A middle-aged patient with a history of injection drug use and frequent ED visits arrives complaining of acute leg pain. The provider has seen this patient before. The chart already labels her. The exam is brief — and what is documented is behavior, not findings. The cognitive autopsy of a case where attribution bias, premature closure, and the gravitational pull of prior labels combined to keep one of the most time-sensitive vascular emergencies in medicine off the differential. The one thing you can do differently: examine the painful area as if you’d never read the prior notes. Then reconcile.

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