Not what the doctor said

Not what the doctor said
Image: Pixabay.com

In 1976 two researchers, James Pennebaker and Deborah Sanders, published and interesting study. They placed two kinds of signs in university toilets, one reading: “Do not write on these walls under any circumstances,” and the other: “Please don’t write on these walls.” Result: the amount of graffiti on the walls with the first, more authoritative sign was significantly more.

This phenomenon is called reactance: when something or someone threatens to restrict our freedom, our intuitive response is to undo this – even if our response may have negative consequences.

Reactance can occur on a massive scale as, for example, in the case of Japanese whaling. The consumption of whale meat in Japan is decreasing – it is considered traditional food and younger generations are not interested in it. Yet, Japanese people respond furiously to the actions of the Sea Shepherd activists against their whaling fleet. Travel writer Sam Vincent, who wrote a book about this topic, concludes: “Japan isn’t pro-whaling. It’s anti-anti-whaling.”

AMA response to the ‘skin spot check’

This week a new pharmacy initiative was in the news: ‘Skin spot checks’. For $35 people can have a single skin lesion of their choice examined at certain pharmacies. The response from the Australian Medical Association was as expected. Dermatologist and president of the NSW branch of the AMA said: “It is irresponsible and inappropriate for pharmacies to offer in-store skin checks.”

Although the AMA has a point, the response can be: “If the AMA doesn’t agree, it should be approved.” Reactance in action! This may be followed by: “The AMA is probably protecting their members’ interests, so let’s give these entrepreneurial chemists a fair-go!”

If the AMA had said: “Look, doctors are busy and fed up with all these people worried about their freckles, so please go away and visit the pharmacy,” the response would probably be the opposite. I’m not arguing that they should have said this, but the point is that most doctors care about their patients’ wellbeing and this is unfortunately not always taken into account in the media and comments.

The following scenario happens often in my practice: a patient asks my opinion about a pigmented but benign skin lesion, and is not aware of the (more common) non-pigmented malignant or pre-malignant lesion elsewhere on the skin. These spots will likely be missed at the ‘skin spot check’ in the chemist store.