oliver@athena.mit.edu (James D. Oliver III) (09/12/89)
The Boston Globe had an interesting article today concerning the issues facing a physician who, on casual observation of a person in an everday circumstance, notices a possible pathological physical finding. The article was prompted by the case of the doctor who supposedly observed clubbing of baseball Commissioner Giamatti's fingers on television, and wrote to American League President Bobby Brown, a doctor, advising Giamatti to get a checkup. Brown passed the information on to Giamatti, who did nothing about it and died of cardiac arrest a few days later. Upon further review of the television sequence, however, it was determined that the doctor had erred and that the fingers he observed were not Giamatti's, but a man sitting behind him. Anyway, I'd be interested in hearing some discussion on the following from both physicians and non-physicians. I think that, for the sake of rigor, we call all agree that there are trivial boundary cases where something should and should not be said. As examples, I would guess that a pregnant woman knows she's pregnant and you wouldn't have to go up to her and tell her (and if she's not, then you *really* don't want to say anything). On the other hand if someone is walking around with a gangrenous arm, there shouldn't be any hesistation in informing. But what about the in-between? Specifically, is a physician obligated to tell someone if, upon casual observation, (s)he thinks (s)he spots a potentially abnormal physical finding. Skin lesions and hormonal imbalances are probably the most common examples. More serious ones would be signs of cardiorespiratory impairment. The arguments against doing so include invasion of the person's privacy (which I don't really buy, how is just talking to someone an invasion of their privacy?), unnecessarily worrying someone (which I see as the major concern), and suspicion that the doctor is just trying to drum up business (maybe, but I hope unlikely). The percentages of such diagnoses probably are that they are mostly wrong, but is it better to err on the side of safety? I feel that it is a judgement call dependent upon the potential seriousness of the consequences, and I think that my tendency would be to err on the side of recommending that they get checked on. Skin malignancies have a bad downside if they're left alone, but if you pick them up, the Rx is relatively simple. Anyway, a skin malignancy would have to be pretty obvious for me to pick it up. Marfan's syndrome is another one that, if I had a strong suspicion, I would have trouble ignoring (but then, as one of the doctors was quoted, you could diagnose any basketball team as having Marfan's). Hormonal problems I would be less concerned with, and would be a much more difficult approach anyway (basically boiling down to polite ways of saying "Excuse me, but you look sort of funny . . .") If someone came up to me and said they though I had something (and convinced me they knew what they were talking about), I would probably be somewhat insulted and mutter something unkind, but would eventually check it out. Most of the doctors surveyed in the article seemed to believe that it was better to say nothing. So maybe with more experience, I might decide not follow up on my observations, as well. By the way, I don't know if any attempts have been made to try and contact the man whose fingers were mistaken for Giamatti's. Should there be? ____________________________ Jim Oliver oliver@athena.mit.edu oliver%mitwccf.BITNET@MITVMA.MIT.EDU
timk@xenitec.uucp (Tim Kuehn) (09/12/89)
oliver@athena.mit.edu (James D. Oliver III) writes: >The Boston Globe had an interesting article today concerning the issues >facing a physician who, on casual observation of a person in an everday >circumstance, notices a possible pathological physical finding. ...stuff deleted.... > >Anyway, I'd be interested in hearing some discussion on the following from >both physicians and non-physicians. > Recently there was a case here in Canada where a semi-retired doctor was successfully sued $50,000 for not treating a man who had a heart attack on his front door. The man was complaining of chest pains and his wife went across the street to a doctor's house. The doctor's wife explained that the doctor wasn't doing a full-time practice, and for the man to come back in the afternoon. While on the doctor's porch, the man suffered a heart attack. The doctor came forward and looked, and an ambulance called (but did not treat the man). The man was taken to a local hospital where he later died. According to court records, when the doctor walked towards the man, he "accepted medical responsibility for his care." (This information taken from memory after reading the article in the KW-Record sometime in the past couple weeks.) An interesting question is - would this kind of thing apply to the question here - about whether a doctor should tell a person they see on the street they may have a illness or not. Would that be construed as "accepting medical responsibility", and as such leave the doctor liable if something happens in the immediate future after the he and the person he's informed ofa potential illness have parted ways? +-----------------------------------------------------------------------------+ |Timothy D. Kuehn timk@xenitec | |TDK Consulting Services !watmath!xenitec!timk | |871 Victoria St. North, Suite 217A | |Kitchener, Ontario, Canada N2B 3S4 (519)-741-3623 | |DOS/Xenix - SW/HW. uC, uP, DBMS. Satisfaction Guaranteed| +-----------------------------------------------------------------------------+
dalex@eleazar.dartmouth.edu (Dave Alexander) (09/12/89)
In article <14254@bloom-beacon.MIT.EDU> oliver@athena.mit.edu (James D. Oliver III) writes: > By the way, I don't know if any attempts have been made to try and > contact the man whose fingers were mistaken for Giamatti's. He has been contacted. His clubbed fingers are congenital and don't indicate anything about the condition of his heart. -- Dave Alexander -- "I'm afraid it's grim news, Sandy - the Vice-Consul intends to ban the wearing of wimples after 7:15 PM." -- Glen Baxter
brian@sequent.UUCP (Brian Godfrey) (09/13/89)
>But what about the in-between? Specifically, is a physician obligated to >tell someone if, upon casual observation, (s)he thinks (s)he spots a >potentially abnormal physical finding. Skin lesions and hormonal > >Most of the doctors surveyed in the article seemed to believe that it was >better to say nothing. So maybe with more experience, I might decide not >follow up on my observations, as well. By the way, I don't know if any It used to be that doctors were doctors because they were concerned about the health and well-being of their fellow human beings. It would seem that such is no longer the case. I suspect that any doctor who exhibited concern unasked-for would be either chastized or at least given the cold shoulder by his colleagues. I am, of course, exaggerating. But not to a great degree. The type of unrequested medical advice described is quite typical of the family doctor of a few generations ago who actually knew most of his patients and really did care about them. Most doctors now-a-days are "clinical" in their manner, not concerned. -- --Brian M. Godfrey Sequent Computer Systems Inc. {uunet|tektronix}!sequent!brian sequent!brian@cse.ogc.edu
reb@squid.rtech.com (Richard Baum (*-= REB=-*)) (09/14/89)
>here - about whether a doctor should tell a person they see on the street they >may have a illness or not. Would that be construed as "accepting medical If you had an illness that could be diagnosed 'curbside' would you want every doctor passing you in the street to remind you about it and suggest treatment? I think that MYOB comes into play here. If someone falls to the ground at your feet that's one thing. Curbside diagnosis of a random person in the street is absurd. reb reb@rtech.com reb%rtech.com@lll-winken.llnl.GOV h:861 Wash Av Westwood, NJ 07675 h:201-666-9207 Ten years ago I walked these streets my dreams were riding tall. Tonight I would be thankful lord for any dream at all.
avery@well.UUCP (Avery Ray Colter) (09/14/89)
Oh, this subject is quite a charged one for me.
I have dated many women now who have told horrendous stories of mostly
non-physicians giving them diet advice on the street!
I have heard one story from a very heavy woman, who told that one day she
was walking down the street with several slim office mates on lunch break.
They all had ice cream cones. A woman passed by, snatched Lynn's cone out of
her hand, smashed it on the ground, and proceed into a tirade about Lynn
killing herself. She conveniently neglected to be so concerned about the
health of the thinner office mates.
--
Avery Ray Colter avery@well.sf.ca.us 71067.606@compuserve.com
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