"Open Chest"

Yesterday we had our first patient interaction!  We had a video conference with a patient who was in Roseau and had the opportunity to ask the patient questions regarding chief complaint.  During the course of the interview, the patient stated that she had suffered an episode of "open chest" when she was a child.  Now you say this to a room of brand-new med students and you couple it with a chief complaint of chest pain, you should expect the entire room to gasp and automatically draw the conclusion that the patient had an open chest surgery.  Nope!  Not at all! When my fellow students started asking the patient questions about the surgery and what exactly happened with it, the patient was utterly confused!

It turns out that "open chest" is a saying here in Dominica that means chest tightness/pain and is generally given to symptoms that are diagnosed as Costochondritis (which is basically a painful inflammation of the cartilage that connects your ribs to your sternum). Needless to say this condition does not have quite the same severity that open heart surgery has.  Once our teacher explained that "open chest" was not in fact open heart surgery but rather the painful inflammation, we were mildly embarrassed.  I think that this experience taught me that whenever my patient's say a phrase that I am not familiar with, I will ask them to elaborate.  This way I will understand exactly what they are trying to tell me and that I will not include faulty information their history.  I am definitely learning a lot about how culture factors into medical practice.