What Does A Lump Mean?

Physicians find lumps all of the time. Most of them are benign and transient (of course the pregnancy "lump" is transient but may not be so benign).  So how does a doctor know which lump merits concern and investigation?

The basic tools are straight-forward. A simple history, which addresses a variety of issues including some of the following, may lead to the correct clinical impression: Have you ever had cancer or any unusual growth on your skin or elsewhere?  What surgery have you had?  How is your appetite? Have you lost weight recently?  Have you had sweats at night or experienced fevers which have no obvious explanation?  Have you been exposed to toxic environments or  materials in your work or personal activities?

And then, the doctor takes the time to perform a competent examination, examining the lump, skin, lymph node areas, thyroid, abdominal organs, breasts, testicles and other areas which may harbor malignancy and which are accessible to palpation or examination.

Only then, does the doctor consider the differential diagnosis and possible laboratory and radiologic tests which may help to establish a diagnosis and differentiate a benign from a more serious condition.  And then,  after a discussion with the patient, the doctor orders the standard tests - and  specialty focused tests such as fine needle sampling (biopsy) of the tissue in question.

Then the doctor and the patient (and those the patient wants to be involved) discuss the findings, the diagnosis and the treatment options and plan. 

Medicine is not television drama. The physician - who has been carefully trained to understand and require each step that I have outlined - collects all necessary information to form an evidence-based diagnosis.  Scientific evidence trumps intuition and conjecture.

But What If He's Irrational Because He's Sick?

Perhaps you have seen the video of the outspoken candidate for US President who raised the issue of someone who has made the decision not to buy health insurance and then, at age 30, becomes sick and will die without medical care.  And perhaps you heard his audience response? See Krugman link.

People make economic decisions which affect health care for a variety of reasons, including their inability to pay for what they need. But one of the reasons that people make "bad" decisions is their own health.  Cancer may be associated with severe depression which makes a person incapable of making a rational decision on every day things, such as purchasing health insurance. Brain trauma, brain tumors, brain infections, diabetes, Alzheimer's disease and other dementias, metabolic disorders such as Wilson's disease - all may be associated with inappropriate decision making.

The solution - in America -  is not to throw these people (or their family members, including their children) onto the junk pile for easy disposal.  It is finding the compassion and common sense to treat them humanely and appropriately. It is surprising for someone from a medical family to miss this obvious point.  What else is he missing - and is there some medical reason for his missing it?

The Unspoken: A Level Playing Field

The formation of the United States, and eradication of the nation-like borders that once presented economic and trade barriers between the colonies and later the states, provided that level playing field which led to the development of flexible movement of people, goods and services. Import taxes across state lines were forbidden and relative uniformity of business opportunity became a strong factor favoring competition and economic growth.

But with employer mandated health care insurance for employees becoming optional in many states, and states manipulating health insurance content, some states provided lower costs to certain employers.  The playing field became tilted in favor of the states which chose employers' benefits as more important than health care access and availability to working women, men and their children.  Competition was for the bottom of the health care barrel.

Health care reform threatens to once more provide access to health care and availability to all Americans through a uniform system. It will level the playing field for all employers, families and individuals.  Too bad no one speaks about the anti-competitive advantage that some of the opponents of health care reform seek for their local political bases and contributors. We all know what flows downstream.

Cost Shifting Without Conscience

When the chief executive of the United States, who professes to be the architect of landmark health care reform,  without significant expression of remorse, abandons his support for clean air because it would be detrimental to industry in this time of worldwide financial stress, we see a unique cost shift.  Manufacturers may save the few dollars they spend on ceasing to pollute the air that seniors, infants, children and working people breathe , but no one speaks about the costs that are shifted to our citizens, costs associated with ill health and suffering. Unclean air is costly.  It makes people sick, filling our emergency rooms, doctors' offices and hospital beds, raising our health care costs.** Sick workers are less productive, raising the cost of production and making American labor less productive and less of a challenger in the world marketplace. Dirty, ozone-rich air destroys buildings and our infrastructure (in addition to lungs) but these costs are omitted from the President's count of national cost and benefit.

The pennies that each manufacturer saves is negligible compared to the health care costs, human suffering, sickness, lost days from work, decreased productivity and infrastructure destruction that filthy ozone-rich air creates.

It makes one wonder what the President of the United States really stands for?  Is he really concerned about the health and well being of the men, women and children who are citizens of this country, or is his focus an ill-advised cost shift that might buy him some short-term  political advantage?  Is this cost-shift from industry -to just plain folks-  a matter of politics without regard to conscience?

New link added 9/6/2011
**New link added 9/7/2011