When is a freckle just a freckle?

Patients and clinicians tend to think of worst case scenarios.
Patients and clinicians tend to think of worst case scenarios.

I was recently visiting with my 10-year-old grandson when he announced that he found a spot on his arm that he was worried about. The look on his face made me a little concerned, so I wasn't sure what he was about to show me. Then his pre-adolescent finger pointed out a small, round, reddish-brown spot on his arm. 

I smiled. "It's a freckle," I assured him. "How do you know?" He asked. I pointed out the spot next to it, and the next, and the next. Then I had him look in the mirror, and I pointed out all the other freckles over the bridge of his nose and on his cheeks. 

"Every spot on you doesn't mean that there is something wrong. Sometimes it's just a freckle," I told him. He seemed reassured and went on his way.

It was a sweet moment with my grandson but also a reminder that sometimes we can jump to the worst case scenario very quickly. As health care workers, sometimes we are the most guilty of this. It doesn't take long for us to diagnose ourselves with the worst imaginable illness when we aren't feeling well. 

Or, sadly, we try to treat ourselves thinking we can figure it out on our own. This is never a good thing! Our patients are no different. They find something unusual and, after running for the phone to make an urgent appointment, they start searching the Internet for what could be causing the problem. But wait, don't we do the same?

Given our medical background, we are supposed to be a little more astute and aware. Right? Not when it is our body. We want to know what is wrong. Something terrible may be getting ready to happen, and we want to be prepared.

I had a very scary moment the other day when a patient presented to my office with ptosis and one dilated pupil. He never mentioned anything until I was examining him, and then he said, "By the way, I noticed that one of my eyes is bigger than the other." 

Of course, my mind was going to all the medical emergencies that could be taking place. I quickly scanned the patient's record. His primary care doctor had not mentioned anything in his notes nor had the nurse practitioner in hers. I was really getting concerned now.

The patient had no idea when this change had occurred. He denied any new neurological problems, but I sent him quickly to the neurologist down the hall, confident that I had saved the man's life. Later, I learned that the man had been in a motor vehicle accident 12 years prior which had caused this abnormality.

It was documented by the ophthalmologist all those years ago. Of course, I had not gone back that far in the documentation. I was going strictly on his report of this being a new finding. You would think that he might have noticed this in 12 years.

Everyday we see the unusual. We are scanning and searching the patient's body from the moment they walk in the door for anything that might give a clue to something amiss. Sometimes though, there is nothing to note. The patient has been hyperaroused by what could be a potential problem. And it might be something very serious. But sometimes, it might just be a freckle.

Sharon M. O'Brien, MPAS, PA-C, is a practicing clinician with an interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.

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