Does one size really fit all?


In the world of healthcare, best practice is ‘protocol driven, evidence based medicine’. While this is commendable for several good reasons, my biggest concerns is it fails to recognise that, as doctors, we work with people, not protocols.

While the purpose of evidenced based medicine is to prevent the unpredictable, it seems to make the practice of medicine robotic. It reduces the doctor/patient interaction to a mechanical process of selecting the right answer, in what could be perceived as a multiple-choice exam. It appears that when it comes to skin cancer, the obvious answer when determining the best treatment is surgery. Always and every time, no questions asked. Evidence based brilliance? Perhaps not.

Where I feel this practice fails is in the ability, or profound inability, to recognise that we are dealing with people; people whose needs and circumstance vary significantly. Perhaps someone is too old to want surgery or is on anticoagulation (blood thinning) medication that makes surgery risky. Or perhaps this person is just tired operations, stitches and pain. Maybe the surgical scars or skin grafts are a harsh reminder of the evidence based, best practice medicine that are not wanted. Maybe, previous surgery has left the individual struggling with other ailments such as an ulcer.

There may be many reasons why a person may not want, or be suitable for, evidence based, best practice treatment. What do we do then? I believe we have two choices. As doctors, we can ignore the person’s requirements in favour of best practice, or we can stop and listen to the individual’s history and concerns, consider alternatives and make a medical judgement based on what’s best for that individual. I know which way I prefer to go, because one size certainly does not fit all.

One of the alternatives in the management of non-melanoma skin cancer is superficial radiation therapy. Yes, if you look, it is also in the guidelines of evidence based best practice medicine, but is often an afterthought and therefore comes last. At Just Skin we are delighted with the results of our treatment via superficial therapy and, more importantly, so are our patients. If you want to consider a non- surgical option in the management of skin cancer, visit our website, give us a call or pop in for a chat. We’re always available to help determine the best treatment solution to meet your needs.

Dr. Colin Dicks
Radiation Oncologist/Co-owner

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