Diagnostic Reasoning in Neurologic Consultation

OBJECTIVE: This article discusses potential pitfalls when consulting on patients who develop neurologic symptoms in the context of systemic disease and describes strategies to avoid diagnostic errors in this context. LATEST DEVELOPMENTS: Cognitive biases that shape clinical reasoning have been identified and studied. Improving clinician awareness of cognitive biases can improve clinical reasoning and reduce the risk of diagnostic errors. ESSENTIAL POINTS: Neurologists consulting on patients with systemic disease should be aware of particular cognitive biases that can lead to misdiagnosis in this context, such as overapplication of Occam's razor, overly narrow framing of a case because of the specific consult question, oversimplification of the case if the consult question is posed as a "curbside" consult, failure to consider less common diagnoses when the signal-to-noise ratio is typically low for the consult question and context, and overlooking potential diagnoses because of the location in which the patient presents within the hospital.