Tag Archives: diagnosis

Stung on the tongue: a careless diagnosis

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Big bee_640

I cannot remember the name of the person who taught us dental pathology back in 1981 at University College Hospital Dental School, but one thing he told us made a deep impression on me.  He said that it was unlikely that we would see oral cancers frequently in general dental practice, but when we did see one we would feel a certain ‘jizz’ (our teacher’s word), a feeling that we were looking at something unusual and worrying.

One day when I was in practice, a delightful late middle-aged woman visited my surgery as a new patient. She said there was something on her tongue that had been bothering her for several weeks and was making eating and speech difficult. She had been to her doctor (medical), who told her that she had had a bee sting on her tongue. She told me that she had been taking antibiotics prescribed for it for  quite a time and the condition was only getting worse.

I had never encountered anyone with a bee sting on their tongue. The lady’s story and her doctor’s diagnosis sounded strange. She showed me her tongue. As soon as I saw the huge ulcer on the side of it and its peculiar border, I felt that ‘jizz’, which our pathology teacher had mentioned. I knew that the poor lady had, almost without a doubt, a carcinoma on her tongue. I told her my suspicions, and she looked relieved, and was grateful. Clearly, she had not believed her doctor’s story. I phoned the local oral surgery department, and they admitted her promptly.

About a year later, the lady reappeared. During the surgical treatment of her cancer, she had lost several teeth and wanted a denture to replace them. Sadly, her mouth was by now so distorted that making a prosthesis was beyond my competence. I referred her to a prosthetic specialist. Unfortunately, she did not live long enough for his work to be completed.

Whether earlier intervention would have saved her life, or at least prolonged it, is a question than cannot be answered. 

In my 35 years in dental practice, I only ever saw two patients with obvious oral cancers. However, I did refer many patients to have unusual looking lesions seen by oral surgical specialists. None of these gave me that ‘jizz’ nor turned out to be cancerous.

Over the counter

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The French philosopher Voltaire is believed to have written:

” Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, for human beings of which they know nothing.”

I was at a party in Athens, Greece, in the early 1980s when I suddenly became aware of bilateral back pain and nausea. Luckily, there was a medical doctor amongst the guests. He diagnosed a kidney or bladder infection and wrote a prescription for bactrim. The tablets were very effective and rapid acting.

A year or so later, I was flying to Greece via Rome in Italy when I experienced a recurrence of the symptoms. As I had quite a long stopover in Rome, I took the opportunity to visit a pharmacy, but this time without a prescription. To my great surprise and relief, the pharmacist sold me some bactrim without requiring a prescription.

In the UK, it is not possible to obtain antibiotics and most other medications without a prescription. There are also rules determining how much non prescription medication can be bought at any one time.

In India, which I visit often, I have never been asked for a prescription to obtain any kind of medication. One just asks for the medicine or tablets required, and then following payment they are handed over the counter. Quite a few of the medications I have needed in India have been clearly marked as prescription only medicines, but these words are ignored by the pharmacy salespeople.

Having been trained as a dentist I have some knowledge of pharmacology. So, I feel that I am unlikely to abuse the ease of obtaining medicines in India, but I worry about others with less knowledge than me.

The freedom of being able to obtain medications without having to first get a prescription has mixed blessings. On the one hand, if you are certain that you need a particular drug or simply need a repeat of what you have been taking, not needing a prescription can save you time and money that visiting a doctor entails. On the other hand, self diagnosis and self treatment is not without risk.

What Voltaire wrote many years ago is less true today than it was then. But, still, even after so many advances have been made in medical science , a great deal of ignorance about the human body remains.