Indexing Title: ROJOSON’s Medical Anecdotal Report [06-02] 

MAR Title: Definite, Indefinite, and Nonspecific Diagnosis  

Date of Observation: March, 2006 

Narration: 

A 50-year-old Filipino male underwent cholecystectomy.  On the second postoperative day, when he was about to be discharged, he had an episode of fainting when he was urinating in the bathroom.  Then, he had melena, twice, at 4 hours’ interval.  He had stable vital signs but on the pale side.  A blood count was done which showed hemoglobin of 82 g/L.  He was given blood transfusion and a nasogastric tube inserted. The latter yielded coffee-ground materials, blood clots, sanguinous fluid, and showed no signs of active bleeding. Intermittent gastric lavage was done to monitor the status of the bleeding.  Discharge was deferred and on the 3^rd hospital day, he was subjected to an esophagogastroscopy.  On scoping, there was no active bleeding nor evidence of bleeding and no lesion seen to explain the previously noted melena and upper gastrointestinal bleeding the day before.  The patient was discharged the following day with an uncertain or nonspecific cause of the upper gastrointestinal bleeding.  He was advised further monitoring at home and medical check-up.

INSIGHT: (Discovery, Stimulus, Reinforcements) (Physical, Psychosocial, Ethical) 

Quite often in the practice of medicine, formulating a diagnosis is a continuing challenge to all physicians.  It may be easy when there is a clear cut syndrome manifested by the patients and /or evident clues or signs for a particular disease or disorder.  The diagnosis derived from such situations is said to be definite or quite certain. Otherwise, it may be difficult and diagnosis ends up being uncertain or not definite or nonspecific, even when paraclinical diagnostic procedures are done.  Thus, in the real world of medical practice, there are times, quite often at that, in which a definitive diagnosis cannot be arrived at.    

Physicians are traditionally taught to come out with specific diagnostic label of a particular disease.  They are rarely taught to use and accept nonspecific diagnostic labels such as nonspecific right lower quadrant abdominal pain; upper gastrointestinal bleeding from nonspecific cause; etc.  There are pros and cons to these approaches in teaching.  Giving nonspecific diagnostic labels may tend to miss something on the part of the physicians.  On the other hand, overzealous search for a specific diagnostic label may tend to overdo things in terms of diagnostic procedures and treatment. In the real world of medical practice, there is such a thing as a nonspecific diagnosis, one that can be defined as something that is arrived at after failure to identify a specific cause and something that is not urgent or life threatening at the moment and which will most likely spontaneously resolve over a period of time but which needs further monitoring and observation.  As in every problem-solving and decision-making in medicine, it is just a matter of balancing between unceasingly searching for a specific diagnosis which may not be attained at all and contending with a nonspecific diagnosis which usually ends up with spontaneous resolution of the health problem of a patient.