The Sermo community discusses how to approach a stranger regarding a potentially suspicious mole, if at all. The fear of frivolous malpractice suits is so high that physicians have differing stances on whether to speak up and potentially save a life. This case highlights some of the repercussions of the widespread fear of being sued, even when acting as a benevolent bystander. Below are a handful of the 200 responses to the discussion.
Originally Posted to the Sermo Community
By: A Family Practitioner on Sermo
Here is the scenario...
You are at a cafe in line; in front of you is a very tanned caucasian woman, in her 30s.
She is holding a blue-eyed, blond, fair-skinned toddler, presumably her daughter.
Poll ResultsThe mother is wearing a halter top. On her back shoulder are two very black nevi, irregular, >5mm. Her other moles are brown and nothing like these.
So the question, do you say anything? Do you identify yourself as a physician?
Response from a Family Physician: "Of course you say something and you identify yourself as a physician to lend some creditability to your observation. Whats the worst thing that could happen?? She thinks you're a quack and she goes on about her life, the best thing that could happen—you save her life. Seems like the risk benefit ratio is favorable here.”
Response from a Family Physician: “No. The moment you say something, jeopardy attaches. At that point, You need to provide documentation to cover yourself."
Response from a Dermatologist: "I would say something also. You have to live your life as you should and not be hostage to the legal system."
Response from a Emergency Physician: "Similar to airplane emergencies and roadside accidents. I stop and inquire. It's the human thing to do. To help each other, just don't be intrusive. "I'm sorry to bother you, but I am a physician and I noticed an abnormal looking mole on your back. I encourage you to have your doctor look at it, soon." Nod your head pleasantly and walk away."
Response from a Pediatrician: “Do what you would want done if the situation were reversed. Suppose you had missed a melanoma in your child and a stranger noticed it."
Response from a Family Physician: "Do you routinely stare at strange women and study their...moles? I have always been taught that staring / studying a stranger was rude and impolite.
Given that I would not have noticed a stranger's moles, I would not find myself in your conundrum.
And had I noticed the moles, I certainly would not have thought it my place to tell her my career choice and then share my concern that she might have cancer.
Put yourself in her shoes. You're in line at the store, minding your child, and waiting to check out while some individual (? pervert) behind you is staring at your back like it's a Tom Clancy novel. Then he abruptly introduces himself and says you probably have cancer. Do you feel reassured? Or would you think the guy was a crazy? I'd think you were crazy.
And perhaps she's had those her entire life and her personal dermatologist (who she's known for years) has told her she's fine. You just don't know, it isn't your business.This scenario has high likelihood of causing unnecessary anxiety and low likelihood of actually helping the person.
Keep your eyes to yourself."
Response from a Radiation Oncologist: "How can you not notice a potential melanoma? I have no problem mentioning that kind of thing."
Response from a Pediatrician: "About 25 years ago I warned a bank teller she needed to get a mole looked at, and then promptly forgot about it. Fifteen years later this woman's daughter came in with her newborn, and told me that the grandmother's mole had been a melanoma, "they told her they got it just in time," and she was alive and well! One of those very precious things about being a doctor!"
Response from a Dermatologist: "Although you can be sued for anything, I don't think you can be successfully sued for saying something like: "Excuse me, ma'am, I couldn't help but noticed that the mole on your back is a bit irregular in its shape. I think that you should have it evaluated by your doctor."
Where is the wrongdoing that a suit could be based on? Some of the people posting on here are paranoid."
Response from a Family Physician: "I have this patient in my practice. I asked her about a relatively large surgical scar on her posterior shoulder. Yrs ago she was in line for a movie. A gentleman behind her tapped her on the shoulder, and apologetically explained that he was a dermatologist, and could not help noticing an abnormal looking mole on her back, and encouraged her to have her own doctor check it soon. That was the end of the conversation, but she did have it checked, and it was a melanoma. Her doctor told her that if it wasn't caught soon, it likely could have metastasized. The dermatologist saved her life and she explained to me that she has no idea who he was (only explained that he was a derm - didn't give his name), but that she is alive today because of him, and she will be eternally grateful.”
Response from a Pediatrician: "Beware the curbside consult, as I have said in the past and someone has said above. If you can suggest a visit to PMD in an offside manner, in a friendly manner, just avoiding work when you are not in your legal element, you and your carrier may sigh more easily. for some whose conscience urges and compels them to talk up so they can rest more easily, you need to learn some self control. You do not know this woman's situation or how your uninvited offside remark may be taken. Do not assume legal liability unless and until you are ready to do so. Then do so in an offside manner and go about whatever you are doing.”
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