In medical school we are always taught the classic presentation, the triad of symptoms, and the pentad of problems when we try and diagnose a disease. To uncover pathology is simply pattern recognition. For example when a patient presents with appendicitis, we expect to find pain in the lower right part of the abdomen, a fever, no appetite, nausea, and vomiting.
Unfortunately, medicine is not so simple. As it turns out, the classic presentation is probably less common than the atypical presentation. Many of the physical exam signs that we rely on to make a diagnosis are not reliable. In the excellent series “The Rational Clinical Exam” published in the 90’s and early 2000’s by JAMA, the authors reviewed literature focusing on the utility of different physical exam signs.
When a patient thinks they have strep throat, for example, the only signs or symptoms that help rule in strep throat are presence of exudates in the throat and recent exposure to somebody with strep throat [1]. Having a sore throat or fevers, the “classic presentation” is not predictive of strep infection, although fever can help secondarily guide the diagnosis in the absence of other signs.
Conversely, oftentimes what appears to be a classic presentation of one disease turns out to be something else, or is labeled idiopathic (another way of saying that “We have no idea!”) One of the hardest things I had to cope with in the clinical years of medical school was how many times there was simply no explanation for why somebody was sick. After watching so many episodes of House, I had assumed that everything would culminate in the diagnostic climax of a happenstance realization: “Did you say cheese? Hmmmm, as the resident pensively braces her chin. It must be Kawasaki’s disease!”
What’s true in the hospital can also be true in the kitchen. Things are not always as they seem. This recipe is for a savory cheesecake. Perhaps upon initial examination it appears to be dessert. But look closer. That green layer isn’t pistachios or mint. It’s spinach and chard. On top is a layer of red peppers and tomato, on top of that a layer of roasted yellow pepper, carrot and saffron. It isn’t dessert, but dinner! The beauty of the savory cheesecake is that it can be eaten for breakfast, lunch or dinner, hot or cold. It can be served as an appetizer or a main course. To warn you though, this is not light on calories, time, or dishes. It is however, rich, filling, and extremely appealing.
It isn't always as it looks--the three layer savory cheesecake (recipe cont...)
