The patient will usually tell you the diagnosis if you just listen.

I guess there have been a million little tips through the years but none better than the one Dr. George Caleel ,in Chicago, gave me more than 30 years ago. He said, " Always walk into the patient exam room drying your hands and dispose of the paper towel in the room so the patient knows you just washed your hands" and always, always listen to the patient when they tell you what they think is wrong with them". He was the smoothest of smooth when it came to bedside diagnosis and was the best at garnering the trust of a patient in the shortest time span of any physician I have ever known.
As far as listening to the patient, I would be remiss if I didn't blog about the story of Shirley Fennington (name altered for Hippa of course). As an intern, the case of Shirley F. was without a doubt the most memorable examples of how important it was to listen. She was a 40 year old woman who had cut her finger at work and had come to the ER 9 days later with an infection in the finger where she had stitches. Her complaint was not her finger--her complaint was that she was having trouble opening her mouth and that she was concerned that she had "lock-jaw". Well, the ER Dr. of course thought she was a kook and sent her home on antibiotics and told her she had TMJ (temporal-mandibular joint ) dysfuntion and recommended she see an oral surgeon. This is where it gets interesting because I was the intern who got to see Shirley when she came back to the ER 3 days later no better and in fact feeling worse and nearly unable to open her mouth altogether. I reviewed her ER record from 3 days previously and saw her complaint about her thinking she was suffering from "lock-jaw". I asked her what she thought was wrong and with Dr. Caleel in my brain I listened to her. She again said ,and now with more difficulty, "I think I have lock-jaw". I called my attending internist, Dr. Dennis Packey, and told him we needed to urgently admit the patient and entertain the diagnosis of acute endotoxicity from clostridium tetanus ie Lock-jaw. Well you would have thought I had insulted his mother. He was all over this poor little intern and wanted to know where I came up with such a hair-brained bizarre diagnosis and did I know that he had never even seen acute tetanus--especially since EVERYBODY gets immunized with DPT booster shots in this country. I, of course, tell him that my diagnosis was easy and that I got it from the patient when she just told me and I listened and I was trained in Chicago to always listen to the patient. He laughed at me but came anyway to see for himself.
Give Dennis Packey credit because he did not blow Shirley F. off and send her home. No he did not. He admitted her to the floor for work up and cultered her infected finger since she worked in a tanning factory where she was exposed to animal hides on a daily basis. 3 hours later we were called to the floor where Shirley was admitted to a 4 bed ward (dating myself) and she was having trouble breathing and sure enough she was about to have cardiac arrest!! Dennis Packey looks at me and says "Oh shit!! you are right she has tetanus!!" Well the next 3 minutes was a blurr because we obviously could not secure an airway with oral intubation since we could not pry her mouth open and we certainly were not prepared to do a tracheostomy since none of us had the skill or equipment or lighting to do a tracheostomy.
Enter Paul Ruble. Paul responded to the code blue as he was the senior anesthesiology resident. He was told of the problem about the "lock-jaw" so he rather calmly and skillfully performed the first blind naso-tracheal intubation I had ever seen--SUCCESSFULLY! Well! I thought Dennis Packey was gonna kiss him. Once we oxygenated Shirley she promptly got a heart beat and then a pulse and then a blood pressure. She moved to the ICU at DOH hospital where she lived for the next 6 months on the medicine service of Dr. Dennis Packey. The diagnosis of tetanus was confirmed on the cultures of the finger wound with the classic organisms of Clostidium tetanus and the titers of endotoxin were the highest reported to the CDC in over 25 years. It was the only case diagnosed in Michigan in a decade and only the 25th case in the US since WWll. She did survive after about every medical complication including kidney failure. Her jaws , and respiratory muscles started to move at 3 months but it took another 3 months to ween her from the ventilator. She actually walked out of re-hab 8 months after she came in and told me what she had. Dr. Packey one day asked me who trained me in Chicago. I responded that it was Dr. George Caleel and he got a great big smile on his face and responded,"He trained me too!"I have not seen another case of tetanus in 30 years. By the way ,we checked and Shirley F had forged her immunization record at work and had not had her DPT booster because she was afraid of needles!!