"Gallstones" isn't a diagnosis — it's a finding. The same word can mean a patient who goes home with a clinic number or one who needs an ERCP tonight. This attending's guide maps biliary disease as one road system blocked at different points: biliary colic, cholecystitis, choledocholithiasis, cholangitis, and gallstone pancreatitis. Learn to ask where the stone is sitting — because the address, not the word, is the diagnosis.

4:52 a.m., day fourteen. You're still rehearsing "I'm Dr. ___" in the parking garage. Two weeks into surgical intern year, here's what the July effect data actually shows — and the pearls that carry you through the rest of PGY-1.

Appendicitis isn't a hard diagnosis — it's the one trainees talk themselves out of when a normal white count outvotes a textbook story. An attending walks through the workup that actually decides it: the symptom sequence, the exam that confirms rather than discovers, the pregnancy test that comes before the scanner, and the atypical appendixes that come back to find you.

The consult says "abdominal pain, evaluate" and your brain opens a list thirty diagnoses long. That list is the problem, not the solution. An attending's guide for surgical interns on sorting a painful belly before you order a single test: sick or not sick, when it started and where it moved, foregut/midgut/hindgut referral, and the soft-versus-peritoneal exam. The story provides the diagnosis; the exam and tests confirm it.