I am in the privileged and humbling position of hearing the stories of patients’ pasts. Sometimes the stories are so horrendous that it takes all my energy to stop myself from crying as they recount the brutality of their experiences. I have heard harrowing descriptions of all manner of abuse done to patients when they were children. The abuse was …
How cancer treatment is affected by past abuse
As many readers are undoubtedly well aware, the doctor-patient relationship has a place of profound significance in health care. The critical importance of this relationship becomes magnified in oncology, where life hangs in the balance, and fear hangs over every soul that walks the invisible line between life and the everlasting night of undrawn death.
In the winter of 2015, a needle biopsy was performed on a mysterious tumor in my …
Doctor-patient relationships would die without this one thing
Eight weeks after I delivered my third child, I was diagnosed with a four-centimeter lung mass. Yes, you heard that right. For those in medicine, this is terrifying to hear as the first thing that comes to mind is lung cancer. Lung cancer is notoriously hard to treat, typically fatal with a short life expectancy after diagnosis and extremely unfair to a lifelong nonsmoker who has spent 12 years in …
Retiring early from medicine: Is it ethical?
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 63-year-old man is evaluated for severe mid-upper back pain following a minor fall 1 day ago. He also notes progressive fatigue of 6 months’ duration and a 6.8-kg (15-lb) weight loss. Medical history is notable for an 80-pack-year smoking history, although he is currently a nonsmoker.
On physical examination, temperature is 37.3 …
MKSAP: 63-year-old man with mid-upper back pain
As an internist with “added qualifications in geriatric medicine” I care for a great many elder individuals. In most cases, these are individuals I met 20 or more years ago and have been privileged to share their lives with them as they aged.
The circle of life is relentless and unforgiving, so there comes a time when these relationships end. In some cases, it comes when they can no longer care …
When you lose someone, it takes a piece of your being with it
I consider myself lucky to be the father to three wonderful kids: My oldest is now 15 and my twins are 9. They are indeed the light of my life. I get asked every so often, why did you want kids? It is a fair question, I suppose. After all, my partner and I relied on …
The power of family at the end of life
In a recent episode of the television series, The Good Doctor, a patient played as Robbie Ato does not tell his doctors he has a history of cancer. You can see his surgeons stare in disbelief as one consulting surgeon recognizes the patient’s name and then alerts the team leader that she treated him three years ago for cancer.
This is one of the very most troubling and dangerous acts of …
The Good Doctor shows us the value of time
Physicians are no strangers to death. We are baptized into medicine with cadavers as first-year medical students. We learn to break bad news. We lose patients, some that are expected and some we never see coming. Through it all, we maintain a distance, an emotional reserve that enables us to shoulder these losses but still see the next patient with the full attention they deserve. But every now and then …
How do you tell a 24 year old that she is dying?
My new patient was having trouble breathing and had lost his ability to swallow; despite this, he had been too proud to call either friends or family for help. He had lost thirty pounds and his clothes hung loosely. His belt was far too long. The day I met him, I thought, “This man could walk through a harp.”
People had tried. Over the previous months, his worried family members had …
The patient who was a former bowling champion
The commentary below is meant to invoke meaningful discourse rather than incite an unpleasant argument.
Less than a year ago, I heard Ben Stiller doling out kudos to his heroic doctor who diagnosed him with early-stage prostate cancer by using a simple, widespread screen.
What was interesting was that Stiller was actually underage. What I mean is that the star was not of age to be screened, according to current prostate cancer …
Screening: Do you follow guidelines or your gut?
This year has brought about change — the theme of 2017. As it comes to a close and I reflect back, it is so hard to believe what is going on in the world today, let alone just the United States.
In 2017, I graduated from my internal medicine residency training program, passed my board exam and celebrated my one-year wedding anniversary. I helped my family cope with my grandmother’s progressive …
What do you do when a colleague has cancer?
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 25-year-old man is evaluated in follow-up after recently testing positive for hepatitis B surface antigen. He underwent testing as part of the immigration process from Somalia. Two other siblings also have hepatitis B virus (HBV) infection.
On physical examination, he is a young, healthy-appearing man. Vital signs are normal. No jaundice is …
MKSAP: 25-year-old man positive for hepatitis B surface antigen
According to Hesiod’s version of an ancient Greek legend, because Pandora has opened a jar stuffed full of evil by the Olympian gods, “countless plagues, wander amongst men … earth is full of evils … Diseases come upon men continually by day and by night, bringing mischief to mortals silently.” Curiously that jar was closed before hope was also allowed to escape.
Is the legend an expression of how bleak the …
Is there danger in hoping too much?
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Harry understood at last that he was not supposed to survive. His job was to walk calmly into Death’s welcoming arms … All those times he had thought that it was about to happen and escaped, he had never really thought of the thing itself: His will to live had always been so much stronger than his fear of death … It was over, he knew it, and all that …
The lessons of Harry Potter and the Deathly Hallows
Women who lose part or all of one or both breasts due to breast cancer surgery may choose to have new breasts created with their own tissue — a process that also may or may not involve breast implants. A wide range of reconstruction procedures is available, including a variety of flaps and options to use either implants or what is known as autologous fat transfer.
Each surgery has its own …
Involve plastic surgeons early in breast cancer treatment
T was the last patient of a busier than usual morning. “New patient, establish care” was her reason for visit. As I would soon find out with the help of our remarkable Arabic interpreter, T and her family recently moved to our area after spending the better part of 3 years moving from refugee camp to refugee camp trying to escape the ravages of the civil war in their native …
The patients that make you realize that we are part of a larger human family
There are some questions in health care that can’t be answered with a randomized controlled trial. We can’t randomize babies to inhale secondary tobacco smoke or not to test its health effects. We can’t randomize people to a different number of hours sitting the ER before receiving antibiotics after the decision is made that the patient has a bacterial infection requiring antibiotics. There are some questions where the best available …
Colonoscopy after a positive stool test: Does the time frame matter?
Lori Wallace sits on a couch with her 11-year-old son and his new pet snake. It burrows under his armpit, as if afraid. Wallace is sure it’s not.
“If he was terrified, he would be balled up,” Wallace said. “See, that is why they are called ball pythons. When they are scared, they turn into a little ball.”
Wallace is dying of breast cancer, but a stranger wouldn’t know. She has a …
The painful side of positive health care marketing
7 a.m. began as it always did; the overnight doc was threatening to quit while rubbing her bloodshot eyes and smearing mascara beneath them. Between heavy sighs, she listed the patients transferring into my care ending with Mr. Mandel.
“He’s eighty-something,” she explained, “hospice care. Cancer with metastases. Came in from home because family ran out of morphine and he was in a lot of pain. Anyway, he’s actively dying now, …
Here’s what death really sounds like
“Doctor, how would you like your schedule template?”
As a hematology/oncology physician in a non-profit hospital group, I am reimbursed by wRVU. This is the standard mechanism of reimbursement for large multispecialty groups and academic centers. In this scenario, the more wRVUs you make, the more you get paid. However, there are only so many hours in the day. One of the first decisions each doctor makes when joining a group …
How you design your schedule has far-reaching consequences
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