Should one offer an unsolicited dermatologic opinion? Ethics for the locker-room dermatologist

Interesting article in JAAD, July 2011

Appreciate any comments please

 

CASE SCENARIO
While changing in the locker room after a workout, Dr Jones, a dermatologist, notices a lesion on the upper back of someone two lockers over that immediately catches her eye. From a distance, it appears to be variegated in color and measures 1 to 2 cm in size, and the lesion arouses suspicion of malignant melanoma.
Dr Jones should:
A. Say nothing, as she has not been asked for her opinion.
B. Walk over to the person two lockers over and introduce herself as a dermatologist and tell her that something on her back caught her eye, and if it is all right with her, she would be willing to take a closer look.
C. Approach the person two lockers over and introduce herself as a dermatologist and tell her that she is worried about the lesion based on its appearance, give her her business card, and suggest that the person contact her as soon as possible for follow-up in the office.
D. Introduce herself as a dermatologist and suggest that something on her back caught her eye and she recommends that that the person contact her physician to have it evaluated more closely.

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  1. #1 by Andrew Montanari on July 21, 2011 - 7:38 am

    Great Q.
    And what if it’s a week after retiring – ie no longer being registered by our beloved medical board?
    Remember we are not supposed to practice medicine at all (paid or unpaid, including any use of our medical skills or knowledge). The only exemption is for immediately life-threatening situations, which MM is not.

    You just have to do what is reasonable, ignoring the current medicolegal and political fashions.

  2. #2 by Luke Bookallil on July 21, 2011 - 7:41 am

    I would follow the D approach of saying that the person has a potentially serious skin lesion and suggest review by their doctor. Luke B

  3. #3 by Paul Elmslie on July 21, 2011 - 8:42 am

    This is an interesting question and also could be asked of Tele Medicine. In this case if I was the person with a possible melanoma I would like to have it pointed out. Medico-legal is the issue. With Tele Medicine I am yet to see if you were to give advice based on limited information whether there are medico-legal issues. Keen to hear others thoughts.

  4. #4 by Gary Pellizzari on July 21, 2011 - 10:49 am

    D is very reasonable. I cant see anybody being sued for taking sensible and reasonable action.

  5. #5 by margaret oziemski on July 21, 2011 - 12:11 pm

    I have been in this situation where a person in front of me in a que in the movies had what appeared to be a very suspicious lesion on their skin. As we progressed in the que I became more uncomfortable seeing this lesion and doing nothing. So I got the courage to say that I was a skin specialist and wanted them to know that I was not asking them to see me but that i would recommend they saw their doctor. This is where it got interesting because they then said they have who told them it was OK. Now you get into the consultation territory because I had to ask how long ago that had been, and again stressed the lesion needed a review and suggested they return to thier doctor. So in essence I would answer “D”. I also gave them my card as I asked if they could let me know what happened and for a long time I stressed not hearing anything. One day I got a call thanking me that I persisted because when they went back to thier doctor the lesion was removed and it was a melanoma. Would I do this all again? Should you check with the Medical defence association before proceeding? I am keen to hear what the correct medicolegal answer is and then what the correct moral answer is.

  6. #6 by Dr. Isabelle Jonsson on August 12, 2011 - 10:11 am

    All this litigation castrates a Doctor and makes you so much more ineffective. You always have to think ” litigation” first. All that set aside I would tell the person and strongly advise they see their Doctor. It does however play on your mind as to what the outcome was. Just wondered if you are allowed to ask their name so you can check up on the outcome?? Or just give them your name and hope they get back to you.

    Morally I just could not ignore it.

    Interesting question!

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