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We created fictional case scenarios that might be managed either in primary or secondary care to compare the approaches of a general practitioner, a neurology trainee and a consultant neurologist. Overall, we found them to be similar, with a preference for an approach of ‘ruling out worst-case scenarios’ but with differences relating to their context and personal risk appetite. A possible diagnosis of functional neurological disorder raised the greatest differences. We discuss these approaches and consider the importance of cognitive strategies, bias and risk appetite in clinical decision-making.