Cancer Alert: “It’s Nothing” is not a diagnosis!

No matter how loud the rejoinder, “it’s nothing” dismisses the content and reduces the listener to a passive, virtual inanimate object. For instance, Protagonist: “I am sorry I forgot your birthday”. Responder: “It’s nothing.” Translation: You blew it and I am not going to acknowledge my feelings.” Protagonist: “I should have paid more attention before I blurted out what I said.” Responder: “It’s nothing.” Translation: You are not important enough for your ill-gotten comments to matter to me.” And the worst by far is when your doctor does a biopsy and you are the Protagonist: “Doctor, you felt I needed a biopsy to protect my health. What was the result?” Doctor: “It’s nothing”. Translation: You are not intelligent enough to understand an explanation and I don’t want to waste my time with you.”
Dr Sanjay Gupta on CNN aired a report on a special unit of the National Institute of Health that investigates patients with previously un-diagnosable diseases. He was asked why the institute repeats tests and repeats biopsies that have already been performed. The gist of his answer is that when a biopsy is positive for a specific disease the diagnosis is established. But, when a biopsy does not diagnose a disease, it is a clue that more work needs to be done. It is not a diagnosis of “nothing”.
In an age of ever more impersonal health care you are the protector of your own health, you are the repository of your own information. It is your legal right to have a copy of your medical records at no charge to you and it is important to give each specialist the name of your referring doctor if there is one as well as your primary care doctor so the physicians can exchange information about you to arrive at the best care decisions possible. When you see a doctor for a health problem and you relate that a previous doctor did a test and said the results showed “it’s nothing” you are depriving yourself of the best care and at the least wasting valuable time.
One of my patients recently developed a brown streak in a toe nail. A podiatrist did a biopsy and did not find any pathology. He warned the patient that this could be a type of cancer. When I examined the toe I felt another biopsy was needed which would include removing the origin of the toe nail. I sent her to an orthopedic surgeon who promotes herself as an expert in hands and feet. For reasons I do not understand she refused to do the biopsy and sent the patient to another dermatologist. The dermatologist cancelled her biopsy because he said the first biopsy did not reveal cancer and that was most likely correct. There is a clear disconnect here between the problem the patient presented and the care she received. I called an associate at Northwestern Memorial Hospital and arranged for a second biopsy to be performed. “It’s nothing” “It’s OK” “It’s probably correct” are simply not good enough to practice good medical care. In an age where the single best weapon we have against cancer is early diagnosis you owe it to yourself to get a specific result for laboratory studies and biopsies, and to keep a copy of your own medical records.