Stand Your Ground

Have you ever referred a patient to a specialist to have a lesion evaluated and/or biopsied for possible cancer, just to have the patient tell you that the specialist said, “Oh, it’s nothing. Just keep an eye on it.” This has happened to me, and while it is extremely frustrating and time-consuming, I have never made light of or dismissed concern surrounding potential signs of oral cancer.

A few years ago, during a routine evaluation, I found what I explained to my patient, “Tom,” to be a lesion on the side of his tongue. He was unaware of the lesion and did not recall suffering any trauma to the site. I brought him back for a follow-up two weeks later, and it was still there and looked worse. I explained to him the different things it could be, one of which could be cancer, and sent him to seek immediate evaluation with an ear, nose and throat doctor, with photographs of the site from both visits.

The first time he went, the doctor was dismissive, and Tom became a bit upset with me for scaring him. When I sat down and explained to him (again) my concern and the horrible risks associated with just “watching” the lesion grow, he started to understand the importance of a biopsy and decided to seek a second opinion. It turned out it was dysplasia. Tom did survive after surgical resection of a large portion of the left side of his tongue.

Unfortunately, this is not my only story.

I’ve been in practice for more than 17 years and have been doing oral, head and neck cancer screenings at least eight times a day, every day I work. I’ve seen and found oral cancer three times in my career, as well as countless skin and thyroid cancers. The excellent training I received in dental school in pathology, my experience and the fact I see my patients routinely makes me — and any of us — experts in doing these screenings.

I realize when your clinical opinion and evaluation is judged by a colleague and then disregarded, it can be downright embarrassing. But if you think your judgement bears merit, don’t give up. Should this happen to you — that a medical doctor opt not to biopsy — I ask you to stand your ground. Approach your patient with empathy, patience and composure. Take time to make sure they understand the issue at hand and urge them to go back or seek a second opinion.

As dentists, our patients rely on us to have their best interest at heart. They hope that we are here to take care of them. I consider it a privilege for a person to put their trust in me and allow me to partner with them in caring for their well-being. It is our job to let them know the good along with the bad things we discover; but remember, what they do with that information it is ultimately their decision to make.

Originally published in The Daily Grind