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