Podiatrists usually hear this statement when they help a patient with a severe diabetic foot infection for example. A few months ago, a patient came into the office to have her feet examined because of foot pain. During my exam I noticed that there was “clubbing” of her toes. This means that the ends of the toes are enlarged. It is not like a swollen toe. The toe is more rounded at the end. This is not from injury or infection. It was a new finding for her.

I knew from my podiatric medical school training & my residency that this could be related to a lung problem. I advised her to see a pulmonary doctor. A few days ago, she returned with a new foot complaint. She related that a dermatologist had advised her to also see a pulmonary specialist also. After a whole battery of tests failed to show anything (including a chest x-ray) the pulmonologist ordered a CT scan

(computed tomography) of her chest. This showed a small mass – 1 centimeter – about a half inch – in the right upper lope of her lung. She had no breathing problem or pain. After it was surgically removed it came back as cancer.

Because of the pulmonary doctor’s persistence, she does not need chemotherapy or radiation. The cancer was small & caught early. Because the dermatologist agreed with my concern the patient went for the testing. If I had not commented on my finding that had nothing to do with her complaint; the patient would not have gone for the testing. The cancer would not have been caught so early.

Another patient came in for foot care years ago. I commented on a growth on her cheek that looked like malignant melanoma. She said I was the 3rd doctor who told her about it; so she decided to have it removed. If I had not spoken up she may not have had lifesaving surgery.

It is called “a high index of suspicion”. A doctor always has to keep thinking and be aware.