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‘Excuse me, sir, I think that’s a melanoma,’ I blurt out, pointing to the lesion on his abdomen.
‘You must see your GP,’ I gesticulate wildly, tracing the shape of an elliptical excision in the air around the offending spot, an elaborate game of dermato-charades. ‘Cut, cut.’
I’ve omitted the niceties of an introduction, there is no privacy (there are probably about 500 or so other people in the area) and I haven’t gauged how much bad news they can take before I’ve gone in with the diagnoses.
After I’ve spotted the melanoma – an ugly, irregular, brown, black and purple island on a sea of sun-damaged skin – I’ve got about a 10-second window to make my diagnosis and convey my message before I lose him in the crowds, as he walks down the swimming pool steps (and I walk up). And I’m doing it all in my 25-year-old GCSE French.
His wife’s English is no better, so I breach confidentiality by enlisting the help of the swimming-pool life guard, whose English is probably a little better than my French. I need to get my message across. His wife tells me that their grandson is also a doctor. I tell them that I am a dermatologist en Angleterre and I leave them my name, contact details and GMC number and he promises to see his médicin in a few days’ time when he gets home.
Although I have a certificate to show that I can swim five metres under water in my pyjamas and rescue a brick from the bottom of the pool, I suspect this will be the only time I ever actually save a life in a swimming pool. However, afterwards I am racked with doubt. I had no time to take a history, I didn’t do a proper examination, I hadn’t even had a proper look at it and there was no dermatoscope anywhere nearby. Was my diagnosis correct? Should I have said anything at all? Breaking every rule in the communication skills book, it could have gone so badly wrong. There was no warning shot, no assessment of how much he understood or how much he wanted to know, I mentioned the big C in my opening line, I breached confidentiality and I didn’t have a translator for a foreign-language consultation.
I often wonder what happened in the end, if he did end up going to see a French dermatologue. In the intervening months I hear nothing. And while a year is a long time to wait for a follow-up appointment, we have rebooked to go to the same resort a year later. The odds are that I won’t recognise him, but he may spot me – an odd one out in a long-sleeved pseudo-surfer Australian SPF 50 UV protection suit. And while I can’t do a lot about many of the factors affecting my swimming-pool consultation, after a quarter of a century, I am finally getting around to doing A-level French.
The author is a consultant dermatologist
Great story. Yes from time to time we have to break all the rules!
I had an extremely grateful patient who was stopped by dermatologist whilst walking on the beach. Her melanoma was formally diagnosed and removed on her return from holiday, with no evidence of recurrence 2 years later.