Roots

They removed a mole when I was 17," Claire said, pointing to her knee. The scar had faded to white in the 50 years since.

Claire had come for a body check. Her special concerns were the seborrheic keratoses on her torso. "Do you think," she asked, eyeing them suspiciously, "these spots coming out are from the mole they took off my knee?"

Clinical work involves a bit of ethnography. Understanding other cultures with alien ideas can be hard; it's even harder when the people from the other culture look just like you.

Claire is a retired teacher from a Boston suburb. You would never guess from her dress and demeanor that her concept of the body has little in common with the one they teach in medical school.

The key to understanding Claire lies in the homely word "roots."

Our patients apply it to the common skin growths we treat every day, as in, "Don't these warts have roots, Doctor?"

That sort of question might not matter to us, perhaps, but to some patients it matters a great deal. A 27-year-old woman, a graduate student in physiology of all things, once asked me, "Isn't it true that plantar warts can grow deep, into the bone?"

That it's not true doesn't stop her—and many others—from wondering. Patients distinguish between wart types. ("These warts on my hands look like 'Planter's warts.'") The salient characteristic of Planter's warts is not their plantar location but their presumed roots.

Or consider nevi. It's not uncommon for patients to ask, "Don't these moles have root systems under the skin, like a tree?" One patient used a different analogy. "I understand," he said as he pointed to a dermal nevus on his hip, "that a mole is like an inverted golf tee. Most of it is deep underneath."

It would be a mistake to think that such people are uniquely imaginative or deluded. Their ideas are not universal, but they're out there. What they imply is that the medical conception of the body, assumed to be held by every modern and educated person, in fact lives alongside a very different one, an older concept that supposedly went away but didn't.

To doctors, the body has a skin on the outside; inside are many organs—stomach, liver, coiled intestines, and so forth. To many of our patients, however, the Inside is something dark and undifferentiated. Bad things come out of it that would poison the body if not gotten rid of: urine, feces, sweat, sebum.

Diseases come out of the inside too, as "eruptions" or "breakouts," on the skin. Surface rashes are really "systemic." Before you dismiss these as archaic metaphors, listen as patients call warts on the hands, "a virus in my body."

Patients conceive our innards less like a Frank Netter illustration and more like a gloomy cavern, complete with cobwebs and bats. Below, a boiling lake expels excretions and emits eruptions that waft up and out. Above, ugly branching tendrils criss-cross up to their points of attachment on the roof and walls—these are the "roots" of what is poking out above.

This may sound fanciful, but don't take my word for it. Next time you remove a keratosis, wart, or mole, try telling:

▸ The woman whose irritated SK you're curetting, "These keratoses are just stuck onto the top of the skin. They don't have any roots."

▸ The man whose mole you're shaving, "Moles don't have roots, of course."

▸ The mother of a child with plantar warts, "You might be interested to know that plantar warts are thick, but they're just in the epidermis. They don't have roots."

See how often your statement elicits a look of relief—and revelation. For 50 years, Claire's been waiting for the roots of her mole to pop up somewhere else, so naturally her sprouting keratoses seemed to her to be the Mole's Revenge.

Exploring roots can bring unexpected rewards. Give it a try.

They removed a mole when I was 17," Claire said, pointing to her knee. The scar had faded to white in the 50 years since.

Claire had come for a body check. Her special concerns were the seborrheic keratoses on her torso. "Do you think," she asked, eyeing them suspiciously, "these spots coming out are from the mole they took off my knee?"

Clinical work involves a bit of ethnography. Understanding other cultures with alien ideas can be hard; it's even harder when the people from the other culture look just like you.

Claire is a retired teacher from a Boston suburb. You would never guess from her dress and demeanor that her concept of the body has little in common with the one they teach in medical school.

The key to understanding Claire lies in the homely word "roots."

Our patients apply it to the common skin growths we treat every day, as in, "Don't these warts have roots, Doctor?"

That sort of question might not matter to us, perhaps, but to some patients it matters a great deal. A 27-year-old woman, a graduate student in physiology of all things, once asked me, "Isn't it true that plantar warts can grow deep, into the bone?"

That it's not true doesn't stop her—and many others—from wondering. Patients distinguish between wart types. ("These warts on my hands look like 'Planter's warts.'") The salient characteristic of Planter's warts is not their plantar location but their presumed roots.

Or consider nevi. It's not uncommon for patients to ask, "Don't these moles have root systems under the skin, like a tree?" One patient used a different analogy. "I understand," he said as he pointed to a dermal nevus on his hip, "that a mole is like an inverted golf tee. Most of it is deep underneath."

It would be a mistake to think that such people are uniquely imaginative or deluded. Their ideas are not universal, but they're out there. What they imply is that the medical conception of the body, assumed to be held by every modern and educated person, in fact lives alongside a very different one, an older concept that supposedly went away but didn't.

To doctors, the body has a skin on the outside; inside are many organs—stomach, liver, coiled intestines, and so forth. To many of our patients, however, the Inside is something dark and undifferentiated. Bad things come out of it that would poison the body if not gotten rid of: urine, feces, sweat, sebum.

Diseases come out of the inside too, as "eruptions" or "breakouts," on the skin. Surface rashes are really "systemic." Before you dismiss these as archaic metaphors, listen as patients call warts on the hands, "a virus in my body."

Patients conceive our innards less like a Frank Netter illustration and more like a gloomy cavern, complete with cobwebs and bats. Below, a boiling lake expels excretions and emits eruptions that waft up and out. Above, ugly branching tendrils criss-cross up to their points of attachment on the roof and walls—these are the "roots" of what is poking out above.

This may sound fanciful, but don't take my word for it. Next time you remove a keratosis, wart, or mole, try telling:

▸ The woman whose irritated SK you're curetting, "These keratoses are just stuck onto the top of the skin. They don't have any roots."

▸ The man whose mole you're shaving, "Moles don't have roots, of course."

▸ The mother of a child with plantar warts, "You might be interested to know that plantar warts are thick, but they're just in the epidermis. They don't have roots."

See how often your statement elicits a look of relief—and revelation. For 50 years, Claire's been waiting for the roots of her mole to pop up somewhere else, so naturally her sprouting keratoses seemed to her to be the Mole's Revenge.

Exploring roots can bring unexpected rewards. Give it a try.

They removed a mole when I was 17," Claire said, pointing to her knee. The scar had faded to white in the 50 years since.

Claire had come for a body check. Her special concerns were the seborrheic keratoses on her torso. "Do you think," she asked, eyeing them suspiciously, "these spots coming out are from the mole they took off my knee?"

Clinical work involves a bit of ethnography. Understanding other cultures with alien ideas can be hard; it's even harder when the people from the other culture look just like you.

Claire is a retired teacher from a Boston suburb. You would never guess from her dress and demeanor that her concept of the body has little in common with the one they teach in medical school.

The key to understanding Claire lies in the homely word "roots."

Our patients apply it to the common skin growths we treat every day, as in, "Don't these warts have roots, Doctor?"

That sort of question might not matter to us, perhaps, but to some patients it matters a great deal. A 27-year-old woman, a graduate student in physiology of all things, once asked me, "Isn't it true that plantar warts can grow deep, into the bone?"

That it's not true doesn't stop her—and many others—from wondering. Patients distinguish between wart types. ("These warts on my hands look like 'Planter's warts.'") The salient characteristic of Planter's warts is not their plantar location but their presumed roots.

Or consider nevi. It's not uncommon for patients to ask, "Don't these moles have root systems under the skin, like a tree?" One patient used a different analogy. "I understand," he said as he pointed to a dermal nevus on his hip, "that a mole is like an inverted golf tee. Most of it is deep underneath."

It would be a mistake to think that such people are uniquely imaginative or deluded. Their ideas are not universal, but they're out there. What they imply is that the medical conception of the body, assumed to be held by every modern and educated person, in fact lives alongside a very different one, an older concept that supposedly went away but didn't.

To doctors, the body has a skin on the outside; inside are many organs—stomach, liver, coiled intestines, and so forth. To many of our patients, however, the Inside is something dark and undifferentiated. Bad things come out of it that would poison the body if not gotten rid of: urine, feces, sweat, sebum.

Diseases come out of the inside too, as "eruptions" or "breakouts," on the skin. Surface rashes are really "systemic." Before you dismiss these as archaic metaphors, listen as patients call warts on the hands, "a virus in my body."

Patients conceive our innards less like a Frank Netter illustration and more like a gloomy cavern, complete with cobwebs and bats. Below, a boiling lake expels excretions and emits eruptions that waft up and out. Above, ugly branching tendrils criss-cross up to their points of attachment on the roof and walls—these are the "roots" of what is poking out above.

This may sound fanciful, but don't take my word for it. Next time you remove a keratosis, wart, or mole, try telling:

▸ The woman whose irritated SK you're curetting, "These keratoses are just stuck onto the top of the skin. They don't have any roots."

▸ The man whose mole you're shaving, "Moles don't have roots, of course."

▸ The mother of a child with plantar warts, "You might be interested to know that plantar warts are thick, but they're just in the epidermis. They don't have roots."

See how often your statement elicits a look of relief—and revelation. For 50 years, Claire's been waiting for the roots of her mole to pop up somewhere else, so naturally her sprouting keratoses seemed to her to be the Mole's Revenge.

Exploring roots can bring unexpected rewards. Give it a try.