The New England Journal of MedicineMy First Patient

Personal Experience with DFSP Shapes Physician’s Approach to Patient Care

Dr. Martin H. Ellis recounts his journey as a medical student diagnosed with dermatofibrosarcoma protuberans (DFSP), a rare soft tissue sarcoma. His experience navigating multiple misdiagnoses, surgeries, and treatment recommendations profoundly influenced his approach to patient care. The commentary highlights the importance of thorough examinations, accurate diagnoses, and empathetic care in medical practice.

Key Points:

• Initial misdiagnosis of DFSP as nodular fasciitis led to multiple recurrences after excisions
• Correct diagnosis of DFSP was made after the third excision
• Wide local excision, including “shaving the radius,” was performed by a hand surgery specialist
• Axillary lymph node involvement was discovered a year later
• Tumor board recommended radiation and chemotherapy for potentially metastatic disease
• A sarcoma expert advised radical axillary lymph node dissection as the appropriate treatment
• The author underwent successful radical axillary dissection with no further recurrences
• The experience taught valuable lessons about avoiding flippancy and indifference in patient care
• The author learned the importance of cultivating interest, care, and a desire to help patients
• The experience emphasized the need for physician involvement in guiding patients through difficult decisions
• The author acknowledges tension between his approach and concepts of patient empowerment and shared decision making

“‘A doctor who treats himself has a fool for a patient’ goes the aphorism — and it is generally accurate. After many decades of reflection, however, I am grateful that I was my own first patient.”
— Martin H. Ellis, MD

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