I was driving to work one morning, and as part of my new routine, I listen to The Moth podcast. If you do not know it, it’s a wonderful community of storytellers — compelling stories, told by people from every walk of life. I often find myself drawn into the program (like a moth …
When patients die, physicians mourn as well
Artificial intelligence is incredibly buzzy in health care right now, and for a good reason. Other industries are already experiencing AI-enabled radical transformations, like real-time fraud monitoring and detection in banking and finance and instantaneous image recognition across the web and social media. Health care now stands similarly positioned to capitalize on the transformative power of machine learning, and the massive potential is driving levels of investment expected to Read more…
It’s time for AI-enabled solutions in health care to live up to their buzz
Do you ever wonder what the staff in hotel conference rooms think about what we talk about in presentations and lectures? I talk about sensitive stuff — sexuality, fertility, etc. — and I use words that many people have not said out loud in front of hundreds or thousands of people. I’m used to the words, of course, and they …
The unexpected people who’s listening to your conference speech
Randomness in life is inevitable because the universe is a pretty random place, although the extent to which you believe that depends upon your own value system. This notion comes into play almost every day of my practice in the PICU because many of the critically ill and injured children I care for experienced a sudden onset of the difficulties that landed them in the PICU. I do see a …
The randomness of cancer: bad luck or something else?
In a world where, in a moment, I can order from thousands of items and have them delivered to my doorstep the same or next day at the press of a button without having to re-enter my name, address, and billing information each time, it would seem that filling out paper forms at the doctor’s office by hand to have someone else re-enter the information into a computer that doesn’t …
It’s time we get the technology working for the patients, and not make their lives more difficult
Some may think that being a dermatologist means taking care of the “superficial.” I beg to defer. We spend a great deal of time performing procedures and talking to patients. During our visits, patients share their truth, and open up their hearts to us in meaningful and vulnerable ways. We hear about their relationships, their work, their fears, and their struggles. We become a part of their inner circle of …
A Health Affairs blog post titled “Fixing Clinical Practice Guidelines” echoed several concerns I’ve discussed previously: practice guidelines are being produced in abundance but often have variable methodological quality, financial conflicts of interest that threaten objectivity, and/or poor applicability to the clinicians and populations for whom they are intended. To address these problems, the authors reasonably suggested restoring funding for AHRQ’s National Guideline Clearinghouse and …
Clinical practice guidelines have problems, but they’re not broken
I saw Kaitlin (identifying information changed) and her husband Brandon seven days before she died. Kaitlin’s cancer had been in remission at our last visit, but this day she looked awful. I estimated she had less than three months to live. As I think being surprised by death is unhelpful, I decided to test whether they were prepared to take on bad news by mentioning that she didn’t look like …
After a spouse’s death, a physician is showered with gratitude
If you’ve ever used a medication to treat an illness, you have a clinical trial to thank for it. Every standard therapy used in medicine today once started as a clinical trial. And it is commonly understood that today’s clinical trials are shaping treatments of the future.
Less understood – but just as important – is the fact that clinical trials are helping patients right now.
From pancreatic cancer patients whose lives …
Clinical trials advance medicine in the future. And help patients right now.
Actor Peter Fonda, son of Henry Fonda and younger brother of Jane Fonda, passed away August 16 at his Los Angeles home. Fonda, who was 79, is probably best known for his role as Wyatt in Easy Rider, a movie he co-wrote, produced, and starred in. Fonda was nominated for the Academy Award for Best Original Screenplay for that film as …
Explaining Peter Fonda’s lung cancer
It can be difficult to tease out the evidence-based science amidst the claims of successful adult stem cell-based treatments for a range of health problems from joint pain to Parkinson’s disease, macular degeneration, and spinal cord injury. Even a number of well-respected medical centers now offer patients regenerative medicine treatments that use the patient’s own fat or bone marrow cells or extracts created from platelets in their blood. …
What to consider before undergoing stem cell treatment or banking stem cells
It was a common enough reason for someone to have a CT scan. The order read, “Abdominal pain, colon cancer resected in January.” It was now March, only two months post-surgery. Yet the patient’s CT scan showed a number of large masses in the liver, consistent with metastatic cancer.
I compared the current study to the CT performed before surgery. The liver had looked perfectly normal at that time.
“That’s an amazingly …
The costly decision of delaying surgery
Prior to my 10-year-old son being diagnosed with leukemia, I worked as a diabetes nurse educator at a local hospital. I had been an RN for over 15 years and was able to balance home life with work; I loved educating patients on how to deal with their diabetes and collaborating with colleagues. All that came to a screeching halt when David complained of hip pain and started limping. Within …
A nurse comes face to face with her son’s serious illness
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During my training to become a primary care physician, the importance of preventive cancer screening was ingrained in me. The idea of catching cancer at an early stage so we can better treat it made intuitive sense. But as I’ve learned over the years, the simplicity of this concept can obscure its limitations and make it difficult …
Convincing patients to stop cancer screening isn’t always easy
Doctors and policy wonks hear a lot these days about “low-value care.” What exactly is that, and should you care?
The term refers to tests, medications, and procedures that add little to a patient’s health or well-being but which cost them or the system more money than any benefit warranted. Some of the earliest research that looked at this was done at Dartmouth, where they found enormous variations in the cost …
What is low-value care, and why does it matter?
Hey there, Dr. Brown.
Just wanted to send a little note to warn you that I’m coming to see you soon for my yearly “checkup.” You and I both know that this is my annual opportunity to spew all of my worries on you and for you to reassure me that I’m not dying. Have you blocked at least an hour for me? I’ve got a boatload of random symptoms that …
A letter before the yearly checkup
Being a first-generation college student is hard. Being a first-generation college student and being pre-med is even harder. And since education and income are closely linked in the U.S., it’s no surprise that many first-generation college students also come from a low-income background.
I fell into this category.
My parents did not finish high school, and money was always tight. I had never heard of pre-med until I got to college. I …
To first-generation college pre-medical students: Your future patients need you
How do you respond when patients with a good prognosis want to delay chemotherapy to try an anticancer diet for a few months or visit an unregulated clinic for unproven therapies? I’m asking because of an alarming finding of ASCO’s 2018 National Cancer Opinion Survey: “Nearly 4 in 10 Americans believe cancer can be cured solely through alternative therapies …” Clearly, we have a problem in today’s discussion about cancer treatments. …
Alternative cancer therapies and the promise of false hope
An excerpt from What Does It Feel Like to Die?: Inspiring New Insights into the Experience of Dying.
People who are diagnosed with a fatal disease sometimes do more than cope. They grow. They repair or strengthen relationships. They find a deeper spirituality or meaning in the life that remains …
A fatal diagnosis doesn’t mean life is finished
Here is some news about cancer that isn’t widely known and is hiding in plain sight: Deaths from melanoma — a skin cancer that has lethal potential — have declined dramatically over the past several years. And while that fact alone is surprising, so is the reason behind the drop.
Let’s make something clear at the outset: too many people die from melanoma. It is not the …
A hidden cancer success story: declining deaths from melanoma
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