The lady was of Russian descent and had returned to my lung clinic seeking advice about a small nodule in her chest that we had been keeping an eye on for the last year. She used to smoke menthols so the threat of lung cancer colored our conversation with a series of what ifs. The nodule had grown on the most recent CT scan. I recommended a biopsy, but I came to expect that she would resist. 

One of the more interesting side effects of practicing medicine for a while is recognizing when doctor think creeps into my everyday approach to problem solving. Before any diagnostic is obtained or any procedure is offered, physicians engage in a ritual of obtaining consent from the patient for what’s proposed. This entails explaining the reason the intervention is being offered, the benefits of the information obtained from the interrogation, but also the risks. Part of the ritual that often gets short shrift is offering alternatives, one of which, doing nothing, appeals to those in denial, those who’ve had enough interventions and don’t want any more (usually the terminally ill), and those who think the risks aren’t worth it. My patient initially chose to do nothing, but I was able to convince her to at least continue monitoring the lesion with subsequent CT scans.

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