BACKGROUND: Physicians rely on intuition and pattern recognition to rapidly evaluate and treat patients. While the realities of our medical system require liberal use of these heuristics to efficiently make clinical decisions, such thinking patterns are error-prone—leaving the clinician at the whims of their cognitive biases.CASE REPORT: We describe a case of Lyme disease in which a pilot’s rash and radicular pain were misdiagnosed on two separate occasions until, nearly a month after initially seeking medical care, the pilot was appropriately diagnosed and treated.DISCUSSION: This case highlights Lyme disease’s mimicry of other common diseases and underscores the need to use slower, more deliberate evaluation in conjunction with pattern recognition and intuition to provide optimal care to flyers.Saul S, Tanael M. Rash, radiculopathy, and cognitive biases. Aerosp Med Hum Perform. 2019; 90(7):652–654.