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Fear annoys. Fear mystifies. Fear masquerades. Fear can be trivial or terrifying. But fear is always there.
Boris has a spot on his nose. I call with test results.
“Boris, I got back your biopsy report. As expected, it did show a basal cell skin cancer.”
“Skin cancer?”
“Yes. As we discussed, basal cells are not serious and don’t spread, but you have to get it taken off.”
“Will I have to stay in the hospital?”
“No, it’s done under local anesthesia. You get it done and go home.”
“Is it urgent?”
“It can wait a few weeks. Just call for an appointment.”
“Will it be done in the hospital itself, or in another building?”
One question succeeds another. Each answer prompts another question. Sometimes the queries circle back and threaten to start the interrogation over. Children use the same tactic before you freeze their wart. “Wait! Will it hurt?” “Wait, wait, how many times will you freeze it?” “Wait, wait, how many seconds will it take?”
It takes patience, but Boris’s tone finally softens, and the questions stop. The queries are less requests for information than stalling tactics. Maybe if I keep asking, the problem will go away.
Stella is more perplexing than Boris, not to mention more challenging.
“I had a melanoma on my forehead, Doctor. But it’s all taken care of.”
“Taken care of?”
“Yes. The dermatologist in Clarksville did a biopsy, which showed melanoma, but I had a healer take care of it.”
“A healer?”
“Yes. I tell the healer my problem. She doesn’t even have to be there. She can heal from anywhere. She took care of it.”
“With due respect, I don’t think she did.”
“Why do you say that?”
“Because it’s still there on your forehead. I can see it.”
Stella and I negotiate. I will perform another biopsy, but only after she promises me that if the biopsy confirms the presence of melanoma, she’ll see a surgeon.
The biopsy shows melanoma in situ. Two weeks later the surgeon’s office calls to say that Stella has canceled her appointment.
I call Stella.
“I decided to cancel my appointment,” she says. “I asked the surgeon to perform another biopsy, but she refused. I found another dermatologist who will do it.”
“Just curious,” I say. “If two previous biopsies didn’t convince you that you have melanoma, why would a third?”
“Because I thought the healer had finished taking care of it, but she hadn’t,” Stella says. “Now she has.”
Stella pauses. “I know I’m on shaky ground here,” she says. “Maybe I don’t have a leg to stand on. But I just need to be sure.”
“You know,” I say, “if you don’t remove a melanoma, it can spread and cause death.”
Stella does know this. But she still isn’t sure it hasn’t already been taken care of. She has to be sure. Wait, wait ...
“You understand,” I say, “that I can’t be your doctor anymore, since you aren’t willing to follow my advice.”
“Of course,” says Stella, “that goes without saying.”
“Actually, it doesn’t,” I say. “If I can’t be responsible for your health, I have to make sure you know that, that you know why, and that you pick someone else to take care of you. It seems you have chosen someone.”
We all see many Borises. There are plenty of Stellas, too, though we don’t often see them. People who think as she does, who put their trust in strange treatments and sundry healers, don’t often show up in our offices. How they can think the way they do passes my understanding. But then much that I read or hear in the news about what people think passes my understanding. They are not my responsibility, though; Stella is, or at least she was.
Stella’s faith in her remote healer seems like one way of abetting denial and addressing fear, one step beyond just pretending the symptom or sign simply isn’t there. How much more obvious can a problem be than a black spot on your forehead?
Dealing with it may be wearying, or impossible. But it’s part of our job, because it’s always there.
Besides, we should be able to relate. Doctors know fear too, don’t we?
Dr. Rockoff practices dermatology in Brookline, Mass., and is a longtime contributor to Dermatology News. He serves on the clinical faculty at Tufts University, Boston, and has taught senior medical students and other trainees for 30 years. His second book, “Act Like a Doctor, Think Like a Patient,” is available at amazon.com and barnesandnoble.com. Write to him at dermnews@mdedge.com.
Fear annoys. Fear mystifies. Fear masquerades. Fear can be trivial or terrifying. But fear is always there.
Boris has a spot on his nose. I call with test results.
“Boris, I got back your biopsy report. As expected, it did show a basal cell skin cancer.”
“Skin cancer?”
“Yes. As we discussed, basal cells are not serious and don’t spread, but you have to get it taken off.”
“Will I have to stay in the hospital?”
“No, it’s done under local anesthesia. You get it done and go home.”
“Is it urgent?”
“It can wait a few weeks. Just call for an appointment.”
“Will it be done in the hospital itself, or in another building?”
One question succeeds another. Each answer prompts another question. Sometimes the queries circle back and threaten to start the interrogation over. Children use the same tactic before you freeze their wart. “Wait! Will it hurt?” “Wait, wait, how many times will you freeze it?” “Wait, wait, how many seconds will it take?”
It takes patience, but Boris’s tone finally softens, and the questions stop. The queries are less requests for information than stalling tactics. Maybe if I keep asking, the problem will go away.
Stella is more perplexing than Boris, not to mention more challenging.
“I had a melanoma on my forehead, Doctor. But it’s all taken care of.”
“Taken care of?”
“Yes. The dermatologist in Clarksville did a biopsy, which showed melanoma, but I had a healer take care of it.”
“A healer?”
“Yes. I tell the healer my problem. She doesn’t even have to be there. She can heal from anywhere. She took care of it.”
“With due respect, I don’t think she did.”
“Why do you say that?”
“Because it’s still there on your forehead. I can see it.”
Stella and I negotiate. I will perform another biopsy, but only after she promises me that if the biopsy confirms the presence of melanoma, she’ll see a surgeon.
The biopsy shows melanoma in situ. Two weeks later the surgeon’s office calls to say that Stella has canceled her appointment.
I call Stella.
“I decided to cancel my appointment,” she says. “I asked the surgeon to perform another biopsy, but she refused. I found another dermatologist who will do it.”
“Just curious,” I say. “If two previous biopsies didn’t convince you that you have melanoma, why would a third?”
“Because I thought the healer had finished taking care of it, but she hadn’t,” Stella says. “Now she has.”
Stella pauses. “I know I’m on shaky ground here,” she says. “Maybe I don’t have a leg to stand on. But I just need to be sure.”
“You know,” I say, “if you don’t remove a melanoma, it can spread and cause death.”
Stella does know this. But she still isn’t sure it hasn’t already been taken care of. She has to be sure. Wait, wait ...
“You understand,” I say, “that I can’t be your doctor anymore, since you aren’t willing to follow my advice.”
“Of course,” says Stella, “that goes without saying.”
“Actually, it doesn’t,” I say. “If I can’t be responsible for your health, I have to make sure you know that, that you know why, and that you pick someone else to take care of you. It seems you have chosen someone.”
We all see many Borises. There are plenty of Stellas, too, though we don’t often see them. People who think as she does, who put their trust in strange treatments and sundry healers, don’t often show up in our offices. How they can think the way they do passes my understanding. But then much that I read or hear in the news about what people think passes my understanding. They are not my responsibility, though; Stella is, or at least she was.
Stella’s faith in her remote healer seems like one way of abetting denial and addressing fear, one step beyond just pretending the symptom or sign simply isn’t there. How much more obvious can a problem be than a black spot on your forehead?
Dealing with it may be wearying, or impossible. But it’s part of our job, because it’s always there.
Besides, we should be able to relate. Doctors know fear too, don’t we?
Dr. Rockoff practices dermatology in Brookline, Mass., and is a longtime contributor to Dermatology News. He serves on the clinical faculty at Tufts University, Boston, and has taught senior medical students and other trainees for 30 years. His second book, “Act Like a Doctor, Think Like a Patient,” is available at amazon.com and barnesandnoble.com. Write to him at dermnews@mdedge.com.
Fear annoys. Fear mystifies. Fear masquerades. Fear can be trivial or terrifying. But fear is always there.
Boris has a spot on his nose. I call with test results.
“Boris, I got back your biopsy report. As expected, it did show a basal cell skin cancer.”
“Skin cancer?”
“Yes. As we discussed, basal cells are not serious and don’t spread, but you have to get it taken off.”
“Will I have to stay in the hospital?”
“No, it’s done under local anesthesia. You get it done and go home.”
“Is it urgent?”
“It can wait a few weeks. Just call for an appointment.”
“Will it be done in the hospital itself, or in another building?”
One question succeeds another. Each answer prompts another question. Sometimes the queries circle back and threaten to start the interrogation over. Children use the same tactic before you freeze their wart. “Wait! Will it hurt?” “Wait, wait, how many times will you freeze it?” “Wait, wait, how many seconds will it take?”
It takes patience, but Boris’s tone finally softens, and the questions stop. The queries are less requests for information than stalling tactics. Maybe if I keep asking, the problem will go away.
Stella is more perplexing than Boris, not to mention more challenging.
“I had a melanoma on my forehead, Doctor. But it’s all taken care of.”
“Taken care of?”
“Yes. The dermatologist in Clarksville did a biopsy, which showed melanoma, but I had a healer take care of it.”
“A healer?”
“Yes. I tell the healer my problem. She doesn’t even have to be there. She can heal from anywhere. She took care of it.”
“With due respect, I don’t think she did.”
“Why do you say that?”
“Because it’s still there on your forehead. I can see it.”
Stella and I negotiate. I will perform another biopsy, but only after she promises me that if the biopsy confirms the presence of melanoma, she’ll see a surgeon.
The biopsy shows melanoma in situ. Two weeks later the surgeon’s office calls to say that Stella has canceled her appointment.
I call Stella.
“I decided to cancel my appointment,” she says. “I asked the surgeon to perform another biopsy, but she refused. I found another dermatologist who will do it.”
“Just curious,” I say. “If two previous biopsies didn’t convince you that you have melanoma, why would a third?”
“Because I thought the healer had finished taking care of it, but she hadn’t,” Stella says. “Now she has.”
Stella pauses. “I know I’m on shaky ground here,” she says. “Maybe I don’t have a leg to stand on. But I just need to be sure.”
“You know,” I say, “if you don’t remove a melanoma, it can spread and cause death.”
Stella does know this. But she still isn’t sure it hasn’t already been taken care of. She has to be sure. Wait, wait ...
“You understand,” I say, “that I can’t be your doctor anymore, since you aren’t willing to follow my advice.”
“Of course,” says Stella, “that goes without saying.”
“Actually, it doesn’t,” I say. “If I can’t be responsible for your health, I have to make sure you know that, that you know why, and that you pick someone else to take care of you. It seems you have chosen someone.”
We all see many Borises. There are plenty of Stellas, too, though we don’t often see them. People who think as she does, who put their trust in strange treatments and sundry healers, don’t often show up in our offices. How they can think the way they do passes my understanding. But then much that I read or hear in the news about what people think passes my understanding. They are not my responsibility, though; Stella is, or at least she was.
Stella’s faith in her remote healer seems like one way of abetting denial and addressing fear, one step beyond just pretending the symptom or sign simply isn’t there. How much more obvious can a problem be than a black spot on your forehead?
Dealing with it may be wearying, or impossible. But it’s part of our job, because it’s always there.
Besides, we should be able to relate. Doctors know fear too, don’t we?
Dr. Rockoff practices dermatology in Brookline, Mass., and is a longtime contributor to Dermatology News. He serves on the clinical faculty at Tufts University, Boston, and has taught senior medical students and other trainees for 30 years. His second book, “Act Like a Doctor, Think Like a Patient,” is available at amazon.com and barnesandnoble.com. Write to him at dermnews@mdedge.com.