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.

A CT scan for kidney cancer? It may depend on where you live.

Peter Ubel, MD

Conditions and Diseases

November 8, 2018

About one in fifty people reading this essay will be diagnosed with kidney cancer at some time in their life. In fact, one out of one people writing this essay has already been diagnosed with kidney cancer. (I had a small tumor removed from my left kidney not long after I turned 50.) But how many people diagnosed with kidney cancer have been overdiagnosed with the condition? And what does moving to Florida have …

A patient’s experience of chemotherapy and radiation

Lynn Lazos

Patient

November 6, 2018

I had my first mammogram at age 35, and for the next 35 years I had mammograms regularly. On my way, I’d pass the entrance to the Thomas Johns Cancer Hospital, outside of Richmond, VA, never thinking that I’d one day cross that threshold myself.

When I heard the “C” word, I didn’t know what to do. I wanted to run far, far away. After much grief, however, I realized that …

This is what the face of resilience looks like

Rebekah Fenton, MD

Physician

November 6, 2018

At the age of 17, my younger sister Elisabeth noticed a change in her body — enlargement of the front of her neck. “I just thought I was building muscle from working out,” she innocently rationalized. A series of laboratory tests and imaging followed and led to a much more grave discovery — cancer.

There are days my family will never forget, like the day of my sister’s diagnosis. My older …

MKSAP: 79-year-old man with a sacral ulcer

mksap

Conditions and Diseases

November 3, 2018

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

A 79-year-old man is evaluated for pain in the buttocks region. He was diagnosed with non-Hodgkin large B-cell lymphoma 6 months ago. Although his lymphoma has responded well to therapy and he is without evidence of active disease, he required hospitalization three times for chemotherapy-associated complications during his treatment course. He has been …

Silence isn’t golden when it comes to health

R. Lynn Barnett

Patient

November 1, 2018

When I was a preemie — all two-and-a-half pounds of me — my mom was understandably worried. She said her doctor wheeled her down the hall to the newborn nursery, and my mom could hear me screaming all the way down the hall. She said, “I’ve got to hand it to you. You let your voice be heard — you let your needs be known. I told her that at …

A bad outcome changed this physician’s life

Anonymous

Physician

October 31, 2018

I’m struggling — truly struggling. This year has been beyond hard. I honestly never thought this time last year that I would be in this predicament. Things were good, I had a great job, and I was working on our fixing up our dream retirement home. We had great vacations every year. Yes, the home remodel wasn’t quite on track, but we were making progress. But then, my world fell …

The Ellen Show broadcasts potentially harmful information about ovarian cancer screening

Jennifer Gunter, MD

Conditions and Diseases

October 30, 2018

Ethical OB/GYNs everywhere sighed heavily when they realized from the action on their Facebook and Twitter feeds that the Ellen Show broadcasted incorrect and potentially harmful information about ovarian cancer screening to almost 4 million people. Millions more will likely hear about it on social media.

Ellen Pompeo, who plays a doctor on the television show Gray’s Anatomy, decided to play doctor in real life and used her celebrity platform to recommend …

Is cancer truly the enemy?

Ken Dixon, MD

Conditions and Diseases

October 26, 2018

Cancer is the enemy. So, our immediate desire is to get rid of it, throw it away, and never hear from it again. Current therapies that require living tissue are proving that false. We know that your living tumor tissue is like your fingerprint, unique to each individual patient. It contains information specific to you, your genetic make-up, your cancer and ultimately the thought is, your treatment. If kept alive, …

Read more…

Is cancer truly the enemy?

There’s no textbook for when your father is dying

Jeremy Pivor

Medical Education

October 26, 2018

On my first day of medical school, my father, a dentist, told me he’d just been diagnosed with stage four pancreatic cancer. Cancer had crept back into my life — except this time not into my body.

At age 12, I was diagnosed with brain cancer. After an aggressive surgery, I was tumor-free for 10 years. Then, at 23, I received the news of an inoperable recurrence.

While going through radiation and …

When breast cancer screening guidelines conflict: Some patients face real consequences

Leda Dederich

Patient

October 25, 2018

Are my breast cancer and I on the wrong side of statistics, or just caught in the confusing and potentially devastating conflict between medical societies about when women should start breast-cancer screening?

One morning more than a year ago, it didn’t seem like either. As both of my kids cuddled in bed with my husband and me, I …

Prostate cancer screening campaigns are giving men the finger

Gary Schwitzer

Conditions and Diseases

October 22, 2018

Fifty years ago, in a golden moment of television comedy shows, Rowan & Martin’s Laugh-In program regularly featured “The Flying Fickle Finger of Fate” award. Wikipedia says it “recognized actual dubious achievements by public individuals or institutions.” Do a Google search. You’ll quickly see how popular this award became.

Yes, I’m dating myself by going back 50 years. But mine is the generation that often becomes obsessed with being given “the …

When diagnosing colon cancer isn’t in a patient’s best interest

Michael Kirsch, MD

Conditions and Diseases

October 15, 2018

So much of life depends upon timing. Sure, we plan, but we know how much of our life’s events are unplanned and unexpected. So often, our jobs and our mates — two of our most defining accomplishments — are the result of a chance encounter or a random act. Life does not reliably proceed in an orderly manner.

This is often true in the medical profession. Here, physicians in our quest …

The key to this patient? Horseshoes.

Bruce Campbell, MD

Physician

October 12, 2018

“Those who suffer illness learn by hearing themselves tell their stories, absorbing others’ reactions, and experiencing their stories being shared.”
– Arthur Frank

We stand together at the clinic room door, preparing to enter.

“Tongue cancer. This is a 78-year-old man with an oral cavity mass and some memory loss. He had an ulcer on the side of his tongue for a few weeks which was biopsied by an outside doctor. No imaging …

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The key to this patient? Horseshoes.

What my mother needs is a daughter, not a doctor

Sanjana Vig, MD, MBA

Physician

October 11, 2018

My mom was recently diagnosed with cancer. I can’t even begin to describe the shock I felt or how my heart just sank. In an otherwise healthy person with no family history, this is not something you ever expect to happen. My mind immediately jumped to so many different conclusions, and I immediately wanted answers. Is she going to beat this? How did this happen? Why did this happen? What …

Dealing with prejudice as a cancer patient

Ton La, Jr., MD, JD

Physician

October 2, 2018

I sat in seat 23F next to the window, took out my leftover dinner from my backpack, and furiously started eating. A few minutes later, a man wearing an Astros baseball cap sat next to me with a puzzled look.

“You sure look hungry.”

“I am, can’t beat fried noodles with chicken. My name’s T.J. Pleasure to meet you.”

“My name’s Mike, Mike Jordan.”

“Are you related to the Michael Jordan?”

“Ha ha! I sure …

MKSAP: 56-year-old man with painless intermittent bloody urine

mksap

Conditions and Diseases

September 29, 2018

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

A 56-year-old man is evaluated for painless intermittent bloody urine of 6 weeks’ duration. History is significant for granulomatosis with polyangiitis (formerly known as Wegener granulomatosis) diagnosed 10 years ago, which is now in remission; he was treated with prednisone for 3 years and oral cyclophosphamide for 1 year. He also has hypertension …

A breakdown of your pathology report

Jena Martin, MD

Conditions and Diseases

September 27, 2018

I’m a pathologist and the main way I communicate to the outside world — to your doctor and ultimately to you, the patient is via the pathology report. But the short missives I send from behind the microscope lack any excitement and can fall short of full communication.

Here’s the usual story:

Skin left scapula, biopsy

Nodular basal cell carcinoma

Negative for perineural invasion

Margin status: Positive

Doesn’t sound real interesting, does it?

How about a more …

Read more…

A breakdown of your pathology report

The dismantling of informed consent is a disaster

David Penner

Patient

September 26, 2018

Informed consent is the cornerstone of medical ethics. And every physician must defend this sacred principle from every form of evil that would seek to dismantle, degrade and debase it. If informed consent is the sun, then privacy, confidentiality, dignity, and trust are planets that go around it. For without informed consent, the descent of health care into amorality is inevitable, and the doctor-patient relationship is doomed to ruination, oblivion, …

Quality over quantity in life and care

Jeffrey Cannon

Physician

September 23, 2018

The surgical team filed out of the patient’s room. I looked over my shoulder to see a shaken daughter holding the wrinkled hand of her quiet, elderly mother who lay in the bed. I shuddered as I thought of the surgery her body would endure the next day. I knew I needed to return to her room later in the day to find out more about her history. After rounds …

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Quality over quantity in life and care

100 percent satisfaction doesn’t work in our health system

Cory Michael, MD

Physician

September 21, 2018

“I want answers!” My mother was upset over the care for her ill husband. Previously able to converse normally, he was now incoherent and disoriented. The recent recipient of a bone marrow transplant to treat his advanced leukemia, he probably experienced a brain infection because of the immune suppression therapy needed to accept the marrow. The marrow transplant didn’t work. He was sent home from the hospital on hospice care …

Oncology and Hematology

Oncology and Hematology

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