Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments

Some Patients Just Won’t Take “No” For An Answer

62-year-old black man with a two inch (that’s inch; not centimeter) lump under his left arm. It is determined that he needs to have it biopsied in order to tell for sure what it is. The differential diagnosis includes a simple reactive lymph node, lymphoma, leukemia, granuloma, sarcoidosis, and several other more esoteric entities, all of which require tissue for definitive pathologic diagnosis.

The dialogue:

Patient Who Will Not be Reassured: What is it, Doctor Dino?

Me: We won’t know for sure until we get the report from the biopsy.

PWWNBR: But what do you think it is?

Me: I have no idea. We have to see what the pathologist says.

PWWNBR: Could it be cancer?

Me: It could be any one of several different things. Yes, cancer could be one of them, but there’s no way of knowing without the biopsy.

PWWNBR: Dr. Dino, do I have cancer?

Me: I don’t know. We can’t tell until we get the biopsy report.

PWWNBR: But what do you think?

Me: I really don’t know. There are some features about it that make me think one thing, but there are other features that make me think something else. So the only thing to do is get the biopsy and see what it shows.

PWWNBR: What do I have?

Me: You have a mass under your arm that needs to be biopsied.

PWWNBR: But what is it?

Me: There’s no way to know for sure until we talk to the pathologist.

PWWNBR: Dr. Dino, what do you think it is?

Me: I can’t tell just by feeling it. We need to get the biopsy and wait until the report is ready.

PWWNBR: Do you think it’s cancer?

Me: I have no idea what it is, and the only way to find out is to see what the tissue looks like under the microscope.

PWWNBR: But what is it, Dr. Dino?


and repeat….


and again……

and yet again…….


Or so it seems. 

*This blog post was originally published at Musings of a Dinosaur*

You may also like these posts

    None Found

Read comments »

Comments are closed.

Return to article »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »