Newsletter #12–June 1992
Beware Dr. Watchit and Dr. Followit
by Marilyn McGregor
Scene: The doctors office. You are nervous. You’ve felt a lump that seems unusual but decided to be a responsible adult facing your fears and have it checked out. The doctor listens to your description, physically examines the suspected area and says, “We'll watch it.”
If the scenario sounds familiar, it is. Dr. Watchit and his colleague, Dr. Followit, too often fail to use usual and customary methods to arrive at a diagnosis to rule out or confirm breast cancer. According to a study of breast cancer malpractice claims by the Physician Insurers of America, in 69 percent of the cases in which claim were paid because of a delayed diagnosis, the patient had discovered the lump and called it to the attention of the doctor. But “the physical findings at examination failed to impress the physician.” The American College of Surgeons reports that 70% of palpable breast tumors are found by women themselves.
Why do doctors delay diagnosis? Sometimes they overvalue their clinical skills. They believe they can “feel” which suspected lesions are cancer and which are not. Or they suspect that the lump is slow growing. They know that a surgical biopsy indicates a benign lesion 75% of the time. Many doctors also have valid concerns about exposing patients to unnecessary biopsies and radiation. But if your lump is cancer, and especially if it is a fast-growing cancer, Dr. Watchit or Dr. Followit has made a grievous error.
Some women leave the doctors office relieved, thinking the lump was so Insignificant the doctor did not think it was necessary to have a biopsy or a mammogram. In one study, some 20 to 40% of breast cancer patients surveyed said they had waited three months from the time they first detected an unusual symptom until they made a medical appointment. If the doctor trivializes the symptom, the women may not return for many months or a year, or not at all. They may not want to face again the terrifying possibility that they have breast cancer. Meanwhile, a cancerous lump can double in as little as three months.
What should a woman do who meets up with Dr. Watchit? Here are some suggestions.
- Ask for a definitive diagnostic workup in addition to a physical examination. In one large screening study, more than 40 percent of the breast cancers were found by mammography alone—that is, the physical findings were negative.
- Put your request on paper. You can even send it registered mail addressed to the doctor directly. Health professionals are very sensitive to requests in writing.
- If you are in a large health maintenance organization, contact a patient relations person and explain what you want.
- Tell Dr. Watchit in a nice way that you want a second opinion to confirm you are not in need of a definitive diagnostic test. Explain that you don’t want to be a victim of a deferred diagnosis. Use of the medical/legal term can trigger a remarkable change in attitude.
- Ask your doctor to describe the size, shape and other attributes of your lump and ask why he does not feel that you need definite diagnostic tests.
- Your doctor may react with some hostility. Don’t let that response intimidate you. Your life is more important. Enlist the help of friends and significant others if you feel you need support and assistance.
When your doctor does discuss the risks and benefits of deferring a diagnosis, don’t allow yourself to be subjected to a paternalistic dismissal of your questions. After all, it’s you, the patient, who is taking the risk.
All medical tests have risks and benefits, and current technology is very limited for detection of breast cancer, especially for younger women who have denser breast tissue. A doctor should tell you specifically why he or she does not think your lump is cancerous and should listen as you explain why you think this lump is different. More important, after explaining the risks and benefits of using specific diagnostic tests, the doctor should leave the choice of going ahead with the tests up to you.
The whole field of deferred diagnosis needs to be better researched to learn its true prevalence and to find out what women can do to overcome the often patronizing dismissal they receive when they present their “lumps.” If the medical profession doesn’t develop better detection methods and professional standards to eliminate deferred diagnosis, the standards may be developed by litigation, legislation, and liability. (See Failure to Diagnose Cancer Focus of New York Conference).
Depending upon the circumstances of her case, a woman may be able to win a malpractice suit against the doctor. Usually the amount of the settlement is proportionate to the seriousness at the diagnosis. But even if the woman wins a lawsuit, she may lose her fife.
We urge readers of the Breast Cancer Action newsletter to write and tell us how they obtained results from their physicians.