James C. Salwitz, MD

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

The unwritten contract: Cancer cannot be beaten any other way

Physician

July 27, 2013

I had a patient this week that really screwed up his medical care when he experienced a predicted side effect of curative chemotherapy. Despite clear instructions and access to every number my partners, my staff and I have, including office, triage, cell, and answering service, he did not reach out. Day-by-day he lay in bed, as he grew weaker and multiple systems failed. No one contacted me. Finally, he sent …

A guide to giving bad news to patients

James C. Salwitz, MD

Physician

July 22, 2013

The massive magnets of the MRI radiate fields through her brain, scanning veins, arteries and every millimeter of cortex. Grey and white matter, containing all she is and all she ever will be, identified, cataloged, mapped. Two centimeters under the front of her skull, just to the left of center, there is an abnormality; a one centimeter mass surrounded by swelling. The lung cancer has spread, metastasized. Really bad news.

A …

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A guide to giving bad news to patients

Are physicians still responsible for mistakes in health care?

James C. Salwitz, MD

Physician

July 14, 2013

Who is responsible for mistakes in health care? Who should take credit for success or blame for failure? Most families, patients and obviously the courts, hold the doctor responsible. It seems to me this is reasonable; it is the obligation physicians assume and which society returns with empowerment and respect. However, is this changing because of the Internet and big data?

In 2013, most patients have spent hours on the Internet …

I failed to appease pain during her life, so she died terribly

James C. Salwitz, MD

Physician

July 8, 2013

Ellen died a clockwork machine, restrained by Versed, fed by nasal tube, secretions in bags, and as her blood pressure dropped intravenous pressors accelerated in dose until blood squeezed from her extremities left fingertips dry and black as coal. Death occurred on the 41st hospital day, after 27 minutes of scripted, six rib fracturing, 360-joule electric shock CPR. A brutal case by any measure, worse because advanced cancer …

The tension between oncology and palliative care

James C. Salwitz, MD

Physician

July 1, 2013

One of the benefits of being an oncologist is that, as a rule, people appreciate our work. That does not mean they want to hear about our day, and the response when someone learns my vocation is rarely, “Hey, that’s sounds like fun!”

Nonetheless, at least there is a modicum of respect. However, I found a group of people with major questions about the work of cancer docs or at least …

The medicine that kept her alive was not in a bottle

James C. Salwitz, MD

Conditions and Diseases

June 24, 2013

Sue wondered if all doctors subscribe to the same magazines, buy the same cheap furniture, post the same worthless insurance information. She wanted to throw it all through the receptionist window. The second opinion was a waste of time and she had little of that. She was there to make her family happy, but was upset they could not cope, that they were not ready to face the truth, and …

Numbers fail to answer that one vital question

James C. Salwitz, MD

Physician

June 16, 2013

When I visited Allan in the hospital yesterday, I told him to get up and stroll the hall. However, when I checked in on him this afternoon, the nurses informed me that he refused to get up, even to the chair. When I asked why, Allan told me he could not walk. I was concerned, but when I examined him, I found his vital signs were fine, he had no …

Looking up health information online: Do you really trust your doctor?

James C. Salwitz, MD

Physician

June 10, 2013

Physicians are bothered by their patient’s fear. One of the worst parts of actually caring is that when other people suffer and especially when they are frightened, you suffer with them. It is bad when the trepidation is about something real, such as a new disease, but it is particularly disturbing when the source of the fear is confusion or bad information.

There are several common sources of inaccurate terrifying data. …

Will patients trade human imperfection for computerized perfection?

James C. Salwitz, MD

Physician

June 2, 2013

The Atlantic this week published a provocative article entitled “The Robot Will See You Now.” Using the supercomputer Watson as a starting point, the author explored the mind-bending possibilities of e-care. In this near future, so many aspects of medicine will be captured by automated technology that the magazine asked if “your doctor is becoming obsolete?”

The IT version of health includes continuous medical monitoring (i.e. your watch will …

Another reason why the house call is dead

James C. Salwitz, MD

Physician

May 27, 2013

We think the reason doctors rarely make house calls is money. Doctors can charge, but it is hard to charge enough to justify the time it takes to drive door-to-door, fill the tank and attend lengthy visits. Thus, the house call has faded into history. However, I have another theory about the end of this valuable service: perhaps it is increased emotional distance between patients and their doctors.

I watched an …

There is no completely safe dose or form of alcohol

James C. Salwitz, MD

Conditions and Diseases

May 20, 2013

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We live in a strange world. What would happen if tomorrow a common sedative was found to cause 21,000 cancer deaths every year? What if it resulted in breast cancer, mouth cancer, hepatoma and esophageal malignancies, and if the average patient lost 19 years of life? What if the drug also killed by cirrhosis, massive upper GI bleeding, accelerated dementia, and for …

Angelina Jolie: Why her story comes at a crucial time for BRCA testing

James C. Salwitz, MD

Conditions and Diseases

May 14, 2013

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Dear Ms. Jolie,

Thank you for your bravery and leadership in the battle against breast cancer. In a small way, through my patients, I understand the challenge and pain it took not only to undergo prophylactic mastectomies, because you carry the BRCA1 cancer gene, but also to reveal this deeply personal part of your life to the world. You had no …

We are simply too busy to die

James C. Salwitz, MD

Physician

May 13, 2013

The unexamined life is not worth living.
–Plato

There are obstacles to dignity at the end of life. Disease inflicted pain and debilitation, cost and confusion, poor planning and fear, all aggravated by our societal ignorance regarding dying, result in unneeded suffering and isolation. In addition, it occurs to me that a hindrance to control and quality is that we are overwhelmed by the pressure of our day-to-day lives. In other words, …

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We are simply too busy to die

When alternative cancer therapy harms patients

James C. Salwitz, MD

Medications

May 6, 2013

After a terribly painful and debilitating illness, Steve died. He had been treated for Stage 2 Hodgkin’s Disease with a series of intense therapies including German enzymes, American antineoplastins, Mexican naturopathy and Chinese herbs, complemented by focused meditation, innumerable vitamins, extreme diet modification and acupuncture for severe pain. He fought the cancer with every ounce of his being, doing everything to survive, except the one thing that had an 85% …

A plea for a universal, unified EMR

James C. Salwitz, MD

Health Technology

April 29, 2013

At some point, this gets to be ridiculous. Online, I can buy any item from anywhere at any price, pay any bill, watch any movie, listen to any song, order dinner, schedule car repair or read about any subject on Wikipedia. I can determine the weather in Rio, sport scores of Barcelona, Parisian traffic or by GPS the location of my kids, just down the block.

However, I absolutely cannot learn …

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A plea for a universal, unified EMR

As an oncologist, I hate running late

James C. Salwitz, MD

Physician

April 22, 2013

Yesterday I had office hours: 26 patients at 15-minute intervals, followed by 3 new patients for one-hour visits, interspersed with 4 emergencies and 33 phone calls. An active normal day. However, the 1:30, 1:45, 2:00 patients all arrived at 2:15 and suddenly I was looking at an afternoon that would run deeply into eve. I really hate it when patients are late.

Now, I have to admit this is a unique …

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As an oncologist, I hate running late

No one asks oncologists how they feel

James C. Salwitz, MD

Physician

April 15, 2013

I was watching a macho shoot-em-up movie the other day; the type where everyone shoots everyone and in the final scene, the dirty blood-stained hero rides homeward on a helicopter or maybe a horse, into a red sunrise or sunset. He stares blankly, focused on nothing, focused on everything, his look reflecting the turmoil of what he has seen, done and lost. The hero’s grease-smeared face shows the understanding that …

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No one asks oncologists how they feel

The best doctors teach their patients

James C. Salwitz, MD

Physician

April 8, 2013

The Oxford English Dictionary (OED) identifies the first use of the term “doctour”, as the year 1303 AD, shortened to “doctor” in the 1557 addition of the Geneva Bible. The OED first defines doctor not as a caregiver or healer, not as a science researcher or expert and not even as one with an advanced educational degree. The OED, the world’s foremost English language dictionary, defines “doctor,” 700 years ago …

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The best doctors teach their patients

Marriage and medicine: Both are not exact sciences

James C. Salwitz, MD

Physician

April 1, 2013

I have been married and practicing medicine for 32 years and during that time I have learned lessons that equally apply. First, listen carefully; both wives and patients need to be heard. Second, prepare and think before you speak; as the saying goes “put brain in gear before operating mouth.” Finally, perhaps the hardest lesson of all is, when necessary, be 100% inconclusive.

Any man or woman, who has been in …

How can you tell if adjuvant chemotherapy works?

James C. Salwitz, MD

Conditions and Diseases

March 25, 2013

Think you know something about oncology? Ok then, pop quiz: If you are giving chemotherapy to a patient who does not have cancer, how can you tell if it works? Ridiculous question? Not at all. The answer to that question is; “hopefully, we will never know,” and it is at the core of modern cancer care.

In the 1960s, breast cancer surgeons had a serious problem. They were doing large complex …