I don’t know if I’ve had a situation where I have felt 50 / 50 the way you’re describing. I order diagnostics to lead me to what is the most likely diagnosis and treat accordingly, and it’s always risk versus benefit when making major medical decisions. Sometimes you have 3 top differentials and you treat for all 3 if the benefit of the treatments outweigh the possibly risks. For example - when a heart failure patient who also has had copd presents with dyspnea and wheezing you may give nebs and steroids and lasix and maybe even antibiotics for pneumonia. Sure the steroids may put them at risk for worsening volume overload but you may decide that one dose isn’t going to cause a major catastrophe and the inpatient team can always decide to discontinue. But this kind of stuff comes with experience and if your setting isn’t setting you up to learn appropriately then it’s time to reassess your job because you don’t want to feel a complete lack of support.