Commentary

When is a biopsy not a biopsy?


 

References

“When I use a word, it means just what I choose it to mean…” – Humpty Dumpty

Even after all these years, I’m still surprised to learn new ways the words we use every day can mean different things to patients to whom we say them.

Take the word “biopsy.” To a dermatologist, it means “a test of a piece of tissue” (in our case, of skin), to help find out what the problem is.

I’ve always known that to many patients, the word “biopsy” suggests cancer, or at least the concern that there may be cancer, because cancer is the context in which most people hear the word: breast biopsy, prostate biopsy, and so on. It can therefore be useful to point out to patients when a biopsy is performed for diagnostic purposes and cancer is not even on the list of possibilities.

Lately, though, I’ve had a few encounters that highlighted other interesting ways the word “biopsy” can be misunderstood.

Case 1: Arnold the Irritated

“Arnold,” I say. “I need to biopsy this. Based on the results, it may need further treatment, but I doubt it.”

“I thought you were taking it off now,” says Arnold.

“No, I’m testing it, “I say.

“But I want it off,” says Arnold. “It gets irritated when I shave over it, so I want it off.”

“Yes,” I say, “but in order to remove it properly, I need to know what it is.”

“What?”

We have to go around a few more times before Arnold catches on.

Case 2: Gaetano the Outraged

“Gaetano is on the phone,” says my billing clerk. “He says you told him you weren’t going to biopsy his spot, and then he got a bill from the pathology lab.”

I call Gaetano. “You said you weren’t going to biopsy this,” he says. “You said you were sure you knew what it was, so you didn’t have to biopsy it.”

“First of all,” I explain, “I’m never totally sure. Your spot looked like a basal cell skin cancer, and that’s what it turned out to be. But I’ve had cases where the pathology results surprised me, and it turned out to be something less – or something more. So I have to check the biopsy.”

“I understand, Doctor” says Gaetano.

“In addition,” I go on, “what I actually meant to say was that I was not going to only take a biopsy of the spot. I was going to remove it completely, so that if my diagnosis was confirmed, you wouldn’t have to come back and have more done. Sorry if I didn’t make that clear.”

“So you biopsied it,” says Gaetano, but you didn’t just biopsy it. I get it. I think.”

Good for you, Gaetano. Next time I am going to – actually, next time I don’t know what I’ll do.

Case 3: Melvin the Clueless

“I understand your former dermatologist removed something from your arm,” I say to Melvin.

“Yes, they took a biopsy, and then they removed it,” says Melvin. “I just have one question.”

“What is that?” I ask.

“Which was the biopsy?” asks Melvin, “the first or the second?”

I didn’t let on, but inside I was shaking my head.

Even with the best will on both sides – and even if both are native speakers of the same language – there are just so many ways people can misunderstand each other. Humpty Dumpty was wrong. Words can mean what both the talker and the listener think they mean. Humpty Dumpty probably didn’t get out much.

Never biopsy an egg.

Dr. Rockoff practices dermatology in Brookline, Mass., and is a longtime contributor to Skin & Allergy News. He serves on the clinical faculty at Tufts University, Boston, and has taught senior medical students and other trainees for 30 years.

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