Docs eager to winkle wrinkles, slow to hole a mole

I'm no fan of the local TV news broadcasts & therefore rarely catch them. So it was quite by accident that I caught a story last night that is the sort to give one the shudders.

The station had two staffers call 20+ dermatologists. One staffer would state that she had a suspicious mole to be checked out, whereas the other staffer would call requesting an appointment for cosmetic Botox. Now, at some level the results shouldn't be surprising, as if the pattern was the opposite it wouldn't have made the local news. But what was striking was the range of difference: in one case the mole would get an appointment several months in the future, but the same office would be willing to Botox away the next day. Yikes!

Perhaps more striking was the one doc who showed such a pattern who was interviewed on camera. She made no apologies and showed neither shame nor remorse. Her practice is no longer taking on new 'medical' patients, but is happy to accept new cosmetic ones. She did say that perhaps if the caller had been more persistant, perhaps they would have gotten a sooner appointment. Alas, the interviewer did not ask her to explain the ethics of the situation. It is not hard to imagine that many patients calling about a mole are on the fence as to whether to worry or not, and being given a long wait will push them back to complacency (hey, if the doctor's not worried about it why should I be?). Some small fraction of those persons may have early stage melanomas, with potentially lethal results from delay in removal.

It's not hard to guess at the driver of this issue: Botox is elective, probably not covered by insurance, and therefore patients will pay top dollar; mole screening is covered & governed by the immense pricing power of insurance companies.

Somewhere in the last week or so I saw an article commenting that increasing numbers of doctors from a wide variety of specialties are performing cosmetic procedures. A Polyanna might think this would provide the competition to drive the dermatologists back to doing the important stuff, but more likely the corruption will just spread to more specialties. In high school I once switched dentists because it was impossible to get appointments at my long-time dentist, but I went running back after a few appointments when I realized the new guy opened every session with an inquiry as to whether I might want to change out my cap for a better color match.

A real pessimist might note that these new-fangled genetic tests are coming down the pike, that they may also be considered elective and not covered by insurance, and may represent another monetary siren tempting docs to neglect treating disease.

By coincidence, I had just watched the one movie I know of that opens with a monologue on ethics, Miller's Crossing. Caspar & the interviewed doc would be unlikely to have any arguments in that department.