Scenario 1:

• A 55-year-old white woman presents with type 2 diabetes mellitus and hypertension. Her glycemic control is excellent with metformin, and she has no history of complications. To manage her hypertension, she takes a small daily dose of a thiazide diuretic. During a 6-month period, her blood pressure is 155/88 mm Hg.

• Initial Question: When treating hypertension, at what target blood pressure should we aim?

Scenario 2

• A previously well although heavy drinker, 55-year-old man presents to the emergency department with an episode of transient loss of consciousness. On the evening of presentation, he had his usual 5 beers and started to climb the stairs at bedtime. The next thing he remembers is being woken by his son, who found him lying near the bottom of the stairs. The patient took about a minute to regain consciousness and remained confused for another 2 minutes. His son did not witness any shaking, and there had not been any incontinence. Physical examination findings were unremarkable; the electrocardiogram revealed a sinus rhythm with a rate of 80/min and no abnormalities. Glucose, sodium, and other laboratory results were normal, and a blood alcohol test result was negative.

• Initial Question: How extensively should I investigate this patient?

Scenario 3

• A 60-year-old man with a 40-pack-year smoking history presents with hemoptysis. A chest radiograph shows a parenchymal mass with a normal mediastinum, and a fine-needle aspiration and biopsy of the mass reveals non–small cell carcinoma. Aside from hemoptysis, the patient is asymptomatic, and the physical examination results are normal.

• Initial Question: What investigations should we undertake before deciding whether to offer this patient surgery?