After reporting lesion, hygienist is concerned about doctor’s response
Dianne Glasscoe Watterson, RDH, BS, MBA
I recently had a 53-year-old woman in my chair. She related that she had never smoked and was an occasional social drinker. When I performed the oral cancer assessment, I found an odd lesion on the left lateral posterior of her tongue. The lesion was not ulcerated, but it was irregularly shaped, and 4 mm to 5 mm in size. The patient was unaware that the lesion was there and told me it had not been sore. I noted all the particulars in the chart notes, including location, size, color, and shape. I felt certain that the doctor would refer her to see an oral surgeon.
The doctor performed the periodic exam, and much to my surprise, he told the patient that he didn’t think it was anything to worry about. He ended by saying that we would check it again in six months. I was floored that he didn’t refer her for a biopsy.
After the doctor left the room, the patient asked me what I would do if that lesion was in my mouth. I had to think fast. Not wanting to contradict what the doctor had just told her, I said that she should keep an eye on the lesion and if it didn’t go away in a week or so, let us know and we’d check it again. I knew as I was saying this it would be difficult, if not impossible, for the patient to monitor the lesion since it was so far back. But in all truthfulness, if I had a lesion like that, I’d want it checked by an oral surgeon.
Now I’m worried. I keep thinking about this patient and wondering if I did the right thing. Should I have referred her anyway? Should I call her? What if the lesion is cancerous? Would I be liable even though the doctor chose not to refer?