https://jamanetwork.com/journals/jama/fullarticle/2839306
I read an interesting and a little provocative article in JAMA this weekend, Critical Thinking for 21st-Century Medicine—Moving Beyond Illness Scripts by Richard M. Schwartzstein, MD; Alexander A. Iyer, ScB
In the opening paragraph, they describe diagnostic errors this way:
Most diagnostic errors involve common diseases the physician did not consider rather than rare diseases the physician did not remember; they are thinking errors, not knowledge deficits.
They then start out describing how much of medical education views diagnosis as relying on pattern recognition. They describe it as “Illness scripts”, trying to match up the patient’s presentation with differential diagnoses and then ranking these by probability. AI uses pattern recognition and can be very good at it. But the authors advocate using a more pathophysiological way of reasoning. This sounds to me like taking a step away from the knee jerk rattling of differential diagnoses and envisioning what the processes are inside the body that could cause a given symptom, before naming a plausible diagnosis.
They continue:
Educators can cultivate adaptive expertise by focusing less on pattern recognition and more on teaching learners to engage in critical thinking, starting from foundational principles of human biology and pathophysiology. In particular, instead of asking trainees to move directly from a patient’s clinical presentation to differential diagnoses, educators can push trainees to develop testable, intermediate hypotheses that explain a patient’s presentation in terms of pathophysiological processes.
I can think of two cases in my career that I have written about, where I pondered what could be happening inside their bodies and arrived at the correct diagnosis, albeit not instantly. Both were patients with shortness of breath whose final diagnosis wasn’t one of the commonest, but certainly not esoteric, Two Red Herrings from 2011 and An Uncommon Cause of Shortness of Breath from 2021.
Two Red Herrings
An Uncommon Cause of Shortness of Breath
A Country Doctor Writes: 
As an experienced physician like yourself – 70 year old working in Sulphur LA – I found that many of our colleagues used something called “the force” after star wars. You just know when somethings not right.
I enjoy reading your stuff