So many medical stories begin when the patient arrives at the doctor’s office or the hospital. The doctor enters the room, and the patient begins the narrative that will determine a diagnosis and treatment. But as hospitalists, we see patients with their stories already unfolding. Someone already made a diagnosis, or at least obtained preliminary information to get us to that point. That affords hospitalists a degree of certainty that can be reassuring to some, frustrating to others. But what happens when the patient arrives and no one knows the answers? What do we do in the face of uncertainty?

Our nameless patient arrived carrying a folder full of diagnostic statements, pathology reports, and a couple of compact discs with radiologic images. She was 14 years old, thin, and had dark circles under her eyes. “She has not been sleeping well,” her mother said, “the fevers keep her up at...

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