Sunday, September 26, 2010

The Black Spot

Nancy is a lovely fair skinned blonde; and because of this, she and direct sunlight do not get along well. It’s often humorous to see pictures of the two of us vacationing in tropical climates – we are the ones under the sun umbrella with cover-up on.

One day I noticed Nancy had developed a dark mole on her forearm. Tucked away in our medicine cabinet we had one of those little paper cards with pictures of various skin cancers printed on it in color. The mole on Nancy’s arm looked an awful lot like the photo example of Melanoma. She was scheduled to see her physician shortly anyway so I reminded her to have her doctor have a look at that mole.

When she came home from her exam I asked what her doctor had said about the mole. “The doctor said it was nothing; she told me that she had done her residency in dermatology and for me to not be concerned about the mole.”

But I was concerned... very concerned, in fact! For one thing, the picture of the Melanoma example on the card could have been taken from the mole on Nancy’s arm. So if what was on Nancy’s are was NOT Melanoma, then of what use is the stupid card? Troubled by this, I asked Nancy to go back to her doctor and have the mole removed anyway.

Nancy agreed and again visited her doctor. They discussed doing a simple a “punch biopsy” but then opted to allay everyone’s concerns (especially mine) and have the whole mole completely removed.

A week later we were out driving in the car, Nancy became very quiet. Then said she needed to tell me something; the results of the biopsy had come came back – Melanoma!

We immediately scheduled Nancy with a dermatologist who promptly carved a deeper chunk out of her arm. Nancy ended her relationship with that general practitioner.

Being scientifically trained, I have a healthy respect for professionals, experts in their fields. It is why we consult lawyers, accountants or landscape specialists rather than try to bang everything out ourselves. It is a perfectly reasonable approach; we recognize that these people have devoted full attention into their interest of study. We correctly rely on the fact that they are the consummate experts in their respective fields.

However, part of being of a Skeptic is to not “blindly” accept the testimony of all “experts” unquestionably. At some level we need to have at least rudimentary knowledge to assess the expert opinions given to us, seeing if they match up with our internal “reasonableness meter”. If the information doesn’t, then it is incumbent upon us to request clarification or justification from the expert until we are satisfied that their expertise is indeed sound.

I am sure there are many people would have just accepted their doctor’s opinion thinking, “Well, she’s the expert”. But I know that had we not questioned the advice we were given, we would have faced a very different and unpleasant outcome. Would we have still celebrated a 25 year anniversary?


Elisabeth said...

That's a scary story, Robert, fortunately one with a happy ending.

You are right about needing to recruit the help of specialists in certain fields, depending on the issue at hand, but also to trust ourselves when we have misgivings that fly in the face of advice.

I have a brother who has suffered from some horrible melanomas but at least they were able to be removed, like Nancy's soon enough.

Skin cancer is a serious issue in Australia. As I understand, we have the highest incidence of melanoma in the world.

Gorilla Bananas said...

Frightening incompetence. I hope you reported that doctor and she was made to take remedial classes. Members of a profession should always be able to explain the basis of their opinion in terms a lay person can understand. When they start to argue from authority the bullshit detector should start bleeping.

Orhan Kahn said...

I have only recently had to deal with people I care about developing cancer, and skin cancer of all things. Nothing exciting about it.

Nancy is incredibly lucky to have a husband like you :)

DJan said...

My ex-boss also had a small mole on his leg that the doctor dismissed. It was removed because Mickey insisted, and it also was melanoma. He recovered and has every tiny little thing snipped off his body these days. I am so happy that it all turned out well for both of you. Thank God you didn't listen to the "expert" who would have killed Nancy, even unintentionally.

Mandy said...

Holy cow. That is scary! I have a black little mole on my back that scares my husband, despite the fact that I have had four doctors look at it and tell me it's fine.

Maybe I'll get it lopped off anyway.

Sometimes gut instinct is more powerful than we know.

Robert the Skeptic said...

Elizabeth I have heard that as well about Australia; supposedly linked to the depletion of the Ozone layer over the Antarctic cap. Not sure about that, however.

Bananas No, we did not file any official complaint. We think it would be abundantly clear to her that she misdiagnosed here. It is probably a good lesson for her as well. She was only recently starting her profession, actually.

Orhan I have had a few Basil cell carcinomas removed; on on this very Thursday that is off the the pathologist, in fact. My bandage on MY arm prompted telling Nancy's story which happened four years ago.

DJan That is the scary thing, we TRUST the opinions of experts even though we may have our own doubts. A majority of the time their education and experience are correct.

Being a skydiver you are probably aware of the issue with pilots: When your instinct is in conflict with what the instruments tell you, which do you believe? In an overwhelming number of cases, the pilots who have ignored the instruments and gone with their gut have ended in disaster. Trust the instruments... there's even a cockpit warning alarm that says "Don't Think".

Mancy Nancy has other spots on her as well. But she has this old curmudgeon of a dermatologist now; he carves a lot of things off Nancy but when he says one particular spot is OK, we believe he knows what he's talking about. I would think that if four docs say a spot is OK, it probably is.

TechnoBabe said...

Good for you to listen to your inner feeling and to relay it to Nancy. My hubby and I were like this before we met and we believe we must be proactive in our own well-being. How long ago was this?

Anonymous said...

A second opinion, especially when common sense indicates the first opinion may not be accurate, is, well,just common sense. Thank goodness you followed your gut on that one. The cancer fighting people don't print all of those informational cards for nothing! Yay to them, by the way, for accurate and helpful information.

Robert the Skeptic said...

TechnoBabe We are both very involved in our medical decisions now. I am awaiting a time to have my heart valve replaced. Nancy's bout with Melanoma has been 5 years now. She can see her dermatologist on a less frequent basis now.

BackRow Sometimes there is TOO much information out there, to the point where every benign symptom can appear to be threatening. This is why it is important to ply one's common sense and seek expert advice. The old saying "an ounce of prevention is worth a pound of cure" is very true.

PeterDeMan said...

Robert, it's a different kind of medical story (one which I hope to write about soon), but I almost died from pneumonia last March and spent 13 days in the hospital simply because, under the rules of an HMO, my doctor blocked me from seeing my pulmonologist (I have advanced emphysema). He felt he could treat me just fine but wasn't the case. I ended up with pneumonia so severe I received 7 different antibiotics simultaneously, three of them intravenous. Later my pulmonologist said they had given me no better than 10% chance of survival. Story is too long, but have now switched to a (more expensive) PPO and can see who I want, when I want.

Robert the Skeptic said...

Peter That is a horrendous story!! I am amazed you have any choice in medical insurance options; we do not, in all practicality.

I'm looking at potential heart surgery myself and it will likely need to be done before I am Medicare age. Between our $1,200/ month premium and the deductibles and portions not paid by insurance, we expect it will financially ruin us for the remainder of our retirement. The option for me, of course, is death.

Vere interested in hearing your story.

Rain said...

Thank you so much for sharing this story. We cannot trust our doctors totally and must trust our instincts. Congratulations on yours for your sake and your wife's

Nance said...

I could not possibly agree with you more about the importance of relying on your own understanding when faced with an "expert" opinion that makes no sense to you.

Medical issues are the most compelling and your experience, Nancy's experience is a powerful lesson. We have to empower ourselves and speak up to protect our loved ones. My most recent example has to do with financial decisions--important, but not critical, in this case, but the lesson is exactly the same. I call my intuition the Short Form of knowledge and I consistently err when I ignore it.

So glad you have your Nancy with you. Thank you both for the lesson.

secret agent woman said...

I definitely believe in getting a second opinion if you have concern. You have to be your own (or our spouse's or your child's) advocate. And even without a medical degree, I'd have coded that mole as susipcious.

Orhan Kahn said...

My close family has never had to deal with cancer or heart disease or diabetes or anything major, actually. I've been blessed with a superior immune system, however not ever having to deal with terminal illness has left mke inept to deal with others who do. Especially when it is someone you care about deeply.

Robert the Skeptic said...

Rain In this case, what I observed did not match the information we were being told, it did not pass the "reasonableness test"; the explanation did not match the conclusion the evidence was presenting me. Some call it instinct, others "inner voice", but in either case I think it comes from being knowledgeable mindful.

Nance There are thousands of things that people try to present to us, financial, health, spiritual. Again, measuring it against one's own reasonableness is the key. The truth is that it is not always easy, it does not come naturally to humans. We are prone to want to accept and believe. This is why a tad of skepticism is a good thing, though not always the easy thing to employ.

SecretAgent I agree; I've been doing a lot of research as I am staring down a heart operation in the not too distant future. But I tell you honestly, that picture of the Melanoma and what was on Nancy's arm shouted to me... they were strikingly identical and it made no sense that her doctor would deny it's diagnosis so quickly off-hand.

Orhan You are fortunate indeed thus far. The statistical truth is that these things happen in statistically predictable numbers. Yet the abject starkness of numbers become meaningless when someone you love or care about is touched by them. Remember, it was only a short month ago that our fellow blogger, Penny was with us. Life can change in a flash.

Kay Dennison said...

I know someone who just died because she took her doctor at his word. Good for you for insisting on a second opinion!!!! A century ago they were using leeches. Yuck!

I remember a doctor telling me that my two year old was just getting on my nerves and that was causing the problem and gave me a scrip for tranqs. I threw away the scrip and decided to go see an ob-gyn who did an exam and informed me that I was 3 months
preggers!!!!!! I think too many people think their doctor is God and he isn't.

I am an absolute freak about doctors doing their job right and ask lots of questions and tell them when I think they're wrong. I'm alive and in better shape than I'm supposed to be because of that.

Robert the Skeptic said...

Kay There are people in any profession who can drop the ball, yet more often, others are top-performers. In the future I will be telling the stories of two docs who were artists in their field - virtual Sherlock Holmes' of the medical profession.

Alpha Za said...

Thank God! Incompetence aside, I think the fact that you stuck to your convictions really made a difference, your girl is really lucky to have you.

We are all human, the more sketpical we are of each other, fewer mistakes fall through the cracks.

MarytrMom said...
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MarytrMom said...

We should all be pro-active about our medical care. Doctors are NOT Gods. I'm glad you insisted she have it looked at further.

PS no one should complain when Docs want what seem to be unnecessary test either

The Mother said...

The visual identification of skin lesions is an art form, practiced well by a few, badly by many and dangerously by many more.

I would have had it yanked. But I'm a fair skinned redhead who covers from head to toe everywhere, often to my husband's general amusement.

He, however, is the moley guy with a family history of melanoma. Once a year he strips in front of our trusted dermatologist and gets three or four popped off. So far, nothing worse than dysplastic.

We keep our fingers crossed.

Marylinn Kelly said...

Such a vivid reminder about trusting our suspicions. I am so glad to read of the good outcome. As a first-time mother, I had an intuitive sense that my 6-month-old was delayed in his motor development. His regular pediatrician was on vacation and a younger partner said, "Oh, you mothers, you always think you know everything," when I mentioned it to him. When the regular doctor returned, we were sent immediately for evaluation and nearly a year of therapies to assist in what was an orthopedic disability. We went through a similar situation a couple years later with a neurologist. Sometimes it is easier to be fierce on behalf of someone we love but we need to be equally vigilant about ourselves.

Robert the Skeptic said...

MayrtrMom Again, the critical point here is to be informed and knowledgeable, but more importantly, to be advocates for ourselves. We rely on experts to give us good information, they should not balk at having to explain things so we understand them.

Dr. Mom We do that as well. Was just informed (updated the blog) that I need to go back in and have Squamous removed in two days. But yes, this skeptic doesn't rule out "crossing fingers" either.

MaryLinn It is important to advocate. Some people have faith in medical and other professionals; I rely more on "trusting" their judgment. Trust is based on experience and built over time. Sometimes when seeing some specialist, there isn't that opportunity to build that history. But it is always good to ask questions.. and their RESPONSE to our questions can be the most telling about what kind of care we may expect to receive.

KleinsteMotte said...

GP's. They are necessary to get help but not always helpful. For two years I complained of a lump in my belly. Just some stool was her response. Once a surgeon took a knife to it it turned out to be stage three colon cancer! Sadly I still have the same GP because of the system here. Glad the outcome at your end has a happy ending as did mine for now.