Trust Your Instincts

By Dr. Becky Warnken

Occasionally, patients remind us why we matter in ways bigger than we can imagine. I don’t have to tell anyone that 2020 was a challenging year as a dentist and practice owner. We all know that. In the middle of the summer, when COVID-19 cancellations were still very much a challenge in our practices and shortly after the World Health Organization had released a statement saying that routine dental care should be postponed, was one such time.

During this period, I saw a 69-year-old female patient for a routine hygiene exam. I begin each exam by palpating for lymphadenopathy. Immediately, my gut told me something wasn’t right when I discovered her right sublingual lymph node was firm, rigid and markedly abnormal from the left side. The patient had a history of cancer years before. I didn’t want to panic the patient, but I didn’t want her to take this lightly or ignore it either. I finished my exam and then sat her up. I showed her the lymph node and had her palpate it herself. We discussed her history and I stressed that this needed further evaluation. I wrote down exactly what description she needed to give her primary care physician (PCP) of the lymph node when she called to make an appointment. She stated that it hadn’t been more than six months since she had seen her PCP, and that nothing had come back abnormal at her last regular appointment. I assured her that we would just rather be safe than sorry, and she agreed. She called her PCP immediately upon leaving my office.

Two weeks later, my office received a phone call from this patient. She told Sandy at my front desk, “I don’t want to bother Dr. Becky, she is busy. But I need you to thank her for me. I need you to thank her for catching my cancer. I am entering Moffitt now for a workup and I don’t have a lot of time either, but please just tell her thank you.” She started crying. Sandy started crying. When Sandy told me, I started crying. I was devastated that my patient was facing a cancer diagnosis. I was simultaneously so thrilled that she had come in for her routine exam and that I hadn’t ignored my instincts. She’s undergoing treatment and, at our last update, her prognosis was good.

The physician assistant students I teach at the University of Tampa always ask how you know something is abnormal, or when you should insist something has a further evaluation. My answer is always the same: If you aren’t sure, insist that they return in two weeks. If the abnormal spot or lymph node hasn’t changed, then you know it is worth further investigation. However, sometimes you just know something isn’t right and you can usually help the patient realize the same and guide them to further care. Trust your instincts. This is the one time when a patient will be truly grateful your instincts were wrong if it is nothing, and even more grateful you followed them if you are correct.

It is my daily mission to stress to my patients and my peers the importance of our role as essential health care providers. Even in our day-to-day routine, what seems like a mundane exam can save lives. We can change lives with a smile, and we can save lives with a routine exam. As oral health care providers, we are essential and should not be undervalued. You matter to your patients. I pray you never forget it!

Reprinted from Today’s FDA, Jan/Feb 2021. Visit to view Today’s FDA archives.

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