Perhaps one of the hardest things about medicine is cross-coverage, that is, to be the covering doctor for your partners, whether for the occasional night, weekend, or longer. It’s not something done only in oncology. All specialties in medicine have this system, which allows us to have lives outside of our hospitals and clinics. What’s …
Cross-coverage has made me aware of the art in medicine
Angela Harris has been here in the hospital for six hours, awaiting the results of her CT scan. I won’t take responsibility for all of that wait time: complicated CT scans and labs do take a significant amount of time to perform. But she didn’t need to wait the last hour.
She was waiting on me — her emergency physician — because I needed to confirm her cancer diagnosis with radiology, …
Cushioning the fall of bad news
Speeding through town, I had just dropped off a kid at football practice. I raced back to the church to drop off another kid, then drove quickly to a soccer practice for a third. At about 7:00, I start to lose my cool. I’m used to my husband being late. But tonight I was frustrated. I sat in the parking lot with two babies, strapped in their seatbelts, fidgeting and …
My spouse is your doctor. And there’s no one else I’d rather share him with.
I met David on the internet. It was to become on of the closest, most intense relationships of my life. For you see, a few months before he crossed my path his daughter finished the same protocol for the same type of brain tumor that my daughter just had started. They had successfully traversed the waters that to me were completely unknown — and frankly terrifying. On the pediatric brain tumor listserv, …
Everyone needs someone to be a safe harbor
He wasn’t particularly likable upon first encounter. He wasn’t apt to answer questions asked. He had a long pause and a long drawl and a tangential, winded story — and backstory — all of which he was bound and determined to tell to its detailed completion. With an irregular heart rate in the 170s and a respiratory rate in the 30s, I tried to steer him in the direction of …
A doctor cries therapeutic tears with her patient
My name is Lucy.
I have stage IV liver cancer. I wanted everything done — even though the doctors told me this disease is terminal. My family, my church and my friends were praying for “the cure.”
Though I believed in God and the hereafter, I wasn’t ready to go. 74-years-old with beautiful children, grandchildren, and a great-granddaughter.
I woke up confused. In the background — wherever I was — I could hear …
I’ve written in the past about how words are powerful — that they can have multiple meanings, how they can change depending on context. I am often reminded of how true that is in everyday oncology practice, especially when it comes to meeting new patients. Some are diagnosed with cancers that carry a relatively good prognosis, …
Words are powerful. Use them carefully.
Medicine is an honorable profession. We meet people at a vulnerable point in their lives — when it comes to cancer, it is often at their most vulnerable. In oncology, care is typically multidisciplinary, and one of the most important advances in my own professional career has been this team approach. To see a patient with …
Patients can live with metastatic cancer
Many months have passed since the spring day when I was hit with the news from my yearly mammogram, but those typewritten words are forever etched in my memory: “The density appears greater in left breast.”
My doctor comforted me with statistics showing that mammograms aren’t 100 percent accurate — but she also lost no time in sending me to a surgeon named Dr. Prewitt. Upon meeting him, I immediately felt …
Do not underestimate the power of touch
An excerpt from Breasts: The Owner’s Manual: Every Woman’s Guide to Reducing Cancer Risk, Making Treatment Choices, and Optimizing Outcomes.
Genetics play a less important role than you probably think. Consider this …
Debunking breast cancer myths: the truth about genes, gender, and destiny
Physicians are the building blocks of value-based care, yet the cumulative human and financial cost of our decisions are mostly hidden from us. Instead, our reality is analogous to being on a diet and a budget at a restaurant that doesn’t put prices or calorie counts on the menu.
We need and want cost transparency. A survey from Deloitte University discovered cost is a part of …
For almost 20 years, the value of the digital rectal exam (DRE), a long time staple of the complete examination of the trauma patient, has been questioned. Performing a rectal examination on all trauma patients is no longer advocated except for a few specific indications.
As recently as two months ago, trauma surgeon Michael McGonigal blogging at the Trauma Pro reinforced the message. Because a rectal examination is so uncomfortable …
The fall of the digital rectal exam
Sarah* is a new patient, referred to me because she is having difficulty deciding on treatment for breast cancer. I don’t know much else about her, and a quick review of her electronic medical record tells me that she is 48 years old and has hormone-positive disease in her left breast. There are numerous missed appointments, and it appears that her …
For those on the margins, access to cancer care is a struggle
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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 57-year-old man is evaluated during a routine examination. His medical history is notable for chronic hepatitis C infection with cirrhosis, which was diagnosed 3 years ago. He undergoes surveillance ultrasound for hepatocellular carcinoma every 6 months.
On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 110/82 mm Hg, pulse rate …
MKSAP: 57-year-old man with chronic hepatitis C infection
Today, you came to me with a chief complaint: right breast lump.
You told me you’ve only been aware of it for the last three weeks. Your eyes told me your terror of not realizing it was there sooner.
You told me there wasn’t a history of any breast, endometrial or ovarian cancer in your family. But you held back that you knew there isn’t always a family history.
You told me you …
Diagnosing your cancer is my cross to bear
As the patient talked, I found myself nodding my head. In so many ways, she was just like me. Highly educated, a professional, a woman who had worked hard and long to get where she was. And then cancer took it all away, or at least that’s the way she described it. She was diagnosed with metastatic cancer one year …
How silence can help us learn from our patients
Home delivery for everything from fresh produce to custom-selected clothing has become a way of life for many Americans. While most home-delivery conveniences are generally changing our lives for the better — giving us more time and choices — at-home genetics kits that reveal information about the risk of developing certain cancers represent a risky step in …
The problem of misunderstanding 23andMe genetic test results
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 62-year-old woman is evaluated for an incidentally discovered left adrenal mass. Two weeks ago, the patient was evaluated in the emergency department for diffuse abdominal pain and vomiting. A CT scan was obtained that was normal except for the adrenal mass. Three hours after presentation to the emergency department, the pain resolved …
MKSAP: 62-year-old woman with a left adrenal mass
When it comes to colon cancer prevention, the polyp is the key player to know. Colon polyps, called adenomas, are precancerous growths originating from the inner lining of the colon wall. There are other types of polyps in the colon which are not considered precancerous, but for our purposes in this article, we will consider the terms colon polyp and adenoma to be …
What you should know about colon polyps
The approval by the Food and Drug Administration of 23andMe’s BRCA test is bound to create a discussion about the merits and pitfalls of direct to consumer genetic testing for cancer risk.
It is also going to add fuel to a growing fire about how we as a nation assess genetic risks for cancer, and whether society is prepared for what is inevitably going to become a …
The FDA approval of 23andMe’s BRCA test: What it means for you
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