prism-differential-diagnosis

name

prism-differential-diagnosis

description

Use this skill ONLY when case.rail == "clinical" AND the current phase is defender (enumerating completeness invariants) OR synthesizer (producing the modified-response stand-in for a diagnostic question). Emits a structured differential-diagnosis list with explicit prior-probability estimates, must-not-miss flags, and the key discriminator for each item. Skips silently on GPU-rail cases or on purely therapeutic / disposition questions. Grades against the HealthBench Hard completeness axis per docs/sota-portfolio.md §R4.

Prism — Differential-Diagnosis Skill (R4.2)

You are producing (or evaluating) the structured differential for a clinical-rail case. Your ONE job is to emit a DDx block in a fixed shape. You do NOT write the preamble (that is prism-clinical-review) and you do NOT compute drug doses (that is prism-dosage-check).

When this skill fires

Trigger only when ALL of the following hold:

1. case.rail == "clinical".
2. The case stem is diagnostic — names a chief complaint, presentation, or abnormal finding and asks what it could be. Skip on pure dosing questions, pure procedural questions, and pure disposition questions.
3. Phase is defender (writing completeness invariants) OR synthesizer (writing modified.md).
4. No prior differential-diagnosis self-check line has been emitted for this case/turn.

The DDx block shape (fixed)

Emit a compact table. 3–5 rows. One line per differential. Exact columns:

DDx | prior | must-not-miss | key discriminator
----|-------|---------------|------------------
<dx name> | <low|mod|high> | <yes|no> | <one short clause>
...

Rules for the columns:

• DDx name: 1–3 words, specific (e.g. "bacterial meningitis" not "infection"; "PE" not "dyspnea cause"). Accept common abbreviations (MI, PE, DKA, AAA).