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Black spot

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We were very busy with sick patients, teaching students and the GP registrar, and taking many phone calls. However, I stopped to answer a query from our registrar who was inspecting a very black lesion on the forearm of a middle-aged male patient. ‘Do you think I should excise this suspicious pigmented lesion?’ After a cursory glance I said, ‘a good idea—use the standard elliptical excision with a 3 mm margin and send it to pathology’.

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A few days later the bemused registrar showed me the report—‘black paint’. Yes, indeed it was and the patient, now supporting an unnecessary wound, confirmed that he had been painting in the days preceding the consultation. We had both learned a valuable lesson—take a good history, don’t rush decisions and be very careful when you are extra busy and stressed. It would be best practice to acquire a dermatoscope and become skilled in its use.

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Smart alec prognostications

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I had just commenced country practice and was trying hard to create a good impression with the locals, who were certainly curious to assess their new doctor from the fledgling Monash Medical School. One of the district’s matriarchs brought her 66-year-old sister who was visiting from Melbourne for a check-up. The consultation was pleasantly social, with no actual presenting problem and all aspects of the history were normal, as was the physical examination. In particular the cardiovascular examination, including the pulse and blood pressure, was normal. I informed her that on my examination she was in good health and could look forward to the immediate future. Unfortunately she died suddenly two days later from a cerebrovascular accident.

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This episode, which must have set people talking in a small rural community, was a real lesson that one can never be too smug with medical prognostications. This was about the time I started to produce education leaflets for my patients.

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With friends like these …

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Gloria was the effervescent catering manager at the major hospital where I ran the staff clinic part-time. Born in London, she was a great character who was full of banter, noise and mischief. She was a regular attendee with multiple minor problems and she joked that her reason for attending was that she was fond of the doctor! One evening there was a huge function at the hospital where the guests included dignitaries such as federal and state politicians, hospital administrators, senior university management and senior consultants. As I walked into the hall I saw Gloria, the hostess, all dressed up and looking like I’d never seen her before. Then from the other side of the hall in the loudest possible voice came the shocker, ‘What’s up, John? Don’t you recognise me with my clothes on?’ What could one say?

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Tails of the unexpected

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