Oncology and Hematology

Physicians writing on KevinMD about cancer: the screening argument that has run since 2009, how a diagnosis is delivered, what treatment costs patients, life after treatment, and what the work does to oncologists. Four maintained records draw on this archive: Cancer: what physicians say, in their own words, End of life: what physicians say, in their own words, Prior authorization: what physicians say, in their own words, and Opioids: what physicians and pain patients say, in their own words.

Have bad news for your patients? Mind your metaphors.

Shannon Casey, PA-C

Physician

March 9, 2019

First, the cancer diagnosis. Then, the barrage of trite encouragements: You can beat this! Don’t give up. Keep fighting! It’s not only friends and family members who utter these clichés — usually at a loss of what else to say. Health care providers also attempt to bolster patients’ morale with well-intentioned but well-worn phrases too. Unfortunately, these sentiments frequently fail to have the intended effect. Instead of conveying comfort and …

Remove your blindfold to your patient’s pain

Christina Abi Faraj

Medical Education

March 8, 2019

“We pass through the present with our eyes blindfolded … Only later when the cloth is untied can we glance at the past and find out what we have experienced and what meaning it has.”
– Milan Kundera

Two days ago, during a clinical skills session on lymph node examination, my classmates insisted that I get what appeared to be an enlarged lymph node in my neck checked by the physician …

Alex Trebek reminds us to go beyond fear of pancreatic cancer

Burton Eisenberg, MD

Conditions and Diseases

March 8, 2019

The news that beloved game show host Alex Trebek has advanced stage pancreatic cancer hit his millions of fans hard this week. His illness has elicited heartbreak and support. As a clinician who treats pancreatic cancer, I anticipated the reaction that would follow next.

Fear.

While it is a rare form of cancer, pancreatic cancer is possibly the most lethal. Survival rates are slim – fewer than 10 percent with advanced disease …

To parents who have lost children: We never forget your children

Quinn Bensi, MD

Physician

March 7, 2019

Her name was Callie (identifying information changed). She was four years old. She loved glitter and princesses and anything sparkly. She was affectionate and silly, and I fell hard for her. She was a patient, my patient, on the pediatric oncology unit during my very first ward rotation intern year.

On my first day, I was as scared as any person can be, palms sweating, heart pounding, faced with these tiny, …

Never take your eyes off of a bleeding patient

Ton La, Jr., MD, JD

Conditions and Diseases

March 4, 2019

“Please help me. I was brushing my teeth this morning and started bleeding a ton from my mouth.”

Joe (identifying information changed) pointed to a bucket next to his bed. I was horrified to see close to two pints of blood in it.

With gloves on, I pulled out my penlight and a new tongue depressor.

“Open your mouth wide for me Joe. I need to see where you are bleeding from.”

I clicked …

MKSAP: 81-year-old woman with headaches, redness of the face, and itching

mksap

Conditions and Diseases

March 2, 2019

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

An 81-year-old woman is evaluated for a 1-year history of headaches, redness of the face, and itching. She indicates being otherwise capable of performing her daily activities on her farm. She reports no shortness of breath, chest pain, or difficulty sleeping. Medical history is significant for hypertension; she has …

How can doctors stop fake medical news

Shikha Jain, MD

Physician

February 27, 2019

When I started on my path in medicine, I was an optimistic, wide-eyed, enthusiastic medical student. I had fond memories of rounding on Sundays with my vascular surgeon father as a child, and I remembered the appreciation his patients would express when we would run into them at our local grocery store. My dad never complained about taking call or not having enough time to spend with his patients. The …

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How can doctors stop fake medical news

An oncologist’s battle with imposter syndrome

Shikha Jain, MD

Physician

February 25, 2019

Somewhere between medical school, residency and fellowship, I lost my voice. I knew what I wanted to do with my life. I thought I knew where I wanted to be in my career, and how to accomplish those things … until one day, I wasn’t so sure. I don’t know if it happened when I was applying for fellowship or when I returned from maternity leave as a trainee and …

MKSAP: 75-year-old man with progressive dysphagia

mksap

Conditions and Diseases

February 23, 2019

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 75-year-old man is evaluated for progressive dysphagia of 8 months’ duration for both solid food and water, and the necessity to induce vomiting several times each month to relieve his symptoms. He also has experienced chest pain and heartburn symptoms. He has lost approximately 6 kg (13 lb) …

Should we start screening for colon cancer at age 45?

Peter Ubel, MD

Conditions and Diseases

February 17, 2019

Here’s what most medical experts agree on: People 50 and older should be screened for colon cancer.

Here’s what is more controversial: Whether that screening should start, routinely, at age 45.

Recently, the American Cancer Society (ACS) recommended that colon cancer screenings start at age 45. Their recommendation was based in large part on an uptick in the number of people 45 to 50 years old who are being diagnosed with colon cancer …

6 resources on the power of narrative medicine

Jennifer Lycette, MD

Physician

February 8, 2019

When I first turned to writing, I had no knowledge of the field of narrative medicine.

It took four years of medical school, three years of residency, three years of subspecialty fellowship and over a decade in practice before I learned of it. (That’s more than 20 years, for those counting.)

Throughout, I’ve struggled to hold fast to my core belief that the key to patient care is to allow the telling …

Radiation oncologists aren’t just strangers in the basement

Mudit Chowdhary, MD

Physician

February 6, 2019

“We have a consult for radiation oncology regarding a 60-year-old gentleman with a history of lung cancer and is currently admitted. His oncologist is Dr. Heme Onc.”

As a new radiation oncology resident, I was surprised to hear the consulting physician refer to the patient’s medical oncologist as “his oncologist.” What about the patient’s radiation oncologist? Indeed, I remembered the patient well: he was diagnosed with Stage IIIB non-small cell lung …

Will artificial intelligence be able to have this conversation?

Shannon Dowler, MD

Health Technology

February 5, 2019

Transformation of health care is underway: The landscape is filled with innovation, and the horizon is dotted with technological possibilities of “Star Trek” ilk. In a recent New England Journal of Medicine Catalyst article, there was a compelling argument for how artificial intelligence (AI) of the future will help deliver us from a high cost, high variability, poorly resourced state and help deliver the IHI triple aim quest we in …

Do you know why you’re having surgery?

Alexandra Lackey

Conditions and Diseases

February 4, 2019

During my third year of medical school, I completed a clinical rotation in surgery. I was certain that it would be horrible. I envisioned myself in the OR, getting lightheaded, passing out onto the sterile field and being yelled at by my attending physician. I worried that the medical knowledge I’d worked so hard to learn would be neglected in favor of memorizing the steps of surgical procedures. My parents, …

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Do you know why you’re having surgery?

“The Wait” after a mammogram changes lives

Shannon Dowler, MD

Conditions and Diseases

January 30, 2019

There is something both intimate and mysterious about the waiting area for mammograms. You sit in a relatively small space; chairs close together with a gown tied to cover your nakedness, your normally restrained lady parts flopping free against the scratchy fabric. There are young and old, black and white, grey and blond and even sometimes bald. There are women with coiffed hair and manicured fingers bright with diamonds and …

A story of treatment failure and end-of-life decisions

Iris Kulbatski, PhD

Conditions and Diseases

January 30, 2019

Part 4 of a series.

By the time my father’s metastatic prostate cancer was diagnosed, he was already experiencing symptoms of poor appetite and weight loss, which grew progressively worse following his first hospital admission. As his nutritional status continued to decline, the protein level in his blood decreased, causing significant fluid buildup in his legs and abdomen. During his hospital stays, we consulted with dietitians who created individualized …

Generics aren’t going to help the cost of chemotherapy drugs

Peter Ubel, MD

Medications

January 29, 2019

Chemotherapy drugs have become ridiculously expensive. Many new drugs come to market costing more than $100,000 per patient for a full course of treatment. Often, patients have to pay a significant portion of these costs. For example, a 20% co-insurance rate, typical for basic Medicare coverage, leaves patients responsible for more than $20,000 of chemotherapy costs, an often crippling burden.

Fortunately, many expensive cancer drugs are going …

What clothing choice says about a patient

Anne Katz, RN, PhD

Conditions and Diseases

January 23, 2019

The woman waiting to see me looked every inch a lawyer or accountant in her black pencil skirt, pink shirt, and a Chanel-style houndstooth jacket. Her ankle boots were reminiscent of those worn by women in Victorian times with a row of small buttons up the side. She had a scarf loosely knotted around her shoulders, and her hair was …

A stage IV lung cancer survivor story

Jennifer Lycette, MD

Conditions and Diseases

January 23, 2019

I want to share how the era of immunotherapy, specifically immune-checkpoint-inhibitors, has changed the landscape of community oncology practice in metastatic non-small-cell lung cancer, for oncologists and, more importantly, patients.

I want to tell you the story of Joe. A stage IV lung cancer survivor story. (Name and details changed to protect anonymity.)

In 2015, Joe was diagnosed with stage IV non-small-cell lung cancer (NSCLC), adenocarcinoma. He had multiple metastases to other organs. …

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A stage IV lung cancer survivor story

Why did it take over a week for doctors to initiate treatment?

Iris Kulbatski, PhD

Conditions and Diseases

January 22, 2019

Part 3 of a series.

Patients with advanced cancer are particularly vulnerable to infection due to a compromised immune system. Moreover, the typical symptoms of serious infection, such as fever and chills, may be absent in cancer patients. If not identified and treated early, infection can lead to sepsis, a life-threatening reaction of the immune system that causes organ failure, shock, and death, as …

Oncology and Hematology

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