How Sure Is Sure Enough?

The step-by-step process of clinical problem-solving is the subject of this new Journal feature. Information about a real patient is presented to an expert clinician in stages (boldface type), to simulate the way such information emerges in everyday clinical practice. The clinician responds (regular type) as each piece of information is presented, sharing his or her reasoning extemporaneously with the reader. A commentary on the process by the authors follows. A 40-year-old housewife was admitted to the hospital for sharp left-sided chest pain. In the preceding six days she had had one episode of left-shoulder pain and one episode of . . .