James C. Salwitz is an oncologist who blogs at Sunrise Rounds.
Sometimes, I think that that guiding principal of the medical profession, “first, do no harm,” is hopelessly out-of-date. Clearly, a physician should understand her limits, and never should she give care, which hurts, more than helps. Nonetheless, this axiom implies that the doctor is in control, and decides the treatment. Some of the time, a modern motto, which recognizes the true position and limits of the modern doc, might be, …
Doctors have become a profession of whiners. Meetings, dinners, doctor lounges and the blogosphere are flooded with physician complaints, tirade, and anger. The volume of pained voices suggests that health Armageddon is only a few moments away.
It was not always so. Medicine is a career where idealism runs rampant. In medical school interviews, young students really do answer that they want to help their fellow man. Nonetheless, in recent years …
Recently, a patient of mine died of cancer, whom I loved very much. She had a special way of enjoying life; a half, wise smile that after our many years together did not take me too seriously and reflected her deep inner strength. She taught me about joy; I will miss her always. Her husband, understanding my loss, said that it was alright, that I had done my best, that he …
Doctors have several bad habits. They order piles of tests just to get a vague, unfocused view of a patient’s health. They order expensive and invasive tests to rule out the unlikely or extraordinarily rare. The worst “bad test habit” is when doctors order a test, which, no matter what the result, will not change what they are planning to do.
Why do doctors over order? These same people thought a …
Among hospice staff, it is called “getting it.” One says, “He doesn’t get it,” “I think she gets it,” or, “They definitely get it.” It is a little hard to define, but as with pornography, you know it when you see it. Nonetheless, given the importance of “getting” good end-of-life care, let us take a moment to try and explain.
The 92-year-old patient is bleeding into her head, but has blood …
“If it walks like a duck and quacks like a duck, it is probably a duck. ”
At 62 years old, Roberta had been healthy. She walked three miles a day, stayed up late and enjoyed events with her three grandchildren. She had no history of significant surgery, and took only a single pill for blood pressure. The only health tragedy in her life was the death of her last child, an …
Like an anthem, a holy grail, the word appears in every journal, every proposal, and every health strategic plan.
“Quality.”
We say, read and hear it so often we are developing quality fatigue. Like iterative hackneyed phrases such as “out-of-the-box”, “deep-dive” and perhaps even “personalized medicine,” quality has begun to feel like water torture and risks being deprived of flavor or meaning. However, do not so fooled or bludgeoned that you lose …
Doctors have an interesting problem. They have an ingrained professional obsessive-compulsive habit; they fixate on the care of individual patients and on the science of healing. This is an admirable trait; it results in high-quality care. However, when physicians need to change their attention from healer to leader, from medicine to the business of medicine, from health care to the health care system, they falter. Stuck in silos, they fail to …
Disclaimer: I have never had cancer. Therefore, at the most basic level, I do not have the right to pontificate about dealing with the dread disease. Rather, I have been the servant and support of those that struggle with cancer. I thought it might be of some assistance to share my observations from the other side of the bed rail. Perhaps, their secrets of survival may help you.
Cancer is a …
Romeo and Juliet, Act II, Scene II: “What’s in a name? That which we call a rose by any other name would smell as sweet. So Romeo would, were he not Romeo call’d, retain that dear perfection which he owes without that title.”
I saw a consult the other day, an older gentleman with a new cancer requiring complex evaluation and extended care. Scary, hard stuff, but with the possibility of …
It was after shoveling winter snow that Brett began to cough. It was a dry cough, a morning cough, a “smoker’s cough.” It persisted, grew deeper. Several weeks later, there was a particularly harsh cough and in the sink was a crimson blob. Frightened, he called his doctor.
For 71 years old, Brett looked healthy. His lung exam was clear and the cough was gone. A case of bronchitis? The chest …
Despite the years, I have not talked about this case. It is not a privacy/ HIPAA problem; rather, I did not want to upset the patient and family. I am not certain that was the right decision; at the time, it seemed best. Still, the patient died, the family moved on, and I carry a guilty memory.
It was after deteriorating months of corrosive cancer that we met. Multiple systems were …
In the fall of 1980, in my final year of medical school, I sat in the main ward of Saint Vincent’s Hospital, Greenwich Village, Manhattan. Filling the vast space were twenty-four beds, in four rows, with twenty-four patients. The prow of the open nursing station thrust from one wall into the center. A high ceiling vanished above. Yellow light filtered through ancient rippled glass windows and distant fluorescent bulbs made …
I was confused. Perhaps, I needed another cup of coffee. The chart did not make sense. Ellen, who I was about to see because she was transferring her care, was receiving medication for cancer that was a simple pill; inexpensive, with few side effects. What confused me is that it was obvious the therapy would not work.
Baffled, I called the oncologist who had been treating Ellen for two years. A …
There are times, as a healer, I feel helpless. These are not just the moments when cancer consumes. I understand that the dread disease has yet been conquered, and there is still terrible loss. This not when I refer a patient elsewhere; I know my limits. Rather, these are the times when I am trapped, ignored, and the result is needless suffering.
In his classic, often quoted, 1942 short story, Runaround, …
Three decades at cancer’s bedside has taught me about fear. I have seen denial postpone critical diagnosis. I have watched mistrust and anger yield poor choice. I have fought against terror that spreads malignancy by delaying treatment. I have shared fury and devastation as horrid growths rip apart bodies, destroy families and end life.
After so many thousands of patients, so many wasted lives, you would think I would have given …
There is only one correct, perfect, absolute approach to life and decisions near its end. This truth relieves the doctor of final decision. The right way lifts the burden of anxiety, confrontation or guilt. The perfect path makes giving care at a very hard time, much easier. That correct course, the only way to treat every patient and every family, is exactly what the patient and family say it is.
This …
To cope with loss, oncologists simply forget. Perhaps, “forget” is not the right word. “Compartmentalize,” “separate” or simply “contain,” may be better. We put all those wonderful people who have died, all that suffering, all those lives, in a corner closet of our minds, close the door and lock them away.
Perhaps. However, all those memories remain; they are part of me. Quietly, they change how I practice medicine, what I …
Invading, spreading and destroying: Terrorism is cancer. A malignant growth, it corrupts healthy cells, yielding fear, pain and death. It lays waste to resources and lives. Every place, every organ of every society, is threatened. Nonetheless, just as we are winning the battle against other cancers, disease-by-disease, year-by-year, we know how to destroy this illness.
It will take time and research. We must …
On the business side of health care, doctors are at a disadvantage. Because of their training, or lack therein, and native personality, they often fail to understand the realities of the market place, take confrontation personally and are suckers for an aggressive sales pitch. They feel that their motives are pure and because they sacrifice themselves and their families, over many years, they should receive respect and success. “I build …
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