I have written many times about how I’ve made a better diagnosis than the doctor who saw my patient in emergency.

That doesn’t mean I’m smarter, or even that I have a better batting average. I don’t know how often it is the other way around, but I do know that sometimes I’m wrong about what causes my patient’s symptoms.

We all work under certain pressures, from overbooked clinic schedules to overfilled emergency department waiting areas, from “poor historians” (those patients who can’t describe their symptoms or their timeline very well) to our own mental fatigue after many hours on the job.

My purpose in writing about these cases is to show how disease, the enemy in clinical practice can present and evolve in ways that can fool any one of us.