Is that a worse patient outcome than leaving the mole in place?

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Oct 1, 2024
2:00:02pm

Bobber Political Junky

Is that a worse patient outcome than leaving the mole in place?

Was the mole in question diagnosed as "clinically benign"? I can understand being concerned about a decision NOT to biopsy an atypical/dysplastic mole.

Also not sure why the removal site cannot be monitored as well. Are you saying it's easier to detect cancer if the mole is in place? If so, how should that benefit be balanced against the likelihood of eliminating the cancer via removal? Seems like most patients would prefer to have a mole removed rather than leave it in place so they can monitor it.

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Bobber

Bio page: Bobber
Joined: Nov 10, 2011
Last login: Oct 1, 2024
Total posts: 548 (21 FO)

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Messages

Author

Time

Why do so many dermatologists insist that if they remove a mole, the patient MUST pay for a biopsy?

Bobber Political Junky

Oct 1, 1:49pm

Because they need the kickbacks from the lab to make their Porsche payment.

cheezedawg

Oct 1, 1:51pm

Are doctors required by law or medical boards to disclose any "kickback" relationship with the lab?

Bobber

Oct 1, 1:54pm

Read up on the Stark Law.

TN_Coug

Oct 1, 2:05pm

Tony Stark?

ochobeeguy

Oct 1, 2:07pm

Yes, Tony Stark Law.

TN_Coug

Oct 1, 2:07pm

That would be against the Stark Law.

TN_Coug

Oct 1, 1:55pm

"Because the patient declined to pay for that analysis"

Skeptical Optimist

Oct 1, 1:58pm

Ask a lawyer. Doctors wonder that all the time.

TN_Coug

Oct 1, 2:05pm

That’s not enough. “Because patient declined test despite my recommendation

cougaman

Oct 1, 2:16pm

How does "could be cancerous" not apply to all clinically benign moles?

Bobber

Oct 1, 2:30pm

You are complaining about a cost. If he didn’t biopsy it and it ended up being

cougaman

Oct 1, 2:40pm

Ummm.. of course you can be sued for misdiagnosing a benign appearing mole

cougfanz

Oct 1, 2:51pm

It was a joke

cheezedawg

Oct 1, 2:43pm

yes, but the OP didn't seem like he knew that.

TN_Coug

Oct 1, 8:18pm

<< Deleted >>

Acorn

Oct 1, 1:52pm

Because when the mole is not removed, you can monitor it for changes to

cougaman

Oct 1, 1:53pm

Is that a worse patient outcome than leaving the mole in place?

Bobber

Oct 1, 2:00pm

You are asking the dermatologist to remove it, expect them to biopsy. I don’t

cougaman

Oct 1, 2:13pm

Because someone once did that and missed cancer and got sued

JimmyZ

Oct 1, 1:55pm

Yup, it's standard of care and could make a potential insurance/malpractice claim invalid.

CSoul

Oct 1, 1:57pm

So doctors can be sued for not following a standard of care that only benefits doctors?

Bobber

Oct 1, 2:08pm

Are you always this obtuse?

JimmyZ

Oct 1, 2:09pm

I mean, I'd saying finding out the mole was cancerous or not also benefits the

fattycoug

Oct 1, 2:35pm

You asked an industry specific question and a few practitioners made a good faith attempt to answer it honestly.

JarJarBeeps

Oct 1, 3:23pm

Why is the doctor liable for failing to identify cancer in a clinically benign mole, if the patient declined biopsy?

Bobber

Oct 1, 2:19pm

Because jurors don’t think you’re smart enough to make these decisions

cougfanz

Oct 1, 2:25pm

Appears benign clinically

WorfoSAUR

Oct 1, 1:57pm

clinically benign diagnosis provides value, removal adds value, biopsy adds more value

Bobber

Oct 1, 2:03pm

RE: clinically benign diagnosis provides value, removal adds value, biopsy adds more value

TN_Coug

Oct 1, 2:06pm

Then remove it yourself.

Oct 1, 2:07pm

If that's the medical establishment's response to an obvious failure to provide patient-centered care

Bobber

Oct 1, 2:14pm

The whole premise of your OP is patently false. “Clinically benign”? Please.

Oct 1, 3:53pm

Are you saying the term "clinically benign" is not a thing?

Bobber

Oct 1, 6:49pm

Patient satisfaction leads to 26% increase in mortality. This isn’t the

Groym

Oct 1, 3:56pm

Thanks for the helpful response. I understand nothing is ever certain in clinical diagnosis

Bobber

Oct 1, 6:55pm

That boat isn't going to pay for itself

Skeptical Optimist

Oct 1, 1:57pm

Also, that typically makes it covered under insurance, where if there is no

BYU-Ite

Oct 1, 1:58pm

Removal of a clinically benign mole is never covered by insurance, is it?

Bobber

Oct 1, 2:07pm

I had a clinically benign mole removed, sent to the lab, and the insurance covered it.

TN_Coug

Oct 1, 2:10pm

Did it have other medical indications (irritation, bleeding)?

Bobber

Oct 1, 2:22pm

It did not. It appeared clinically benign.

TN_Coug

Oct 1, 2:28pm

OK, your experience appears to be very unusual

Bobber

Oct 1, 2:31pm

Same story for me. I had one removed from my face. Doc told me to have it

BYU-Ite

Oct 1, 2:30pm

Lawyers. Answer is always lawyers.

BGRTHNUMEGO

Oct 1, 1:58pm

Especially when they want to use a deli slicer to get it:

Doctor Rosenrosen

Oct 1, 2:00pm

Call your insurance company and ask why they refuse to cover things.

Oct 1, 2:00pm

With high deductible plans these days, most of the time it's still an out-of-pocket expense

Skeptical Optimist

Oct 1, 2:03pm

Root of problem remains insurance companies

Oct 1, 2:05pm

That they don't cover it, or that you can't actually call anyone and find out?

ochobeeguy

Oct 1, 2:09pm

You answered your own question, you just don't like the answer. Emphasis added

Sparkling Delirium

Oct 1, 2:17pm

He doesn't want there to be an answer.

TN_Coug

Oct 1, 2:19pm

Anytime I cut a tissue out of the mouth, I biopsy it. I’m not removing anything

Oct 1, 2:24pm

Over 15 years, I’ve found 2 squamous cell carcinomas.

Oct 1, 2:56pm

I agree with that policy, but I'm asking about biopsy of a clinically benign mole

Bobber

Oct 1, 7:01pm

Yeah, I see your point. And I get it. My wife had a mole removed from her

Oct 1, 7:11pm

So maybe what I should do is get a dermatologist to evaluate, but go to a cosmetic surgeon to remove?

Bobber

Oct 1, 7:28pm

The dermatologist has the same liability.

cougaman

Oct 1, 7:39pm

The cosmetic surgeon has the same liability than a dermatologist if they remove a lesion

TN_Coug

Oct 1, 8:19pm

I am ONLY talking about a mole that a competent dermatologist has diagnosed as benign

Bobber

Oct 1, 9:32pm

Doesn’t matter. All parties are sued. The surgeon and the dermatologist.

cougfanz

Oct 1, 10:07pm

But how is the liability risk any different when the mole is NOT removed?

Bobber

Oct 1, 10:57pm

Yep. Thats why in medicine you don’t do something unless you want to

cougfanz

Oct 1, 11:10pm

If you biopsy a mole and don’t get path done and a patient dies from melanoma

Groym

Oct 1, 2:27pm

^ this can end the thread.

cougfanz

Oct 1, 2:32pm

thanks, that's a helpful explanation of the current state of things

Bobber

Oct 1, 2:33pm

Liability and patient safety. First and foremost

byusage

Oct 1, 2:33pm

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