June 7, 2010

The travails of a dermatologist.

Querying the advice columnist:
On an elevator, I once noticed a mole on a woman's back that looked very suspicious. Obviously she was not my patient, nor can I perform a lab test at that moment. However, I quietly mentioned that as a dermatologist, I felt she should have it checked by a doctor. Her response was very negative. I felt I was being treated like a pervert or an off-the-street weirdo. So, my question is: When I go out in public, should I shut my mole-dar off? After all, they are not my patients. Or is it the right thing to point out to someone that they may have a dangerous mole and should see a doctor as soon as possible?
It must be difficult to see skin this way. When everyone else is just enjoying ogling the fleshly parade, you're zeroing in on the flaws and speculating about cancer and death.

We were just talking about our dermatologist. It seems that every time we go in for a check-up, she finds one little dot to excise and test. I was thinking that if I were she, I'd visualize all those cut-out moles and wonder what a career's worth of moles would look like if they were all piled up into a big mountain... I mean, a mole hill.

59 comments:

Pogo said...

I see stuff all the time that is/could be a health threat , but have learned to keep my big yap shut.

Remeber Dorothy Parker's law:
No good deed goes unpunished.

Scott said...

...I'd visualize all those cut-out moles and wonder what a career's worth of moles would look like if they were all piled up into a big mountain... I mean, a mole hill.

My God, that's revolting.

Sixty Grit said...

I would be grateful for the feedback. Some people, apparently, are not. No reason to assume that all humans will have the same reaction. Keep pipin' up doc - it's the right thing to do.

WV - readaton - when youse reads a lot of books in Southie.

Freeman Hunt said...

So, my question is: When I go out in public, should I shut my mole-dar off?

Hell, no.

After all, they are not my patients. Or is it the right thing to point out to someone that they may have a dangerous mole and should see a doctor as soon as possible?

Yes, it is the right thing to do.

Perhaps if some dermatologist had noticed the bad mole on the back of my father's head and said something to him, he wouldn't have melanoma spreading throughout his liver and lungs right now.

traditionalguy said...

That is funny. Other doctors say that Did you hear that Dermatologists are the richest doctors because their patients never get well and never die.

Trooper York said...
This comment has been removed by the author.
edutcher said...

Freeman's point is well-taken. The Blonde's little whatever on her chest may well turn out to be nothing - and, if so, it gave her a bad scare for nothing, but I'm sure there are plenty of dermatologists who have a trunkful of "if onlys".

PS Sorry about your Dad, Freeman. The Blonde worked oncology for several years, so I can sympathize.

Trooper York said...

You know, I have almost the exactly same problem everytime I am out in public.

I can see right away that a woman is wearing the wrong bra. Now should I mention it to her and tell her to watchthe wife's video about getting a properly fitted bra?

Or will she think I am a perv?

I am kinda betting on the perv thing.

Not that there's anything wrong with that

Big Mike said...

He might do better if he introduced himself merely as a doctor and not as a dermatologist. The way he puts it, it must come across to some folks as trying to drum up business.

c3 said...

Here's another famous physician who made an unsolicited and unappreciated recommendation for surgery

dbp said...

I would wonder if all the little pieces of skin together would ever make-up a whole person's worth.

MadisonMan said...

Freeman, I'm very sorry to read about your Dad. I'm of Scandiwhoovian extract myself, and dad and my aunt have both had skin cancer, but I'm thankful that none of their has metastasized because theirs were easily seen in the mirror.

Shanna said...

I think he should tell them if it really looks suspicious, although people may not appreciate it.

My friends mom went to get a manicure and the lady told her that she thought she had cancer, based on some sort of line on her fingernail! She freaked out and went to the doctor and the doctor was like, no, you don’t have cancer. So she wasn’t very happy about that.

So sorry Freeman. I would want someone to tell me for sure.

Pogo said...

It's a tough call. I have never seen a melanoma on a stranger, but I have seen other skin cancers and mentioned them. And gotten yelled at.

But a melanoma?
Shit.
It's like seeing blood streaming out of a wound. How do you not mention it?

For most medical stuff, I shut the hell up. But a few things I do mention. I would have a hard time avoiding a melanoma; saying nothing would in fact rack me with guilt.

David said...

He should stop being so thin skinned and tell the poor sucker what he saw.

Pogo said...

OTOH, when I've told them their prostate seems enlarged or the that that breast lump should be checked out, people absolutely freak.


You can't win sometimes.

Pogo said...

Just be glad that proctologists aren't offering unsolicited advice.

Tibore said...

"Pogo said...
Just be glad that proctologists aren't offering unsolicited advice."


What, haven't you been watching the news lately?

;)

Freeman Hunt said...

I have seen other skin cancers and mentioned them. And gotten yelled at.

That's crazy that people would yell at you for free, qualified medical advice.

I would be thankful if a doctor pointed something out to me that I might need to have checked on. Even if it was something unimportant or something that made him look nosy, I certainly wouldn't yell; I would just say, "Thank you."

John Stodder said...

But a melanoma?
Shit.
It's like seeing blood streaming out of a wound. How do you not mention it?


The dermatologist's mistake was in expecting gratitude or even the scarcest display of good manners. He absolutely did the right thing. It would have been nice if the person had recognized it as the life-giving gesture that was intended. Nice, but irrelevant to the doctor's mission.

Having complete strangers wrongly think you're skeevy is not the worst fate one can imagine. Knowing you could have saved a life and didn't would be much harder.

Tibore said...

And on a more serious note: I completely understand and sympathize with the fact that the dermatologist feels a little wounded by the reaction. But at the same time, if I were in his place, I'd dismiss the whole incident as something I had to do, regardless of the consequences. So what if the woman reacted negatively at first? As long as the message is there, and she cues from it and goes to the doctor, then the good deed is done, even if the dermatologist didn't receive any praise for it.

I'm not saying that he should not feel normal human feelings for a person being negative towards him. Rather, I'd counsel him that he can look on the whole incident as a net positive, even though there was negative involved. At least he offered important info where it was needed.

Fred4Pres said...

I would welcome mole-dar myself. I do not trust those pesky things. But everyone is different.

So when she gets melandoma she will think, "I should have listened to that pervert in the elevator."

You can't save everyone.

Fred4Pres said...

So Doc, thank you from those who welcome information about their skin conditions. Keep up the good work.

Pogo said...

Dermatologists need thick skin.

Bob_R said...

While I sympathize with the Doc, I also sympathize with the woman who was freaked out by the stranger who pulled her aside and whispered quietly about the mole on her back. She was right to be careful and assume the guy was a perv. Hope she was careful enough to have the mole checked out.

One should also be careful of bloggers who put up long posts for the purpose of telling "mole hill" jokes.

wv: viplize - yes they do.

Freeman Hunt said...

My husband had to have a mole removed from his back along with the skin some radius around it. About two weeks later, while it was still healing, I had a routine appointment with the same dermatologist.

My husband requested that I ask the dermatologist, who he knew from his fraternity, the following:

"While I'm here, my husband had a question he wanted me to ask you. He says the incision is healing just fine. But he was looking at it in the mirror, and he wanted to know if it was normal for it to sort of blink open and closed and for there to be an eye looking out from inside it. Is that normal?"

I asked very dryly. The facial expression was most excellent.

Pogo said...

Aaaaaaaaaaaaaaaaiiieeeeeeeeeeeeeee!

I'm gonna have nightmares now for sure.

traditionalguy said...

This may explain why Saudis make "their" women wear all that extra clothing. Only their noses can get skin cancer. Seriously,the professional relationship will hardly ever work when the professional asks to help someone before that someone asks for the help. But she most likely called someone else right away. This is sometimes called the "no good deed shall go unpunished" law.

Pogo said...

Imagine finding Helen Thomas's eye peaking out of a skin excision, blinking.

ironrailsironweights said...

There was an episode of Scrubs involving a very similar issue. JD spotted a dangerous-looking mole on a man (I don't remember which character). Except this time the mole was on the schwantzstucker rather than on the back.

Peter

Freeman Hunt said...

I bet that a lot of times if the person is rude, they're just being rude out of reflex, just an automatic recoiling from the intrusion. But how many of them then go on to get whatever it is checked out? A lot, I'll bet.

Freeman Hunt said...

A friend of ours was complaining that a serious medical issue of his was not improving despite repeated trips to the doctor and diligently taking his medicine. "What do they have you taking?" He listed herbs of some kind. Our expressions must have been quizzical, because he continued, "He's a homeopathic doctor."

Oh my. If only Crack had been there. We suggested he go to an actual doctor.

HDHouse said...

Is this where we break into song....

"I've got you...under my skin..."

Alex said...

Bottom line, strangers should mind their own fucking business.

EDH said...

It was over the course of a few years that I noticed a strangely colored, irregular mole on the back of the neck of a client/associate.

Repeatedly, I almost said something, but every time I just assumed his wife must have noticed it and he had it checked out. So, who was I to bring it up?

Within a few years he was dead of melanoma.

Peano said...

Althouse makes junior-high jokes, Freeman Hunt makes good sense.

Fair and balanced. Thanks, Freeman.

Peano said...

Ann opines: "We were just talking about our dermatologist. It seems that every time we go in for a check-up, she finds one little dot to excise and test. I was thinking that if I were she, I'd visualize all those cut-out moles and wonder what a career's worth of moles would look like if they were all piled up into a big mountain... I mean, a mole hill."

Oh, heavens, what a nuisance that must be.

Years ago while in grad school, I worked as a nurse technician on the internal medicine service of a Midwest university hospital.

One night I was assigned a patient who had malignant melanoma. She was about 40. She remarked that "I just had this little mole arm that sort of itched now and then, and I didn't think anything about it." Until she was diagnosed. Too late.

Her 15-year-old daughter would soon be without a mother. The patient's husband sat in the room each night and tried to put on a brave face, but he was already devastated.

I have to wonder how those good people's lives might have turned out if some alert dermatologist had taken trouble to "bother" that poor woman before it was too late.

Pogo said...

Don't be too hard on strangers and their responsibility to speak up, Peano.

We're all flawed. Some are dissuaded from intervening in other's lives because of experience, anxiety, shyness, culture, shame, fear of appearing foolish, or fear of being physically injured.

I've had my ass handed to me for intervening in similar situations, and in others where I saw danger afoot. I still do it, but I fully understand the hesitancy, and I don't blame people for holding back.

Advise the high road, but don't expect it to be used too often.

Jason said...

Save the life in front of you.

This is not a difficult question.

Maybe keep some business cards handy, and a photograph in your wallet or on your iPhone of what a potential melanoma or other cancerous growth looks like. Explain why you mentioned it by looking at the photo. Give the person the photo, if you can keep a hard copy. So they can go home and ask their spouse, and have him or her confirm.

Grown men should not be wilting lilies about delivering bad news or warnings. It's part of being a grown-up.

Accepting that your warning will not always be well-taken is also part of being a grown-up. That's more the other person's problem than yours. Cowboy up.

If you're too much of a pussywhimp to take a moment of resentment in order to possibly save a life, then resign your medical license and go deliver pizzas or something.

Sheesh.

k*thy said...

I think it's actually fine if he speaks up. He's under no obligation to, of course, and that can be his out. He just has to careful about having any expectaions once he does. Regardless of their reaction, once they part, he has no idea what it'll all lead to.

Jason (the commenter) said...

dbp: I would wonder if all the little pieces of skin together would ever make-up a whole person's worth.

They probably just throw it in a pot of chili, like the people at the piercing places do.

Penny said...

Emily Yoffe told the good doctor, "You can't go chasing people down the street."

If you think it's melanoma, run after her as fast as you can, Doc!

Don't forget, you asked "Dear Prudence". If you had asked "Ms. Imprudent", she would have chewed your ear off, wrapped it a Mike Tyson autograph and sent it back to you with a note berating you for even daring to worry about an impolite reception.

Penny said...

"...I'd visualize all those cut-out moles and wonder what a career's worth of moles would look like if they were all piled up into a big mountain... I mean, a mole hill."

There are no "mole hills" in Hollywood. ;)

Just one too many plastic surgeons who have no qualms about chasing women down the street to hand over their business card.

Jason said...

The dumb ones chase people down and give away their card.

The smart ones stand in front of them, introduce themselves, and get theirs!

William said...

I had a friend who was a nurse. She told me to get a little white pimple checked out. It was basal cell cancer. The good news is that there were no sequlae; the bad news is that every time I get another pimple I start freaking out.....Just another travail that we red haired people must endure in our painful journey through life. We're like Sisyphus, constantly rolling our moles up the hill.

Peano said...

Pogo said: "Don't be too hard on strangers and their responsibility to speak up, Peano."

Read what I posted. I wasn't being hard on "strangers and their responsibility to speak up." I was criticizing the witless drivel that opened this thread.

Ralph L said...

After my dad retired from the Navy and got a job with real health insurance, my mother dragged me and herself to a dermatologist. She had about 50 red spots removed from her upper abdomen, which I wonder know might have had something to do with the pancreatic cancer she got a year or so later.

I had two dozen moles cut off my back, neck and face, but I still had so many several years later that a doctor sent me to GWU Hospital to be inspected by a room full of med students.

Fortunately, the teacher briefed me on the warning signs (and let me keep my briefs, though he did hike them into a thong). Five years later, a flat dark mole became a pink & black lump and bled a little.

If I hadn't been warned, or the melanoma had been where I wouldn't have noticed it immediately, I'd be long dead.

It hadn't occurred to me that people got skin cancer at age 30.

Yeah, the doctor should speak up, in fact, he should hang out in locker rooms looking everyone over.

ErnieG said...

My wife and I go regularly to a dermatologist, and he always finds a couple of spots to excise. I joked to my wife last week that it was like he had a license to print money. The other day his office called and asked me to come in for further treatment for a spot on my temple. The pathologist said it was squamous cell carcinoma. So that's where I'll be at 8:30 am on June 15.

Ralph L said...

From the Slate comments:
"Needless to say, it's definitely not on the level of when I had a student try to give me bra advice while I was teaching a class - now there's a topic you should never, ever bring up with someone you don't know well!! "

Guess Trooper is SOL.

EDH said...

"I've had my ass handed to me for intervening in similar situations, and in others where I saw danger afoot."

Ask Bob Marley...

In 1977, Bob Marley found a wound on his foot, which he believed to be a soccer injury, but was later discovered to be malignant melanoma. Doctors recommended an amputation of his toe, but he refused for religious reasons. The cancer eventually spread. When he finally decided to get medical help (in 1980), the cancer had become terminal. He wanted to die in Jamaica, but could not withstand the flight home, and died in Miami.

Chuck Pelto said...

TO: Freeman Hunt, et al.
RE: Cancer

I'd recommend that those who have been told by doctors that they have no hope take a look at pawpaw. Yeah. I mean the plant in that children's song....

"Picking up pawpaws;
Put them in your pocket."

I've seen it cure an aggressive squamous carcinoma in ONE MONTH. Not a large one. But it had grown a quarter of an inch out of a woman's arm in ONE WEEK. She'd had such before. So she recognized it at first sight. And she'd had to have them surgically removed. Which she did not look forward to as it was close to her elbow and would take quite some time to heal properly.

I told her about this pawpaw business, so she got some of the powdered leaves and stems in capsules. Four pills a day.

She told me the insane itching stopped within one day. Then she watched as it (1) stopped growing, (2) dried up and (3) fell off.

Shortly after that, she reported that her arm at the site ejected what looked like a b-b attached by a single tiny blood vessel. It broke off, bled a bit and now her arm is completely healed.

What's my point?

There IS a cure for cancer. And, based on what I've seen, it will cure most forms, while leaving healthy cells alone.

Also important, it doesn't ravage the family fortune, as do most officially recognized 'cures'.

One bottle of 120 capsules, i.e., one months supply, costs about $30, last time I looked.

Or, if you have such a tree in the area, just (1) go out and get some leaves and stems, (2) dry them out, (3) grind them up, (4) put the powder in some capsules and save someone's life.

What does someone who's been told there is no hope got to lose? Nothing. And they have everything to gain. Especially their life.

Regards,

Chuck(le)
[God made the Earth and everything therein for Man. We just haven't figured out how to use it all yet.]

bearing said...

I've heard of charity cancer screenings for breast cancer. I've heard of charity screenings for diabetes. I've never heard of charity or free-public-health screenings for suspect moles. But it strikes me that it might be a very easy-to-set-up and low-cost one, since it apparently only requires an expert eye.

Am I wrong here? If there were a few dermatologists who wanted to give back to the community, how hard would it be to set up a suspect-mole-screening event? What do you need -- a private room with good lighting? And if you find something, all you have to say is "You need to get this one checked out by your own doctor."

How about installing how-to-recognize-suspect-moles posters in department store fitting rooms? It's one time when people are often naked in front of angled mirrors that let them see their own backside.

AllenS said...

Moles are round. If you have a mole and it's an odd shape or constantly growing, then you have problems. I'm not a doctor, but that's what I've been told. My cousin has cancer and started taking pawpaw. He claims that it is contributing to his health while he battles against the disease.

mcnorman said...

Okay, so the person looks at you funny, or tells you to mind your own business. If only someone had said, "hey, don't you think that third eye is starting to show a bit," that person might not need to make a second visit to a plastic surgeon or radiation oncologist.
Believe me when I say that there are MANY people who wait far too long to do anything about these odd lesions. It's better to take care of the problem before it becomes a life or death issue.

Troy said...

That mountain of moles looks like money.

As they would say in West Texas when the wind would raise up the smell of cow shit... take in a deep breath and exclaim "I love the smell of money!"

On a more serious note... absolutely the doctor did the right thing. Gratitude is a rare thing.

Fred4Pres said...

"While I'm here, my husband had a question he wanted me to ask you. He says the incision is healing just fine. But he was looking at it in the mirror, and he wanted to know if it was normal for it to sort of blink open and closed and for there to be an eye looking out from inside it. Is that normal?"

I asked very dryly. The facial expression was most excellent.


That is very funny.

theobromophile said...

I'm not saying that the dermatologist was anything but polite to the woman, but dealing with personal matters with strangers requires an extra helping of sugar.

Try:
I'm so sorry to bother you, and you probably already know this, but I just wanted to double-check because I don't want something to happen to you. I'm so sorry if this is intrusive, and I normally wouldn't say anything to someone who isn't my patient, but I'm a doctor and I'm worried about the mole on your neck.

It's possible that this doctor was very straightforward - which is fine - but it can come off as being brusque and officious. Also, some women have no lack of men telling them what to do and how to run their lives, so it might not have been a "pervert" look, so much as a "Yet someone else with a Y chromosome who is bossing me around" look.

Ralph L said...

Also, most men have no lack of women telling them what to do and how to run their lives, so it might not have been a "bitch" look, so much as a "Yet someone else without a Y chromosome who is bossing me around" look.

Chuck Pelto said...

TO: All
RE: Another 'Indirect' Approach.....

....might be to comment....

Gee. THAT looks 'dangerous'.

This invites a reply from the target audience of "WHAT looks 'dangerous'." Thereby engaging the subject in the conversation that leads to their being informed of a possible carcinoma.

In military parlance it is known as Napoleon's 'Indirect Approach'. Which is known to be a VERY effective tactic.

Regards,

Chuck(le)
[Know your enemy and know yourself and you shall never be defeated. -- Sun Tzu]