"You should get that looked at" -- yea or nay?

September 18, 2009 3:13 PM

How far does -- or should -- a medical professional's ethical responsibility go when it comes to the health and well-being of strangers (i.e. people one might see on the street, or in line at the supermarket)?

As a purely theoretical example, let's say I'm paying for my groceries and I notice that the cashier behind the till has some pretty characteristic signs of a disease that may be potentially serious, but that they may not realize they have. (For argument's sake, let's say Cushing's syndrome or melanoma.) Should I assume it's (a) none of my business, (b) something that is my business, but perhaps is not a good idea to address because I could be wrong and cause unnecessary anxiety, or they could already be seeing their doctor about it, (c) something I should definitely mention, or (d) something else?

If it's not venturing too much into the realm of ChatFilter, how would you feel if someone came up to you and said, "Excuse me, I'm a doctor/nurse/dentist, and I think you should get [x] looked at."?

posted by greatgefilte to human relations (31 comments total)

I think the benefits - being informed of a disease, thus saving my life - would in no way outweigh the possible harm - like, "thanks, I know I have x disease, now it's public even though I'm getting it treated and I'm quite sensitive about it but it's wonderful for you to bring it up, in public, at my work"
posted by Think_Long at 3:26 PM on September 18 [1 favorite]

Eh...gut says don't do it, in most cases. It would be interpreted in many cases as being too nosy, busy-body, know-it-all, presumptuous, etc, despite your best intentions. Best to just bite your tongue and hope/assume/wish that the person (a) is cognizant of it, (b) has friends or family that are aware of it, and/or (c) is taking action.
posted by davidmsc at 3:28 PM on September 18

how would you feel if someone came up to you and said, "Excuse me, I'm a doctor/nurse/dentist, and I think you should get [x] looked at."?

"And you should really get that broken nose seen to."

Okay, my reaction would not really be that extreme. But put this on your list of Things Not to Do.
posted by FishBike at 3:30 PM on September 18

Can a doctor even do this if it's not his/her patient? I thought there was some legal restriction here on giving medical advice to someone who's not your patient. (IANAL or D)
posted by desjardins at 3:31 PM on September 18

I think the benefits - being informed of a disease, thus saving my life - would in no way outweigh the possible harm - like, "thanks, I know I have x disease, now it's public even though I'm getting it treated and I'm quite sensitive about it but it's wonderful for you to bring it up, in public, at my work"

Er, presumably the suggestion would be done without blurting it out in front of everyone in view. You know, discreetly.
posted by greatgefilte at 3:34 PM on September 18

I get where everyone else is coming from, but if it was me - or anyone I cared about - I'd want you to say something.

But I would advise you to:

a) limit yourself to commenting about symptoms that are both potentially quite serious and also commonly ignored or misunderstood, so that you have a good reason to believe people are really unaware that they might be very ill

b) make sure you can comment to them discretely - a note, a quiet aside when no one else is around - so that the only social and interpersonal consequences are between you and them
posted by shaun uh at 3:36 PM on September 18 [1 favorite]

Im just uncomfortable with the presumption, even if you have the best of intentions. This changes if you know the individual, but for a complete stranger?

Not that this is a totally apt analogy, but consider this: "Hi, I'm a professional hair-stylist. As a professional, I couldn't help but notice that your hair do is ugly. Please, I urge you to seek help". If someone does not ask you for a consultation, then no amount of training really gives you the social right to give it to them
posted by Think_Long at 3:40 PM on September 18

My MIL discovered she had a skin cancer (not melanoma) in just this way. Her regular doctor didn't notice it, but another doctor advised her to have it looked after. Now, the other doctor was someone she knew, not a random stranger, but he was not her doctor.

I, personally, would want to know.

Given the differences in opinion here, though, I'd be careful what I said and to whom.
posted by clarkstonian at 3:46 PM on September 18 [2 favorites]

What the world needs more of is sick people who don't know it yet so that by the time it becomes apparent to them the cost for treating it has increased significantly.

If it's something reasonably serious please tell them.
posted by any portmanteau in a storm at 3:48 PM on September 18 [3 favorites]

Absolutely do not do this. Other people's medical care is none of your business unless they have asked you for your opinion. I suppose you could make an exception if they appear to literally be dying right in front of you, but otherwise, keep your mouth shut.
posted by decathecting at 3:50 PM on September 18

Interestingly, the legal advice given to doctors in the UK (last time I checked) was "don't get involved" - even in big things like car accidents. In practice the vast majority of doctors ignore this, but there is a distinct possibility of legal action against you if you are active medically outside your job description. Say for example you say something along the lines of "I'm a doctor and that mole really should be looked at" leads to the unnecessary exision of the mole, is the doctor who brought the person's attention to it in the supermarket culpable?

Sorry that I can't remember the exact ins and outs of the legalities, but it is something that has legal and ethical questions within medicine.
posted by Coobeastie at 3:55 PM on September 18 [1 favorite]

Walking across a car park a doctor told me I had a skin cancer, which I didn't know, appreciated hearing, and got fixed. (It was on my face - I'd been treating it with antibiotic as a wound.)
posted by anadem at 4:23 PM on September 18

I'm surprised so many people seem not only against this, but vehemently against it. If it were me, or someone I care about it, I would want a doctor to say something. I think annoying someone is well worth the risk. Plus, I'm sure some people might be ticked off in the moment, but actually get it checked out later.

And yeah, obviously it would be done discreetly. Someone would have to be pretty stupid to do it any other way.
posted by Nattie at 4:52 PM on September 18 [3 favorites]

Probably depends on how life-threatening it is (or if your name is Gregory House).
posted by Jacqueline at 4:53 PM on September 18 [1 favorite]

FOAF was advised to go see a neurologist by another neurologist at a dinner party, who called him as having a brain tumor, and was right. (Apparently it's a thing where it noticably alters your appearance by pressing against a gland, or whatever.) So obviously that was pretty helpful. I really can't understand why people are so dead against it, I'd think if you were tactful and reserved comment for fairly serious things, that would be ideal.

I think there was an AskMefi once where the OP was a wedding photographer, and as her dentist-husband was flicking through the photos he noticed one of the attendees had very developed gum disease and was likely to be sans-teeth a few months down the line. Similar ethical debate ensued.

But I think your theoretical example has the most important criteria, as long as you aren't booming at strangers "Hey, check out that eczema on your face, for god's sake get an ointment!" then I think peeps would understand the concern even if they already knew. In absolutely no way is it like a hairstylist criticizing your hairstyle, because nobody dies of bad hair.
posted by so_necessary at 6:04 PM on September 18 [1 favorite]

Me personally, I think if it's done professionally, discreetly and in a spirit of sincerely wanting to avoid unnecessary suffering in the world, it is the right thing to do.

I see the issue around legal concerns, and in the US you can be sued for anything. But, it seems to me that it would be worth it to say something because the physician in question is often not the actual arbiter of any care (unless possibly a car accident situation). It seems that the most they would say is have your GP have a look, and it would be that doctor who would - beyond a brief glance - review the situation and make a decision.

My one other data point is Mr. Anitanita who said that his training as a physician doesn't actually include guidelines on this that he knows of, so I suppose one is left to personal values and a sense of how great your malpractice insurance is (though you can perform basic, minimal medical care before the ambulance arrives - CPR, moving them away from the burning car, assuming no spinal injuries, stopping bleeding, etc)

Anyway, he said in the case of the cashier, if he saw symptoms for a particular illness, he would tell them, but not at that moment. He would get their name, and send them a brief note that said Dear X, you rung up my groceries on X date, and as physician, I noted X, Y, and Z, which can in some, rare cases, be symptoms of A or B. While this is not a diagnosis, I feel obligated to suggest - if your own physician has not already addressed this - that you mention this to your GP. Apologies for any intrusion or awkwardness this letter may have caused. Best, Mr. Anitanita.

And then he would include his name/contact information. If it was someone standing at a bus stop, if he could in about 10 seconds politely identify himself as a doctor, and say based on X,Y, Z, which can in some, rare cases, be symptoms of A or B, if you aren't already aware of this, you might want to get that looked at, just to be safe.

Tough question though. But I still hope more health professionals/people would err on the side of helping, because I think their language and approach would be more circumspect than that of a worried, clinically uninformed friend or family member might: Oooh, that mole looks awful! I think that's cancer. Is someone looking at that?
posted by anitanita at 6:13 PM on September 18 [3 favorites]

If I were in the supermarket and saw someone behind the cashier about to stab her, would I yell "watch out!" to her? Yes.

To me, the only difference between this and the skin cancer is HOW SOON it's going to kill her. Thus, I think that I am morally required to (discreetly) tell the cashier that she appears to have skin cancer.
posted by moreandmoreso at 6:24 PM on September 18 [1 favorite]

I too am surprised how many people seem to think this is grossly taboo. Supposing that

- this professional, being a medical professional, could tell that it deserved attention
- he brought it up discreetly
- the conversation does not expose him to any sort of legal risk (say, by some extension of the "Good Samaritan" laws beyond emergency aid)

What's the problem, beyond the possibility of re-diagnosing someone several times through the course of his treatment?

>nosy, busy-body, know-it-all, presumptuous,

It's not nosy because he's not prying into anything that the "patient", willingly or not, isn't already displaying to anyone with the eyes to see; it's not "know-it-all" in the normal sense, because he really does know; and I don't even know how it could be called "presumptuous" if he limits himself to "maybe you should talk to your GP about this, if you haven't already".
posted by d. z. wang at 6:25 PM on September 18

My father was alerted to the skin cancer on his face in just this way. A dermatologist noticed him at the dealership he was working at, pulled him aside and said, I'm pretty sure that's skin cancer, you should have it looked at immediately. He did, and sure enough, it was cancer. As it turned out, he had it in several other places as well.

If you can do it discreetly, you should do it. I think that potentially saving someone's life is more important than the potential that you might offend them.
posted by crankylex at 6:34 PM on September 18

This is turning out to be quite an interesting discussion so far. I find myself thinking I should change my attitude towards being told this sort of thing, should it ever happen.

Perhaps those of us who are (or maybe, were) strongly averse to this idea feel that way because of general dislike of being told by strangers that we are doing something wrong? In this case, either failing to notice, or ignoring, a potentially serious medical symptom.

Given how many people have said a stranger has told them something like this, with beneficial results for their health, it's becoming clear that is the wrong way to look at it. This isn't like telling someone in a gym that they are doing an exercise incorrectly, but perhaps more like warning them that their house is on fire.

So... do you have an ethical responsibility to tell them? In my opinion, you do not. Would it be a good idea, if it's your area of expertise and you're quite sure they have a serious problem? Yes, I think it would be a good idea. Should you be prepared for a potentially dismissive or hostile response? Yes, but after reading the other answers to this question, you wouldn't get that from me, any more.
posted by FishBike at 7:06 PM on September 18 [8 favorites]

"First, do no harm." If you feel as though not telling would in effect be doing them harm, you're pretty well bound to tell them. Discreetly, of course.
posted by notsnot at 8:10 PM on September 18

I am a lawyer. I represent physicians in medical malpractice cases. Some time ago, a radiologist who was reviewing a film told me that there was something that he saw on the film that was suspicious for something - something unrelated to what was being claimed in the case at hand. The chances were maybe 30-35% that this was something that needed attention.

I had a "what do we do?" discussion with the people at the insurance company. My advice was that, legally, we had no obligation to the person in question. But my recommendation was that we go beyond what the legal obligation is - he should be notified. They agreed with my recommendation. We contacted the other attorney. He had his client check it out, and he was in the clear.

Did we do the right thing? Absolutely. A good lawyer knows the difference between a legal obligation and doing the right thing for another human being.
posted by megatherium at 8:44 PM on September 18 [1 favorite]

There was a story about something like this happening in the UK recently - and the guy who was told he had a tumour certainly appreciated it! I would too, by the way, to add my data point.
posted by hazyjane at 12:46 AM on September 19

I would keep it short. "It may be nothing, but I'm a doctor and I'd get X checked out by a doctor if I were you."

If they want to know what your specific concern is, they will ask. If they want to end the conversation there they will say "oh ok I will thanks, ok bye."
posted by whoaali at 1:54 AM on September 19

If some random person came up to me in the street and said "You have cancer", I'd laugh at them and go on my way. Probably while musing about care in the community. I completely understand why you'd want to say something, but unless you have some connection to the other person, they'll probably not take you seriously.
posted by Solomon at 3:02 AM on September 19

There was a situation a few years ago in Australia where a doctor was watching someone on television and they noticed a lump on the persons neck and suggested she have an immediate examination. It turned out to be thyroid cancer.

It's possible that she would have found out about this from her regular doctor, however it's also possible that she wouldn't have done anything about it.

My suggestion is that if you saw someone showing signs of a possibly life-threatening disease that you mention it to them in the most tactful of ways whilst also mentioning that you're a doctor and you just want to make sure that they've checked it out with their own doctor.
posted by h00py at 6:54 AM on September 19

Cost-benefit analysis:

Cost of telling someone something they already know: they're slightly miffed.

Cost of not telling someone something they don't already know: they're dead.

How much annoyance would you put up with in order not to die early?
posted by musofire at 7:21 AM on September 19

I was just reading ' the skin type solution ' and the author, a dermatologist, spoke about telling people to get possible melanoma looked at in checkout lines, etc. I thought it was fantastic.

I know if you know first aid you are legally obligated to help at an accident scene (here) - I don't see how this would be any different, assuming you are helping with something life threatening (not like my acne. I would hit you for that.)
posted by Acer_saccharum at 8:44 AM on September 19

I would appreciate your observation. If it's obvious enough to get your casual attention, it could very well be worth looking at professionally.

Something like "Sorry to sound rude but are you all right? I noticed [x] and that's something I would see the doctor/nurse/dentist about."
posted by tksh at 2:44 PM on September 19

It's not nosy because he's not prying into anything that the "patient", willingly or not, isn't already displaying to anyone with the eyes to see;

but that doesn't mean they don't have an expectation of privacy or discretion regarding their physical appearance.

I guess my opinion on this isn't necessarily set in stone. I can see that there are plenty of positive examples of this situation, and yes I do believe in a community of caring versus a community of insanely private individuals who resent anyone trying to help them.
posted by Think_Long at 5:39 PM on September 19

For emergency situations, you should know the law in your state. I think all states have some sort of Good Samaritan law, that gives health care providers some protection if they provide emergency assistance, i.e., car accident.

If you see someone smoking, I don't think you have to explain the dangers to them. But if you see something that indicates someone has a serious medical condition of which the may be unaware, I do think you should tell them. Say the waitress has the extremely rare "Floogemann's spot" indicating Pernicious Scourge; you say "Excuse me, I'm a physician, and I can't help but noticing that pulsating spot on your eyelid. Have you had it looked at?" and if they say Yes, you wish them luck and proceed along with your day, but if they say No, you urge them to seek care. And, more likely, if you see somebody choking in a restaurant, use the Heimlich maneuver.

I think most health care professionals want to resist being asked health care questions at a party or outside the office, and really don't want to intrude, and are unlikely to intrude unless it's urgent. (Dad was an M.D, Mom was an R.N.)
posted by theora55 at 7:33 PM on September 19