James C. Salwitz, MD

James C. Salwitz is an oncologist who blogs at Sunrise Rounds.

Legalize medical marijuana? See how a decision can affect this cancer patient.

Meds

September 28, 2015

What is not to like about medical marijuana? It treats pain, vomiting, fatigue, anxiety, depression, insomnia, seizures, muscle spasms, Crohn’s disease and allows many cancer patients to resume remarkably normal lives. It is not addictive. It does not interact with other medicines. It acts quickly and is easy to adjust. It can be consumed in numerous ways. It is safer than essentially any other drug: 1,500 Tylenol deaths in the …

It is time for an honest conversation about money and cancer

James C. Salwitz, MD

Physician

September 22, 2015

There are two, old, particularly nasty rumors, about cash and cancer. The first, which seems to be fading, is that scientists cured the disease long ago, but the pharmaceutical industry suppresses the cure so they can get rich selling worthless therapies. This never made sense to me, since the company or person that cures cancer will be rich beyond anyone’s wildest dreams. In addition, I have personally known several thousand …

Treating cancer: Doing nothing is also a choice

James C. Salwitz, MD

Physician

September 14, 2015

Dear doctor:

Attached please find the medical records of Mr. Ron C., who is transferring medical care to your office. Ron is a 63-year-old gentleman with recurrent lung cancer, which has spread to his opposite lung and bones. There are multiple treatment choices for his disease, which we have discussed in detail. However, Ron is leaving my care, because he does not trust me.

As you are well aware, metastatic lung cancer …

Patient empowerment: Scaffolding has a place in health care

James C. Salwitz, MD

Physician

September 2, 2015

A colleague complained that during a particular type of critical conversation his advice is ignored. Women with breast cancer deciding whether to have mastectomies disregard his guidance and seem to have reached a conclusion before he discusses the issue. Given that this physician has committed his career to the study and treatment of breast cancer, communicates clearly and patiently, projects caring and compassion, I thought that his observation warranted discussion.

Some …

Maybe health costs should be a quality measure

James C. Salwitz, MD

Conditions

August 25, 2015

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How do we measure a doctor? Hospital length of stay? Infection rate? Flu shot compliance? Waiting time? These reality surrogates do not tell us how a patient feels or the quality of life. They are complex to measure, require major data crunching and may not focus on an individual physician. This week, two patients reminded me of a basic screening tool for …

The crumbling walls of health care is a good thing

James C. Salwitz, MD

Policy

August 18, 2015

There was a doctor. The doctor had an office. In the office, he had a practice. The doctor worked hard, was honest, smart and compassionate. He took care of many patients, everyday, and helped many people. The people paid with cents, checks, and chickens. He was solo, alone, by himself. It was good.

There was a hospital, near the doctor. It was an important hospital. It took care of many patients, …

A father keeps his cancer secret from his daughter. The reason will break your heart.

James C. Salwitz, MD

Physician

August 4, 2015

Norman cried the night his daughter was born. For hours and hours. Each time he looked at her perfect head, touched the few strands of blond hair, held her in his arms, soft, smooth skin, soapy smell, pale blue eyes, tears poured down his cheeks. He felt alive. He felt alone. They named her Matilda, after his father. It was the right thing to do, because his father, Matthew, had …

Your cancer doctor can’t judge what life means to you

James C. Salwitz, MD

Physician

July 27, 2015

Let me be clear. I have spent a career, my adult life, 80 hours a week, 131,000 hours, fighting the dread disease: every method, every drug, every machine, every medical technique, every sinew of my being, to control or cure malignancy. A synopsis of my existence will say, “fought cancer.” Nonetheless, let us take a step back, if just for a moment, and reflect on the idea of saying, “no.”

In …

Pain control and abuse prevention: Doctors should take responsibility

James C. Salwitz, MD

Meds

June 25, 2015

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In the movies, pain is glorious. The runner pushing to the edge. The magic of childbirth. The soldier battles impossible odds to conquer. Pain? “Suck, it up, maggot, pain is nature’s way of telling you that you’re alive.” But, to the cancer patient, in the real world? Pain is nature’s way of saying “you may soon be dead.”

For a patient suffering …

How do we feel about algorithm-driven prescriptions?

James C. Salwitz, MD

Conditions

June 3, 2015

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Much of medicine is no harder than Mom, a Band-Aid and a scrapped knee. Flu shots save lives, give flu shots. Bleeding causes anemia, give iron or, if severe, blood. There is a fracture, fix it. A boil hurts, lance it. This is not rocket science.

Perhaps medicine is so simple that it can be automated. Instead of a doctor at all, …

The tale of Jack and Mildred: Communication in a cancer diagnosis

James C. Salwitz, MD

Physician

May 19, 2015

That first time there was a moist sweet smell, the hiss of oxygen and pictures of grandchildren on the wall. Unopened juice containers, papers, a Kindle, the phone and some plastic table wear, crowded the bedside stand. Jack was thin, tired, and the tightness of his eyes spoke of uncontrolled pain.

“Oh, I know you. You took care of my wife’s friend. You’re the cancer doc.’

“Yes, that’s me, nice to meet …

Grandma was tired. So she told me goodbye.

James C. Salwitz, MD

Physician

May 8, 2015

At the wake, when the kids kept running around, disturbing the disturbed, their mother, or maybe their aunt, or maybe their neighbor, shooed them to the basement. Adult quiet and proper mourning returned. However, I noticed that Mary, eight years old, or so, stayed upstairs. For a while, I watched her, carrying food, clearing plates, even answering the front door. A petite, hard working, hostess. I wondered why.

“Mary,” I said, …

The right, or freedom, to die

James C. Salwitz, MD

Physician

April 28, 2015

The theater darkens; children stop laughing, adults sit forward in their chairs. Framed by a single light in the center of the stage, he stands; tuxedo, white shirt, black tie. He stares into the silent crowd, slowly turning his head, lips touched with the slightest, smallest, cruelest of smiles. His gaze fixes upon you; he is just feet away. His hand rises to the brim of his tall hat and …

Read more…

The right, or freedom, to die

As the doctor exits, what does it mean for the humanity left behind?

James C. Salwitz, MD

Tech

April 13, 2015

The nightmare sickens me. A small child trusts a man to protect her, take care of her, and shield her from harm. The man, for incomprehensible and useless reasons, neglects her unto death. For me, when I think of Germanwings flight 9525, I am haunted by the photo of a single tiny girl, taken in the last days of life; the obliteration of that perfect life’s potential. Waste, tragedy, evil.

In the …

Where does the doctor stop and computer begin?

James C. Salwitz, MD

Tech

March 26, 2015

Where does doctor stop and computer begin? Who is in charge? Do we care? Are these silly, academic questions from some sci-fi future or is it an onrushing tomorrow?

Consider:

Ten years ago, the EMR recorded the date you or your nurse gave Sam his flu shot.
Today, the EMR reminds you it is time to have your nurse give Sam his flu shot.
Soon, the EMR will order the flu …
Read more…

Where does the doctor stop and computer begin?

I broke my own rule when giving bad news

James C. Salwitz, MD

Physician

March 11, 2015

For 25 years, I have taught medical students how to give bad news. Step one: Be prepared. Step two: Find a safe, personal, quiet environment. Step three, and this is most important: Before you speak, ask. What do the patient and family understand? Fail to follow this vital rule and reap the whirlwind. So, therefore, you might ask, if I have such wisdom and experience in this critical area …

What cancer denial has to do with global warming

James C. Salwitz, MD

Conditions

February 27, 2015

Cancer patients depend on denial. Without its protection, we would be overwhelmed by terror. Denial filters and slows bad news, so we can digest reality in the merciful morsels; thus, we cope. Without denial, we would shut down, withdraw, and lose hope; healing would not be possible. However, if we do not move beyond denial, accept the diagnosis and loss, make a plan, we die.

Allen, a 43-year-old man, came to …

The cancer metamorphosis is different for each patient

James C. Salwitz, MD

Conditions

February 24, 2015

“I had no idea how much cancer sucks.”

My patient’s observation seems silly, basic. Of course, cancer sucks. It maims, humiliates and kills. It takes. What made the statement remarkable was its source. This is not a medically naïve person, waiting to die. Rather it was spoken by a patient in complete remission, likely cured, who is an expert in cancer care. To her amazement, it changed life forever.

I think that …

Real miracles: The love that we give to others

James C. Salwitz, MD

Physician

February 17, 2015

Short-of-breath, weak, in pain. Cancer — aggressive, cold, unfair — ravaged Roger’s body. But maybe, just perhaps, there was a modern medical miracle. A drug. A single daily pill to attack the genetic growth switch in each malignant cell. Only, there was a problem. Not a big problem, really, but possibly fatal. The kind of real life annoyance of living in a modern medical miracle society. The co-pay cost to …

The line between comfort care and murder

James C. Salwitz, MD

Physician

February 6, 2015

“So, I told the doctor at the nursing home that I loved my father more than anything. Dad was my friend and the most wonderful man I had ever known. I wanted everything for him. But, I said, Dad was sick, weak, confused, and he never wanted to live like that. The next morning he was dead. That was OK by me.”

I once participated in a panel discussion about hospice, …