What's Your Differential?

It's humbling and frustrating to see patients in clinic and have no idea what the diagnosis is. After medical school, internal medicine clinic was often a breeze - one could easily come up with a list of possible and probably diagnoses for things like chest pain, cough, headache, etc. And even if you weren't sure, you could kinda think through the problem and work your way (or BS) to a list of possibilities. Now patients show you a spot on their skin and want to know what's going on. The only catch is I've never seen such a spot before in my life! So when the attending asks "what do you think is going on," the answer, most unfortunately, is often "um, no idea..."