At the start of your shift, you log on and click into your first ED chart of the day and sigh, “Not again.” It’s the chart of one of your “frequent flyers,” a young woman who has come to the ED several times in the past few months with a variety of nonurgent complaints. Itching eyes is one. “I seem to be tired all the time,” is another. “I have fevers sometimes.” “My muscles ache. My joints hurt sometimes.” Her workups are always unrevealing. She carries multiple diagnoses, many nonspecific: anemia, possible depression, medication-seeking behavior, myalgias, possible malingering, etc. Today’s chief complaint is abdominal pain. “It's going to be a heck of a day, if this is the start of it,” you think, but remembering how bias can cloud decision-making, you take a deep breath and enter the exam room...
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