soft tissue

In your career you will see suspicious areas of oral soft tissues that you will not be able to definitively diagnose without biopsy. And whether you do them yourself or refer it to an Oral Surgeon, you will have to inform the patient of the need to do so. The word “biopsy” is a very scary word to many people and conjures up an automatic diagnosis of cancer.

Best to approach it more tactfully: Mrs Smith, I see an area of ulceration under your tongue that was not there the last time I examined you and I would like to know what caused it. I would like to take a little sample of this area and have it examined under a microscope to know exactly what it is. It may be nothing serious but we always want to know the reason for any abnormal areas we see or feel in your mouth that we don’t know the cause of and this is the routine and safe thing to do. This is usually called a biopsy which means nothing more than taking a close look at a bit of tissue to see if it might be anything harmful. I would not worry about it and I’ll give you a buzz as soon as I get a report. And make sure you do! Many patients will tell you they weren’t at all concerned while they were waiting to hear from you but invariably they were quite worried and your kind phone call of a safe result will not be forgotten.

If there indeed is a diagnosis of cancerous tissue, you might ease the news thus: Mrs. Smith, I just received the report on that tongue sample we did last week and the specialists that looked at it did have some concern. Can you come by the office where I can explain what we know so far? or May I arrange an appointment with an Oral Surgeon who can explain what ought to be done? If the patient panics and asks you directly if it is “cancer” you must be truthful but you can ameliorate the response by stressing that you found it when it was quite small (hopefully) and that there are good treatment options. Be reassuring and upbeat but respectful of the patient’s well-founded anxiety.

Once in a while you will have a patient that simply refuses to have a biopsy performed. I would again stress the minimally invasive nature of the biopsy procedure but I would very clearly state to an obstinate patient that the area could indeed be something harmful and it wouldn’t be ethical on your part to just let it go. If there is still refusal on the patient’s part, you may need to consider if it is a dismiss-worthy event due to non-compliance with doctor’s orders. Be mindful though that sincere gentle concern can be more motivating than scare tactics.

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