His preliminary report was devastating. It identified multiple standard-of-care violations: failure to perform an adequate physical exam, failure to order appropriate diagnostic testing despite clear clinical indicators, failure to document defensible reasoning for the diagnosis, and evidence that patient appearance had improperly influenced treatment decisions. More troubling still, Torres had identified a pattern. Over five years, there were at least eighteen cases in which Vance had made snap judgments about patients that led to missed diagnoses or delayed care. The pattern was not random. Young patients, minority patients, patients with tattoos, piercings, or otherwise unconventional appearance were disproportionately likely to be dismissed as drug seekers, anxious, exaggerating, or noncompliant. In medicine, patterns are what transform a bad day into misconduct.