James C. Salwitz, MD

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

The fine balance between hope and cope in cancer patients

Physician

March 15, 2013

At tumor board recently, we discussed what we tell our patients about prognosis. Some oncologists give detailed information, including specific survival times. Others never discuss the future, and let the events of the illness teach patient and family. All try to adjust what they say by what the patient needs, because each physician expressed one core goal; “Whatever I say I don’t want the patient to lose hope.” I thought …

Learning about costs: A gross failure in medical education

James C. Salwitz, MD

Education

March 5, 2013

Of the 2.7 trillion dollars that will be spent on health care in these United States in 2012, more than $600 billion will be wasted. Excess testing and procedures, inflated charges, archaic business models, futile end-of-life care and exploding drug costs are some of many reasons. Predicted 25 years ago this crisis has been the focus of extensive academic analysis. It is reasonable to assume that with the primary goal …

Do most patients with cancer receive proper prescriptions for pain?

James C. Salwitz, MD

Physician

February 28, 2013

To state the obvious: 1) most advanced cancer patients have pain, and 2) we have excellent pain medications which can effectively treat more than 90% of cancer pain. Therefore, most patients with cancer receive proper prescriptions for pain. Obvious, yes? True? No.

In Europe, Australia and North America narcotic analgesics are widely available, and frequently prescribed. While there is access, many patients, particularly those in certain groups such as seniors and …

Why don’t doctors talk about death with their patients?

James C. Salwitz, MD

Physician

February 21, 2013

The failure of doctors to talk to their patients about end of life decisions perplexes me. This gap in vital communication results in poor care, uncontrolled pain, futile treatment and death in hospital or nursing home, where no patient wants to be. Certainly, for oncologists, every patient they see is concerned about dying and by not opening the topic it leaves each isolated.

I have generally taught my students that this …

When should a physician obtain a palliative care consult?

James C. Salwitz, MD

Physician

February 8, 2013

I had a most surprising visit with a patient last week; she came to say goodbye, because she was dying. The surprise was that while she does have a terminal illness, she is not actively dying; I would put her prognosis at four to eight months. She was bidding me adieu, because I had referred her to hospice.

There is confusion about the role of the primary doctor, when a patient …

Taking care of other physicians and their families

James C. Salwitz, MD

Physician

January 28, 2013

Terry is a particularly difficult patient. She is not hard because of her cancer, which is in remission, nor is there a problem with pain, of which she has little, and Terry is not particularly demanding for the nursing staff. No there real problem, the challenge, the thing that makes her so difficult is that Terry is married. Terry is married to Dr. P and he is a particularly difficult …

When is making the decision to be DNR appropriate?

James C. Salwitz, MD

Physician

January 22, 2013

Here is a little appreciated fact: Patients cannot order medical care; they can only accept or refuse it. Only a doctor can order medical treatment. In an extreme medical situation, the doctor can offer CPR, but it is the patient’s job to accept or reject. Any patient can refuse CPR. This refusal is known as Do Not Resuscitate or DNR, and for obvious reasons needs to be made ahead of …

Finding a cancer cure: Maybe we should shift gears

James C. Salwitz, MD

Physician

January 11, 2013

Now here is a novel idea to save lives and stop the cancer plague; stop trying! Sounds as crazy to me, as it does to you, but this idea actually may have merit. Some smart people are saying that we have spent too much money for little gain, thus it is time to give up and by retreating win more battles in the war on cancer, than by charging ahead.

The …

A poorly managed end of life experience can transform families

James C. Salwitz, MD

Physician

December 30, 2012

A grandfather-father-husband-salesman-cook-gardener-hiker-gentleman, adored by many, is struck down by cancer. His disease is particularly horrible, spreading quickly though his body causing damage not only to bone and organ, but to sinew and nerve. He suffers terrible pain for weeks, relieved poorly with inadequate doses of inferior medications, thrashing in misery witnessed by his kin, always at the bedside, ages seven to seventy. Finally, uncomfortable and agitated until the end, he …

Stop the proliferation of guns by ending the fear

James C. Salwitz, MD

Physician

December 19, 2012

“I kissed my daughter as she left for school today and realized it might be the last time I would ever see her.”
-New Jersey mom, three days after the Sandy Hook, CT shootings

On December 14, 2012, twenty school children died of the Gun Disease, shot making gingerbread houses. As guns beget guns, firearm injury and death spread like a virus. Doctors, the healthcare system, have failed to protect the most …

Why IT is the core of the healthcare renaissance

James C. Salwitz, MD

Tech

December 11, 2012

Warning! I am a practicing doctor who sees real patients using an electronic medical record (EMR). My sole agenda is to provide the best patient care. I have no financial stake in information technology (IT). However, unlike the editorial board at the Wall Street Journal, Mr. Stephen Soumerai of Harvard or Mr. Ross Koppel of the University of Pennsylvania, I have actually …

The importance of diet and nutrition in cancer patients

James C. Salwitz, MD

Conditions

November 28, 2012

Starve a cold, feed a fever. Eat a balanced diet, don’t overeat, he is so thin he should fatten up before he wastes away, avoid junk food, she needs to keep her weight down. Our society is obsessed with food and food advice, and nowhere is that more true than when dealing with cancer.

Nearly 100% of the time when an oncologist sees a new patient, they are asked about nutrition. …

Is it possible to ignore prostate cancer?

James C. Salwitz, MD

Conditions

November 17, 2012

Is it possible to ignore a cancer? Prostate cancer infests almost 250,000 men in this country each year and will kill 28,000 men in the United States in 2012, over 200,000 around the world. Many lose their lives “too soon”, dying in their 60s or even their 50s. Nonetheless, authorities do not recommend the PSA blood test for routine screening of this disease. How can this make sense? Partly this …

The deep psychic effects of medical care

James C. Salwitz, MD

Physician

November 4, 2012

In his brilliant 1993 satire “Et Tu, Babe,” Mark Leyner proposed a new concept in body art, which is the specialty of “visceral tattoos.” The narrator travels to Mexico where his chest is opened and the insignia of a “guy surfing a wave of lava, wearing polka-dotted trunks,” is tattooed directly on his heart. The dye used shows up on CT scans and apparently women, especially x-ray technicians, love it. …

A moral duty to help build healthier societies

James C. Salwitz, MD

Conditions

October 22, 2012

Nairobi, Kenya basks under a brilliant sun, its dusty frontier soul, noise, construction and vital humanity speak for a nation and a people rushing into the modern world. Full of ideas, growing exports and exploding industry, its expanding middle class has seized on education and commerce as the path to tomorrow. One of the richest nations in Africa, with a new Constitution and new hope, it races forward. Tragically, even …

How well does your doctor play with others?

James C. Salwitz, MD

Physician

October 3, 2012

How do you choose a doctor? Perhaps you start with a recommendation from a friend or a trusted physician, then you look at factors such as training, experience, board certification, access, online reviews and of course that vital issue, how well you like the doctor when you meet him or her. Tough thing, picking a person you barely know to whom you trust health and life. To this list, I …

When patients decide the best is not for them

James C. Salwitz, MD

Physician

September 24, 2012

I have been practicing medicine for 35 years and the great secret is that it just keeps getting better. No day goes by without an important learning moment, a unique observation or just the satisfaction of making a difference. Today I had one of those moments of revelation that will slightly change all days which follow.

Stan is a 57-year-old man with curable colon cancer who requires surgery. Unfortunately, that surgery …

When patients stray from the common sense approach to health care

James C. Salwitz, MD

Physician

September 12, 2012

It turns out that the practice of medicine is just common sense. If someone has fallen and their hip hurts, it is probably related. If someone does not have an infection, do not give an antibiotic. Exercise and good food are, well, good for you. If it is not broken, do not fix it.

Usually, patients understand this basic idea. The best chance of becoming and staying healthy is the simplest …

How long do I have? The question of prognosis has no simple answer

James C. Salwitz, MD

Physician

August 28, 2012

“The question” comes in several forms: “Doc, what stage is my cancer?” “What is my prognosis?” “Can it be cured?” “Am I going to die?” “Have long have I got?” These tough honest words require courage. “The question” superficially asks for a simple answer. Time to live. However, in the real world of life and death, these questions and therefore the answers are far more complex and subtle.

Years ago we …

Why brain tumors are my least favorite cancer

James C. Salwitz, MD

Conditions

August 20, 2012

If I had to choose my “least favorite” cancer, it would be brain tumors. This malady is not only challenging to treat, but it attacks in such a personal and disturbing way. It is hard enough to fight a complex disease, but to do it when the ability to focus and understand is disrupted by brain injury is a terrible curse. Still we have learned a lot and therapy is …

James C. Salwitz, MD

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