It usually starts with a phone call:
“Doc, can I come and talk to you about something?”
The “something” might be erectile difficulties or other side effect(s) from prostate cancer treatment. It might be confusion or indecision about what treatment to agree to. I always inform the caller that any of these issues are better resolved if their spouse/partner is present and …
When men struggle with treatment decisions
1. Cancer is not rare. Technically, childhood cancer is rare compared to adult cancer, but it’s not as rare as you think. Outside of my work, I can think of 3 people who I know personally that had a childhood cancer. A teammate on my high school basketball team, my sister-in-law, and a high school debate teammate. My guess is that you also know someone from church, a coworker’s …
10 things a pediatric oncologist wants you to know
This must be my eighth cancer scare. (No, I really don’t undergo excessive testing.) Decades ago, I’d noted a possibly normal finding but dropped it after getting no response at subspecialist visits. Recently, following pertinent CME, I asked again and the physician bit. You can guess the rest.
One night while dodging traffic I accessed on my phone the ultrasound report from the designated cancer center’s (DCC) patient portal, revealing a …
My faith in healthy lifestyle choices is shaken
Watching patients suffer and die is not an easy thing to do. Left unchecked, I don’t think most front-line doctors would last too long immersed in that kind of setting. First, the emotional toll would be too high to maintain over a long period of time. Second, working at the extremes of emotion doesn’t allow a physician to competently and objectively apply medical knowledge to heal disease and alleviate suffering. …
The price of being a compassionate doctor is often worth it
Recently, a patient came in around 11 p.m., just as the chaos of the day had settled, and I was thinking of rest after 16 hours of work. He was an older gentleman with vague and concerning complaints that would demand a thorough workup. I suspended my thoughts of self-preservation and stepped in to evaluate him.
After an hour and a half, I had found a source of infection that explained …
A day in the beautiful life of this doctor
July was an interesting month for artificial intelligence in medicine.
A study from MIT found when human doctors order tests on patients, they factor in something that artificial intelligence is not currently aware of. The authors analyzed charts of about 60,000 ICU patients admitted to Beth Israel Deaconess Medical Center in Boston.
By looking at physician progress notes with positive or negative sentiments in patient records, they derived scores which they correlated …
Artificial intelligence in medicine: not ready for prime time
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 77-year-old woman is evaluated for frequently fluctuating INRs (<1.8 to >3.5) while taking warfarin therapy. She has undergone INR testing every 1 to 2 weeks and frequent warfarin dose adjustments. She reports a consistent dietary intake. Medical history is notable only for recurrent deep venous thrombosis. She takes no other medications.
On physical …
MKSAP: 77-year-old woman with frequently fluctuating INRs
In the second week of April, I headed to San Francisco where I took part in the SWOG Semi-Annual Meeting. To those who might be unfamiliar with us, SWOG is a member organization of the National Clinical Trials Network (NCTN) and is tasked in running clinical trials across disease sites and scenarios, from prevention to …
How clinicians can impede clinical trial recruitment
I’m not much of a tennis fan, but I am a fan of Serena Williams. Who wouldn’t be after hearing her story? Her rise to the upper echelon of athletics was remarkable, and her longevity is incomparable. All the while, she has challenged the sporting world’s notions about who and what an elite tennis player is supposed to be. I watched her interviews after this year’s Wimbledon finals and was …
My story isn’t Serena Williams’ story, but some things sound the same
Fear can show up at inappropriate times uninvited and unexpected, like a knock on the door in the middle of the night. We have all felt it. Sometimes, it can stop us from an adventure or getting into trouble. Sometimes, it can prevent us from living up to our potential or considering a new path. Sometimes, it can stop us from taking care of our health.
A few years ago, in …
A physician and patient face their fears
I remember visiting my pediatrician as a child, and even at a young age I was in awe of his degrees hanging on the wall. Looking back, I think I may have looked like the kid in Norman Rockwell’s Doctor with my behind in the air waiting to get a vaccination while staring in fascination at my pediatrician’s diplomas. Even at that young age, I could appreciate that these placards …
Our medical degrees are in boxes
The headline scrolling across the bottom of an evening news show certainly grabbed my attention: a new blood test had the possibility of detecting early melanoma and saving thousands of lives. And then there were more reports elevating this early research report to a point that I became quite interested — and frankly concerned.
News flash: The research is far from being shown to have proven value in the early diagnosis of …
A blood test to detect melanoma? Not so fast.
I am a medical oncologist specializing in breast cancer. I often try to conceal what I do for a living when I meet people for the first time as it always leads down a particular road. “Is that so depressing? I don’t know how to deal with that all day, every day.” But in truth, it …
The most valuable lessons in life can be learned in oncology
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In an era where health information is freely flowing thanks to the internet and Dr. Google, I’ve come to expect that patients who see me for the first time will have done their homework — about their cancer, treatment options, and yes, even about me. To be frank, it’s not uncommon for patients to mention they’ve …
Accept the decisions patients make
My first patient of the day has metastatic pancreatic cancer. She’s had it, in fact, for two years. Getting chemo for two years. Her hair has fallen out, her pain is becoming uncontrollable and she’s been in and out of the hospital.
Her daughters came to the clinic with her. She is tearful. Her daughters pull me aside. “Tell her to focus on the positive,” they request. I wonder if there …
It’s 9:30 a.m. on a Wednesday, I get on the elevator, and I hear a man in his 40s, having a conversation on his cell. He says: “He had a brain bleed yesterday, and they had to put a breathing tube in, they don’t know how much damage his brain has suffered at this point.” He gets off on the adult ICU floor. I quickly think “that sucks” and carry …
Am I the cold and detached physician?
The American Cancer Society (ACS) recently released new guidelines regarding colorectal cancer screening for the average-risk individual. The big news is that they now recommend that screening for colorectal cancer begin at age 45 rather than age 50. This reduction in the starting age was in reaction to recent data showing that colon cancer is increasing in younger Americans for unclear reasons. By screening people at a younger age, the hope is …
Colon cancer screening at age 45: Here’s what a gastroenterologist thinks
“I feel very dizzy when standing,” was Ms. A’s* chief complaint. She originally came to the ER for sudden onset double vision and severe balance issues. After briefing myself, I took the stairs to the fourth floor and found her.
When I arrived, Ms. A was the only person there. She was wearing a silver visor and a crisp white shirt. As a native of west Texas, she loved her BBQ, …
My first patient to be diagnosed with cancer
As a system, we don’t invest as much time in understanding the broader context of the patient in front of us. The before/after factors that we don’t notice have a far-reaching impact on care.
Recently, I shadowed a patient through a day procedure at an endoscopy center from the time that the nurse checked her weight to the time that she was discharged.
Let’s call her Nancy. She was 82 years old …
Patients know what’s wrong with the industry more than we do
I’ve been practicing as an interventional pain management physician for over six years. It was a long road to get here — four years of medical school, four years of residency in anesthesiology and one year of fellowship (in addition to the four years of undergraduate education). So people say, “You must really love what you do.” Sure, during residency there was light at the end of the grueling tunnel …
The painfully fine line of pain management
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