Psychiatryniche
A 52-year-old man born in Vietnam, who has had schizophrenia for 25 years, comes to an emergency department with six hours of epigastric pain. He speaks limited English and no interpreter is booked. The triage note reads 'known psych patient, multiple somatic complaints'. The resident does not examine his abdomen, records that the pain is part of his usual presentation, and discharges him with reassurance after 40 minutes. He returns 18 hours later with a perforated duodenal ulcer and peritonitis. Which one of the following best names the reasoning error at the first presentation?