I would do an erythrocyte sedimentation rate . Find the probability of patient have endocarditis with ensuing negative ESR test. Create a decision tree. Formulate decision problem. If surgery is performed there is a chance that he might not survive, become wheel bound, have poor mobility or be restored to full mobility.
Residents tend to segment a patients problem into separate sub problems.
Critiquing systems could be developed that suggest potential relations among sub problems.