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Mystery Diagnosis: Bad Taste in the Mouth

Learn how doctors figure out what’s happening when patients have strange symptoms.

By
Rob Lamberts, MD
5-minute read
Episode #66

It’s time for another “Mystery Diagnosis” article. So far, I’ve covered mystery coughs and dizziness. Both are fairly common things for me to see in the office, and both are things I was taught to evaluate. But what happens when a person comes in with something strange?

Mystery Diagnosis: Bad Taste in the Mouth

This week’s topic actually comes from Richard, one of my Quick and Dirty Tips bosses, who wondered what could cause a bad metallic taste in the mouth. 

Hmm...well, I must have slept through that “metallic taste in the mouth” lecture in medical school. Unfortunately my patients are a lot like Richard--not polite enough to have symptoms that follow the textbooks. It’s actually stuff like this that makes my job challenging.

So how do you approach this kind of strange symptom? The same way you approach any medical problem: systematically. In my previous medical mystery articles I stressed the importance of a disciplined and detailed approach to any problem—even the common ones. For unusual complaints in particular, the detailed approach gives the most information to help unravel the mystery.

Step 1: The History

The first step in the diagnosing process is to take a history of the problem itself. It’s time to ask the what, when, where, how long, and how bad questions? In this case, Richard (who is now a fictional patient, not my boss) says that the symptom started two days ago when he woke up with a bad taste in his mouth; and the bad taste has stayed with him through the day, although it seems to improve over time. The bad taste is very annoying, but not at all painful. He’s never had symptoms similar to this. He tried brushing his teeth and using mouthwash, but that didn’t make it any better.

More Questions About the Symptom

In asking more questions, another interesting fact came out: the night before he first experienced the symptom, Richard went out to eat with a friend--and they both awoke with the same funny taste in their mouths. What did they eat? He told me he had eaten tapas, which I learned (being the backwater Southerner that I am) is a Spanish food consisting of small portions of different dishes--kind of like appetizers. The temptation here is to jump to the obvious conclusion: something in the tapas is the culprit. After all, it would be a major coincidence for both people to have the same symptom at once. It’s tempting, but good medicine is always thorough.

What are the Supporting Facts?

So now I move on to the supporting facts around these symptoms. The review of systems--when I ask the patient a bunch of questions about any other symptoms he may be having--is the next bit of information I gather. Richard has not been having any fever, fatigue, or body aches. He feels pretty good overall. The only other symptom he’s been having is a cough that has gone on for several weeks, as well as some runny nose and sore throat in the morning (which he attributes to allergies). 

He’s not taking any medications at the present time, and has no significant medical problems. 

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