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As for the right way, the correct way, and the only way, it does not exist." -Friedrich Wilhelm Nietzsche Ward attending rounds have dual purposes: teaching and developing trainees for a variety of clinical skills while providing quality patient care. While rounds occupy a central position in the training of Internal Medicine physicians (dating from Osler), attending rounds currently face increasing challenges due to the complexities of our demanding healthcare environment.The modern residency experience has maintained ward attending rounds to a position of prominence. In a world of competing demands from documentation and billing, this time on the inpatient service has become increasingly sacrosanct for teaching. Recently, many have espoused a style of rounds that includes presenting exclusively at the bedside. We believe that presenting (and discussing) the patient prior to entering the room has major patient care and educational advantages. This approach can serve the myriad, often competing, demands of ward attending.

While much diagnosis literature focuses on errors, our goal is to learn how to achieve diagnostic excellence. Before the explosion of cognitive psychology studies on errors, authors of fictional detectives understood the principles of arriving at the correct diagnosis (in their case the guilty party). Using quotes from many fictional detectives, we discuss a framework for diagnostic excellence. Understanding the implications of these quotes should help aspiring diagnosis experts on their path to excellence.

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