Step 1: recognize cues
Nine charted findings travelling left to right through three filter plates, most dropping into a tray marked context not cue, two emerging into a boxed output marked cues.
The three filters
A finding earns your attention if it is new, if it is worse than the last recorded value, or if it does not fit the working diagnosis. Everything else is context. Chronic findings, stable findings, and findings the diagnosis already predicts are all real and all documented, but they are not the cue driving the item in front of you.
Worked cue sort
Second day after abdominal surgery.
| Finding | Verdict |
|---|---|
| Incisional pain, improved since yesterday | Context. Moving the right direction. |
| Low-grade temperature, lungs clear, breathing shallow | Context. Common early postoperative pattern. |
| Absent bowel sounds, unchanged since the operative day | Context. Expected on day two. |
| Heart rate climbing across three consecutive sets | Cue. New and worsening. |
| Hypertension, long-standing, treated at home | Context. Chronic and stable. |
The heart rate is the cue because it is a trend, not a snapshot. No single value in that set is dramatic. The direction is.
Memory hookNEW · WORSE · DOESN'T FIT. Three questions, asked of every finding, in that order.
Margin notea number is a cue only when you know what it was before.
Watch outA finding that is expected for the diagnosis is not a cue, however abnormal it looks on its own.
TakeawayCue recognition is a sorting task, and a trend beats a single value every time. → BOOK 02 · P4 · → BOOK 07 · P2