The literal translation is “I know not what,” but I use the phrase “Je ne sais quoi” to mean “hard to describe.” This paradoxically describes my exam. My task was to interview a young woman experiencing abdominal pain. Just like diarrhea or fever, there are limitless possibilities to the cause of abdominal pain. You also need to take into account age and sex. These could be given to you to help or to hinder your diagnosis. Being in the Endocrine, Gastrointestinal and Reproductive Block of our medical school learning, I was hinted into believing our patient’s ailment. Her being young can lead you to think appendicitis or a new onset of irritable bowel syndrome. A young woman patient leads one to explore the possibility of pregnancy or some fault in her menstruation. Interviewing patients is something I pride myself at being good at. I enjoy establishing a relationship with the patient and cracking the case of their illness.
I enter the patient room with about 10 possible diagnoses in my head. The most probable being ectopic pregnancy and appendicitis. The interview proceeds and I walk out almost baffled. The patient had signs pointing to one diagnosis and signs pointing to another. Believe me I was thorough. She did not have the “classic” presentation of any one ailment. She had a certain je ne sais quoi, it was hard to describe, she had…I don’t know. After my frustration had subsided, I pondered why there was no definite answer to her complaint. There are a million possible explanations, but the one I choose to believe is that we were being taught that patients are not simple. One diagnosis is almost never the case. Patients may only tell you about the worst diagnosis, or the one that affects their life the most. They don’t notice the open wound in their leg becoming gangrenous because it does not bother them.
Science and medicine are not an exact, I guess, science. People’s bodies may have the same parts, but no one’s works the same as another’s. Your mind needs to be open when approaching a patient. I came in with 10 diagnoses and could have missed many things in this patient’s life. The abdominal pain was a guide, not a destination. We are not learning all these diseases just to pick out what is most common, something Wikipedia can come up with. Our job is to think, something I am continuously working on.