-death consequences. The physician must balance the immediate need for intervention with the potential risks associated with using emergency equipment and medications, especially when the patient’s condition is rapidly deteriorating and definitive diagnostic information is limited. The ethical imperative to act to preserve life must be weighed against the principle of non-maleficence, ensuring that interventions do not cause undue harm. Adherence to established medical guidelines and the physician’s scope of practice are paramount. Correct Approach Analysis: The best professional practice involves a rapid, systematic assessment of the patient’s airway, breathing, and circulation (ABC) to identify immediate life threats. Based on this assessment, the physician should then consider the most appropriate, evidence-based emergency interventions, including the judicious use of emergency medications and equipment, while simultaneously initiating efforts to obtain further diagnostic information and prepare for advanced care. This approach prioritizes immediate life support, aligns with established emergency medical protocols, and reflects the physician’s duty of care as outlined by the Medical Council of Canada’s ethical guidelines, which emphasize acting in the patient’s best interest and utilizing available resources effectively and safely. Incorrect Approaches Analysis: Administering a broad-spectrum antibiotic without a clear indication of infection or considering potential contraindications fails to adhere to the principle of evidence-based medicine and could lead to adverse drug reactions or contribute to antimicrobial resistance. This approach bypasses essential diagnostic steps and risks treating a symptom without addressing the underlying cause, potentially causing harm. Initiating immediate chest compressions and defibrillation without confirming the presence of a shockable rhythm or pulse is a deviation from standard resuscitation protocols. While rapid intervention is crucial, it must be guided by objective assessment to avoid unnecessary and potentially harmful procedures. This approach disregards the need for accurate rhythm interpretation, a fundamental aspect of advanced cardiac life support. Delaying any intervention until a definitive diagnosis is established, even in a rapidly deteriorating patient, violates the ethical obligation to provide timely care and potentially save a life. The principle of beneficence requires acting to alleviate suffering and preserve health, which may necessitate intervention based on a strong clinical suspicion and the patient’s critical state, even if all diagnostic pieces are not yet in place. Professional Reasoning: Professionals should employ a structured approach to emergency situations, often guided by algorithms like the ABCDE assessment. This involves prioritizing interventions based on the severity of the patient’s condition, utilizing available resources efficiently, and continuously reassessing the patient’s response to treatment. Decision-making should be informed by current medical knowledge, institutional protocols, and ethical principles, with a focus on minimizing harm while maximizing benefit.

Scenario Analysis: This scenario is professionally challenging because it requires the physician to navigate potential cultural misunderstandings that could impede accurate history taking. The patient’s reluctance to disclose certain information due to cultural beliefs about privacy, family involvement, or the nature of illness presents a significant barrier to obtaining a comprehensive medical history, which is fundamental for diagnosis and treatment. Failure to address these cultural nuances can lead to misdiagnosis, inappropriate treatment, and erosion of patient trust. Careful judgment is required to balance the need for information with respect for the patient’s cultural background. Correct Approach Analysis: The best professional practice involves actively seeking to understand the patient’s cultural perspective and adapting the history-taking approach accordingly. This includes creating a safe and non-judgmental environment, using open-ended questions, and being attentive to non-verbal cues. When faced with reluctance, the physician should gently inquire about any concerns the patient might have regarding the questions or the process, framing it as a desire to provide the best possible care. For example, asking, “Is there anything about my questions that makes you uncomfortable, or any way I can ask them that would be more helpful for you?” demonstrates respect and opens the door for the patient to articulate their cultural reservations. This approach aligns with the ethical principles of beneficence (acting in the patient’s best interest by obtaining accurate information) and respect for autonomy (honouring the patient’s values and beliefs). It also reflects the principles of culturally competent care, which emphasizes understanding and responding to the cultural and linguistic needs of patients. Incorrect Approaches Analysis: One incorrect approach is to proceed with a standard, direct questioning method without acknowledging or exploring the patient’s potential cultural reservations. This fails to recognize that cultural norms can significantly influence how individuals communicate about their health. It can be perceived as insensitive and may cause the patient to withhold crucial information, leading to an incomplete and potentially inaccurate medical history. This approach violates the principle of respect for persons by not making a reasonable effort to understand and accommodate the patient’s cultural context. Another incorrect approach is to assume the patient is being uncooperative or untruthful without further investigation. This judgmental stance can immediately damage the physician-patient relationship and create an adversarial dynamic. It overlooks the possibility that the patient’s behaviour is rooted in cultural practices or beliefs, not in a lack of willingness to engage in their healthcare. This approach is ethically unsound as it lacks empathy and fails to uphold the duty of care, which requires a compassionate and understanding approach to patient interactions. A further incorrect approach is to dismiss the patient’s reluctance as unimportant and to focus solely on obtaining the necessary medical facts through persistent, direct questioning. While obtaining a complete history is vital, the method used must be respectful and culturally sensitive. Ignoring the patient’s discomfort or perceived barriers can lead to a superficial understanding of their health status and may alienate the patient, making them less likely to seek future medical care. This approach prioritizes the physician’s agenda over the patient’s experience and cultural dignity. Professional Reasoning: Professionals should employ a patient-centred approach that prioritizes building rapport and trust. When cultural factors appear to be influencing communication, the decision-making process should involve: 1) Active listening and observation to identify potential cultural barriers. 2) Gentle, open-ended inquiry to understand the patient’s perspective and concerns. 3) Collaborative adaptation of the history-taking strategy to accommodate cultural needs while still striving for comprehensive information. 4) Seeking clarification and confirmation from the patient about their understanding and comfort level throughout the process. This iterative process ensures that care is both effective and respectful.

This scenario is professionally challenging because it requires the physician to balance the need for comprehensive risk assessment with the patient’s right to privacy and autonomy. Obtaining accurate and complete information is crucial for effective medical care, but the method of inquiry must respect the patient’s comfort and trust. The physician must navigate the potential for a patient to feel interrogated or judged, which could lead to withholding vital information. The correct approach involves using open-ended questions initially to encourage the patient to share information freely and in their own words. This allows the physician to gain a broader understanding of the patient’s situation, including their perceptions, concerns, and any factors they deem relevant to their health. This method aligns with ethical principles of patient-centered care and the principles of good medical practice, which emphasize building rapport and trust. Specifically, the Canadian Medical Association (CMA) Code of Ethics and Professionalism emphasizes the importance of effective communication and respecting patient autonomy, which is best facilitated by allowing patients to express themselves without undue constraint. Open-ended questions empower patients to direct the conversation to areas they feel are most important, fostering a collaborative approach to risk assessment. An incorrect approach involves immediately resorting to a series of closed-ended questions. This can make the patient feel like they are undergoing an interrogation rather than a consultation. It limits the patient’s ability to elaborate on their experiences or concerns, potentially leading to missed diagnostic clues or an incomplete understanding of the risk factors. This approach can undermine the physician-patient relationship and may violate the spirit of respectful communication advocated by professional medical bodies. Another incorrect approach is to make assumptions about the patient’s risk factors based on limited information or stereotypes. This is ethically unsound and can lead to biased assessments and inappropriate care. Professional medical practice, as guided by regulatory bodies like the College of Physicians and Surgeons of Ontario (CPSO), mandates that risk assessments be based on objective information gathered through thorough history-taking and examination, not on preconceived notions. The professional reasoning process for similar situations should involve a tiered approach to questioning. Begin with broad, open-ended inquiries to establish context and encourage patient disclosure. As the assessment progresses, strategically employ closed-ended questions to clarify specific details or confirm information. Throughout the process, maintain a non-judgmental and empathetic demeanor, continuously assessing the patient’s comfort level and adjusting the questioning style accordingly. This iterative process ensures that the risk assessment is both thorough and respectful of the patient’s dignity and autonomy.

Scenario Analysis: This scenario is professionally challenging because it requires the physician to balance the patient’s immediate concerns with potentially life-altering underlying conditions that may not be immediately apparent. The patient’s presentation of vague symptoms, coupled with a history of non-adherence and a lack of detailed information, necessitates a thorough and systematic approach to risk assessment to ensure patient safety and provide appropriate care, adhering to the principles of the Medical Council of Canada’s (MCC) ethical guidelines and professional standards. Correct Approach Analysis: The best professional approach involves a comprehensive and systematic risk assessment that prioritizes gathering further information while ensuring immediate safety. This includes a detailed history, targeted physical examination, and consideration of relevant investigations. This approach aligns with the MCC’s emphasis on thorough patient assessment, the importance of a detailed history in identifying potential red flags, and the physician’s duty of care to investigate symptoms appropriately. It acknowledges that initial presentations can be misleading and that a structured approach is crucial for accurate diagnosis and management, preventing potential harm from missed diagnoses. Incorrect Approaches Analysis: One incorrect approach involves dismissing the patient’s symptoms due to the perceived lack of severity or the patient’s history of non-adherence. This fails to uphold the physician’s duty of care, as all patient complaints must be taken seriously and investigated appropriately, regardless of past behaviour. It also risks overlooking serious underlying conditions, which is a direct contravention of ethical obligations to provide competent and diligent care as outlined by the MCC. Another incorrect approach is to immediately initiate aggressive, broad-spectrum treatment without a clear diagnostic hypothesis or sufficient information. This is professionally unacceptable because it can lead to unnecessary interventions, potential side effects, and can mask or delay the diagnosis of the true underlying problem. It deviates from the principle of evidence-based medicine and responsible resource utilization, which are implicit in MCC standards. A further incorrect approach is to rely solely on the patient’s self-reported symptoms without further probing or objective assessment, especially given the history of non-adherence. This approach is insufficient as it does not account for the possibility of the patient misunderstanding their symptoms, omitting crucial details, or having a condition that is not fully appreciated by them. It bypasses the critical step of clinical correlation and objective evaluation, which is fundamental to medical practice and the MCC’s expectations of thoroughness. Professional Reasoning: Professionals should employ a structured approach to patient assessment, beginning with a detailed and open-ended history, followed by a targeted physical examination. When red flags are identified or suspected, a systematic approach to differential diagnosis and investigation is paramount. This involves considering the patient’s entire clinical picture, including their history, current presentation, and any relevant social or behavioural factors, while always prioritizing patient safety and well-being. The decision-making process should be iterative, allowing for adjustments based on new information gathered during the assessment and investigation phases.

Scenario Analysis: This scenario is professionally challenging because it requires the physician to balance the patient’s immediate discomfort and desire for a quick solution with the ethical and regulatory obligation to conduct a thorough risk assessment. The patient’s insistence on a specific treatment, without a comprehensive understanding of their medical history or potential contraindications, presents a conflict between patient autonomy and physician responsibility for safe and effective care. The physician must navigate this by gathering essential information while respecting the patient’s concerns. Correct Approach Analysis: The best professional practice involves a systematic approach to patient history taking that prioritizes risk assessment. This begins with open-ended questions to understand the patient’s chief complaint and their perception of the problem. Crucially, it then moves to gathering a comprehensive medical history, including past medical conditions, allergies, current medications, and family history, as well as social history relevant to health. This structured approach ensures that all potential contributing factors and contraindications are identified before any treatment decisions are made. This aligns with the principles of good medical practice and the ethical duty to provide care that is both safe and evidence-based, as expected by regulatory bodies like the Medical Council of Canada, which emphasizes comprehensive patient assessment. Incorrect Approaches Analysis: One incorrect approach involves immediately prescribing the medication the patient requests without a thorough history. This fails to meet the regulatory and ethical standard of care by potentially overlooking serious underlying conditions, drug interactions, or allergies that could lead to adverse events. It prioritizes patient demand over patient safety and a proper diagnostic process. Another unacceptable approach is to dismiss the patient’s request outright and refuse to discuss treatment options without first understanding their medical background. While caution is necessary, a complete refusal without attempting to gather relevant history can be perceived as dismissive and may erode the patient-physician relationship, hindering future care. It fails to acknowledge the patient’s concerns and engage in shared decision-making after appropriate assessment. Finally, focusing solely on the immediate symptom without exploring broader health factors is insufficient. While addressing the chief complaint is important, neglecting to inquire about other medical issues, medications, or lifestyle factors means the physician is not performing a complete risk assessment, which is a fundamental requirement for responsible medical practice. Professional Reasoning: Professionals should approach patient encounters with a framework that begins with establishing rapport and understanding the patient’s primary concern. This is followed by a systematic and comprehensive history, including a review of systems, past medical history, medications, allergies, family history, and social history. This information forms the basis for a differential diagnosis and a tailored risk assessment. Treatment decisions should then be made collaboratively with the patient, based on this thorough assessment and in accordance with established medical guidelines and ethical principles.

This scenario presents a professional challenge due to the inherent uncertainty in assessing risk for a patient with a complex medical history and potential for rapid deterioration. The physician must balance the need for timely intervention with the potential for iatrogenic harm or unnecessary resource utilization. Careful judgment is required to accurately gauge the severity of the patient’s condition and the urgency of treatment, adhering to the principles of patient safety and evidence-based practice as mandated by the Medical Council of Canada’s (MCC) ethical guidelines and professional standards. The best approach involves a systematic and comprehensive risk assessment that integrates multiple data points. This includes a thorough history, a detailed physical examination, and the judicious use of diagnostic investigations tailored to the patient’s presentation. The physician should prioritize identifying immediate life threats and then proceed to evaluate less acute but significant risks. This aligns with the MCC’s emphasis on a patient-centered approach, the principle of beneficence (acting in the patient’s best interest), and the requirement to practice within the bounds of one’s competence and to seek consultation when necessary. This approach ensures that decisions are informed, evidence-based, and ethically sound, minimizing the likelihood of overlooking critical issues or over-treating. An approach that relies solely on a single diagnostic test without considering the broader clinical picture is professionally unacceptable. This could lead to misdiagnosis or delayed treatment if the test is inconclusive or misleading, violating the principle of non-maleficence (do no harm). Similarly, delaying definitive management based on a subjective feeling of low risk, without objective supporting data, is ethically problematic. It fails to adequately address potential harms and may contravene the MCC’s expectations for proactive patient care and risk mitigation. Furthermore, initiating treatment without a clear understanding of the underlying cause or potential risks, based on assumptions rather than a structured assessment, demonstrates a failure to adhere to evidence-based practice and could lead to adverse outcomes, thereby breaching professional obligations. Professionals should employ a structured decision-making process that begins with a broad differential diagnosis, followed by a focused history and physical examination to narrow down possibilities. Risk stratification should then guide the selection of diagnostic tests and the urgency of therapeutic interventions. Continuous reassessment of the patient’s condition and response to treatment is crucial. When faced with uncertainty, seeking consultation with colleagues or specialists is a hallmark of responsible practice and is strongly encouraged by the MCC.

Scenario Analysis: This scenario is professionally challenging because it involves a patient presenting with symptoms that could indicate a serious underlying condition, but also have a plausible benign explanation. The physician must balance the need for thorough investigation to rule out serious pathology with the potential for over-investigation, which can lead to patient anxiety, unnecessary costs, and potential iatrogenic harm. The physician’s responsibility is to apply clinical reasoning effectively to arrive at the most appropriate diagnostic and management plan, adhering to ethical and professional standards. Correct Approach Analysis: The best professional practice involves a systematic approach to risk assessment that begins with a comprehensive history and physical examination. This allows for the generation of a differential diagnosis, prioritizing the most likely and most serious conditions. Based on this initial assessment, targeted investigations are then ordered to confirm or refute these hypotheses. This approach is ethically justified by the principle of beneficence (acting in the patient’s best interest) and non-maleficence (avoiding harm). It aligns with the Medical Council of Canada’s emphasis on evidence-based practice and the responsible use of healthcare resources. This method ensures that investigations are not ordered indiscriminately but are guided by clinical suspicion, thereby minimizing unnecessary patient exposure to risk and cost. Incorrect Approaches Analysis: One incorrect approach is to immediately order a broad range of expensive and invasive diagnostic tests without a clear clinical rationale derived from the initial patient assessment. This fails to adhere to the principle of proportionality in medical investigations. Ethically, it can be seen as a failure of non-maleficence due to potential iatrogenic harm from the tests themselves, and a failure of justice in terms of resource allocation. It also risks causing undue patient anxiety and may lead to a cascade of further investigations based on incidental findings. Another incorrect approach is to dismiss the patient’s symptoms as likely benign without adequately exploring the differential diagnosis or considering the potential for serious underlying pathology. This is a failure of beneficence and can lead to delayed diagnosis and treatment of serious conditions, potentially resulting in significant harm to the patient. It neglects the physician’s duty of care and the importance of a thorough clinical evaluation. A third incorrect approach is to rely solely on patient requests for specific tests without independent clinical judgment. While patient autonomy is important, the physician retains the ultimate responsibility for determining the appropriateness of investigations based on their medical expertise and the patient’s clinical presentation. Uncritically ordering tests based on patient demand, without considering their necessity or potential risks, can lead to over-investigation and misallocation of resources, violating principles of responsible medical practice. Professional Reasoning: Professionals should employ a structured clinical reasoning process. This begins with information gathering (history, physical exam), followed by hypothesis generation (differential diagnosis), then hypothesis testing (ordering appropriate investigations), and finally, decision making and implementation of a management plan. Throughout this process, continuous reassessment and reflection are crucial. Risk assessment is an integral part of this, involving evaluating the likelihood and severity of potential diagnoses and the risks and benefits of diagnostic and therapeutic interventions.

The review process indicates a potential gap in the documentation of examination results, which is a critical aspect of patient care and professional accountability. This scenario is professionally challenging because it requires a physician to balance the immediate need for accurate and complete patient records with the potential for retrospective scrutiny and the implications for patient safety and continuity of care. Careful judgment is required to ensure that all findings are recorded appropriately, reflecting the physician’s clinical reasoning and the patient’s condition. The best professional practice involves meticulously documenting all objective findings from the physical examination, including normal and abnormal results, and clearly correlating these findings with the patient’s reported symptoms and the physician’s diagnostic impressions. This approach ensures that the patient’s medical record provides a comprehensive and accurate reflection of the clinical encounter, serving as a vital tool for future care, communication among healthcare providers, and legal or regulatory review. Adherence to the standards set by the Medical Council of Canada (MCC) and provincial/territorial medical regulatory authorities emphasizes the importance of thorough and accurate record-keeping as a fundamental ethical and professional obligation. Such documentation supports evidence-based practice, facilitates continuity of care, and protects both the patient and the physician. An approach that involves selectively documenting only abnormal findings or those that directly support a pre-determined diagnosis is professionally unacceptable. This failure to record all relevant objective data, including normal findings, can lead to an incomplete picture of the patient’s health status, potentially hindering subsequent diagnostic efforts or treatment planning by other healthcare professionals. It also represents a deviation from the ethical obligation to maintain accurate and complete patient records, as mandated by regulatory bodies. Another professionally unacceptable approach is to rely on the patient’s subjective reporting alone without adequately documenting the objective physical examination findings that either corroborate or contradict these reports. This omission neglects the physician’s responsibility to conduct and record a thorough physical assessment, which is a cornerstone of medical diagnosis and patient management. Such incomplete documentation can obscure the physician’s clinical reasoning and create ambiguity regarding the basis for diagnostic and therapeutic decisions. Finally, an approach that involves summarizing examination results in vague or ambiguous terms, without specific details, is also professionally unacceptable. This lack of specificity makes it difficult for other clinicians to understand the patient’s condition or for the physician themselves to recall the precise findings at a later date. It undermines the purpose of medical documentation as a clear and precise communication tool and fails to meet the standards of professional record-keeping expected by the MCC and other regulatory bodies. Professionals should employ a systematic decision-making process that prioritizes comprehensive and accurate documentation at the point of care. This involves understanding the regulatory requirements for medical records, developing a consistent method for recording examination findings (e.g., head-to-toe approach), and critically reviewing documentation for completeness and clarity before finalizing it. When in doubt, erring on the side of more detailed and explicit documentation is generally advisable.

This scenario is professionally challenging because it requires a physician to balance the immediate needs of a patient with the potential for future harm, all while adhering to ethical principles and regulatory expectations for patient care and resource allocation. The physician must consider the patient’s current condition, the likelihood and severity of potential future complications, and the availability of resources. Careful judgment is required to avoid both under-treatment and over-treatment, ensuring that decisions are evidence-based and patient-centered. The best approach involves a comprehensive risk assessment that systematically identifies, analyzes, and evaluates potential risks to the patient’s health and well-being. This includes considering the patient’s medical history, current symptoms, diagnostic findings, and the potential impact of various management strategies on their prognosis. This approach aligns with the Medical Council of Canada’s emphasis on evidence-based practice and the physician’s duty to act in the best interest of the patient. It requires a thorough understanding of the disease process, treatment options, and their associated risks and benefits, ensuring that management plans are tailored to the individual patient and are regularly reviewed and updated. This systematic evaluation allows for informed decision-making that prioritizes patient safety and optimal outcomes. An approach that focuses solely on the immediate symptoms without considering potential long-term sequelae would be professionally unacceptable. This failure to conduct a thorough risk assessment could lead to suboptimal care, where underlying conditions are not adequately addressed, potentially resulting in more severe complications later. This contravenes the ethical obligation to provide comprehensive care and the regulatory expectation to manage patient conditions proactively. Another unacceptable approach would be to dismiss the patient’s concerns due to a perceived low probability of serious outcomes without a structured evaluation. This demonstrates a lack of due diligence and can lead to a failure to identify significant risks. It disregards the patient’s subjective experience and the physician’s responsibility to investigate all potential causes of symptoms, even those that may seem less likely. This can erode patient trust and lead to missed diagnoses, which is a significant ethical and regulatory failure. Finally, an approach that relies solely on anecdotal evidence or personal experience without consulting current medical literature or guidelines would be professionally unsound. Medical Council of Canada guidelines emphasize the importance of evidence-based medicine. Relying on outdated or unverified information can lead to inappropriate management decisions, potentially harming the patient and failing to meet professional standards of care. Professionals should employ a structured decision-making process that begins with a thorough patient assessment, followed by a comprehensive risk assessment. This involves identifying potential risks, evaluating their likelihood and impact, and then developing a management plan that addresses these risks. This plan should be communicated to the patient, and their informed consent obtained. Regular reassessment and adaptation of the plan based on the patient’s response and new information are crucial components of ongoing professional responsibility.

Scenario Analysis: This scenario is professionally challenging because it requires the physician to synthesize multiple, potentially conflicting, physical findings in a patient presenting with vague symptoms. The challenge lies in moving beyond a superficial interpretation of individual signs to a comprehensive risk assessment that prioritizes patient safety and guides appropriate management. The physician must consider the potential severity of underlying conditions, the urgency of intervention, and the need for further investigation, all while managing patient anxiety and ensuring clear communication. Correct Approach Analysis: The best professional practice involves a systematic and comprehensive risk assessment that integrates all physical findings with the patient’s history and presenting complaints. This approach prioritizes identifying potentially life-threatening or rapidly progressive conditions. It involves considering the constellation of findings, their potential implications for various organ systems, and the likelihood of different diagnoses based on the overall clinical picture. This aligns with the ethical obligation to provide competent care and the regulatory requirement to practice within the scope of one’s knowledge and abilities, ensuring that patient well-being is paramount. The Medical Council of Canada’s emphasis on evidence-based practice and patient-centered care mandates a thorough evaluation that considers the totality of the clinical presentation. Incorrect Approaches Analysis: One incorrect approach is to focus solely on the most benign interpretation of individual physical findings, dismissing or downplaying more concerning signs. This fails to acknowledge the potential for synergistic effects of multiple findings or the possibility of an atypical presentation of a serious condition. Ethically, this constitutes a failure to exercise due diligence and can lead to delayed diagnosis and treatment, violating the principle of non-maleficence. It also falls short of the professional standard of care expected by the Medical Council of Canada. Another incorrect approach is to over-react to a single, alarming physical finding without considering its context within the broader clinical picture. While vigilance is important, an immediate, aggressive intervention based on a single sign, without a systematic assessment of other findings and potential differential diagnoses, can lead to unnecessary investigations, treatments, and patient distress. This approach may not be cost-effective and can erode patient trust if subsequent investigations prove the initial alarm unfounded. It demonstrates a lack of nuanced clinical reasoning, which is a cornerstone of professional medical practice. A third incorrect approach is to defer definitive interpretation and management solely to a specialist without conducting an initial comprehensive risk assessment. While consultation is often necessary, the initial physician has a responsibility to perform a thorough evaluation and form a preliminary assessment of risk. Abrogating this responsibility entirely can lead to delays in care and may miss crucial early signs that a specialist, seeing the patient later, might not have the benefit of observing. This approach can be seen as a failure to uphold the primary responsibility for patient care. Professional Reasoning: Professionals should employ a structured approach to interpreting physical findings, beginning with a thorough history and review of systems. This is followed by a systematic physical examination, documenting all findings accurately. The next critical step is to synthesize these findings, considering their potential implications for different organ systems and formulating a differential diagnosis. This differential diagnosis should be prioritized based on the likelihood and severity of potential conditions. Risk stratification then guides the decision-making process regarding further investigations, immediate management, and the need for specialist consultation. Throughout this process, clear communication with the patient about findings, potential diagnoses, and the plan of care is essential.