For otolaryngologist Erich Voigt, MD, a lump on the neck is never something to ignore — even if said lump is spotted on the neck of a stranger appearing on a national TV show with unknown whereabouts.
So, when Voigt noticed a woman's lump while casually watching the HGTV program Beachfront Bargain Hunt, he knew he had to act.
"When I noticed the lump, I simply had a feeling that it could be something serious," Voigt, who is director of General and Sleep Otolaryngology at NYU Langone Health in New York City, told Medscape Medical News.
"I paused the TV show, rewound a few times, reviewed the images with a few family members, and then felt obliged to reach out in some way," he said. "I wondered if she knew she had this."
Voigt took to Facebook, sharing a video and voicing his concern: "I am watching a TV show and notice this woman has a left thyroid mass," he posted on his site. "She needs a sonogram and fine needle biopsy. I wonder if she knows and hope it's benign."
It took about 2 weeks, but the posting managed to make its way to the attention of the woman, Nicole McGuinness, 32, who indeed did not know, as her doctors had never noticed the mass. A follow-up biopsy, received in response to Voigt's advice, resulted in a diagnosis of thyroid cancer, and McGuinness was reportedly set to see a surgeon for treatment.
In several subsequent TV appearances related to the story, McGuinness expressed her deep gratitude to Voigt, and the two were brought together in person on an episode of Inside Edition.
"You have no idea how much you've impacted my life," McGuinness told Voigt on the show.
Voigt told Medscape Medical News that in addition to being "very surprised" to learn that his Facebook post successfully made its way to McGuinness' attention, he was alarmed that no one had spotted the lump, even over the passage of time since the show's taping.
"I was surprised that the show she was on was filmed in November 2017 and aired in May 2018 when I saw it, and no one noticed the mass prior to me," he commented.
The case isn't the first time a suspicious mass later determined to be thyroid cancer was brought to an individual's attention thanks to an attentive TV viewer. In an earlier instance in 2013, also involving an appearance on HGTV, a registered nurse spotted a suspicious mass on the neck of Tarek El Moussa, the host of the network's popular program Flip or Flop.
Upon noticing the mass, the nurse, identified in a Today Show report as Ryan Reade, sent an email to the show's producers, alerting them of her suspicions.
As in the subsequent case involving Voigt, the large mass had not been detected by El Moussa's doctors.
After acting on Reade's notification, El Moussa was diagnosed with stage II thyroid cancer, and he went on to undergo surgery and radiation therapy.
In comments to the Today Show, Reade said certain features simply stood out on El Moussa's neck that caught her attention.
"I noticed that at certain angles, at certain times, it just caught my eye that Tarek had a lump on his throat," Reade said, "and I thought it was something that needed to be brought to his attention."
Watchful Eyes Also Spot Potential Skin Cancers
Thyroid lumps aren't the only suspicious features that attentive viewers have spotted. Television personality Piers Morgan reported being made aware of an alarming "blemish" on his chest by Gillian Nuttall, the founder of Melanoma UK, who noticed it while Morgan was conducting an interview.
Morgan explained in media reports that upon examination, a top dermatologist immediately removed the lesion and informed Morgan that with much further delay it could have turned cancerous. Morgan invited Nuttall to appear on his British TV show Good Morning Britain.
"Gillian Nuttall, you were my savior," Morgan told Nuttall on the show. "I am living testament to actually getting it checked because you told me to and I'm very grateful to you for that."
"As a Physician, My Role in Life Is to Help Others"
While the cases underscore need for closer checking for lumps or masses during routine exams, they also raise some ethical issues in terms of the clinician's role outside of the clinical setting, particularly considering complicated patient consent and privacy concerns.
Voigt noted that, in compliance with federal laws on health information, he does not discuss his patients' information outside of the clinical setting, but he felt he was not violating any privacy issues in pointing out the lump on Facebook.
"In this unique situation, my conclusion was that this person has already identified herself on television, so I was not revealing anything that was not already in the public eye," he said.
"She is not my patient; however, I chose not to type her name in my post and simply identified the TV show. Additionally, when the media contacted me to discuss the case, I referred them to her and let her make decisions regarding any media participation," he explained.
Voigt meanwhile said that with the media attention regarding his case, he has received "an overwhelming outpouring of kind words to me from people all over the globe about helping a stranger."
He expressed having no reservations about reaching out to offer help even outside of the clinical setting.
"As a physician, my role in life is to help others, not only in my office, but in daily life," Voigt said.
"I am asked very frequently for medical advice when I am not 'working,' and I provide whatever information I can," he said."However, I tell people to see their doctor and get appropriate tests and treatment."
"If I see something that looks dangerous or serious I will reach out to help," he added.
"If You See Something, Say Something"
Approached for comment, Peter Angelos, MD, PhD, chief of Endocrine Surgery and associate director of the MacLean Center for Clinical Medical Ethics at the University of Chicago, agreed that the confines of the clinic should not represent boundaries of offering patients help, when possible.
"I do not see there being a major ethical issue if, for example, I see something concerning and suggest to someone that they should see their physician to have it checked out," he told Medscape Medical News.
"It is much like a good Samaritan telling another driver that they have a flat tire. The driver of the car with the flat tire would never know if someone didn't notify him or her of the problem," Angelos said.
"Certainly, in the era of social media, it may be easier to contact even those that we may not have a relationship with. However, I would still consider this a matter of being a good Samaritan where it is good to help, but not mandatory," he added.
In terms of Voigt's case, while a lack of details on McGuinness' medical background prevents speculation about earlier detection of the lump, Angelos says the case nevertheless serves as a reminder that thyroid nodules may be lurking, unnoticed by the patient.
"The case does certainly emphasize the importance of a thyroid examination in the course of a routine physical examination," he said.
"And if you see something concerning in another person, do them the favor of bringing it to their attention and suggesting that a physician be consulted for an appropriate workup — in other words, 'If you see something, say something,' " he said.
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