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The narrative shows the medical team’s diagnostic process, from noticing subtle physical exam findings to considering differential causes and ultimately identifying neurosyphilis with confirmatory testing. A multidimensional curiosity model is introduced as a roadmap to strengthen distinct curiosity skills for hospitalists. 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Schiffman Humanism in Medicine: Reflections  \nA Curious Eye  \nSam Woodworth, M.D.1,2  \n1 Department of Medicine, Division of Hospital Medicine, Maine Medical Center, 2 Department of Medicine, Tufts University  \nJournal of Brown Hospital Medicine Vol. 5, Issue 1, 2025  \nArticle Information  \nKeywords: curiosity, medical education, diagnostic dilemma  \n[https://doi.org/10.56305/001c.151862](https://doi.org/10.56305/001c.151862)  \nSubmitted: August 03, 2025 EST  \nAbstract  \nIn this paper, the author describes a case in which being curious pushed the medical team to help a patient in an unexpected way. A multidimensional model of curiosity is presented as a roadmap to enhance distinct curiosity skills as a hospitalist.  \nAccepted: December 04, 2025 EST  \nPublished: January 01, 2026 EST  \nThe late Faith Fitzgerald wrote in her seminal essay, Curiosity, that teaching physicians should “identify [learners] with a gift for curiosity and take infinite pains not to suppress but to encourage that gift.”1 Storytelling provides fertile ground for an exploration of curiosity, as together the pair “converts strangers…into people we can empathize with.”1 As a hospitalist, busy and buried in the minutiae of daily clinical work, the importance of keeping curiosity at the forefront cannot be overstated.  \nWorking with medical residents one morning, my team cared for a patient in his late 60s who had briefly lost consciousness and was admitted to the hospital for investigation. The patient’s vital signs, physical examination, laboratory data, and electrocardiogram were deemed unremarkable. Apparently, he didn’t look sick.  \nI’ve made a habit of combing through the electronic pile of my patients’ emergency department documentation, the initial intake note, and nursing updates. Interesting tidbits inevitably crop up, and, in this case, I learned that the patient had endorsed forceful coughing fits and that one nurse thought his pupils were of different sizes. Other notes simply stated PERRL, the clinical shorthand for “pupils equal, round, and reactive to light”.  \nWalking to meet the patient, the residents and I reviewed common causes of syncope, making a point to consider laryngeal ictus (i.e., cough syncope) as a fitting explanation for his presentation. I usually wouldn’t have pressed the team to closely examine the pupils ofa patient presenting with syncope, but in this case, I did. His pupils were identically sized. They were also completely tonic, failing to constrict even the slightest to the bright flash of a penlight or accommodation maneuvers. Try as we might, we couldn’t connect the patient’s syncope to his  \ntonic pupils, and I had never encountered the latter before. It seemed possible they were not connected. The patient denied any visual symptoms, and his other workup soon concluded without any compelling reason for ongoing hospitalization. The tonic pupils could have become an incidental finding, passed over without further thought, but my curiosity got the better of me. I pushed the residents to pause and think creatively.  \nWe considered autonomic dysfunction as a cause of increased cough sensitivity, syncope, and tonic pupils. Alternatively, we wondered whether an infiltrative pathology or vasculitis might present with isolated neurologic symptoms. We then remembered that syphilis could present with pupillary abnormalities. Although not the classically described Argyll Robertson pupils (which fail to constrict to light, but respond briskly to accommodation), perhaps the patient’s ophthalmologic oddity hinted at an occult syphilis infection. We learned that Adie’s pupil (which constricts sluggishly or not at all to both light and accommodation) can be bilateral in 20% of cases and has been associated with syphilis infection.2, 3 Denying any concern for sexually transmitted diseases, the patient consented to syphilis testing, which was pending at the time of discharge.  \nThe Fluorescent Treponemal Antibody Absorption test ","cbCaitTTPmTgTdyJ","https://ap.wps.com/l/cbCaitTTPmTgTdyJ","pdf",108532,"English","# Article Information\n## Keywords and Abstract\n# Curiosity in Medical Teaching\n# Clinical Case: Syncope and Tonic Pupils\n## Initial Evaluation\n## Differential Diagnosis\n## Testing and Diagnosis\n## Treatment and Outcome\n# Curiosity as a Learning and Memory Factor\n## Studies on Physician Training\n## Managing Curiosity’s Risks","[{\"question\":\"How did curiosity change the diagnostic approach in the case?\",\"answer\":\"The clinician insisted the team pause and examine unusual exam findings closely, which opened the path to considering neurosyphilis instead of stopping at an unremarkable workup.\"},{\"question\":\"What key clinical feature supported the neurosyphilis diagnosis?\",\"answer\":\"Completely tonic, non-reactive pupils were noted, which aligned with Adie’s pupil patterns that can be associated with syphilis infection.\"},{\"question\":\"How was neurosyphilis confirmed and what treatment followed?\",\"answer\":\"Syphilis testing returned positive, and cerebrospinal fluid testing confirmed neurosyphilis. Treatment began with IV aqueous penicillin G and was completed without further neurologic complications.\"}]","Humanism in Medicine - A Curious Eye - Reflections on Curiosity in Hospital Medicine | PDF",1790621548]