A small, red wound—no bigger than a poppy seed—appeared mysteriously on the bridge of my nose a few months ago. At first it sat there quietly and behaved itself, and I assumed the strange bump would heal steadily and vanish as furtively as it had arrived. Only it didn’t, and pretty soon it started to grow bigger and act out. One day it would bleed; the next it would scab over in a sort of mini, leathery patch; and then, right when it seemed the ugly scab had almost disappeared—when it seemed we’d soon part ways—it would open up and bleed irritably again.
Day to day, I couldn’t predict its mood; it was like living with a touchy teenager.
Eventually, I realized that I would need to make the necessary arrangements to evict the tiny squatter. And so I went to see a dermatologist, who peered at my nose suspiciously and asked if I’d been under the sun much. I thought of all the summers I’ve spent thoughtlessly plopped in a beach chair, toes dug into the warm sand, book propped on my lap, while the sun toasted my skin a rich, bronzed color of rotisserie chicken.
“Umm… not really,” I hedged. I felt a pang of guilt, like I was 17 again and coolly asking our family doctor for birth control pills solely to regulate my periods, when I actually had something more interesting in mind. What is it that makes us want to present a scrubbed, sanitized version of ourselves to those in positions of authority?
Instantly, I recanted. “Well, I usually use sunscreen,” I allowed, rationalizing that “usually” was interpretive enough to make it a true statement.
“Well, we’ll see.” She was brusque—and efficient, clipping off a piece of the angry interloper, which in response promptly bled at her. “We’ll be in touch,” she said.
A week or so later I got a flimsy white postcard in the mail from the doctor’s office. On it were three pre-printed options with open boxes next to them, and one was checked off: “Your biopsy showed a cancerous growth,” it read next to the check mark. “Please call our office to schedule a follow-up appointment.” In ballpoint pen, underneath, someone had scrawled, “Basal cell carcinoma.”
I had to admit: It was efficient. Nonetheless, there was something a little off-putting about it—the healthcare equivalent of a service-call reminder that it was time to rotate my car tires.
My teenage son, reading over my shoulder, snorted and said, “Wait a minute… did you just get a postcard from your cancer?” Immediately I pictured a small skin growth waving to me from the deck of a catamaran in Cancun. “Weather to die for. Sights are gorgeous. Wish you were here!!!” Of course, I wish it were vacationing there, too, preferably on somebody else’s nose.
Basal cell carcinoma is pretty much the milquetoast of the skin cancer family. In medical-speak, it’s not very “aggressive.” It’s small and weak—a pipsqueak—and it generally doesn’t spread to other outposts on or in the body. Even the most ambitious basal cell carcinomas—the valedictorians of their cancerous classes—can usually only ever hope to achieve an ugly disfiguring. “It’s the one you want,” my doctor had explained. Still, I thought, that was kind of a curious way to describe any cancer, even a wimpy one.
And, even so, the news came as a downer, if only for the portended hassle of another visit to another doctor, and then a third visit to a plastic surgeon to re-putty the small but prominent spot in the center of my face.
But I cheered myself almost immediately by considering, still gripping the doctor’s postcard, the idea that this little dot on my nose was so trifling, so insignificant, that it didn’t even warrant a telephone call. Instead, a cheap piece of mail moseying its way to my mailbox sufficed. This pipsqueak was nothing my doctor hadn’t seen before, a million times. There was comfort in thinking that she already had a system, a routine in place to roust it from its perch on my nose, and I was grateful that I was in such experienced hands.
In fact, I kind of liked this process of postcard notification. It seemed an inherently easier, less messy way to deliver news that is otherwise a bummer. Imagine, for a minute, all the drama that could be avoided when the surgeon greets the family after a risky procedure. “Will she live…?” the family pleads, plaintively. And the doctor shrugs, “Go home and you’ll receive a postcard in 7 to 10 days.”
I think of all the unpleasant news I’ve ever had to deliver or—worse!—received. Slacker employees fired. Bad relationships severed. Emotionally wrought times in life when pages and pages of conversation that start with “we have to talk…” and end up, three days later, with both parties exhausted and bleary-eyed and rung out from endless faults, accusations and indiscretions examined and exposed. Wouldn’t it be so much cleaner to just send your once-beloved a white, clinical postcard, with a box checked next to: “It’s over. Don’t call.”
I was still liking this postcard process, because the day hadn’t yet come when I’d face certain realities. I hadn’t yet had the follow-up appointment with a new surgeon, when his nurse would circle the spot on my nose with a purple felt-tip pen and photograph it at pore-close range. Then, as I sat across from the surgeon and his partner and discussed the surgical procedure with a fat purple circle on my face, finally one of them, sensing my humiliation, would lean over and wash it away with an alcohol wipe, like I was a preschooler with some jam left on her face from snack time.
The truth is, when it’s our own health nothing is really routine: no pregnancy, prostate, cancer or canker is much like another—at least, when it’s happening to us, inside our own skins. But modern healthcare—with its postcards, and patient appointments stacked one after another, and whatever other efficiencies administrators can manage—seems to stumble along as if it were… workaday, just plain routine.
In fact, the system seems teed up in way to disrespect both the patient and—at the same time—the physician. The factors that lead to patients in tightly packed queues and diagnoses sent through the mail are the same ones that burn out doctors. Mostly, it’s because of the lack of financial stability and autonomy, says Salon’s medical writer, Dr. Rakul Parikh. And unlike most business transactions, in healthcare the customer is not in control.
“A generation ago,” Parikh writes, “doctors were accountable only to their patients.”
But these days, of course, they are accountable first to insurance representatives and hospital administrators, “many of whom have no direct experience in healthcare but hold power over budgets and reimbursements,” he points out. “It’s that lack of control that has frustrated many doctors and left them feeling pessimistic about the future of healthcare.” And burned-out doctors feel about and behave toward their patients very differently.
If it’s frustrating to be a patient in the system, it’s alienating to be in the doctor’s shoes, accountable to administrators rather than their actual customers. On top of it all: they have to hear folks cop to only two drinks a day when regularly they pour themselves a few more—or swear they take multivitamins, or say they wear sunscreen… when they don’t. I’m vowing to do a bit better there from now on.
This election season, talk of healthcare reform usually centers on access. But I’m wondering if we should also be talking about how to reinsert a bit more humanity—some real caring—in healthcare.
Find more like this: Politics & Society , basal cell carcinoma, cancer, doctors, health care, medical care, modern medicine, skin
Hi Ann – really happy to hear that your skin cancer was not melanoma and that all will be okay! The state of health care in America is, for lack of a better word, sad. I was trying to think…would it have been better if your doctor at least sent you an email or Twitter DM? I don’t think so.
Hi Ann – really happy to hear that your skin cancer was not melanoma and that all will be okay! The state of health care in America is, for lack of a better word, sad. I was trying to think…would it have been better if your doctor at least sent you an email or Twitter DM? I don’t think so.
Ann – my 2 cents .. no matter that it was the whimpy kinda cancer (thankfully), it was also whimpy of the doc not to inform at by a call from the office nurse.
btw .. thinking you’re setting a new style with toast photos. perhaps next one might be a bagel?
Ann – my 2 cents .. no matter that it was the whimpy kinda cancer (thankfully), it was also whimpy of the doc not to inform at by a call from the office nurse.
btw .. thinking you’re setting a new style with toast photos. perhaps next one might be a bagel?
Ann – I think many of us are aware that health care just isn’t right, but this post helps put a finger (or possibly a fat purple circle) on exactly why it’s not right. True patient care is being overshadowed and in many cases pushed right out the door in favor of administrivia and bureaucracy. In many cases those who know virtually nothing about patient care are not only influencing it but dictating it. I’m not exactly sure what action I will take yet, but you’ve certainly got me thinking.
Oh, and I second Mark’s happiness for your prognosis. So glad you’re okay.
Ann – I think many of us are aware that health care just isn’t right, but this post helps put a finger (or possibly a fat purple circle) on exactly why it’s not right. True patient care is being overshadowed and in many cases pushed right out the door in favor of administrivia and bureaucracy. In many cases those who know virtually nothing about patient care are not only influencing it but dictating it. I’m not exactly sure what action I will take yet, but you’ve certainly got me thinking.
Oh, and I second Mark’s happiness for your prognosis. So glad you’re okay.
Still traumatic and glad you are okay. I wonder if the postcard is any more personal, engaged or connected than an email, voicemail, twitter etc.? We hear stories about doctors not having a good bedside manner and not knowing how to speak with people. I know it is not all of them. I fear that our disconnected connectedness may make it easier and more accepted when people do not truly engage e.g. postcards and electronic messages in situations like yours. I have to say I am appalled at how you were told.
Still traumatic and glad you are okay. I wonder if the postcard is any more personal, engaged or connected than an email, voicemail, twitter etc.? We hear stories about doctors not having a good bedside manner and not knowing how to speak with people. I know it is not all of them. I fear that our disconnected connectedness may make it easier and more accepted when people do not truly engage e.g. postcards and electronic messages in situations like yours. I have to say I am appalled at how you were told.
Glad to know that nasty little thing is basal cell and not worse. but it’s your nose and i’d rather that it have none of the above.
and jeez, any doctor who sends you a postcard to tell you that you have cancer is a pretty heartless SOB.
I do hope you’ll print out this post for everyone involved.
Glad to know that nasty little thing is basal cell and not worse. but it’s your nose and i’d rather that it have none of the above.
and jeez, any doctor who sends you a postcard to tell you that you have cancer is a pretty heartless SOB.
I do hope you’ll print out this post for everyone involved.
Thanks for another thought-provoker – and so glad you are OK.
A very interesting way to summarize modern health care…bad news delivered by postcard and checkoff box, checked off.
I must admit, even with the seriousness of the subject, I did laugh out loud at this part:
“Then, as I sat across from the surgeon and his partner and discussed the surgical procedure with a fat purple circle on my face, finally one of them, sensing my humiliation, would lean over and wash it away with an alcohol wipe, like I was a preschooler with some jam left on her face from snack time.”
Thanks for another thought-provoker – and so glad you are OK.
A very interesting way to summarize modern health care…bad news delivered by postcard and checkoff box, checked off.
I must admit, even with the seriousness of the subject, I did laugh out loud at this part:
“Then, as I sat across from the surgeon and his partner and discussed the surgical procedure with a fat purple circle on my face, finally one of them, sensing my humiliation, would lean over and wash it away with an alcohol wipe, like I was a preschooler with some jam left on her face from snack time.”
Wow, if this isn’t a treatise on the abysmal state of our healthcare system — nevermind our society — I don’t know what is. Thanks for being so entertaining in delivering the message!
Wow, if this isn’t a treatise on the abysmal state of our healthcare system — nevermind our society — I don’t know what is. Thanks for being so entertaining in delivering the message!
“The one you want” – never in a thousand years would I have dreamed that any cancer would be described in those four words. Thank you for writing about a not-very-fun topic in a human and touching way. I’ll be expecting you to wear a huge floppy hat and to smell like coconut oil while you’re in AZ this week (seriously, glad you’re OK and don’t stop giving us these wonderful nuggets!)
“The one you want” – never in a thousand years would I have dreamed that any cancer would be described in those four words. Thank you for writing about a not-very-fun topic in a human and touching way. I’ll be expecting you to wear a huge floppy hat and to smell like coconut oil while you’re in AZ this week (seriously, glad you’re OK and don’t stop giving us these wonderful nuggets!)
um – the doctor who sent a postcard re: your cancer should be outed – that’s one of the crummiest things I’ve ever heard
great post
um – the doctor who sent a postcard re: your cancer should be outed – that’s one of the crummiest things I’ve ever heard
great post
I think this post should be required reading for all health care providers. Thank you for sharing.
I think this post should be required reading for all health care providers. Thank you for sharing.
Doesn’t that violate some patient right privileges since anyone could have seen it?
Doesn’t that violate some patient right privileges since anyone could have seen it?
I don’t care how minor and unaggressive teh cancer was, sending a postcard is beyond ridiculous.
I don’t care how minor and unaggressive teh cancer was, sending a postcard is beyond ridiculous.
Ann,
I, too, am glad to hear that your pimple like object is a mini form of Cancer.
But a postcard? Tacky!
Joel Libava
Ann,
I, too, am glad to hear that your pimple like object is a mini form of Cancer.
But a postcard? Tacky!
Joel Libava
Ann, I am so glad that it was not melanoma and that you are okay. However, as you said when it happens to you….I worked in healthcare for more than two decades and grew up in a house with a mom who was a nurse. I have spent more time in hospitals and doctor’s offices than in my own home. I am appalled at the postcard system. While in medical terms, it was good news have we forgotten that patients are people and that same diagnosis efficiently dispatched by mail may have sent another person over the edge.
Ann, I am so glad that it was not melanoma and that you are okay. However, as you said when it happens to you….I worked in healthcare for more than two decades and grew up in a house with a mom who was a nurse. I have spent more time in hospitals and doctor’s offices than in my own home. I am appalled at the postcard system. While in medical terms, it was good news have we forgotten that patients are people and that same diagnosis efficiently dispatched by mail may have sent another person over the edge.
I had the same reaction as Jessica – that has to be a major HIPPA violation.
As always your post was insightful, entertaining, and thought provoking. Keep up the great work!
I had the same reaction as Jessica – that has to be a major HIPPA violation.
As always your post was insightful, entertaining, and thought provoking. Keep up the great work!
Wow Ann a post card. I thought my friends story took the cake, but this one is up there. My friend went in for scheduled back surgery, went under, actually went under, and then got bumped last minute because of an emergency operation (which is understandable). When he woke up in recovery, he was told that the operation was not complete because of the emergency and the doctors shift was over and went home. Can you believe that, sorry my shift is over, i am outta here.
Wow Ann a post card. I thought my friends story took the cake, but this one is up there. My friend went in for scheduled back surgery, went under, actually went under, and then got bumped last minute because of an emergency operation (which is understandable). When he woke up in recovery, he was told that the operation was not complete because of the emergency and the doctors shift was over and went home. Can you believe that, sorry my shift is over, i am outta here.
Back in the late 80′s I was getting some blood work done, and asked the doctor while you’re at it could you check for VD…..I got a postcard, stating the VD results were normal……to this day I wondered if it was normal for a 30 something guy to have it or not……still wondering.
Back in the late 80′s I was getting some blood work done, and asked the doctor while you’re at it could you check for VD…..I got a postcard, stating the VD results were normal……to this day I wondered if it was normal for a 30 something guy to have it or not……still wondering.
Ann, very glad you are well. More glad you continue to write and share with the rest of us A N N A R C H I S T S !
You touch on so many important issues here, and healthcare is just the tip of the iceberg. I am old enough to remember the doctor COMING TO OUR HOUSE (Queens Apartment) if I was “under the weather” as a child. Dr. Reiman (I even can recall his name) had an office down the block and around the corner and would regularly make house calls in our apartment building. He was accountable to US, and he knew every kid in the neighborhood by name, as we were all his patients. Imagine that today…the makings of fiction. LOL. Stay well!
-Jeff
Ann, very glad you are well. More glad you continue to write and share with the rest of us A N N A R C H I S T S !
You touch on so many important issues here, and healthcare is just the tip of the iceberg. I am old enough to remember the doctor COMING TO OUR HOUSE (Queens Apartment) if I was “under the weather” as a child. Dr. Reiman (I even can recall his name) had an office down the block and around the corner and would regularly make house calls in our apartment building. He was accountable to US, and he knew every kid in the neighborhood by name, as we were all his patients. Imagine that today…the makings of fiction. LOL. Stay well!
-Jeff
Ann, glad your cancer was ‘the good kind to have’, but I think cancer, no matter how non-aggressive, deserves more than a postcard. The comfort we find telling ourselves that “our doctor must not think this is any big deal, I’ll be fine” is a ruse. It’s just a coping mechanism for dealing with the un-dealable. I guarantee the doctor didn’t think two seconds about how sending the postcard would make you feel.
A friend of mine was just telling me yesterday how he went to see a doctor who didn’t take his hand off the doorknob for the entire visit, then left abruptly before my friend was able to get a word out. My friend went to find the doctor and told him, “before you continue with the rest of your day, I just want you to envision yourself holding on to the doorknob the entire time you’re with a patient and what that signals to them.” The doctor proceeded to rant about the stress he’s under, insurance costs, how he’s making less money this year, has to fit in more patients to pay for private school, etc. Not sure he got the point. We’re all under stress – if you’re a doctor, your job requires human interaction – so be human.
Ann, glad your cancer was ‘the good kind to have’, but I think cancer, no matter how non-aggressive, deserves more than a postcard. The comfort we find telling ourselves that “our doctor must not think this is any big deal, I’ll be fine” is a ruse. It’s just a coping mechanism for dealing with the un-dealable. I guarantee the doctor didn’t think two seconds about how sending the postcard would make you feel.
A friend of mine was just telling me yesterday how he went to see a doctor who didn’t take his hand off the doorknob for the entire visit, then left abruptly before my friend was able to get a word out. My friend went to find the doctor and told him, “before you continue with the rest of your day, I just want you to envision yourself holding on to the doorknob the entire time you’re with a patient and what that signals to them.” The doctor proceeded to rant about the stress he’s under, insurance costs, how he’s making less money this year, has to fit in more patients to pay for private school, etc. Not sure he got the point. We’re all under stress – if you’re a doctor, your job requires human interaction – so be human.
I’m also very glad that your cancer was the pipsqueak variety, although I agree with the others that a postcard is a bit insensitive and slow to arrive. I mean jeez, what is that like 3rd class mail?
A few years ago, my Mom was diagnosed with breast cancer — the most aggressive kind. Anyway, they pushed chemo on her so quickly that, to her, it seemed like she was putting her life on the line without radical intervention right away.
However, they turned out to be wrong. She had cancer, but a different kind that didn’t warrant the chemo. We found out after she had already received the first round, which, in her case, was enough to make her lose all her hair.
I guess this is a bit of an opposite experience, except for the underlying insensitivity. In both cases they were beholden to procedure and liability rather than humanity. In my mother’s case, they even recommended against letting her a night at home away from the hospital (she had already been there for 3 days) to make a decision.
I think in both instances, big cancer/little cancer, a little humanity would have been nice.
I’m also very glad that your cancer was the pipsqueak variety, although I agree with the others that a postcard is a bit insensitive and slow to arrive. I mean jeez, what is that like 3rd class mail?
A few years ago, my Mom was diagnosed with breast cancer — the most aggressive kind. Anyway, they pushed chemo on her so quickly that, to her, it seemed like she was putting her life on the line without radical intervention right away.
However, they turned out to be wrong. She had cancer, but a different kind that didn’t warrant the chemo. We found out after she had already received the first round, which, in her case, was enough to make her lose all her hair.
I guess this is a bit of an opposite experience, except for the underlying insensitivity. In both cases they were beholden to procedure and liability rather than humanity. In my mother’s case, they even recommended against letting her a night at home away from the hospital (she had already been there for 3 days) to make a decision.
I think in both instances, big cancer/little cancer, a little humanity would have been nice.
Gad, I’m sorry you’re having to go through this, even if it’s the pipsqueak variety! I hope they at least actually call a patient if they suspect something serious!
I’ve been pretty lucky with my doctors so far–their systems seem to have some level of caring and personal attention built in. This is a good reminder to never take those factors for granted. Slather on that sunscreen and take care of yourself, girl!
Gad, I’m sorry you’re having to go through this, even if it’s the pipsqueak variety! I hope they at least actually call a patient if they suspect something serious!
I’ve been pretty lucky with my doctors so far–their systems seem to have some level of caring and personal attention built in. This is a good reminder to never take those factors for granted. Slather on that sunscreen and take care of yourself, girl!
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Glad you’re ok Ann. But I can’t believe that doctor sends a postcard with that news. What if you had questions or you didn’t know basel cell is relatively not so bad.
I’d switch doctors right away, for starters.
Glad you’re ok Ann. But I can’t believe that doctor sends a postcard with that news. What if you had questions or you didn’t know basel cell is relatively not so bad.
I’d switch doctors right away, for starters.
Thanks for all the feedback here, all. Interestingly — I didn’t think about whether it violates HIPPA. But in theory the US Postal Service (or at least my mail carrier) knew before I did. Which is kinda weird.
And JeffreySass : I love “Annarchists.” Must. Print. T-Shirts: “Are you an Annarchist?” What do you think?
Thanks for all the feedback here, all. Interestingly — I didn’t think about whether it violates HIPPA. But in theory the US Postal Service (or at least my mail carrier) knew before I did. Which is kinda weird.
And JeffreySass : I love “Annarchists.” Must. Print. T-Shirts: “Are you an Annarchist?” What do you think?
Physician bedside manners have been an issue long before healthcare became the transactional business it has become, although the current environment certainly exacerbates poor physician-patient communication.
I thought it was ludicrous to send you a postcard about your biopsy results, and I bet there’s a case for HIPAA here. I can’t even stand in the same area as another pharmacy customer lest I hear about what meds they’re getting.
Physician bedside manners have been an issue long before healthcare became the transactional business it has become, although the current environment certainly exacerbates poor physician-patient communication.
I thought it was ludicrous to send you a postcard about your biopsy results, and I bet there’s a case for HIPAA here. I can’t even stand in the same area as another pharmacy customer lest I hear about what meds they’re getting.
Glad to find your great writing via Chris Brogan, and LOVED the tale and what it raises. DON’T love the privacy issue being ignored by your Doctor’s Office — for shame! Your poor mailman must be worrying too!