Pertinent Positives and Negatives

Abstract

In the oral case presentation, pertinent positives and negatives are presented after the timeline. Pertinent positives, which are disease-specific and can be learned by rote, are used to “rule in” a particular diagnosis. Pertinent negatives, which require more analytical and creative thinking, are gleaned from the differential diagnosis and function to “rule out” other diagnostic possibilities. Taken together, the pertinent positives and negatives help to put the case in focus and make an argument for the most likely diagnosis. Four example cases are given to illustrate the crucial role of pertinent positives and negatives in the case presentation. Active listening on rounds, involvement in case discussions, and ongoing experience with patient assessment will help medical students to both memorize the pertinent positives and develop the differential diagnosis skills needed to identify the pertinent negatives. Finally, careful consideration of pertinent positives and negatives can help students to recognize the underlying patterns and diagnostic possibilities in patients with atypical or ambiguous presentations.