As the experts noted, the clinicians in this case diagnosed the patient with migraine based on her history and not much else. The examination was incomplete, little testing was done, and no differential diagnosis was presented. Once the clinicians relied on the working diagnosis of migraine, they dropped everything else. In the case of a chronic patient, frequent interactions or comments by other clinicians (such as the EMTs) might cause the clinical team to become biased or immune to that patient’s complaints.

In cases of chronic patients, the hospital might consider using a diagnostic checklist to aid the clinicians in checking the completeness of their diagnostic process, and expanding differential diagnoses. Also, while chart notes are vitally important, how they are written is vitally important too. Chart notes should be objective and contain facts rather than value judgments. While it is essential to document contemporaneously at the time of care, it is also essential that the notes be fact-based and not subjective.