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From: oliver@athena.mit.edu (James D. Oliver III)
Newsgroups: alt.sex,sci.psychology,sci.med,sci.bio,soc.singles
Subject: Curbside Diagnoses?
Message-ID: <14254@bloom-beacon.MIT.EDU>
Date: 12 Sep 89 09:26:53 GMT
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Sender: daemon@bloom-beacon.MIT.EDU
Reply-To: oliver@athena.mit.edu (James D. Oliver III)
Organization: Massachusetts Institute of Technology
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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